Category Archives: Massage Therapy

Arkansas Massage Therapists: Be(a)ware

The state of Arkansas has more massage legislation going on than you can shake a stick at.  Here’s a quick recap of this legislative bonanza:

AB 145 would dissolve the Arkansas Board of Massage Therapy and transfer duties to the Department of Health, effective Oct. 1, 2015. This has passed both the House and the Senate and been sent to the Governor, and it’s almost a 100% certainty that licensing massage therapists is going to be turned over to the DOH. It’s beyond incredible to me that the current board members apparently did not protest the dissolution of their Board. However, from the mess that they seem to be in, perhaps the Board members felt it’s best to just go along with the change. Unfortunately, in the past few years, the Arkansas Board has apparently been on a downhill slide with their finances.

According to past Board member Susie Byrd, the current board took power in ’09 when Byrd left. At that time, there were 3550 therapists, two people running the board office, and an annual budget of $74,5000. Marilyn Graham was hired as the Executive Director in ’09. As of 2014, 5 years into Graham’s tenure, there are 1990 therapists, four people in the board office, and an annual budget of $248,000. According to Byrd, when she departed from the the Board, the Board had $250,000 in reserves. That $250,000 has been spent, and according to Byrd, Graham has asked for an additional $60,000 twice in the past year. The Dept of Finance and Administration told the board they had to either fire two people or raise fees, and that the legislators would not grant a fee raise. Considering that Arkansas has lost so many licensees, while doubling their staff and moving to bigger, better offices, their spending definitely seems out of control, and it’s no wonder the state feels compelled to do something.

Derick Corbin, a massage therapist in Russelville, Arkansas, has used his social media pages to try and rally the troops to get in touch with their legislators to prevent the dissolving of the Board, but I am almost certain that due to the mismanagement that has been allowed to go on for the past 5 years, it will in fact be dissolved. Corbin initially brought these legislative issues to my attention. He confirms that the present Board has allowed Graham to run the agency unchecked and unmonitored and believes that has caused the insolvency. When he first contacted me about it, I suggested that the Board needed to reach out to the Federation of State Massage Therapy Boards, who helps guide member Boards in situations like this. Unfortunately, this administration also saw fit to drop their membership in the Federation. Corbin states that the previous Board was comprised of honest, hardworking people. As he truthfully pointed out to me, the burden is on a Board to oversee an Executive Director, and to question it when finances (or any other executive decisions and actions) seem improper. It looks like this Board should have been asking some hard questions long ago, and didn’t, or they wouldn’t be in this mess right now.

I read all the minutes from Board meetings that appear on the website. Donna McGriff, a former Board member who has served three different tenures on the Board, told me that she and Byrd had repeatedly asked the Board to require a review of Board finances in the meeting once per quarter. According to McGriff, that never happened, and there is no mention of it in any meeting minutes.

AR: HB 1729 will require all boards to be subjected to a sunset review every 12 years as of 2017 by a Sunset Review Committee. The Committee will also review board finances.  I’d be very interested to see a detailed accounting of the past five years myself.

AR: HB 1589 would have exempted Bowen Therapy/Technique practitioners from licensure requirements for massage therapists. This bill was defeated yesterday and is just waiting on the Governor’s signature.

AR: SB 546 eliminates  a former requirement of a  general education development and changes  the requirement to a high school diploma or high school equivalency diploma approved by the Department of Career Education and is just waiting on the Governor’s signature.

AR: HB 1562 changes the requirements for CE hours for instructors to 250 CE hours, requiring the 125 hours for a master massage therapist license (only 18 are allowed to be taken online); Master Massage Therapist licensure requires 125 CE hours (with no more than 10% online); adds human trafficking, sexual misconduct, and lewd behavior to reasons for license denial and revocation; provides exemption from licensing for cosmetologists and Bowen Therapy practitioners (the Bowen exemption was defeated yesterday on a separate bill), if they are certified by a professional organization or credentialing agency; adds new sanitation requirements; requires massage schools to maintain board licensing examination pass/fail rates and includes the provision and that if a school has a pass rate of below 75%, the board can place the school on probation; requires massage therapy clinics and spas to register with the board; provides policies for probation and addresses military active duty considerations, and is just waiting on the Governor’s signature .

