Adding Massage Therapy to a Chiropractic Practice

I got a call from a friend and colleague the other day.  His assistant/office manager said they would like to bring a massage therapist into the office and had wrapped herself into a mental pretzel trying to work her way through a hypothetical situation involving a massage therapist with a W-2 employee arrangement.  They were trying to figure out how to make ends meet, since this therapist would need to perform a minimum of 15 massages a week just for the clinic to break even, without seeing any profit.

This concern deepened when the receptionist mentioned this to a friend (who happened to be a massage therapist) who then said, “oh no, no, no – a therapist can only do about 10 massages a week!”

This receptionist was beside herself, because she saw massage therapy as a very common offering in a chiropractic office and yet at the time, she could not see how it was possible.  So she called me.  Having been an LMT before becoming a DC, I’m in the unique position of having been on both sides of the fence.  And I have a little business sense, if not much.  So, that inspired this post, because if that friend and colleague was toiling over that question, chances are others are wondering the same thing.

Before I go any further, I need to get something squared away: massage therapy is NOT unskilled labor; it is a healing profession and a real career.  For many, it’s a calling.  The best massage therapists have a personal breakthrough experience that changed their lives forever.  Sometimes this experience was negative and painful, such as watching a loved one die at the hands of conventional medicine.  Other times, this experience was positive and uplifting, such as a miracle healing via natural medicine methods.

It’s also important to understand that massage therapy is an extremely energy-intensive profession.  These people draw upon an effort and energy that come from deep within.  They use a gifted intuition, as well as a vast knowledge base.  These assets often go unrealized by those around them, including the doctors they work for.  They often get overlooked and unaccounted for.  As a result, the therapists themselves, being naturally giving people, tend to be overworked, undervalued, and underpaid.

That being said, please know that it’s very easy and profitable to bring a massage therapist into your office.  You can make a generous profit, while simultaneously paying fair and generous compensation.  Also, please realize there isn’t much to it.  Certain aspects are easier than you may think, and yet other aspects are trickier and require more finesse than you may realize.

The first thing you should know if you are planning to bring a massage therapist into the office is that they should always be brought on as an independent contractor (IC), not an employee.  The IRS has rules about what constitutes a contractor vs an employee, but sometimes they’re subjective, not clear.  However, you need to know those rules and follow them very carefully, because the penalties for failing to do so are quite stiff and expensive.

The major difference between an IC and an employee is control.  An IC always controls their own schedule, how they do their work, etc.  An IC also pays their own taxes and all other costs associated with maintaining their license – the fees, continuing education classes, malpractice insurance, and more.  You can train them, but you can’t legally pay them for any of the training.  ICs only get paid for the work they actually do.  They aren’t “on the clock” getting paid just to be there if there is no work for them.  In addition, if a patient misses a scheduled massage appointment, the therapist does not typically get paid.

The drawback is the scheduling part – as the employer, you can’t dictate their schedule.  You CAN say, “we’re open from 9a-12p and from 2-6p, and we need a therapist to work those hours”.  After all, you have little use for a therapist who can’t be there during the hours you’re open.  But if they need an upcoming day off, you can’t refuse to let them take it.

The benefits definitely outweigh the drawbacks: no withholding taxes to pay on their Social Security/FICA, no paid training to shell out for, no hourly wages to pay if they’re not actually working, no OSHA posters to put up…you get the idea.

I must include this warning: DO NOT attempt to “have it both ways”.  You cannot pay someone as an IC and treat them like an employee by attempting to dictate their hours or other aspects of their work.  In a chiropractic office, the therapist understands that they take a certain amount of direction from the doctor.  However, exactly how they perform that work is up to them as long as they’re acting in the scope of their license and in accordance with your direction as a doctor and also the well-being/safety of the patient.  However, don’t attempt to micromanage them.  It will backfire.

When the therapist is an IC, and thus you’re only paying for time they work and nothing else, this means that any massage they do translates to profit for you, because you’re not paying them UNLESS they’re doing a massage.  So there is no “break-even” point on massage therapy.  Make sure you’re collecting more from the patient than you’re paying the therapist.  (This is a completely acceptable practice.)  Voila!

I was asked how to hire a massage therapist.  Here’s where things get trickier.  First, CraigsList is the best source for jobhunters that I’ve encountered.  You’ll certainly get responses, as long as your ad is fair and attractive.  Pick and choose carefully.  You want to strike a delicate balance: natural talent, formal education, an open mind, and yet an earthy personality.

One word about massage therapists – I love them.  However, they have a well-deserved reputation for being flaky, meaning that they can be unreliable, immature, forgetful, illogical, or drama-prone.  None of these personality traits is good, so look closely.  Hire mostly for personality.  The well-grounded, compassionate, down-to-earth, soulful practitioner will also typically possess an astonishing level of natural talent.  This person is usually also wise enough to accept a fair amount of direction with grace and understanding, as well as accurate comprehension.

Make sure to interview those that made the final round.  Determine whether they’re in for the long haul, or if they view your office as a stepping stone to something else they’re working toward that they want more.  And always make sure to sample their work, known as a hands-on interview or practical interview.  Never take advantage of their services, but do spend 15-60 minutes evaluating their quality of touch, care, flow, strength, attention to needs, and generally getting an overall idea of what they can do.

Never work without a contract.  Always put everything in writing.  The contract should state–among other things–topics such as pay rate, paydays, services provided by the therapist, responsibilities of the clinic to the therapist and vice versa, who supplies various massage therapy tools (table, music, linens, furniture, etc), and more.  Check with your state laws or seek legal advice when drawing up a contract.  Contracts provide protection for everyone.

I shouldn’t have to say this but I realize I should: make sure your therapist is state licensed, if your state requires licensing!  If they’re not, and your state requires a license, that could spell BIG trouble.  I’ve had inquiries from people in India who had never had a massage therapy license, let alone one issued in my state.  Ask them to bring their license, and photocopy it.  Photocopy their malpractice insurance policy card as well.  Keep both on file, along with a copy of their state-issued ID.

Massage therapy rocks, and the right therapist will transform your practice!

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