Pain Management for Your Pocketbook

Let’s do some numbers – and I’ll tell you now they’re not pretty. The average bodywork session in the Northwest is about $75, from which we need to pay expenses and only after that try to get ahead. For a self-employed bodyworker, overhead includes rent, utilities and Internet, laundry service, insurance, lotion, tools, magazines, and tea, after which you finally get paid. Let’s look at an example of $800/month overhead for a one-room treatment space. Estimating revenue of $75 and taxes of approximately $6.75 per session (based on a 9 percent rate), where x = the number of sessions needed to cover overhead, ($75)x – ($6.75)x – $800 = breakeven. This comes out to slightly less than 12 sessions. For employers, whose overhead also includes wages to therapists, the breakeven is much higher—about 24 sessions. 24 sessions! This simple example accounts for just the basics; other expenses and higher taxes would increase these numbers.

As Daniel Pink explains in his national bestseller, Drive: The Surprising Truth About What Motivates Us, “Too many organizations – not just companies, but governments and nonprofits as well … continue to pursue practices such as short-term incentive plans and pay-for-performance schemes in the face of mounting evidence that such measures usually don’t work and often do harm.”[i] Applying Pink’s theory to our industry reveals what I think is an important yet shrugged-off topic within the industry: demotivating remuneration plans.

One compensation model used by employers is to pay only for work completed rather than time spent on the job. This type of pay is called piecework. The term was first applied to production-oriented work, where employees were paid literally for how many “pieces” were produced. It is best suited for repetitive work that can easily be assessed for quality control such as sewing or widgets. The more pieces the worker churns out, the more money paid.

Paying on a piecework basis is also widely used within the bodywork industry. But it doesn’t translate cleanly because we don’t negotiate for a finished product per se. The unit of measure for the work we do is pay in exchange for time and expertise. Yet, I’ve called businesses across the nation and heard the same story: “Therapists have to be available on one-hour’s notice during their shift but are paid only for sessions worked.” Employers require a time commitment but pay only for client contact. They get the other time the therapist reserves for them gratis. Even some of the chicest hotels and spas have been known to do this.

It is my sincere hope that therapists who work on a piecework agreement – whether as employee or contractor – rise up, get gutsy, and renegotiate with their employers or quit. After all, what reputable business sector takes on more workers than it needs and gets away with keeping them on a one-hour on-call notice, insists they sign often illegal or unenforceable non-compete agreements, and pays them as contractors, affording no protection should they get laid off? Businesses lure talent with promises of good per-session pay, but if you calculate how much you are paid versus how much time you are “on call,” you’ll often net a fairly low hourly wage.

You might expect membership-based franchises like Massage Envy and Elements that offer low-priced massage are the worst offenders. They do, in fact, take a lot of flak for the lower per-session rate they pay. Yet they keep hundreds of therapists employed, and these therapists gave over 11 million massages last year. What is going right here? First, these employers have found a price point attractive to millions of customers. Second, they pay therapists as employees with hourly wages rather than piecework wages. Their therapists might be getting a lower per-session commission, but they are being paid for all their time.

In this way, I believe the franchises are running their businesses more responsibly, and independent bodyworkers and businesses may have a lot to learn from them. By paying people for their time, the franchises avoid the pitfalls of incentive-based pay that in reality demotivates people. If you’ve ever had duties between clients such as folding sheets or washing dishes and thought, “I’m not getting paid for this!” you’ve experienced this demotivation. How engaged would you be if you were paid for your whole shift rather than just a few scattered sessions filled in with unpaid “busywork”?

It is time to change the way we incentivize ourselves. My recommendation: Stop buying into a broken paradigm in which you are compensated only for billable hours.

If you work for yourself, I challenge you to figure out the salary you need to live on and build a stable financial future. Next, take a hard look at your business’s expenses and determine the average money left over (net profit). Then you’ll know: Can you live on what your business pays you? Take a step back and ask, “If someone offered me this job, would I take it given the amount of time to earn this salary?” The flip side is that if your business doesn’t make enough money to pay your salary, you should determine how long you’d be willing to work for a corporation that regularly lacked funds for your paycheck. Hold yourself to high standards!

If you are an employer who pays on a piecework basis, I challenge you to calculate how much business you have, hire the commensurate number of therapists, and compensate them fully for their time. The harsh realities of having ample working capital or a compelling marketing campaign to attract revenue are your business mandate, and lack thereof should not be passed on to employees under the guise of helping them “build their practice.” Co-owners build solid businesses on sweat equity, not on employees paid on a piecework basis.

Together, let’s change the struggle inherent in the private financial lives of so many of our practitioners. By moving away from the piecework model, we can stabilize our workforce and whittle away at the bigger issues at hand, such as treating clients holistically, getting massage and bodywork into corporations, and doing the research to garner respect and referrals from the medical community. It is time to shift paradigms!

I invite you to visit my newly fashioned Facebook page “Bodywork Economics.” What works for your business? In what ways might the industry move toward a more sustainable, wider-reaching business model? I look forward to our continued discussion!


[i] Pink, Daniel. Drive. 2009. New York: Riverhead Books.

Click the link below to see this article in the WA State Massage Therapy Journal. Chase_WMTJ_2011-07_Pain Management for your Pocketbook

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3 responses to “Pain Management for Your Pocketbook

  1. Those numbers aren’t pretty. What has to happen to the business model to make it more appealing?

    • Good question! Having more solid business skills as a practitioner is a good start – and a solid cancellation policy.

  2. Companies with less wasted work hours and less sick time end up with lower health care costs — and an improved bottom line

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