This article outlines the steps needed to build a successful career in massage therapy, with an emphasis on setting realistic expectations and creating a 5-year plan. Learn about the challenges new therapists face, such as fluctuating income and the lack of business training provided by massage schools, but highlight the rewards for those who persevere. By focusing on continuous learning, developing soft skills, and setting long-term goals, massage therapists can build a sustainable and fulfilling career.
Key Takeaways
- New massage therapists should create a clear, long-term plan, outlining goals such as whether to work for an employer or be in private practice, how many hours they want to work, and their income targets.
- The first 6-18 months in massage therapy can feel more like a paid internship, with inconsistent income and a learning curve in client retention and business skills.
- Massage school provides foundational skills, but therapists must keep learning soft skills like communication and client retention to grow in their careers.
- To avoid burnout, therapists should set boundaries around work hours and strive for a manageable work-life balance, especially since massage therapy is physically demanding.
Everything You Need to Create a 5-Year Massage-Career Plan
As long as the massage therapist is willing to put in a few years of time and effort continuing to learn after massage school, it is a fantastic career path and a great time to be a massage therapist. With a 5-year plan in place, the prospective massage therapist can get on a path to a sustainable massage career.
Becoming a massage therapist is an act of faith and compassion, an act that leads a person into a field of helping, learning and, ideally, succeeding financially. I wouldn’t trade my 17-year massage career in for another type of job, but getting to where I am today as a multi-clinic owner and employer of massage therapists wouldn’t have happened if I hadn’t stuck it out during the early phase of my career.
What if the person reading this graduated from massage school years ago? They shouldn’t panic. It is a great idea for anyone to create a plan at any time if they aren’t where they want to be in their career. They will likely be able to accelerate their plan and get there in one to three years given that they already possess experience.
The profession as a whole is advancing each year and massage therapy has gone from a mostly luxury service to something many Americans are aware of and have tried for pain and stress relief.
Side Hustle or Career?
First, we’re going to get upfront and clear about where massage therapy is as a career field in relation to other, more established, career fields.
When the massage student first thought about massage school, they likely did some research to find out what the average massage therapist makes annually. What was sadly missing from those reports was the fact that the amount of money earned providing massage is the income earned for all practice-related work—and if one is self-employed, that work includes the hours spent running a business.
That combination of office manager-bookkeeper-marketer-therapist is not found in other health care professions, and it’s one reason massage therapy is a profession that can still look like a side hustle as much as it can a career path.
That fluctuation is reflected in how massage education and state licensing regulations vary from state to state. Then there is the fact that many states did not implement state-mandated licensure (or another type of credential) for massage therapists until quite recently—and some states still do not have a credential requirement.
Massage schools often lack robust support and training to help students understand the reality of current employment and career opportunities. This isn’t the schools’ fault; massage schools have to run a lean operation in order to keep hours and tuition manageable. Schools often have just a few days of business classes or hold job and alumni fairs. In practice, this mostly amounts to advising students to file taxes and licensure paperwork correctly and covering the ethical boundaries and requirements of our field.
Taxes and boundaries are important topics, but understanding them is not enough to provide a new massage therapist with a realistic idea of how long it will take to truly develop a sustainable practice—or what additional work the therapist needs to do following graduation to build the skills, habits and experience that will help them succeed.
I was lucky enough to enter massage school at age 35, after a 10-year career as a freelance writer. I had already struggled through lean years to develop the skills, experience and client base needed to run a successful service-based business. That meant I was able to spend my time in massage school focusing on learning the actual hands-on skills to be a massage therapist.
With clarity on what to expect as a self-employed small-businessperson once I graduated and became licensed, I knew I could apply my freelance experience to build a successful career in a new profession. My clarity didn’t come from massage school, and I had no illusion that my first few years would be easy—but I knew that if I stuck with it, that there was a great career to be had.
As a therapist, clinic owner and employer, I want to help other new massage therapists understand what they can really expect after massage-school graduation, and how to hang in there and create a successful career.
To enter most established professions, a person attends school, earns a degree, perhaps earns a license as well, and then interviews for jobs. Depending on the job market, résumé and interview skills (and luck), the person will get hired into an entry-level job with a guaranteed salary. If they do well, they will move up in their career, get promoted and get raises in income and benefits.
In that established profession, the only time an employee will run into a real struggle worrying about income after entering the workforce—assuming they budget their salary well and live within their means—is if their employer runs into cash-flow issues or decides to lay off workers, or if their own poor performance gets them fired.
However, if they decide later to strike out on their own and form their own business, they will wind up facing all of those initial, several-year struggles every new business owner has. And that’s to be expected.
