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Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
How to Reach Your World With the Chiropractic Message
My latest effort to share chiropractic occurred in mid-May while I was sitting at an introductory parent information night for high schoolers. The IT instructor informed us that each student would be receiving a computer for all their studies.
The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
Living Well: Lessons From Our Oldest Old
Aging is a significant public health problem, important to chiropractors in practice and important to DCs who teach students training to become chiropractors.
A Different Way of Looking at It
The way you and your chiropractic colleagues access information has changed over the past decade. According to a recent survey conducted by Dynamic Chiropractic, almost half (48 percent) of DCs read online articles on their personal computer or laptop daily.
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
Billing Timed Services
Q: I do not always use physical medicine services but in my state I do have a scope of practice that allows me to provide many of these services. I am trying to understand what "direct one-on-one patient contact" means in relation to physical medicine services.
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
Constructing Our Reality, Part 2
My last article discussed perception and its relationship to the primary channels. Before we get to the channels most commonly used to treat sensory disturbances, the small intestine and triple heater, we should first talk about the bladder channel.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
Low Fat vs. Low Carb & the Power of Protein
A science-based website recently posted a nice summary of 23 randomized, controlled trials from peer-reviewed journals pitting low-carb diets against low-fat diets.
Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
One of the most common trends to see in clinical medical practice and public health is the cycles of health "buzzwords." These come and go depending upon the current cultural zeitgeist. One year, "parasites" are causing all the issues, and the next year it's "candida."
In This Current Age of Anxiety
Anxiety, also referred to angst or hysteria, goes by many names. One, popularized by the sagacious Zhang Zhong Jing, who many practitioners of Chinese Medicine may be familiar with, is known as Restless Zang/Fu disorder.
Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
June, 2014, Vol. 14, Issue 06
By Cherie Sohnen-Moe
The spa industry has expanded in new and exciting directions over the last two decades. While the image of the local day spa remains most familiar, spas have also become common vacation destinations and are desirable amenities at resorts, in luxury hotels and on cruise ships.Dental and medical offices are including spa treatments to make their procedures more pleasant and attractive to their patients. Many spas have expanded their scope from simply furnishing beauty services to offering healthcare services. Estheticians, massage therapists, aromatherapists, acupuncturists, reflexologists, yoga teachers, nutritional consultants and energy practitioners are commonly found in these spa settings.
As public demand has grown, even the image of the local day spa is growing and changing with corporations like the Red Door Spa and franchise systems like Massage Envy Spa, Elements and Massage Heights getting involved in promoting day spas at the national level.
Online forum chats overflow with comments about the good, bad and ugly aspects of working for spas. Franchise organizations seem to bear the brunt of the negative remarks. Practitioners complain of the poor working conditions and the low wages. The people posting in these forums often claim these companies are making it difficult for independent therapists to survive. I have to question that. Because of these companies, many people are now receiving massage that wouldn't have even considered it in the past, and probably weren't aware of the benefits even a year earlier. These companies provide thousands of employment opportunities for massage therapists, as well as tremendous visibility at the national level. For example, in 2012, Massage Envy Spa provided 14.5 million services to 1.17 million members and 2.6 million guests. In 2013, they provided 56,000 services per day. And that is only one of the many national franchise organizations today. I see this as being analogous to the hair styling industry. Yes, there are many franchises such as Supercuts, where you can receive a haircut for about $15. Yet, many people still go to other salons where they pay closer to $60 for a haircut.
Most people working at a franchised day spa earn more than $25 per hour, including tips. So, if you are working 25 hours per week, that's about $30,000 per year. Plus, many of these companies offer benefits such as health care, paid time off and educational opportunities. That is much better than the average worker receives. Also, while some therapists have a college degree and extensive training, others enter into this field with a mere 500 hours of schooling. This is a good return on investment.
Part of the problem comes in when people think about how they could charge between $50 to $60 per hour (even more in some cities). Worse, they fail to consider the cost of building and maintaining a business. That $30,000 salary starts looking better when you factor in rent, utilities, equipment, linens, supplies, front desk staff, marketing, taxes and insurance. Just the cost per session (e.g., linens and lubricants) is between $2 to $6. Even the bare bones minimum cost to operate a small practice is about $12,000. And that amount doesn't include taxes, staffing, health insurance, continuing education or other benefits. Finally, this number includes a barely existing marketing budget — which needs to be dramatically increased when building a practice.
