Category Archives: Massage Therapy

Federation of State Massage Therapy Boards: All Talk and No Action?

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I hear through the grapevine that the Nevada State Board of Massage Therapists has voted to terminate their agency’s membership in the Federation of State Massage Therapy Boards. Why the big thumbs down? The main reason was a failure to deliver on the many promises FSMTB has made to its Member Boards.

It’s been several years since I was a delegate to the FSMTB annual meeting, so I went to the website to see what’s happening. The page entitled “Member Services” is “under construction.” That could be because the member services, many of which have been talked about since the Federation was first formed in 2005, don’t actually exist. Projects that have been launched but not completed include the national database of state board disciplinary actions , the practice exam and study guide for the MBLEx, the Model Practice Act, and a comprehensive solution to continuing education regulation. These are all basic services that a board federation should provide to its constituents.

Eight years after the creation of this organization, it’s hard to see exactly what has been accomplished, other than a well-used licensing exam and an annual meeting of Member Boards in generally pleasant locations like San Juan, New Orleans and Redondo Beach.

I’ve had my own concerns about the FSMTB for several years. While I support the idea of all the state boards coming together in the interest of seeking solutions to common problems, I am of the opinion that if you’re spending the money to have meetings, something concrete ought to arise from that. So far, we haven’t seen it. There are quite a few committees and task forces for all these as-yet-undelivered initiatives, but we don’t know what they’re doing, since they don’t publish their minutes for public scrutiny.

As licensees in regulated states that are Member Boards of the FSMTB, I am of the opinion that all their operations need to be transparent and that includes to us, the stakeholders. I’ve heard from former FSMTB board members that they are placed under gag orders not to discuss what’s going on there. That doesn’t work for me at all. They should be as transparent as a clean window, not operating like national security is at risk should their actions become known.

Furthermore, as I have detailed in several previous blogs, the balance of power has shifted to the “Central Command” that consists of the FSMTB Board of Directors and the Executive Director. Over the past several years, this elite group has put through changes to the FSMTB Bylaws that has concentrated organizational control while minimizing the input of the Member Boards. The Directors also managed to get their terms of office lengthened, and to be able to serve two terms AFTER they are no longer serving on their own state board. Once a person has rotated off their state board, they are not beholden to the public interest, they’re serving themselves.

This is just like what we saw at NCBTMB a few years ago, when their Board of Directors voted to double the length of their terms of office, and sewed up the nominations process so that it’s impossible to tell how candidates get on the ballot. This kind of behavior in our non-profit organizations is just unhealthy.

The FSMTB has in the past offered scholarships to state boards if finances meant they couldn’t afford to join, so one assumes that if the Nevada Board was in financial distress, the FSMTB would give them a pass. That isn’t the case, here. The Nevada Board has just plain decided they aren’t getting what they’re paying for. I have to say I applaud them for making this decision.

Talk is cheap, and PowerPoint presentations are not a substitute for action. Maybe this boot from the Nevada Board will serve as a wakeup call that the Federation needs to reevaluate their leadership and where they are going as an organization.

A Change for the Better at the Massage Therapy Foundation and AMTA

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This past week the Massage Therapy Foundation announced that Gini S. Ohlson will become the new Executive Director of the organization, effective July 1. Ohlson has been the AMTA’s staff director for the MTF since 1998.

This is part of the paradigm shift between the two organizations, and I think it’s a good one. AMTA was the founder of the Massage Therapy Foundation back in 1990, and the Executive Director of AMTA has also always acted as the Executive Director of the Foundation. I’ve always wondered how well that worked out, since both organizations carry a lot of responsibility and it would seem to me to be a full-time job to fill either position. Both organizations have come to the same conclusion and have mutually agreed that it is time for the MTF to function more independently.

The Foundation will continue to be housed in AMTA’s offices in Evanston, IL, and the AMTA will continue to support the MTF, albeit in a different way from in the past. AMTA has traditionally paid the staff salaries for the Foundation staff. Under the new agreement, AMTA will continue to contribute to the finances of the MTF, but they will be paying their own staff salaries. AMTA has also committed to donating $50K per year earmarked specifically for massage therapy research.

AMTA’s new Executive Director, former Deputy Director Bill Brown, will be taking over when current ED Shelly Johnson steps down on May 17. I spoke with both of the at the International Massage Therapy Research Conference last weekend. I had previously asked Brown to consent to an interview for my blog when he takes over, and couldn’t resist jerking his chain a little bit by telling him I was going to have Johnson do a guest blog first entitled “Final Instructions for Bill.” Both have years of service to AMTA. I wish Johnson the best in her retirement and look forward to seeing what Brown will do as leader of the organization. AMTA and the MTF will continue to work together for the good of the profession, I have no doubts.

