crisis. Spa visits increased in 2019 · Spa visits increased 1.1% from 2018 to 2019. · Spa industry revenue reached $19.1 billion in 2019. Year Estimated spa visits Estimated spa industry revenue 2010 150 million $ 12.8 billion 2011 156 million $ 13.4 billion 2012 160 million $ 14.0 billion 2013 164 million $ 14.7 billion 2014 176 million $ 15.5 billion 2015 179 million $ 16.3 billion 2016 184 million $ 16.8 billion 2017 187 million $ 17.5 billion 2018 190 million $ 18.3 billion 2019 192 million $ 19.1 billion Figure 30. Information on spa revenue and visits Highlights from Figure 30 Spa visits increased 28% from 2010 to 2019. Estimated revenue for the spa industry increased 49% from 2010 to 2019. 43 The number of spa locations continues to increase The number of spa locations increased by 270 locations from 2018 to 2019. (See Figure 31). 23,000 22,500 22,430 22,000 21,500 21,000 19,90019,85019,960 20,180 20,660 21,020 21,260 21,770 22,160 Number of Spas 20,500 20,000 19,500 19,000 18,500 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Figure 31. Growth in Spa Locations (US) Highlights from Figure 31 The number of spa locations grew 1.2% from 2018 to 2019. 44 Other findings regarding the spa industry: · Average revenue per spa visit increased 3.1% to $99.50 per visit in 2019. · Total employment in the spa industry as a whole increased 1.5% to 383,700 in December 2019, from 377,900 in May 2018. The number of full-time employees increased 3% over this time period to 177,100. Part-time employment increased 0.2% to 178,800. The number of contract employees in the spa industry increased 1.5% to 27,800. · Spa visits by consumers decreased in 2020 due to the pandemic, with 85% of spas citing a drop in consumer visits in the third quarter of 2020. · COVID-19 impacted spa staffing as well, with 32% of spas saying they were filling vacant positions only, and an additional 13% implementing or continuing an existing hiring freeze. Just 19% of spas said they were laying off employees in the third quarter of 2020. · In 2020, because of COVID-19, any gains the spa industry had seen in the previous five years were mitigated. · Revenue growth is expected to be 2.7% per year from 2020 to 2025 for the spa industry, as the economy is expected to improve during this time period.12 Massage therapists’ employment in spas is down slightly · AMTA research shows that 20% of massage therapists worked in spas or salons in 2020, down slightly from last year. 7 45 2H. What impact are national massage chains having on the profession? Franchises and chains continue to open new locations National massage chains continued to expand National massage chains have been growing for the past several years. In 2020, this growth was expected to continue, but COVID-19 led to reduced expansion of this market. Per the 2020 AMTA Consumer study, 36% of massage consumers had a massage at a franchise or chain in the previous 12 months, and 18% of massage consumers stated they had their last massage in a franchise or chain. Note that some consumers may not differentiate between a spa and a national massage chain.1 Six percent of massage therapists worked at national massage chains in 2020. Here again, some therapists may report that they work in a spa as opposed to a franchise or chain. The main players in the massage chain market include: Massage Envy was established in Arizona in 2002 and has roughly 1,150 locations in 49 states. Approximately 1.65 million consumers are members of Massage Envy locations. Massage Envy is the largest employer of massage therapists in the country, with more than 35,000 massage therapists and estheticians employed by the company. Hand and Stone has over 470 locations throughout the United States and Canada. The company is headquartered in Pennsylvania, was founded in 2004, and began franchising in 2006. Elements Therapeutic Massage employs over 3,000 massage therapists at their roughly 250 locations in the United State and Canada. Massage Heights originated in San Antonio, Texas in 2004. The company has roughly 140 locations. Outcall massage services managed through companies like Soothe and Zeel allow consumers to request massage at their homes, offices, or hotels. The companies vet the therapists, consumers, and process the payments. Consumers can schedule a massage in advance or get a therapist within an hour via a mobile app. Soothe operates in over 70 cities in the United States, United Kingdom, Canada and Australia with dozens more in the works. Zeel operates in roughly 77 cities in the United States. There are dozens of other franchise concepts in the massage market that have developed over the past several years. 46 Section 3 — Health Care and the Massage Profession Consumers continue to seek massage for health and wellness reasons. As the health care industry continues to grow, health care providers are more commonly viewing massage therapy as a beneficial option to address health concerns. This section discusses dynamics of the health care industry and the participation of massage therapists in this sector. Key Concerns: How is massage therapy being affected by the growth of the health care industry? How much are insurance companies reimbursing massage therapists? In what ways is massage therapy being integrated into various