According to Byrd, 4 schools were previously given probationary status because of low pass rates, and three of the four school owners went screaming to the legislature that the Board members had a vendetta against them. One of them only had a 50% pass rate–actually up 2% from the 48% they had a few years ago. That’s pitiful, in my estimation, and I can’t imagine spending my money to attend a school with that kind of record. Any school can experience a temporary setback for a number of reasons–incompetent instructors, management changes or upheaval of some sort–but a school consistently having that low a pass rate ought to be out of business altogether, if they can’t get up to snuff within a probationary period. If they can make a case for why they’ve had a short-term lapse in pass rates, that’s one thing, but just being allowed to carry on permanently with that kind of rate is beyond the pale.

I’ve seen it happen time after time that when some detrimental legislation gets passed–many times directly due to the failure of people to contact their legislators to express their concerns and ask them to vote the other way–within a few weeks people will start calling me or asking on social media what to do. I applaud Byrd and Corbin for trying to motivate massage therapists to take action,and applaud those therapists that did take action. I’d like to be proven wrong here, but I fear the Arkansas Board is going down the river. Those of us who have been around for awhile will recall when a previous director, now deceased, almost single-handedly bankrupted the National Certification Board for Therapeutic Massage & Bodywork. Board members–on any board–need to keep in mind that they are charged with running a board in a fiscally and ethically responsible manner, and that includes questioning the decisions of an executive director, and intervening before things deteriorate to the point they have deteriorated here. This Board is one of the oldest massage boards, formed in 1952. To see it lost in this way is a travesty, and one that could have been prevented.


I’ve been writing about the goings-on in the world of massage since 2007, reporting on what’s going on with regulations, the associations, scams and so forth, along with a healthy dose of my opinion about it. I’ve written somewhere in the vicinity of 300 blogs (my whole blogroll is on Massage Magazine’s website). I’ve slowed down lately. There are always things going on in the massage profession that are news-worthy, and I’m not hanging it up on the blog, but I am taking a little break.

Around the first of December, my husband, Champ, was diagnosed with Stage IV cancer in his tonsils and three lymph nodes on his neck. Our life was changed in the blink of an eye. I now think of it as BC (Before Cancer) and AC (After Cancer). Our life revolves around his treatment. He’s getting radiation 5 days a week (today ends week #3 out of 7 weeks the doctor has planned). Today he’s getting chemo #2 and the doctor has not yet made the final call on how many he’ll be receiving. Maybe as few as 4, or as many as 7. We’ll cross that bridge when we come to it.

Champ has a life-long platelet condition that complicates things. Most people have a platelet count of between 150,000-400,000. His are normally less that 20,000. They have been as low as 3,000. Right now, thanks to a platelet-building drug called Promacta, they’re up to about 40,000. Chemo knocks platelets down, so they’re monitoring his blood a couple of times a week to make sure he can withstand the chemo.

I’ve spent a lot of time on the phone with the insurance company. They want you to have pre-approval to sneeze. They want all referrals to come from the person they think it should come from. They want to get out of paying whenever possible. I’m not taking that lying down, and it’s time-consuming and stressful. Nothing, however, prepares you for the stress of seeing the love of your life sick with a life-threatening disease. I lie awake at night and worry. Then I’m tired during the daytime. I cry. I stress over things that are beyond my control, and I have frequent meltdowns. Our friends and family have rallied around  and the emotional support is invaluable. It has spurred me to start hosting a Cancer Caregiver Support Group at my office, and to start a campaign to provide cancer caregivers with free massage.