My attendance at the International Massage Therapy Research Conference last week just reaffirmed for me how important it is to support the Massage Therapy Foundation. I urge every massage therapist to support the Foundation in whatever way you can. If each therapist donated the cost of one massage per year to the MTF, that would be a huge amount of money. Just do it! You can donate here.

NCBTMB Call for Comments: 911 for Approved Providers

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The NCBTMB has decided to call for comments on their latest revisions for the CE/Approved Provider program–something they should have done before they ever unrolled the plan to start with–and I can virtually guarantee they aren’t going to like the responses they receive. I have been cc’d on numerous letters to them from providers, and so far, the only responses I have seen are anger and disgust.

I’m not one to get too bent out of shape about paperwork, and in reality, the revised new requirements are not adding that much of a burden, time-wise. One wants to assume if you are teaching a class that you actually have all the paperwork they are asking to see. Uploading it shouldn’t be such a big deal.

The flash point here is the almighty dollar. It is no secret that the NCBTMB has lost a lot of revenue to the MBLEx in the past few years, and there’s no indication that trend will ever reverse itself. The NCB is proposing quite a drastic increase in approved provider fees, no doubt hopeful that it will increase their financial coffers.

I personally have organizational approval. In their new paradigm, I am considered a “small” organization. In spite of that, my renewal fee is jumping from $300 to $750. Larger organizations are taking a much bigger hit. The biggest increase is going to fall on trade shows and conferences….something I personally enjoy attending. There are already some conferences out there that don’t pay the instructors (or only pay those who are at the top of the big heap), but instead provide them with a table to sell their wares. That’s well and good, but I don’t carry my wares around, personally. My publisher is usually at big conferences, so I don’t go to the expense of shipping books to sell. They’re there selling mine and those of the other authors they represent, and in reality, if I were to pay to ship them myself, my profit would be so miniscule it wouldn’t be worth the trouble. Those conferences, as well as those that do pay instructors, are going to see a big increase in the amount of money they have to pay, so the fallout is going to be either paying the instructors less, charging the students more, or both.

While I frequently get invited to teach in other places, I sometimes host as few as six classes a year at my own facility. I spend several thousand dollars a year to advertise these events. I handle all the registrations, I provide massage tables and linens so people don’t have to worry about transporting those, and I provide snacks for the classes. I pay the instructor 70%–and sometimes more. In the past, when I’ve had a teacher scheduled to come from out of state and they didn’t get the minimum number of students they wanted, I have forgone my percentage altogether in order to make the class happen.

Like many instructors, money isn’t my primary motivation. It’s the love of education, and the thrill that I get when a student calls me up a year or two later and says “Thank you so much. What I learned in  your class that day has really increased my business.”

Providers will really not have any choice at all except to pass this increase in costs on to those who attend our classes.

Adding insult to injury, the FSMTB seems to be charging ahead with their ill-conceived plan to do away with continuing education requirements altogether, except for the classes centered around “public protection” that they plan to offer from their own website.

I’m beginning to think we might as well give up continuing education altogether. We have a couple of national organizations here, one who is in dire need of money and looking at CE providers as the cash cow that will keep them afloat, and the other who is already rolling in money and wants to force their ownership of continuing education down our throats. I don’t like either scenario.

While I am glad that the NCBTMB decided to send out the call for comments, I am wondering how they are going to yet again revise this plan after they see that those comments are all negative. So far, I haven’t seen one single comment on my networks that is in support of this plan and these price increases.

If you have not added your two cents worth yet, I urge you to view this video and then fill out the survey. The NCB has left plenty of space for comments, and you should seize this opportunity to give them your opinion.

MOCC-ERY Redux

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I have received the following from the Federation of State Massage Therapy Boards. I personally think they are far off the mark on what they intend to do with continuing education, and with their refusal to consider any joint effort with the NCBTMB to organize and streamline the approval process for the good of all concerned. This is their MOCC-ERY plan redux, and it’s giving me a bad case of acid reflux. The first time this plan rolled around, the national office of AMTA responded by shooting 20 holes into it. Those holes are still there, and it is my fond hope that AMTA will reiterate its position.

This is nothing more than another ill-conceived ploy to put the NCBTMB out of business by taking CE out of their hands, making only what THEY want to be required–and furthermore, to require you to get it from them. To add insult to injury, the FSMTB proposes that THEY will choose the experts who will create the courses that YOU will be required to take from them on their website and occasional live classes. CE Providers might as well kiss your income goodbye. Give me a break. If this isn’t a naked power grab, I have never seen one. Here is the communication:

February 27, 2013
 
Dear Colleagues:
 
A White Paper circulating in professional and social media circles proposes the creation of a new organization to approve continuing education providers. FSMTB has not indicated support for such a move and would like to correct certain assumptions pertaining directly to the FSMTB that are made in the paper.
 
