How to Work With a Licensed Massage Therapist (a guide for physicians)

This article will help you to understand:

  • What all massage therapists in Florida have in common
  • How therapists are different
  • Other considerations for choosing a therapist to refer to
  • How to communicate with bodyworkers
  • How to enhance your patient’s outcomes with massage therapy
  • How to make your massage therapist love you

(To answer the question, “why should I prescribe massage therapy to my patients” check out this article on the physiological benefits of massage, which includes links to clinical studies, a survey of patients beliefs about massage therapy, and links to share with your patients.)

All massage therapists in the State of Florida must be licensed healthcare providers by the  Department of Health. This means every therapist has received a minimal number of hours in required subjects, clinical hours, and has passed a state board licensing exam. (Link to the DOH website.)

While each school is required to cover the same basic information their approach, philosophy, and qualifications of their teachers will vary greatly. For Sarasota, Lakewood Ranch, and Bradenton massage therapists the best training facility is the Sarasota School of Massage Therapy.

Like other healthcare professionals such as physicians, nurses, and physical therapists, licensed massage therapists must complete a set number of continuing education units every two years and apply for renewal to keep their license current.

The choice of what to study, however, is up to the individual therapist. As long as required classes (such as “Medical Errors” and “Ethics”) are taken and a certain number are hands-on in-person classes, a therapist can choose from “neuromuscular therapy” or “reikI”, “myosfacial release” or “aromatherapy”. There are dozens of classes that qualify for continuing education credits.

When choosing a therapist to work with, would you rather refer to someone who does the bare minimum of required education, or someone who is constantly striving to improve their technique, knowledge of anatomy and physiology, and patient outcomes?

While it’s unlikely that you’ll be reviewing every therapist’s resume, you will be more comfortable referring to someone whose education is well rounded, thorough, and shows a passion for their medical career in scientifically-grounded bodywork modalities. (Myofascial release, neuromuscular, Anatomy Trains, myoskeletal, structural integration, Rolfing, Trager, and many others are highly regarded.)

You also want to consider the experience level of the therapist. How long have they been out of school? How long have they held their license? Have they practiced full time or have they only seen two or three patients a week? How many bodies have they had their hands on?

You will also want to consider the location of the therapist you would like to refer to. In general patients will prefer going to someone’s office, and preferably someone who is located close to their home or workplace. Some patients in nursing homes or who cannot drive themselves may prefer a housecall. The massage therapist should have hours that are convenient for patients.

Once you’ve chosen a potential therapist, it’s a good idea to get to know them in person. Having them visit you at your office may be more convenient, but visiting their professional office will give you a better feel for how they conduct their business.

Massages can only be provided in a location that is inspected by the DOH and licensed as a “massage establishment”. (There are a few exceptions such as the patient’s home, at conventions and trade shows, etc.) You’ll want to see the massage establishment license to ensure you’re sending your patients to a credible facility. You’ll want to see the massage therapist’s license as well. (You can also look up the information on the DOH website.)

Look at the facility with the same eyes you inspect your own office with. Is it clean? What kind of environment is it? Would you send your own mother, sister, or child to this place to get treatment? If the answer is no, please move on and find another location.

What kind of treatments does the facility focus on? If it’s a salon or spa, relaxation massages and “pampering” type treatments may be more the norm. How do you feel about that? Would you prefer a therapist that specializes in medical massage and performs mostly therapeutic bodywork? Is the facility itself ADA compliant? This may not be a deal-breaker unless you see many elderly or differently-abled patients.

This probably seems like a lot of work, and most physicians won’t take the time to get to know a referral partner that well. And that’s okay, too. At least be aware of what questions to ask, even if you only have a phone interview.

Once you’ve determined that the therapist you will refer to seems educated, trust worthy, professional, and knowledgeable, it’s time to set up some ground rules for referrals.

  1. How much control do you, as the physician, want to have over the treatment sessions? Some physicians like to establish and share Specific Objective Measurable Goals (SOMGs) and work towards these with the therapist. (This is more common with chiropractic physicians and physical therapists who see patients on a frequent basis as opposed to once a year.) This might be to increase range of motion in a particular joint or to reduce pain to a certain level. You may just want to have the patient show up ten times for bodywork and let the therapist decide what to work on. You can also write “evaluate and treat” on the prescription, which allows the therapist more freedom to choose how to treat the patient. This is considered a huge sign of trust.
  2. How often do you want to hear from the therapist with updates on treatments? Some doctors want reports after each session, others weekly or monthly, and some only at the beginning and end of the treatment series. Make sure you tell the therapist what your protocol will be.
  3. How do you want to hear from the therapist? Do you want them to mail, fax, hand-deliver, or check in via phone?
  4. What kind of information do you want? Do you want complete SOAP notes or just a summary of what kind of outcomes were experienced? You don’t want to receive fifteen pages of notes when simply, “he showed up, we did the sessions, patient feels great” will do, nor does the therapist want to go through all that work to give you notes if you didn’t really want them.
  5. If the therapist needs to get a hold of you by phone, what is the protocol for doing so? Should they call at certain times, or call and leave a message for you to call them back? Will they have your “back office” number? If you’re not available is there a particular nurse or aide that you’d like them to talk to?
  6. What if the therapist thinks the patient needs to see a different healthcare professional either instead of or in tandem with themselves, such as a physical therapist, chiropractor, shoulder specialist, etc.? Should they send them back to you for a referral and evaluation or can they make that suggestion on their own? What if they think the patient needs more bodywork treatments?