Champ is getting the best of care. Janet Powell, Nurse Practitioner; Dr. Patric Ferguson, ENT; Dr. Zvonimir Milas, Surgeon; Dr. Mary Ann Knovich, Director of Blood Disorders at Levine Cancer Institute; Dr. Diego Pavone, Surgeon; Dr. Jeffrey Roberts, Oncology Radiologist, and Dr. Matt Rees, Oncologist/Hematologist, are all involved in his care. The nurses are wonderful. Everyone has moved as quickly as possible to take care of his needs.

So at the moment, my priority is seeing my husband get well. If something earth-shaking happens in massage-land, I usually mention that on my Facebook page, which you’re welcome to follow. We really appreciate all who have sent us messages, cards, called us on the phone, offered us food, financial help, prayers and well-wishes. Thank you all.

A lot of people have asked me if I have set up a gofundme page or something for Champ. I have not, and it isn’t that we don’t need help, but people were kind to us to donate to the silent auction that was held for me and send contributions to us last fall when I was the one who was sick, and I haven’t wanted to take advantage of people’s generosity.

Another thing has hit home to me since Champ has been sick, and that is the amount of stress that caregivers are under. Every morning when I go with Champ to his radiation treatments, I talk with the other caregivers who are in the waiting room. They are all in the same boat I am, trying to navigate the cancer maze, while dealing with fear, uncertainty, and the misery of seeing their loved ones sick. I want to offer them all a free massage, and I can’t. I am usually the receptionist/maid/laundry person at our office, and I have missed a lot of work and had to pay someone to do that while I go with Champ to all his appointments, and needless to say he cannot work right now, either. It has been a strain. So I have had the idea that instead of a gofundme, I would ask people to buy a gift certificate from our business for a cancer caregiver. The profit will help me pay for the people who are covering the office, and we’ll be able to provide some massage for people who need it. If you feel led to contribute to that, you can go to our online gift certificate. In the area that says recipient, put CANCER CAREGIVER and for the email address, put If you’re a local person, please consider giving a gift certificate to any cancer caregiver (or other caregiver) you might personally know. We appreciate the support, and we appreciate the emotional support. Thank you so much.

To those who are going through the same thing, don’t go through it alone. Join a support group–or start one. I’ve had to let go of some things. The world isn’t going to come to an end if my house isn’t clean, or if I don’t make it to the Chamber of Commerce meeting, or if the paperwork is piled higher than usual at the office. At the end of life, no one is going to wish they had spent more time cleaning or working. We will all wish that we had spent more time with our loved ones. That’s my priority.



Board Certification: Just Do the Right Thing

In my last blog, I was critical of the fact that  the NCBTMB‘s new Board Certification exam has been adopted by VA and CA for licensing purposes. I have heard through the grapevine that Oregon intends to do the same, but nothing is on their website to that effect yet.

After the blog was released, I was contacted by the NCBTMB’s CEO, Steve Kirin, and Board Chair Leena Guptha, who were upset with my criticism and wanted to set the record straight. Kirin sent me a timeline of the events leading up to the acceptance of the exam by the states, stated to me that the NCBTMB had no prior knowledge that it was going to happen, and that they notified the FSMTB as soon as these developments came to their attention. I appreciate that they contacted me. I appreciate that they notified the Federation; it was the right thing to do.

They also stated to me that the NCBTMB has no control over the state boards, and that’s very true; the NCBTMB is not a regulatory agency, and has never been one.

However, the NCBTMB can and should take control of this situation by putting some controls in place with Pearson Vue, the vendor that administers the exam, and I stated this directly to Kirin and Dr. Guptha during our conference call.