For these established professions, a clear line defines working for an employer as equaling a safe income and defines working for oneself as a gamble with no guarantee of income but with potential for a much better income later on.
Unfortunately, that clear line does not really exist yet for massage therapists. Very few employers have such an established client base that they are able to pay a new therapist a guaranteed wage that looks anything like what a well-established, independent therapist makes. There are some exceptions, such as working underneath another licensed professional like a chiropractor or physical therapist who can take insurance, but those massage jobs are rare and there is high competition for them.
Everyone else will likely be paid a commission or flat rate on services performed, which means when they are booked up, they will make a decent-to-great income, but when they are not booked up—they won’t.
Now, before any reader goes on a rant about how bad those employers are, it’s worth keeping in mind how this works from the employer’s perspective.
The Employer’s Side
This information on the employer’s side will give new massage therapists insight into how employers of massage therapists work out their pay rates and why it probably will continue to work that way for the near future.
This information includes reasons most employers aren’t willing to take a chance on paying a new massage therapist a guaranteed high salary, and a reality check on where we are as a profession.
Unlike Western medicine, massage is not yet widely perceived by consumers as a necessary part of their self-care. Further, most states do not require massage therapy to be covered by health insurance policies and very few insurance companies take it upon themselves to include massage therapy as a covered service.
This means that, unlike how it is for other health care professions, massage does not have a guaranteed client pool. While that is slowly changing, massage is still competing with a host of other health practices, such as acupuncture, chiropractic and physical therapy, all of which are more likely to be covered by a client’s health insurance.
For services that are covered, such as physical therapy, there is a guaranteed pool of clients ready to use their insurance to cover the services. We simply do not have that in our field yet. (I often get clients who come to me through word-of-mouth who have tried all of these other approaches first, not gotten hoped-for results, and come in sort of hopeless and “willing to take a chance that I can help them even though it’s expensive and it will be out-of-pocket.”)
Due to the lack of a guaranteed client pool, spa, clinic and massage studio employers spend a fair amount of their own time and money on marketing to bring clients in the door. In fact, it usually costs quite a bit more in marketing time and money to bring a new client in the door than the business actually makes after paying the therapist’s commission.
Guaranteeing a high wage to a newly licensed therapist who doesn’t yet have the professional or hands-on experience needed to retain clients can be a huge monetary loss for the business—up until the therapist is retaining enough clients to fill their schedules by at least an average of 60% or more with repeat clients. With a brand-new therapist, this can take anywhere from six to 18 months.
Employers are well aware that massage schools do not offer enough training and development on soft skills for client retention. Soft skills include things like being adept at conflict management and professional communication, the ability to apply creativity to problem-solving, critical thinking and an attitude of teamwork. Employers are also aware that most therapists will need to learn such skills on the job, unless they have previous experience in another field.
Even if an employer hires a more experienced therapist with good retention skills, it will still take several months for that therapist to meet and work with enough clients to reach that 60% mark with repeat clients.
In order to be able to keep the business afloat and pay such major overhead expenses as rent, marketing and support-staff payroll, most employers need to use a commission-based pay structure. This means the massage therapist gets paid only when they actually perform services.
If the commission and service rates are decent, a therapist should be making between $35 and $75 per hour that they work, if they are booked solid. Employers can’t afford to guarantee those wages to a new therapist during the initial six-plus-month phase that the therapist is mostly seeing brand-new clients and is not fully booked.
If the employer did guarantee wages … well, in all likelihood, they would go out of business and would not be able to offer any jobs to massage therapists at all.
At best, some employers provide a guaranteed minimum wage to therapists as W2 employees, with a greater income from commission available as therapists’ bookings increase.
The Stable Income
With a fair employer, there is a clear pathway to reach a comfortable and relatively stable income within one to three years; however, there simply is not a way for an employer to guarantee that income to the new hire from day one without putting themselves at great financial risk. That is true all the way from the level of a private practitioner who is adding one therapist to handle their overflow to a large corporate entity with multiple locations.
Lest the massage therapist see this as simply unethical on employers’ parts, keep in mind that the cost of entry to the massage field is far lower—both in money and in time—than for many other professions.
In fact, that is likely one of the main reasons any massage student or therapist chooses to attend a massage therapy school. They get to join the workforce much sooner and for far lower upfront costs, but will really need to keep learning and advancing on their own to reach a point of stability and success.
Depending on which state the massage therapist lives in, a school program designed to fulfill state massage therapy licensure requirements will run anywhere from 500 to 1,000 hours of training.
This can take anywhere from six months of full-time attendance to two years of part-time attendance to complete, which is well under the amount of training required to become an acupuncturist (four years of full-time attendance), physical therapist (three years of full-time attendance after earning a bachelor’s degree) or chiropractor (four years of full-time attendance after earning a bachelor’s degree).