The most important reason for regulating the massage and bodywork profession is to ensure public protection and consumer confidence without unduly restricting the ability of licensed, professional therapists to make a living. To better address needs in the area of license renewal, the FSMTB was directed by a vote of its members (State boards and agencies that regulate massage and bodywork therapy) to develop and deliver a solution.
 
To do this, FSMTB looked at research and listened to experts, including consumers, educators, and the therapists themselves. Our recommendation was published in October 2012 in a paper called “Standardized Licensure Renewal Recommendation for Continuing Professional Competence“.  
   
Standardized Licensure Renewal Recommendation
Here’s what we believe is fair and reasonable to ensure competent licensed professionals and protection for the public they serve.
 
Licensed massage and bodywork therapists will be required to complete six (6) hours of license renewal requirements annually. At least three (3) of the six hours must meet the State-sponsored Ethics and Professional Practice course requirements that specifically address content pertaining to public safety. The remaining three (3) hours could be exchanged for certain Professional Development Activities, including but not limited to meeting accredited certification standards, community service, and research.
 
We further believe that it is preferable for all six hours of the license renewal requirements to be in the Ethics and Professional Practice areas, thus eliminating the need for therapists to engage in other activities or classes in order to renew their license. The rationale for limiting the licensing renewal requirements to the Ethics and Professional Practice areas is to ensure that therapists have standardized, current knowledge necessary for safe and competent practice. Additional activities and classes, though beneficial and encouraged, should not be required for re-licensure.
 
Recognizing that there will be a transition phase as the profession progresses, we will establish standards for acceptance of other Professional Development Activities for licensure renewal, such as attaining certifications and attending professional conferences. Again, these activities are to be encouraged but are beyond what should be required to maintain a license.
 
Our goal is to create easily accessible online courses each year on the topics that matter to the State boards, not just to address complaints or sub-standard practice, but to focus on issues such as ethical concerns and therapist safety. Our intent is not to compete with agencies already providing certifications or CE, but to ensure adequate attention to our area of emphasis, Ethics and Professional Practice.
 
For those without access to computers we are considering live classes at events where therapists already gather. We will select experts to work with our licensing boards to create the best courses and we encourage your participation.
 
For States that already have CE requirements, the FSMTB will establish Standards to assist States in determining Professional Development Activities that are acceptable during the transition. We are not proposing that we approve CE Providers, Instructors or Courses; instead, we are concentrating on an alternative solution to address the needs of the regulatory community and the therapists.
 
Considering licensure, we must keep in mind that a license does not reflect that a therapist is brilliant, enthusiastic, nice, or possesses a healing gift. Licensure demonstrates that a therapist has met basic professional standards and is entitled to legally practice.
 
Licensing boards:
-work for the public, not the profession.
-are created to regulate the profession, not elevate it.
-cannot require a double standard – education for experienced professionals that is different from that of entry level therapists.
-must provide the public with an avenue to address harm.
-ensure only that a licensed therapist meets standard competency levels to receive or renew a license.
 
In summary, our role and intent is to work with State boards to protect and to serve the public while at the same time offering a simplified, standardized and relevant solution for therapists.

All providers of continuing education need to contact dpersinger@fsmtb.org and jhuffman@fsmtb.org and let them know we do not want this plan shoved down our throats. Furthermore, providers and licensees can send a letter to your own state massage therapy board letting them know that you do not support this plan of the FSMTB to take over the CE business. Does a practitioner who has been in business 25 years really need to repeat the FSMTB-ordained ethics class for every renewal? Do not sit on your hands–send those emails right now and let the leadership of the FSMTB know you are against this plan.

Blowin’ in the Wind

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Whether you prefer the Bob Dylan original version, or the popular treatment by Peter, Paul & Mary, we have our own version of Blowin’ in the Wind being sung by the leaders of FSMTB and NCBTMB.

My last blog (February 11) focused on problems with regulation of continuing education in the massage profession, and put the spotlight on a comprehensive white paper written by Rick Rosen that offers a innovative solution to a very confusing situation. There’s been a lot of activity around this issue, and from what I hear, a lot of CE providers have contacted FSMTB and NCB to express their displeasure with the programs each one has in the works. I believe that Rosen’s concept of a National Continuing Education Registry is the right tool for the job at this point in the massage therapy profession. It will require cooperation and collaboration from both organizations, and would utilize the talents and resources of both. To me that is a far superior state of affairs than the animosity and one-upmanship that has been the prevailing atmosphere between these two organizations for the past half-dozen years or so.