Board Certification was introduced as “the highest voluntary credential attainable to massage therapists and bodyworkers in the profession today. Board Certification demonstrates a much higher level of achievement beyond entry level licensure—including completing more education, hands-on experience, and a background check—that will be a differentiator for you as you advance through your career, especially in a time where health care and other pivotal third-party professions require Board Certification in order to fill stable and rewarding positions.” From the NCBTMB’s website, here are the qualifications:

  • Pass the Board Certification exam
  • Complete 750 hours of education*
  • Complete 250 hours of professional hands-on experience**
  • Pass a thorough national background check
  • Maintain a current CPR certification
  • Signed commitment to the NCBTMB’s Standards of Practice and Code of Ethics
  • Signed commitment to opposing Human Trafficking

It’s my opinion that the NCBTMB should put the policy in place that if a candidate wants to take the Board Certification exam, they should have to demonstrate proof that they have completed the other requirements. VA and CA both require 500 hours of education, and in fact, as is the case with the MBLEx, people can take it while still a student. That does nothing to indicate advanced practice.

I became Nationally Certified in Therapeutic Massage & Bodywork in 2000, and I have maintained it ever since. I transitioned to Board Certification when the new credential was introduced. I allowed it to expire a couple of weeks ago, after these new developments came to my attention. My own state, NC, is also a 500-hour state. The school I attended was 525 hours, and in the past 15 years, I have taken more than enough continuing education to meet the 750-hour requirement. And that’s my complaint: I’ve met the requirements. It is just my opinion that allowing people who have not met those requirements to take the exam is minimizing this credential.

This is easily fixable. No, the NCBTMB cannot control the states. But they can control what happens to their credential, by the simple act of having applicants submit proof of meeting all the other the requirements to the NCBTMB, and then issuing them permission to test.

The NCBTMB’s agreement with the FSMTB put the NCBTMB out of the licensing exam business. While I appreciate the fact that the NCBTMB had no prior knowledge of what happened with the exam (and will continue to happen, if the controls aren’t put in place), I urge them not to sit on their hands.  I am dismayed that this happened at all, because if the stipulations had been put in place to begin with, this situation could have been avoided. I implore the NCBTMB to just do the right thing. Seize control of your exam, if you really want it to mean anything above being an entry-level licensing exam.



Exam Wars: The Sequel

As I reported in my blogs of October 3 and October 20, 2014, FSMTB and NCBTMB reached an agreement where “…NCBTMB will no longer provide examinations for licensure purposes and will now focus exclusively on delivering quality certification programs.” That’s a direct quote from the joint press release issued by both organizations.

In the wake of this news, cheers were heard ’round the profession, as it signaled an end to the ugly and costly “exam wars” between the two organizations. In case you forgot, NCBTMB darn near bankrupted itself trying to fight the FSMTB and their upstart licensing exam. The fact is that the Federation offered the better testing solution for state massage boards, and the profession has migrated to the MBLEx – leaving NCBTMB with ever-shrinking exam revenues.

With so few people taking their rebranded National Certification exams for state licensure, NCBTMB was compelled to strike a deal with the FSMTB to throw in the towel in exchange for some amount of money. And we don’t know how much cash, because the terms have not been made public. As part of this agreement, NCBTMB said it was going to stop taking new applications for its National Certification Exams on November 1, 2014, and will cease administering these two tests on February 1, 2015.

Sounds like we’re finally moving towards the single licensing exam solution for the massage therapy profession, doesn’t it? Well, don’t head for the lobby to get your tub of buttered popcorn yet, because the next installment of Exam Wars is heating up!

NCBTMB may be bringing down the curtain on the two National Certification exams, but they are now reported to be offering their Board Certification Exam for state licensure purposes. Doesn’t that fly in the face of the agreement with FSMTB?

