Bielinski's creative efforts have paid off for massage therapists. When she took over as government relations chair for the AMTA Washington chapter, she asked for a budget to hold meetings all over the stateŅin clinics, schools, libraries, wherever they could get people to come. That was the singular activity that increased AMTA membership in her state. It also got a personal-service sales tax lifted (with the help of local politicians), and removed massage therapists from the same category as Turkish bathhouses and tattoo operators. Her advice: When problems arise, do not think small. Maximize and vary your approach to solutions.

Being a "people person" has helped Bielinski in many ways.

Maintain Balance 
Although it is tempting to sign up for insurance payments, Bielinski believes massage therapists would do well to keep a hold on cash practice to maintain balance. Because the health-care system is in crisis now, CAM providers, in general, can fare better than other health-care providers can if they are not totally dependent on insurance. 
Medical students ask Bielinski why CAM providers want into the system when they are managing on a cash basis. Her response is that it is not so much what massage therapists and other practitioners want, but what consumers are demanding. When clients or patients say they would come more frequently if their insurance paid for it, CAM providers equate more visits with more money, and more opportunities to help people with their problems.
Her advice: Do not rush into a practice that entirely depends on insurance reimbursement.
 
Know Your Limits
Bielinski reminds massage therapists that it is not in their purview to make a diagnosis or prognosis. Instead, as experts in soft-tissue conditions, they must pay attention to the doctor's prescription for their services. If they do not like being second to such a gatekeeper, they need to consider the reality of educational requirements. Most massage therapy programs run a year or less. That puts them on the outskirts of what other providers consider acceptable. To those health-care professionals who have attended school for six to eight years, it does not make sense that a massage therapist would be a primary caregiver. 
She adds that, as CAM providers, massage therapists have to be careful about saying they can save carriers money when they cannot. As utilization climbs, costs will climb and carriers will more carefully examine such claims. Bielinski warns, "We can't reach further than what is there." 
 
Her advice: Don't expect to be on a par with doctors when you have a basic massage education.

Challenge Yourself
Bielinski believes massage therapists should challenge themselves to be specialists in their field. She points out that physicians learn basic sciences, then undergo medical training and residency, followed by practice and specialization. If massage therapists want to work on a par with them, they need to go beyond a primary level of massage education. 
Toward that end, she recommends not a general national certification, but certifications in the many aspects of massage therapy and bodywork. Even if a state does not have licensing, such certification would allow massage therapists to specialize in the categories they prefer to practice in, whether medical treatment, spa therapy, pregnancy massage, or sports massage. A national board that offers massage therapists credentials in specialties would result in higher competency, the kind that would create a different acceptance of the profession than now exists. It would enable massage therapists to become assistants, for example, to osteopathic physicians. This specialty excellence also would help consumers make clear choices about whom to work with.
 
Her advice: Take advantage of opportunities to become a specialist in your field.
 
The Future
 
Bielinski foresees a greater level of health-care integration throughout the country in the next five to seven years. However, what happens in the West and East will not be the same. And states with regulation will be different from those without it. For one thing, payment for massage therapy services will be higher in areas where there is regulation because of the competence certification that it confers. 
 
While it would be a great asset to have a massage therapist fulfill Bielinski's role in every state, Washington is unique in incorporating such a position into its government structure. Still, in their own states and in their own way, all massage therapists can lend hands-on expertise to changing the political face of health care in the United States. 

Mirka Knaster, author of Discovering The Body's Wisdom (Bantam Books), writes from Oakland, California. She can be reached at: Knaster@aol.com.