Over the past two weeks, information has come out of NCB that suggests they may be having second thoughts about their “upgraded” Board Approved CE Provider Program. Donna Sarvello, NCB’s CE manager, said, “Providers do not need to renew until their renewal date because while we are reviewing the new program we have reinstated the past program. I can’t give the exact details on the Organization status at this time because we are tweaking the details and then will put it out for public comment.”

If you look on the Continuing Education page on NCB’s website, there is no evidence of what Ms. Sarvello is talking about. The new Board Approved CE Provider Program is right there in all of its convoluted and excessive glory, with a demand that all providers have to renew with the new system by December 31 of this year. What are providers supposed to believe? I am personally choosing to believe Ms. Sarvello, and I advise the NCB to update the website immediately! Any time there is an update in information and/or policy, the stakeholders need to know that, and having incorrect information on the website for these past few weeks is just inexcusable. I am calling out the NCB to clear up this mass confusion right now by making DAILY updates if necessary. Even a message that says “Sorry, we haven’t decided what to do, so no action is expected of you at this time” would be superior to the incorrect instructions that are still posted.

The FSMTB is no clearer about their plans. Their President, Jaime Huffman, claims that FSMTB is not going to create a CE approval program. That just doesn’t jive with their Call for Participants to create three different volunteer workgroups as part of a new Licensure Renewal Committee. And their Standardized Licensure Renewal Recommendations adopted last year by the Board of Directors states that “FSMTB will establish standards for acceptance of professional development activities, including those offered by membership and voluntary certification organizations.” If that doesn’t sound like some kind of approval program, then what is it supposed to be?

The very latest word I’ve received is that the top two leaders from FSMTB and NCB have had “a conversation” about the continuing ed issue in the past week. That’s a positive development, but we don’t know a darn thing about what was discussed or what these two organizations might be willing to do. Whatever it is, it isn’t going to  happen overnight, but I am very pleased that they are finally at the point of having a discussion, something that Rick Rosen and I both have been calling for for a couple of years now.

In the meantime, keep those emails flowing in to Debra Persinger and Jaime Huffman at FSMTB, and Mike Williams and Sue Toscano at NCBTMB. Let ‘em know that you expect them to work together to forge a unified solution for how CE should be handled, while easing the regulatory burden on CE providers. The contact information for these two organizations is on page 17 of Rosen’s white paper, which can be accessed from this short link: http://tinyurl.com/NCER-Proposal-FEB2013

It’s time we harnessed the hot air that’s been blowing from these two stakeholder organizations, and direct it towards a positive solution that gives the massage profession what it’s really needing.

The Financial Health of Our Organizations: AMTA

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This is the fourth year that I have reported on the financial status of the non-profit organizations that represent the massage therapy profession. I am not an accountant or a financial expert. The information is taken from Guidestar, a clearinghouse where you can look up the financial filings of non-profits.

This blog has been revised–after I posted the original blog, Guidestar posted AMTA’s latest 990. Since non-profits have a different filing schedule that the rest of us, it is not unusual for the “latest” 990 appearing on the website to be a year old or more. This revision reflects the 2012 filing. It was signed in October of 2012 and just made it to the Guidestar site within the past week. Thank you to Rachel Mann, VP of AMTA Board of Directors, for bringing it to my attention.

The American Massage Therapy Association is showing a net revenue of over $419K, compared to their loss for the previous year of almost $110K. Glad to see they’re out of the hole.

The revenue increased over $600K from the previous year.

AMTA compensates the members of their elected Board of Directors, in amounts ranging from $5000 for members-at-large to almost $40K for the President (during this filing, that was Glenath Moyle.) Executive Director Shelly Johnson was paid almost $261K–a drastic cut from the $316K plus almost $10K in “other” compensation that was paid out on the 2011 filing to the immediate past ED, Elizabeth Sublewski (aka Liz Lucas).  Sublewski also received severance pay of over $82,000 on the 2011 return. On the 2012 return, she received almost $260K….apparently, it was quite expensive to the organization to get Sublewski off the job. My hope is that in the future, AMTA will negotiate executive contracts that are more favorable to the organization. Total salaries accounted for about 3.5 million; that is actually almost $500K less than they were the year before.

Over $11 million dollars worth of AMTA’s revenue came directly from membership dues. The remaining revenue is derived from sales of literature, convention sponsorships and booths, advertising, and investments.