In October 2014, the Massage Therapy Advisory Committee of the Virginia Board of Nursing voted to accept NCB’s Board Cert exam to meet their statutory certification requirements (in place of the sunsetting National Cert exams). On December 11, 2014, the California Massage Therapy Council voted to accept NCB’s Board Cert exam, along with the MBLEx and the two NCB National Cert exams taken before 2/1/15.
If that weren’t bad enough, NCBTMB is now allowing people to take the Board Cert exam BEFORE they have met all eligibility requirements for Board Certification. Since NCBTMB is touting it as the “highest voluntary credential attainable to massage therapists and bodyworkers in the profession today”, this policy cheapens the credential. It’s already a stretch for NCBTMB to make these claims, but their use of the Board Cert exam to stay in the state licensure game is a real howler. In fact, I think it cheapens it to the point that I will not renew mine in a few days when it expires. I don’t have anything to prove. And after 15 years of practice, I am not going to spend my money to maintain a voluntary credential that is supposed to indicate you are an advanced practitioner that someone fresh out of massage school is being allowed to get. It doesn’t say anything about my knowledge and years of experience at all. It’s apparently turning into just another entry-level credential instead of what it was designed to be, and that truly distresses me.

Are NCB’s actions in violation of their agreement with FSMTB? That may have to get worked out between the attorneys for each side. Whatever the agreement actually says, we’re headed right back to the same old conflicts between FSMTB and NCBTMB. And we didn’t even have to wait long for the Sequel!

An Interview with Paul Ingraham

A few years ago, I came across a website that has become one of my favorites. It’s at, and the writer behind it is Paul Ingraham.

Ingraham is a former Registered Massage Therapist from Vancouver, Canada. He practiced for ten years in downtown Vancouver, taking as many difficult chronic pain cases as he could. Since 2009, he has been the assistant editor for I recently had the chance to ask him a few questions about his life and work:

LA: Paul, one of the reasons I find you so interesting is because we share the circumstance of formerly being into energy work, and all sorts of things along those lines that we no longer embrace. Was there a defining moment when you decided to leave that behind and become the skeptic you are today?

PI: It was a series of defining moments, a gradual process, many things chipping away at my faith. For instance, I had a colleague who I shared some beliefs with. We both did energy work and talked shop about it. For me it was more like art and poetry, while for him it was much more literal and real, like he thought he was a Jedi in training or something, and he shredded his credibility with increasingly bizarre belief and overconfidence — like healing over the phone — until I one day I thought, “Wow, way too far. That is just not quality thinking!”

There were many more little disappointments like that over the years. Some were bigger. I remember a workshop taught by someone I greatly admired. I went in beaming, but came out rolling my eyes — a whole day of fringe science and sloppy, self-serving “logic.”

When I started questioning this stuff publicly, I got hate mail, even about stuff I thought was no big deal to question. And that finished the job. Seeing a steady stream of incoherent arguments from unhinged true believers — never calm, never gracious, never “balanced” — finally turned me into an actual card-carrying skeptic. It took about a decade to go from true believer to doubter to curmudgeonly skeptical gadfly.

LA: For years, your website was known as What precipitated your recent name change?

PI: is more serious and dignified. And just more descriptive of what I do.

I never really cared for the connotations of “save.” Some people immediately think of Jesus when they think of being saved. And I didn’t want to imply that anything I write can “save” anyone — it smacks of the same kind of unethical over-promising that I often criticize in health care.

PainScience fits great. It feels like putting on a nice suit after years of doing business in a Hawaiian shirt.
LA: I’ve seen a few snarky comments from people on the Internet concerning the fact that you’re not a scientist, but you write about science. What are your qualifications, and what do you say to your critics?

PI: Yes, that comes up a lot. And they’re half right: I am not a scientist! But of course hardly any science news and reporting comes directly from scientists, and it can’t, because scientists are busy doing their jobs. And hardly anyone outside of science actually reads scientific papers (least of all the kinds of people who complain that I’m not a scientist).

I am a writer, and my job is to understand and translate science as well as I possibly can — to be a liaison between scientists and clinicians and patients. It’s a tough job, but I care deeply about it and work my hind end off to do it right.