Keep in mind that this may change as your relationship with the therapist grows. If your patients are raving about how great the manual therapy treatments are and how much better they feel and function, you may not need as many updates. You may also not need as much information for every case.

The number one reason many doctors are unhappy with their referral relationship is because ground rules and expectations were not clearly defined prior to the referral process.

The next step is to actually start sending patients to the licensed massage therapist. Very few therapists bill insurance, however it’s a good idea to write a prescription so that the patient can submit their own receipts. It also helps to reinforce the treatment that you’re recommending should be taken seriously. That will help with compliance.

Write a prescription for your patient. (Click here for more info on how to write a prescription for massage therapy).

Here are some suggestions for handing that written massage prescription to your patient:

  • Explain to the patient why you are recommending the treatment.
  • Tell the patient how many sessions you expect them to receive, and that you expect a follow-up appointment to evaluate their condition afterwards.
  • Emphasize that you are “prescribing” the therapy.
  • Suggest a local professional who you know and trust and reassure the patient that you’ve seen good outcomes with this type of therapy.
  • Remind the patient to call that day to set up their first appointment.
  • Here is an example: “Mrs. Jones, studies have shown that neuromuscular therapy is an effective, non-invasive, low-risk treatment for low back pain such as yours. I would like for you to receive twelve treatments from a licensed massage therapist. Once you have received all the treatments I’d need you to come back for a follow-up. Here is a prescription and a card for Lizz Pugh, who is excellent and has done great work for many of my other patients. Please call her today to set up your first appointment.”

(Note: Certain conditions such as diabetes, uncontrolled high blood pressure, aneurysm, cancer, osteoperosis, and other serious conditions, should have a written doctor’s note as well from the physician. “Mr. John Doe is cleared to receive massage therapy services from (therapy provider’s name) with the following limitations: _______ or with no limitations.”)

If you plan on discussing the patient’s case with the therapist you should have a signed release, and the therapist should get one from the patient during their intake process.

If you’ve requested that the therapist update you on the patient’s progress, look for regular progress reports. (Again, be specific in setting up your expectations and make sure everyone is aware of what they are.) If you aren’t receiving updates, have a staff member contact the therapist to make sure that the patient is being compliant and that the therapist is clear on what is expected.

You can enhance your patient outcomes in several ways:

  • Make sure you recommend enough treatments. Massage benefits have a cumulative effect and changes to structure and function of the body take time.
  • Encourage your staff to get massages on a regular basis as well. Low back pain is a common complaint for nurses and dental hygienists, and neck pain is common for office workers and billing staff. Not only will they be more productive because they’re less distracted by pain, they’ll be able to reinforce your recommendation from positive personal experience.
  • Try to pair up patients with a therapist who specializes in their condition. Some massage therapists in Sarasota are better with low back pain or headaches than others. Some do internal jaw treatments for TMJ dysfunction, others do not. Some work mostly with athletes and have little geriatric experience or vice versa.
  • If your patient will also need physical therapy services, consider using a therapist who is nearby or even allied with your preferred PT provider.
  • If you have several massage therapists in the Lakewood Ranch area that you know and trust, you can consider personalities.
  • Have your staff follow up on patients who aren’t compliant and with therapists who haven’t given progress reports.

If you have a therapist that does an outstanding job for your patients, here are a few suggestions for showing appreciation:

  • Continue to refer!
  • Written “Thank You” cards are always appreciated. We know that you’re overworked and busy, and taking time to send us a note is highly appreciated.
  • Testimonials are even more appreciated. Your referrals are one thing; telling the world that we’re trusted professionals that you recommend and letting us use that to show others? That’s a step and a half beyond. Written testimonials on your letter head, reviews on websites, recommendations of Facebook, and even video testimonials are popular these days.
  • Bring us in to do chair massage for your staff on a regular basis. Not only will this boost morale in your office, it will also make them more comfortable and allow us to get to know the people that support you and make what you do possible.
  • Let other doctors know that we do a great job for your patients as this can lead to even more referrals.

What are you waiting for? Have your team call me today at 941-321-5311 to set up a tour of your office (or mine) and discuss how we can partner to help give your patients the best possible outcomes.

Is there something that I should have covered here and didn’t? Please email me at lizzpughlmt@gmail.com and I am happy to add it.

Have a great experience with a local Sarasota massage therapist or a Bradenton massage therapist? Let me know. I’m always looking for other qualified medical massage therapists to refer patients to when needed.