To tip or not to tip? Do you accept massage therapy or bodywork appointment gratuities?

To tip or not to tip?  Do you accept massage therapy or bodywork appointment gratuities?

Massage as a Health Care Service

Many massage therapists and bodyworkers view their work as health care practice, and tipping is not normal in most medical settings.  To start, we should be clear that massage therapy is health care.  In fact, massage can be used in both preventative and rehabilitative health care management which doubles its viable application. Even if a client schedules a massage on vacation for enjoyment purposes, the increased circulation and other healthy therapeutic benefits achieved in massage practice cannot be avoided.  Massage provides health care by almost any basic standard.

To answer the question of accepting tips, ask yourself:  do you consider your massage to be health care or service?  Most massage therapists will find it is both.  This places massage in two separate categories where tipping is accepted in service but not practiced in health care. This is what creates the dilemma.  How does a practitioner navigate tipping practices and policies when they simultaneously operate in two opposite worlds?

Is Your Massage Straight-up Health Care? Or is it Health Care Service?

Here’s an example of massage practiced as health care without a service-oriented approach: working in a medical setting where the practitioner applies therapeutic touch to achieve the best health outcome, at a health care office, weekdays only, Monday through Friday, between 9 am to 5 pm, during normal business hours.

A large element of service can be extracted from massage health care practice.  I am not suggesting that anyone should extract their service element but it can be done.  And it is your service element that should be considered if you are questioning whether or not you should accept tips, because it’s the service industry where tipping is normally accepted and practiced.  Providing a service element with your massage is commonly accepted and expected as an American standard. 


What Massage Looks Like When it is Executed with Service

Massage therapy service standards usually place a client's personal wishes and directions first. That in itself is service. And it’s the service industry where gratuities are normally exchanged. Accepting gratuities does not make you any less of a health care provider.  Its simply acknowledging that you are providing a high level of service with your health care.  

The following are some questions to help determine the level of massage therapy service provided. The more you answer yes to these questions, the greater level of service you are likely providing with your massage:

  • Do you often work outside of regular business hours, sometimes providing appointments as late as 7 pm or later at night or on weekends, giving up valuable personal time with your friends and family to serve your customers' wishes and needs?
  • Do you accommodate last minute emergencies, making a choice to cancel your plans to care for someone else's?  Massage therapists often serve their client's needs first because they recognize that their client reciprocally pays for their plans.
  • Have you worked in temperatures or spaces that you would not find comfortable, to keep a client comfortable?
  • Have you hauled massage stones or acquired other equipment to provide better service without charging extra for it?
  • Do you offer a client a choice of working with oil, lotion, gel, cream, aromatherapy or anything else they desire?
  • Do you provide whatever type of appointment a client wishes over the type of bodywork that you would prefer for that client?

These questions have been provided to help inspire thoughts to create your own tipping policies. Now ask yourself, does your massage practice lean towards a high level of service? Or is it a straight-up health care operation with normal weekday business hours and best medical objectives practiced at all times? 


Do No Harm While Providing Massage Service

All forms of massage are generally healthy, so there's usually no harm unless your client is asking you to burn them with rocks or apply more pressure than they can tolerate or lie prone and flat on the table while nine months pregnant.  As long as you’re practicing within normal service standards, there’s little harm that can be achieved through quality therapeutic massage or bodywork.

While its difficult to do harm with proper practice, there are many times that massage therapists do less satisfying work, not from our own volition but because of our client’s choices, and because we regularly provide our massage appointments as a service-oriented business.


Providing Massage Service Instead of Practicing for Best Medical Outcomes

There are times that a client does not want to receive the bodywork that I believe would be in their best medical interest, such as deep cross fiber friction to break-down scar tissue.  Instead, some of my clients have preferred a good foot rub or nice oily back massage.  All of this is health care, but I feel like I am providing more service-oriented treatment when I practice what the client wants instead of fulfilling what I think would be best for their medical needs. 

Of course, best medical outcomes with massage therapy could be highly subjective.  For example, some clients would prefer a nice relaxing generic full body Swedish massage when they are in pain because of their bad posture.  It would probably be best to try to improve their posture with more technical bodywork, but instead the client has chosen a different form of massage to temporarily mask or relieve their pain. 

Most of the time I would prefer to work for best medical outcomes that can be achieved with highly technical bodywork, but to provide the best service, I'll explain my bodywork recommendations, and then I'll let the client choose whatever type of massage they would like to receive.  That is providing a service.

Accepting Tips for Massage Therapy Health Care Service

My clients have recognized the many selfless contributions I have made to provide them exceptional health care service and they appreciate it. One of the ways they show their appreciation is through gratuities. And yes, I accept them, graciously.  I appreciate them.  Their tips are one of the rewards I receive for a lot of selfless work that could be easier or more rewarding, but sometimes it is not. 

I answered yes to the list of questions above, often working outside of regular business hours, following a client’s requests at all times I can reasonably provide them, and as long as I do no harm with their service directions. Their gratuity seems like a fair exchange to compensate me for my level of provision and service.


Setting Your Own Tipping Policies

Tipping policies are a personal decision that each therapist must make for themselves. There is no massage industry tipping standard nor should there be. If you work for an employer, hopefully your attitude regarding tipping matches theirs.  And just know that there is no wrong or right answer about accepting tips.  This is a personal decision that must be made in a manner that aligns with your practice and best serves you.


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This article is written by Selena Belisle, the founder and one of the instructors at CE Institute LLC in Miami, Florida.  There, they teach massage, nursing and cosmetology industry CE courses. Selena has been practicing massage therapy and bodywork for over 30 years. She is approved as a continuing education provider by many industry state boards and the National Certification Board for Therapeutic Massage & Bodywork.

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