Information about the implications of science can and should only be judged on its own merits. It doesn’t matter who wrote it. Is it good? Is it reasonable and referenced?
LA: One thing I have always admired about your writing is that you provide footnotes for everything. How much time do you spend researching and preparing an article?

PI: It never ends! I never stop editing and upgrading articles, because science is a moving target. They need to change. This is a distinctive thing about I don’t publish stuff and then just leave it there to rot on the server forever.

But a first draft of a typical 2500-word delve into a topic is usually about a 40-hour project, assuming I’m really going for it. The main way to distinguish yourself online these days is quality. You can’t just write a lot — you’ve got to write well. Serious polish. So I really get into making an article as good as I can possibly make it. It’s not unusual to thoroughly edit at least five or six times.
LA: Like my own blog, some of your articles have generated controversy and even gotten you some hate mail. Is there an article that stands out in your mind for that?

PI: By far the most hate-mail generating article I’ve ever published is Does Chiropractic Work? The modern version of it is more diplomatic and generates much less hate mail, while the original was somewhat snarky and made a lot of heads explode. But I still stand behind any statement I ever made there.

But the most interesting hate mail generator is this one: Trigger Point Doubts. It doesn’t generate a lot of hate mail, but some people just go bonkers when they think they’ve caught me in a contradiction. That is, criticizing “trigger points” while also selling a book about trigger points. Even though the article tackles this so-called contradiction head on. And of course it’s very intellectually healthy to question your own ideas. But I get mail from people who are just furious with me: they take me for a trigger point guru and then freak out when they find out I have concerns about trigger point science being half-assed.

LA: gets about 30,000 hits a day. I notice there’s no advertising on your site, but my guess is you’ve been offered plenty of deals; is that so? What’s your reason for running an ad-free site?

PI: I just like it better. Classier. Different than most of the rest of the internet. And I can generate enough revenue with e-book sales.

LA: You’ve written quite a few e-books. What is the focus of those?

PI: So far I have written eight books about eight musculoskeletal pain problems that are often puzzling and stubborn, like patellofemoral pain or chronic low back pain. The goal of the books is to explore the puzzle with the reader, who can be a patient or a professional: to dive into the interesting mysteries and try to figure out what works, what doesn’t, and why. My goal is to simply teach the reader as much as I possibly can about the condition. In the absence of proven treatments, good information is the next best thing.

LA: What’s the most gratifying thing about what you do?

PI: Oh, that’s easy: email from people who like my sense of humour! Best people in the world! Or librarians who recognize the mad genius of my bibliography.

But seriously, of course it’s the readers who feel that something they learned from me has really helped them. I do love that. That’s the whole point.

LA: Is there anything you haven’t accomplished yet that you plan to do? What’s next for Paul Ingraham?

PI: Lots! It’s taken me a few years to get going and prove that it can pay the bills. I’ve had to do a lot of technology work to get it to that point, which often distracted me from writing in a big way. Now it’s time to get back to the writing, and lots of it, both professional and personal. I’d like to get going on my first novel. And some other technology business projects with a genius buddy of mine, for the diversification and fun of it. Going to be a busy couple decades!

Deal, or No Deal?

In my last blog, The Good, the Bad and the Ugly, I reported that the only good thing that came out of the recent FSMTB Annual Meeting was the announcement that NCBTMB and FSMTB had reached an agreement on licensing exams, which promised to spell the end of the long “exam wars”. FSMTB trumpeted this news in their October 3rd press release, which stated:

“FSMTB and the NCBTMB have worked cooperatively to reach an agreement that the NCBTMB will no longer provide examinations for licensure purposes and will now focus exclusively on delivering quality certification programs. This supports the common goal of the FSMTB, Associated Bodywork and Massage Professionals (ABMP), American Massage Therapy Association (AMTA) and the Alliance for Massage Therapy Education (AFMTE), for the Massage & Bodywork Licensing Examination (MBLEx) to be utilized as the sole licensure exam for the profession, thus facilitating licensure portability for therapists.”