AMTA has the same kind of expenses that any other business or organization does–office supplies, information technology, advertising, postage, banking and credit card processing fees, and so forth. None of it looks out of line, considering the size of the organization. AMTA represents over 57,000 members. They’ve seen recessions come and go and have survived them all. As a long-standing member myself, I have never seen service suffer in any way, whether it was a fat year or a lean year.

As an aside, I hear that Executive Director Shelly Johnson is stepping down later this spring to spend more time with family. She has done an excellent job during the 8 years she spent as Deputy Director, and since she stepped up into the ED position in 2010. She will be missed by the organization, and I wish her the best of luck.

Caught Between Hubris and The Grudge

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All the talk in recent weeks of the “fiscal cliff” and the refusal of the Republicans and the Democrats to play nice together in the interest of the highest common good reminds me of the current situation between the NCBTMB and the FSMTB.

The NCB is operating from hubris (not to mention cluelessness), as they continue to put forth wrong-headed initiatives for the field. The latest plan to do away with organizational approval for CE providers is just the latest in a stream of missteps from the organization. They rolled that sudden announcement out like it was the best thing since sliced bread, and providers are choking on it. The application to become an approved provider has been totally removed from their website in the last day or two. I think they might be revisiting some of that plan in response to the unfavorable reception, which has included rumblings of boycotting the organization.

FSMTB is doing their own thing with the MBLEx well enough–in fact, extremely well, but when it comes to dealing with NCBTMB, it appears that the leadership of the FSMTB would rather see the organization fail than lift a hand to help them. They appear to be bearing a huge grudge over the way NCB has treated the Federation, and their unwillingness to move beyond that is stopping progress at the whole-profession level.

In case you’re uninformed, the NCBTMB has had their exam removed in a few states, and they have successfully legally challenged and won those challenges. That doesn’t sit well with the Federation, who would like to see the MBLEx as the only exam for entry-level massage licensing.

The NCB needs to get out of the entry-level exam business, in my opinion, but they can’t afford to right now. I believe they were depending on the increased revenue from the new requirement of CE course approvals to be the cash cow that would bail them out and make them financially viable again. The problem is that it’s unfair and unreasonable to put this burden on the backs of the CE provider community that is already challenged in so many ways.

FSMTB could provide that bridge through a transfer agreement and compensation package, which would resolve the “Exam Wars” once and for all. That type of action is not without precedent; it has happened in other licensed professions when it became apparent that it was time to evolve into a more streamlined process for the good of all concerned, including licensees.

It’s insane for FSMTB to even be meeting about building its own CE approval program, which they are in fact doing, when it would create more problems than it would solve. If these two organizations would sit down and hammer out such an agreement, the NCBTMB could remain the administrator of a dialed-back CE registry program, which state boards could reference, and which could finally serve as the one unified solution that the CE provider community has been needing. If the Federation jumps into the fray with yet another approval program and persuade the states to accept that, it will take but a few short years for them to put the NCBTMB out of business once and for all, which I would prefer not to see happen.

It’s time to put the hubris and the grudge and the egos aside and come to the table. The board members of both of these organizations have the power to make that happen. Your directors serve at your discretion and you ought to remember that you are not there to blindly follow the leader. A meeting of the minds is not possible when a meeting hasn’t taken place. If I were serving on either of these boards, I would be making the motion to sit down together and come to an agreement that will serve the profession on the whole.
 

 

CE Providers React to NCBTMB’s New Approval Plan

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In the past couple of weeks since the NCBTMB unveiled their new plan for CE providers, which includes doing away with organizational approval, the reaction of providers has for the most part been very negative–and frankly I’m not surprised. The long-standing organizations who are providing quality continuing education approved feel, for the most part, that the organization they have supported for many years is throwing them under the bus.

Some of the main concerns that I  have heard are from providers who have created proprietary classes and who have trained and approved their own instructors to go out and teach their work. They are now faced with the instructors that they have invested time and money in training and marketing classes for going out on their own, taking copyrighted teaching manuals and proprietary handouts with them, and acting as if they are under no obligation pay the percentage or per-student charge that they have agreed to pay as teaching members of the organizations. Those same instructors who have been mentored and marketed under our organizations are now saying “we’ll just be out on our own after 2014.” They are making it clear that they feel free to take our proprietary materials away with them—because the new rules are basically blessing that—and never give the organization that put them where they are another dime.

Those who have organizational approval do not want unqualified people teaching for their organizations and misrepresenting their good names, and have gone to considerable effort and expense to make sure that is not the case. While there is certainly nothing wrong with requiring us to provide proof of that, taking all instructors from under our organizational umbrella and putting them out there on their own is also going to create logistical nightmares. The organization has been responsible for collecting and maintaining registration forms, evaluation forms, etc. and issuing CE. In the case of Upledger, for example, now instead of one organization handling those administrative tasks, there will be more than 100 separate instructors keeping up with that. The organization will have no control and no more quality assurance that they will be able to exercise.

