Every therapist who works for themselves has heard these phrases before, likely numerous times.
“Your prices are really high”
“The therapist down the street cost less”
“Why do you think your massage is worth that much?”
Many clients have asked why I set my prices the way I do. People will use the excuse that others with degrees like nurses and chiropractors don't even charge what I do. So let’s talk about prices. But first a little history.
Massage started out in America as a luxury and was mostly introduced by large chains that made massage a household word. While it has been integrated into many cultures as a healthy practice that was often part of medical treatment the wide spread chains that introduced it did so by creating an experience around it that was targeted towards the wealthy as a luxury treat.
Massage in America is a relatively young field that is rapidly evolving as the world finds faster ways to communicate, connect, and learn. There are research foundations that focus on scientifically understanding how massage works and advancing the field. Many states are bringing massage back under the umbrella of health care and integrating it in treatments like pain management, emotional regulation, and palliative care. As research increases the knowledge of how massage works and what it is useful for, programs like the VA are bringing in therapists as a strategy to reduce the use of opiates and prescription painkillers.
So as the field advances lets talk about what it takes to become a therapist and a little bit of why our background is important.
Becoming licensed as Health Providers
Over time the field of massage is becoming more regulated and slowly working on joining the ranks of medical professionals. Some states like Washington or New York already license and regulate massage under the Department Of Health. Many states have independent boards for regulating massage licenses but over time it is becoming more common for the DOH to integrate those independent boards.
Trade School and Education
Did you know that we have to go to a trade school to become licensed? Not many people know that therapists go through intensive programs to learn how to massage. The practice is more complicated than just putting lotion on someone and spreading it. Therapists are educated in the trade of massage therapy in an intensive program that can be anywhere from 6 months to 4 years long. There are independent schools as well as some colleges that have integrated massage training programs. Schools can vary widely but there are common state requirements on the number of hours students must have in certain subjects like kinesiology, anatomy, ethics, pathology/ biology, contraindications, body mechanics, as well as hands-on hours physically providing massage to a person.
These are all important skills and subjects as they help us give a massage that produces positive results like reduction in pain or discomfort, and avoid contraindications that massage can make worse. A contra indication is a sign or symptom of a condition or situation in which a massage should not be used because it may be harmful to the person. Great examples of this are a cold or flu, skin irritation or infections, uncontrolled high or low blood pressure, deep vein thrombosis (blood clotting in major arteries and veins), open wounds or sores, recent broken bones, recent surgeries (within 2-4 weeks depending on invasiveness and healing), contagious or communicable diseases like covid19. All of the above are important because it influences the way we massage and treat the area or the person as a whole. We use all our knowledge to problem solve, accommodate, and treat clients in a safe and effective manner.
Schooling can vary from $5,000 to $14,000. The school I attended cost me $13,000 for a 750 hour course with clinicals which was 150% of the hours required for licensure in the state of Washington where I attended. These schools are also regulated and approved by the state boards as well as The Commission Of Massage Therapy Accreditation (COMTA)
Many schools teach a number or skills and types of massage starting with Swedish and may include: neuromuscular, trigger point and tender point therapy, myofascial, hydro-therapy, sports massage, medical massage, and special population including prenatal. Some teach or specialize in Thai massage, shiatsu, craniosacral, somatic, or lymphatic drainage in their continuing education courses. These can also be taught in intensive courses by independent teachers licensed by the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB). Many times these teachers may come into a school, travel and teach at conventions, and in private classes. Intensive classes can be anywhere from 18 to 40 hours of in class instruction in a week or over a few weekends.
Massage Licensure Exam
After attending school we have to pass the Massage Board Licensure Exam MBLEx which costs $265 to take. Many therapists don’t pass the first time which can become expensive if retaken. This test is also constantly being refined based on input from schools and different massage organizations to include new information and make the test better reflect the working knowledge that therapists need to know.
State Licensure Costs
After we pass the MBLEx therapists have to get licensed by the state they reside in which can cost multiple hundreds depending on the state. We are required to pay for and submit fingerprints, background checks, passport photo, school records, MBLEx scores and more. Each item listed is an expense on top of the fee to file for a license which commonly costs $20 to get the application packet and $150 or more to submit the packet. This is also an ongoing yearly fee that therapists must maintain and can cost anywhere from $100 to $300 a year. States set requirements and standards for therapists getting licensed out of school as well as therapists that have moved from out of state. The board requires us to keep in good standing by taking a set number of continuing education hours, keeping a clean background check, and adhere to the practice act. Some boards also regulate businesses themselves on top of licensing individual therapists and write the regulations for those as well.
Additional taxes and licenses
Some states have additional taxes and licenses like the NC Privilege Tax for $50 a year and the Establishment License which can cost almost $350 to attain and another $150 per year to maintain. Some cities and counties also require therapists to have additional licenses to work in their city like Raleigh NC. This is not the same as a business license and can be equivalent to the cost of a state therapist license. Because licensing is so widely decentralized some areas may have different regulations or guidelines around who can practice and how, in addition to what license they need on top of the standard state license.
The cost of being a therapist and maintaining our licenses has more to it. We have to take something called Continuing Education (CE) which most health providers are required to take in order to keep up to date on current information surrounding their field. These cost a lot and we are required to have on average 24 hours a year. Each CE credit can cost anywhere from $18 to $80 an hour not including supplies and travel costs. We can take up to 6 online but the other 18 have to be in person and in some states like Illinois they dictate the subject of most of these hours and require things like sexual harassment prevention to be at least 1 hour of the 24. These classes can include research, ethics, hands on techniques, and business classes.
Continuing education is another regulated field in massage therapy. Teachers have to go through a vetting process to attain licensure and another process with test classes and feedback for each course they plan to teach. There is a central body that regulates CE teachers called the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB). However some states have their own additional teaching license that must be obtained to qualify classes as CE for therapists in that specific state. The NCBTMB can also set price ranges for classes to regulate the cost across providers. Its also worth noting that there is a different license and regulation requirement to teach in a school versus being a CE provider they are not the same.
Insurance and Associations
Massage therapists like doctors, nurses, and chiropractors have to carry liability insurance. If anything were to happen to a client or the therapist we are required to carry insurance to make sure any damages are covered. If our practice burns down our insurance covers the equipment, If a client gets injured or sues us for whatever reason our liability protects us. If something happens in a spa or chain and we are employees, we still need to be personally protected as the therapist is usually the one held liable and not the business. This is another important yearly expense and often is provided by massage therapy associations.
The two giants in this field are American Massage Therapy Association (AMTA) of which I am a part of, and Associated Bodywork and Massage Professionals (ABMP). There are a handful of other providers but these two associations offer additional benefits like CE, conferences, local chapters, find a therapist listing, discounts, and other benefits. The cost of insurance is about $240 a year.
The Break Down for Entry to The Field
So lets do the break down together in one place so its easy to see what it takes to become a therapist. These numbers are the average of 4 states and my experience in the field. Results and costs vary by location and change over time.
All this doesn’t include those who are practicing on their own and the costs of running a business on top of being licensed. Therapists who work as self employed or Independent Contractors shoulder the cost of the business in addition to taxes on profits and self employment taxes which can be 30% of all income.
Part two will talk about the cost of running a practice and the break down of what is included in a massage price after getting licensed. There will also be a guide for new therapists on how to do the math and research to set their prices for their area.