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Four Ways to Attract Patients
Acupuncturist A has been in practice for six years and has struggled since day one. She spends as much time and money on marketing as she can, but since her practice is slow, her budget isn't that big.
First Annual ICD-10 Updates Take Effect
Yes, there was an update to ICD-10 codes on Oct. 1. It was a regular update to the diagnosis coding system and will take place every Oct. 1, just as it did when the ICD-9 system was in place.
Update from the International AIDS Conference
The 21st International AIDS Conference in Durban, South Africa, brought together more than 15,000 of the world's leading scientists, activists, funders, policy makers, and consumers from 153 countries.
Upgrade to "Parker 2.0" in Las Vegas
Continuing your education and refining your practice: two key elements of a successful chiropractic career. Parker Seminars promises both as it celebrates its 65th anniversary in Las Vegas next February, according to Parker University President, Dr. William Morgan, and seminar consultant Dr. Mark Sanna.
Getting Paid by Medicare Is Getting a Major Adjustment
The 2015 Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law to implement a new approach to clinician payments and replace the Sustainable Growth Rate formula.
Going Beyond Just Feeling Good
We all know that most patients come to us for some pain complaint: neck pain, back pain, sciatica, carpal tunnel, etc. We also all know that acupuncture is a great first-line care for these issues, as well as supporting overall health and wellness.
Dysautonomia: The Medical Condition You May Already Be Treating
TCM practitioners have spent thousands of years healing patients without knowing or needing the names of their diseases as defined by allopathic medicine. We have syndrome names that are both poetic and efficient.
Integrative Cancer Care: Chiropractic for Chemotherapy-Induced Hiccups
Hiccups (singultus) are a frequent occurrence during cancer treatment. The cause of the hiccups may be the chemotherapy drug itself, such as Cisplatin; or the prophylactic use of corticosteroids such as Decadron, which is used to prevent nausea and/or vomiting.
Power to the Patient
Against a backdrop of splintered political parties, polarizations within nations, civil unrest, and distrust of established government (such as the growing anti-Washington, D.C. sentiment) comes the not-so-surprising finding that health care authorities and practitioners (with perhaps the exception of insurers) are turning over more and more powers to the individual patient.
Six Things Every DC Should Know About the Zika Virus
The Zika outbreak continues to spread across the continental United States and U.S. territories. We offer this brief overview on this important public health problem for the practicing doctor of chiropractic.
Treating Peripheral Neuropathy: Multi-Faceted Approach Including Laser Therapy
Peripheral neuropathy affects at least 20 million people in the United States1 and nearly 60 percent of all people with diabetes suffer from diabetic neuropathy. Many suffer from the disorder without ever identifying the cause.
Treatment Success at the Won Institute
According to the World Health Organization's 2003 report titled, "Acupuncture: Review and Analysis of Controlled Clinical Trials," acupuncture has been shown to improve many physical, emotional, and mental conditions.
National Board Apologizes for Testing Issues
The National Board of Chiropractic Examiners (NBCE) has issued a formal apology following a series of computer-based testing malfunctions that impacted two separate examinations (March and June 2016) and caused "widespread confusion and frustration" to the nearly 1,500 examinees taking the tests.
Pediatric Asthma: A Case Study
I have had very good success with pediatric asthma, combining acupuncture with Chinese herbal products. Treatment is given over four to eight months, twice monthly, with herbal formulas rotated every month.
Pediatric Footwear: Function Over Fashion
As practitioners, it is not uncommon for parents to bring us their children to treat or ask us questions related to the pediatric population. Children's feet tend to be a perplexing region for parents and practitioners alike.
ITB Syndrome: Treat the Tensor Fascia Latae
Iliotibial band syndrome is usually the result of repetitive knee flexion, such as in runners or cyclists. Pain may be experienced in the knee and/or the hip. The patient may express a sense of the hip dislocating, popping or snapping.
Natural Cancer Prevention: Pomegranate for the Prostate
In recent years, the ingestion of pure pomegranate juice (8 ounces per day) has been shown in clinical studies with human subjects to slow, and to some degree, reverse, the progression of prostate cancer – the second leading cause of cancer death in North American men.
Using the Lens of Chinese Medicine
One of the most common medications I see in clinical practice on a daily basis is fluoxetine or Prozac. Consequently, I hear many complaints concerning the side effects of this medication and am frequently asked by patients to help manage these side effects with acupuncture and Chinese medicine.
Decoding the Mystery of Medical Insurance Acceptance
In the constantly evolving profession of acupuncture, one of the least understood areas is medical insurance acceptance. The profession is filled with controversy surrounding this topic: Is it ethical?
U.S. Olympians Have a DC in Their Corner
It's probably old news to you that doctors of chiropractic play an increasingly prominent role in treating athletes, from youth sports participants to weekend warriors, to elite / professional competitors.
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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