The organizations and schools that sponsor CE workshops at the national, state, and local levels will suffer from these changes as well. This is also financially crippling and over-burdensome to smaller organizations who may not teach that many classes each year. When it comes to education, quality and quantity are not the same thing.

The notion that having people turn in all their lesson plans as proof that they are a competent teacher is also flawed. My publisher hires me to write lesson plans all the time to go with their textbooks and for career schools who want customized plans. I’ve written at least 20 this year alone. If you have the money to hire me, I will write one for you. It still will not make you a competent teacher. A well-written lesson plan doesn’t necessarily indicate that you’re a great teacher; it indicates that you are either a competent writer, or that you hired someone like me to write it for you. Requiring people to send in a video of themselves teaching would be more indicative of whether or not they are competent, since the organization obviously cannot afford to vet every class in person.

In response to the outcry since the NCBTMB announced the plan, they have stated that they will consider some of these issues on a case-by-case basis. I would like to know how they plan to carry that out with volunteers—volunteers whose qualifications to judge us we have no knowledge of, as they are not releasing the names of the people on that committee. Are they experienced educators? Are they trained in teaching methodology? Are the research literate? We don’t know; we can only hope so.

I find it necessary to bring up that the reason the NCBTMB changed from vetting individual classes years ago was because the task became too overwhelming for the paid staff to handle and getting volunteers together to do it caused the process to move at the pace of molasses. It is unacceptable for someone to wait six months—as has been common at several points in time—to get their approval or denial. It is very apparent from the latest 990 filing that the NCBTMB cannot afford to hire new staff and that they will indeed be depending on volunteers until such time as this might generate enough money to enable that. This is one of the service problems that has come very close to knocking this organization to its knees in the past, and they do not need to go backwards instead of forward.

Considering things on a “case-by-case” basis also leaves this organization open to accusations of favoritism, if not worse. The massage community is a tight-knit and close community, in spite of the fact that there are thousands of us. Those of us who are organizational providers tend to attend the same events, and travel in the same circles. What you allow for one, you must allow for all. To do otherwise is simply unethical and unprofessional, and the first time it comes to light, and it certainly will, that any consideration given to one has not been given to all, it is going to be another public relations nightmare for the NCBTMB. I don’t think they can stand to have many more of those.

Let’s look at a few facts.

There are currently a half dozen states with their own CE approval process. The NCBTMB is not the only game in town…and it is that same complacency of thinking that has resulted in the FSMTB kicking their butt with the MBLEx. I would not fall into the mistake of thinking that the Federation isn’t willing to step up and do something about CE approval as well. They may seize upon the dissatisfaction of the current environment; they already have the infrastructure, and big cash reserves at their disposal. The Federation doesn’t “need” the money, and the perception here from providers is that the NCBTMB is trying to bail themselves out of the red with this plan.

There is no evidence to support that regulation, including requiring CE, has contributed to the safety of the public. There have always been unethical and incompetent practitioners, and for that matter unethical and/or incompetent CE providers, and they will continue to exist, regardless of the amount of rules and regulations. Look at how things stand in other professions. There are 17 states that don’t require nurses to obtain CE. There are 10 states that don’t require PTs to obtain CE. Even MDs have 7 states that don’t require them to obtain CE—but all three of these professions are licensed in all 50 states.

Other than the 30 or so of us (including myself) who were present at the meeting the NCBTMB convened in Chicago to discuss this issue a couple of years ago, there has been no attempt to gather the input of the (hundreds of) providers that are currently under the auspices of the NCBTMB.  I believe this organization is in need of our support, not our animosity and distress.

I urge them to abandon this plan, and gather input from a much broader slice of the profession before considering such drastic measures again.

The Financial Health of Our Organizations: NCBTMB

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Note: For the past few years I have done a series of reports on the financial status of the non-profit organizations that represent the massage therapy profession. I obtain this information from Guidestar, a financial information clearinghouse for non-profits. The organizations can provide their Form 990 (Return of Organization Exempt from Income Tax) to Guidestar, and if they don’t, the IRS does it for them. I will state for the record that I am not an accountant or a financial analyst; I just report what I see (and maybe offer a few opinions). I usually get asked the question every year why I am not reporting on ABMP. Associated Bodywork & Massage Professionals is a privately-owned for-profit company, and they are not obligated to release their financial information. Non-profits are on a different filing schedule than the rest of us, and there is variance amongst them in when their fiscal year ends. The deadline for filing is the 15th day of the fifth month after the end of their fiscal year. An organization can also request and receive up to two 90-day extensions, and due to the number who haven’t filed yet for 2011, it appears that some of them have done that.