Tuition for a massage therapy program costs roughly between $8,000 and $15,000, far below the typical cost of $120,000 to earn a doctorate in chiropractic, for example.
What such short educational programs mean for massage therapists is the training a person normally receives in other professions, on business practices and client-retention skills, is mostly absent from a typical massage therapy program. Also absent is the several years’ on-the-job training of a residency or apprenticeship program that is often typical in other professions. Massage school clinic hours do not compare.
Any expectation a massage therapist might have that an employer can afford to foot the bill for them to train on the job while paying them a salary equal to what an experienced therapist makes is unrealistic.
A Realistic Mindset
The first obstacle to a successful career is an unrealistic idea of what to expect during the first few years after school. A realistic mindset is that a massage school gives students the working knowledge and hands-on skills to get a license. Graduates’ first few years working give them the necessary experience and confidence to apply that knowledge in a way that leads to a successful career.
Acknowledging that the first six to 18 months after massage school will feel more like a paid internship or residency than a full-time job will keep the new massage therapist in the student mindset they will need to make it. (However, they should hang in there because it’s so worth getting through this first stage.)
An additional mindset shift to take on is that the new massage therapist will need to be a self-starter to work on client retention skills on the job.
Few employers take the approach that I’ve taken at my own studio of offering in-house training and continuing education on these skills to my staff for free, but there are plenty of books, articles and video resources online that can get a new massage therapist started.
Create a 5-Year Plan
Before I left school in June 2007, I wrote out the following basic 5-year goals, and I read and reviewed them weekly.
By year 5 after graduation:
• I will be in private practice only working for myself.
• My practice will have an annual revenue of $100,000-plus.
• My practice will require me to work on it (or in it) no more than 35 hours a week including actual session time with clients and also administration of the business.
• My practice will only require me to work 5 days per week.
• My practice will average 24 table hours of work with clients maximum per week.
• My weekly practice schedule will be set so that I don’t feel the need to see clients during my off hours.
Having these goals posted on my wall and motivating me actually pushed me to complete all of it early, within three-and-a-half years.
Another new therapist’s 5-year plan may differ depending on the going rate for massage and cost of living in their area. Goals may differ, as well, if the massage therapist would rather work for an employer than take on the stress and burden of running a private practice.
Here’s how a new massage therapist can use this as a model to design a 5-year plan that works for them:
• Decide if they envision wanting to eventually be in private practice or if they would rather work for a good employer.
• Decide if they plan on being full-time, or if they want a part-time job that supplements their total income.
• Research local average rates for massage therapy, and cost-of-living rates. Use this research to calculate an annual amount earned that would allow them a comfortable living wage. (My $100k number was based on New York, New York, which has much higher rates but also a much higher cost of living than most of the U.S.)
• Decide on a total number of hours they want to work weekly in order to create a comfortable work/life balance. And to account for the fact that massage therapy is very physical and seeing more than 30 table hours per week of clients is hard to sustain in the long run.
• I recommend thinking about a set schedule and learning to say no to clients who want the massage therapist to work outside of that schedule. Otherwise, the therapist will be running around all hours of the day, seven days a week trying to make their proposed income—which is also not sustainable in the long run. Is the new therapist a morning person? Night owl? Do they need certain days off for other obligations?
They should make an ideal weekly schedule and slowly but surely work toward sticking to it rather than bending to clients’ time requests. To the new therapist, I say: Trust me, there are always more clients!
Help People & Feel Great
Another mindset shift I suggest is to remember that experience is gained through practice. It takes time to integrate all of the school-learned knowledge and skills.
It is one thing to understand something—and another thing entirely to smoothly and quickly apply something with a client. It is yet another thing to apply knowledge in a confident way that allows a client to instantly trust that the massage therapist knows what they are doing. Getting to that third thing can take hundreds or thousands of hours of practice, not just the typical 30 to 50 hours of clinic practice time a student had during school.
Overall, it’s best to simply accept that one’s first years in the massage field will be challenging, but if a new massage therapist hangs in there, they can create a solid professional career that allows them to work less and make more per hour than most of their peers—all while helping people and being able to feel great about the work they do!
About the Author
David Weintraub, LMT, owns Bodyworks DW Advanced Massage Therapy, a pair of medical massage studios in New York, New York. Bodyworks DW is a National Certification Board for Therapeutic Massage & Bodywork-Approved CE Provider in New York and nationally. His small-group live, webinar and on-demand CE courses offer training on advanced techniques, with a focus on improving assessment and treatment design to get better results with a wide range of clients.
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