If you want to work an equivalent of the 25 hours per week at a franchise spa, then you really will only have time for 15 clients per week, as you will need at least 10 hours per week (and a lot more in the building phase) to manage and market your practice. Let's say you charge $50 per hour and work 50 weeks per year, seeing 15 clients per week. Your gross revenue would be $37,500. Then deduct the $12,000 for the base operating expenses and you are now making $25,500 per year. Realistically, your net profit will most likely be closer to $20,000 — and you have to bear all of the risks.
Of course, you can change those numbers by working more hours, charging higher fees and selling products. Yet, many people don't have the desire or personality to run their own business. According to CG Funk, Vice President of Industry Relations and Product Development for Massage Envy Spa, working for a franchise spa may be a good option for practitioners who are new graduates, those that want to supplement their private practice income, those that don't want the responsibility of operating their own business or those who simply want to work part time.
Overall Success Strategies
Working in a spa requires conforming to a corporate image and structuring your treatments to align with the company's schedule, treatment protocol, policies and philosophy. Marketing is another area that is often a source of conflict. In a spa, you don't have to do marketing or schedule clients, but there's no guarantee your work hours are filled. Many practitioners discover to their dismay that to increase the client flow they need to market their services themselves (this is more so in a local day spa than a destination spa).
To be successful in these environments, a practitioner needs to understand employer expectations and understand the rationale behind the policies and procedures set by the employer. Certainly these measures are set up to protect the client and the company; very often they are set to protect the practitioner as well.
Good communication skills are vital in this environment. In addition to client interactions, practitioners need to communicate well with the front desk staff, management and co-workers.
The Work Environment
Creating an ethical working environment is, of course, the mutual responsibility of spa management and employees. Ideally, spa management acts diligently to protect and serve the rights of both employees and clients. On their side, spa employees ideally commit themselves to quality work at all times and in all circumstances and express loyalty to the organization by cooperating with policies and procedures and avoiding conflicts of interest. Difficulties arise not just with actual lapses in these ideals, they also arise when suspicion and distrust surface within the organization. Both management and employees, therefore, need to practice transparency, honesty and integrity in communications with one another.
On one hand, the relationship between spa management and employees boils down to a question of autonomy. In most spas, practitioners don't have a choice about how many clients to see in a day, which clients they'll work with or even what type of work is to be performed. Serving the customer is the spa's priority. Management expects employees to work to an assigned schedule, to expand their therapeutic repertoire by learning spa treatments outside their specialty and to conform to the corporate image. On the other hand, spa management may offer the employee numerous benefits such as compensation based on seniority, commissions on product sales, health insurance, paid vacations, paid sick days, pension plans, profit sharing and reimbursement for continuing education.
Perhaps the most serious ethical concerns in the spa environment surround issues of inappropriate touch and sexual misconduct. Management usually has a zero tolerance policy, meaning that if a client complains of sexual misconduct on the part of a practitioner, that practitioner is terminated without recourse. A similar policy might exist regarding practitioner complaints against clients who sexualize a session. Management needs to examine whether their policies disempower practitioners in these situations, while employees should know the limits of their legal rights.
The next sections highlight some of the ethical considerations shared by spa management and spa employees to create an atmosphere where cooperation and ethical behavior are encouraged and supported.
Ethical Guidelines for Spa Employees
Ethical Guidelines for Spa Management
Destination spas and day spas are here to stay. The growth rate continues to be strong for these companies. The question really isn't, "Are these companies good for the profession?" The question is, "Are these companies good for you?" Evaluate your goals, style and personality before you decide to work for a spa on a part-time or full-time basis. Then evaluate each specific company to see if you mesh well with their corporate culture. Find out if they follow the above guidelines. Keep in mind that even though a company might be part of a larger corporation, every manager or owner has their own style and may run that specific location differently than others.
Click here for previous articles by Cherie Sohnen-Moe.
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