The National Certification Board for Therapeutic Massage & Bodywork has filed their 2011 Form 990 in a timely manner so I’m going to start with them this year. I’ll be following that up with my report on the Federation of State Massage Therapy Boards. The financial status of these two organizations are intertwined for one reason: since it’s introduction in 2008, the MBLEx has taken a substantial market share of the entry-level exam market away from the NCBTMB. For many years, the NCBTMB exams were enjoying a monopoly, except for the few states that require their own exam.

In 2008, the first year that the MBLEx was available, the NCBTMB’s revenue from exams was in excess of $6 million. By 2011, that had dropped to $3,380,813. Instead of a monopoly, they had a 47% share of the market. I confess that I was expecting it to be even less, since the Federation has relentlessly encouraged their member states to use the MBLEx exclusively. I think the fact that the NCBTMB has retained as much as they have is proof that plan has not yet come to fruition. The income at the NCBTMB from people recertifying dropped by a little over $5k, and sales of their exam guide were down about $17k. Sales of their mailing list also took about a $20k hit this year.

They are showing a total revenue of $5,357,738 for 2011. From 2010 to 2011, the NCBTMB’s total revenue went down to the tune of $443,312. That’s not exactly a shocking figure in this time of recent recession.

The 2011 return, due to the timing of the NCB’s fiscal year, reports the salary of former CEO Paul Lindamood; although the filing was signed by his replacement Mike Williams. Lindamood’s compensation and benefits amounted to over $257,000. No word on what Mike Williams is doing the job for. Non-profits have to report the breakdown of compensation of officers, directors, trustees, key employees, highest compensated employees, and independent contractors. All together, the NCBTMB paid out over $1.7 million in compensation during 2011. Their other major expense is over $1.3 million in exam administration fees.

The bottom line is what tells the tale for most businesses–for profit or not–and their net revenue after expenses for 2011 is $227,326 which is down over $240,000 from 2010.When you consider that during Paul Lindamood’s reign at the helm, the organization went from being almost $270,000 in the hole in 2009 to having a net income of over $469,000 in 2010, it looks like it’s time to either slash expenses, the way he did, or generate more money.

That’s exactly what the NCBTMB hopes will happen in the coming year(s) on both fronts. They are rolling out the new rules for national certification, as well as the new rules for continuing ed providers, and doing away with organizational approval. The requirement that each individual be approved as a provider in their own right should generate some additional funds. The new rules for becoming nationally certified, in my humble opinion, is initially going to cause a further decrease for them. Since the new rules are jacking up the education requirement from 500 hours to 750, and requiring 250 hours of work experience, that will automatically disqualify people who might have otherwise taken the exam for entry-level licensing. The NESL is still an option in some states, but with the entry-level exam revenue steadily declining for the past four years, and the MBLEx becoming more firmly entrenched with the member states as time goes on, I’d be surprised if they don’t continue to lose ground in that market.

Their expenses could go back down. The application and recertification processes are online, and that’s going to knock a few staff members out of a job. They spent about $40k more in 2011 attending conventions than in 2010. I feel that they should be present at all major massage meetings, so I don’t begrudge that money…conventions are never held at Motel 6 so unless I’m an invited speaker, I feel that one in my own pocketbook. Legal expenses also increased by about $13k this year, but lobbying decreased by almost that same amount. It does cost money to go in and challenge a state that is considering dropping your exam–or appealing to one that has already dropped it to reinstate it.

On a positive note, total assets increased by about $70k, while total liabilities decreased by about $142,000.

All in all, it wasn’t the best year they’ve ever had–and it wasn’t the worst, either. The NCBTMB has had some administrations in years gone by that seemed hellbent on bankrupting the organization. I feel pretty safe in saying that isn’t the case here; they have some dedicated staff and board members that are determined to make it work, and we’ll just have to wait and see what happens. In the meantime, their new website is very snappy. You can check it out and all the new changes they are implementing at www.ncbtmb.org

NCBTMB Making Major Changes to CE Provider Approvals

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Disclosure: I have agreed to pass along comments, questions and concerns to the NCBTMB on this matter, and the management there reads my blog. They are fully aware that I use this blog to express my own opinion whether it is in line with theirs or not. Your comments here will be seen by the CEO, Mike Williams, and the Board of Directors.

The NCBTMB has announced major changes in the works to their Approved Provider program for continuing education. You can read those here.They have also set up a page for Frequently Asked Questions about it, and you can read those here.

As soon as they sent out the press release I started getting emails and FB messages from people asking questions about it, some applauding it, and some complaining about it.The biggest change is that they will no longer be offering organizational approval. Every individual who teaches a continuing education class will need to obtain individual approval as a provider. That’s going to affect a LOT of entities: AMTA, the American Massage Conference, massage schools, and other organizations who have previously been able to take people in under their umbrella.

It’s affecting me, personally. I have organizational approval myself. I normally host a dozen or more teachers at my facility each year, and while 90% of them are approved providers in their own right, a couple are not. I don’t perceive it to be such a big deal for me…it’s not going to be a problem for them to get their own approval, and I have until the end of 2013 to prod them along into doing so. All who are approved as organizations have until the end of 2013 to get your act together and come into compliance under the new rules.

One of the first complaints, naturally, was about money, and people having to pay yet another expense. Organizational approval up to this point has cost $400. In reality, an organization that only has two teachers has been paying the same amount as one that has twenty, and that’s not really fair. Under the new paradigm, approvals will cost $175 and will last for three years. You must also pay a $25 fee for each class you submit to be reviewed. As a clarification to one point that has been brought up, if you have a full class and you teach portions of that, as sometimes happens at conferences and conventions, you are not having to pay $25 for each version of it…just the one fee. That’s good. I teach for a lot of AMTA chapters and I am often asked to cut an 8 hour class down to 6 hours or make a 3 hour class last for 4, so it’s good to know you’re not paying $25 for all derivatives of the same course.

People have also stated issues with them requiring a criminal background check. Some state boards require that, and some don’t. My particular state does, and if memory serves I think the fee is $30 or $35. It may be duplicating efforts for the NCBTMB to require it in some instances, but not in others.

I have personally had discussions with the powers that be at the NCBTMB over the approval of course content. They are now vetting individual courses again–to a point. The first concern I got wind of was from a colleague who was concerned that they would throw out everything that doesn’t fit in the box of Western medicine. Have no fear. My own wish is that they would get rid of some of the more questionable classes that are approved….at least they were questionable to me, and of course, I’m just one person with an opinion in a sea of many.

They have no intent of getting rid of energy work courses and other classes that don’t have any basis in science…as long as the course content shows some connection to or lineage from massage, it will still likely be approved. I say likely because during the vetting process, they are paying more attention to quality, whatever that truly means. For one thing, they are asking you to turn in your complete handouts, which has never been done before and which also has some people concerned about letting their proprietary information out of the bag. I have expressed my own concern that some of these courses people have invented that don’t have any basis in science and in fact have in some instances been proven to be totally contrary to accepted scientific principles are still going to be approved, so I’m not sure how “quality” that is. A lot of people disagree with me on that front. There is obviously a very huge demand for those types of classes, or they wouldn’t continue to exist.

What I would personally like to see happen is a national certification for science-based education. I’m going to keep after them about that; you can count on it. People can do all the unsubstantiated things they like, but there are some who would like to have a credential that is based on the actual evidence-informed practice of massage. I am one of them. Does that mean I am claiming to be better than you? No, it does not. It just means I would like for there to be something out there that differentiates those who want to be known as evidence-based practitioners as opposed to those who don’t.

Other questions I’ve been asked include exactly who is doing this, and the names of the committee members have not been released that I am aware of. They just state on their website (which is new and snappy-looking, incidentally) that it is a team of experienced practitioners and educators.

People ought to be aware that the buck doesn’t really stop with the NCBTMB. They, along with numerous other certification agencies,  are accredited by the Institute for Credentialing Excellence (formerly NCCA, National Commission for Certified Agencies).  They are the only national accreditation body for private certification organizations, in all disciplines, to demonstrate adherence to established standards. Among the certifying agencies that this organization accredits include healthcare programs in chiropractic, dentistry, EMT, nursing, medical assisting, nutrition, prosthetics and orthotics, and pharmacy. They also accredit certification programs in the arts, construction trades, and a host of other things. And ICE is accountable to the Council for Higher Education.

Bottom line: changes are coming, and you can either go with the flow or go away…while a few states have their own approval process, the vast majority still depend on the NCBTMB for approving continuing education.

I’d like to state for the record that I personally am acquainted with the majority of the people at the NCBTMB, and I have certainly written my share of criticism of the organization in the past–and patted them on the back when I thought they deserved it. The fact is that if they stand on their head and whistle Dixie, it is never going to suit all of the people all of the time. I think they are a dedicated and hard-working group of people. I certainly don’t agree with everything they do, and I take frequent advantage of my status as a certificant and an approved provider to let them know that.

Here’s your opportunity to comment, so take it. As I said, these comments will be seen by the CEO and Board members.