Too bad that we really can’t celebrate this news because the so-called “agreement” did not include the Approved Continuing Education Provider Program operated by NCBTMB (which 27 state massage boards use in one way or another). Like rubbing salt in the wound, the FSMTB turned right around and passed a resolution to create their very own CE approval program–as if NCBTMB didn’t exist.

It actually gets worse. I received word that at last week’s Florida Board of Massage Therapy meeting in Orlando, it was stated publicly that there was really only a “letter of intention” between the two organizations that was signed before the FSMTB Annual Meeting, and that the details of this letter would be worked out later in a formal agreement.

Now I’m no attorney, but a letter of intention is NOT the same thing as a legally-binding agreement. It’s more like putting a small deposit down on a house to get the process started, with the purchase contract and the mortgage money to come later. A lot can happen between those two steps.

So I’m confused here… is there a deal, or is it no deal? For the FSMTB to send out a national press release with the subject line “FSMTB AND NCBTMB REACH AGREEMENT” when no final document appears to have been signed, raises all kinds of red flags and ethical questions.

We never needed two competing licensing exams, and we sure as blazes don’t need two competing national CE approval programs. Looks like it’s time for the heads of these two organizations to get back to the negotiating table and work out the rest of this deal, for the benefit of the CE community and the profession as a whole.  And don’t come out until you get it settled!

The Good, the Bad, and the Ugly

With apologies to Clint Eastwood, I’m using the title of his classic Western to talk about three major announcements from the Federation of State Massage Therapy Boards, and what they mean to the rest of the profession. This all came down at the recent FSMTB Annual Meeting, held in Tucson on October 3-4.

The Good: FSMTB and NCBTMB reach an agreement on licensing exams.
Woo hoo! Praise the Lord and pass me the MBLEx! After six years of costly and damaging “exam wars” between the two organizations, NCB was unable to keep its market share of the entry-level testing business. As FSMTB’s exam revenue grew each year, NCB’s declined. NCB finally saw the handwriting on the wall and agreed to stop offering its national certification exams for state licensure as of November 1, 2014 – in exchange for an unspecified amount of money.

This is a huge benefit for the profession, as we can finally move towards having a single licensing exam that is under the direct oversight of state massage boards. (Only Hawaii and New York are still hanging on to their own state exams.) It means less confusion for students and massage schools, and a boon to portability of licensure in the future. This has been a long and painful struggle between FSMTB and NCB, and I for one am thrilled to see it come to a peaceful end.

The Bad: FSMTB adopts CE standards and license renewal recommendations.
Two years ago, FSMTB proposed a radical shift to the continuing education landscape, as outlined in their Maintenance of Core Competency proposal. The MOCC was slammed by organizations, schools, CE providers and individual therapists alike – and yet, the worst of it has made its way into FSMTB’s new continuing education and license renewal standards.

This is a classic case of “If it ain’t broke, then don’t try to fix it.” Overall, our existing CE system works reasonably well, so the last thing we need is yet another organization coming in with an agenda to transform and/or grab control of it. Last year, we suffered through an attempt by NCB to do just that. After a massive grassroots effort, NCB toned down most of the unacceptable changes they were trying to force on providers and sponsors of continuing education. They’ve been behaving themselves since then, and their CE approval processes have been operating more smoothly, although personally some of the classes they have approved are still an issue with me. I’d like to see some sort of designation for those of us who don’t practice or teach pseudoscience and don’t want to be lumped in the same category as those who do.

Now we have the FSMTB trying to flex its muscles. It’s like we just got King Kong calmed down, and now we have to do the same with Godzilla!

At the recent FSMTB Annual Meeting, state board reps passed a resolution from their CE Task Force to “implement a program that provides reliable, unbiased and appropriate vetting of continuing education providers and the classes offered to the consuming public.” That sounds high and mighty, but there is no reference to NCB and their existing national Approved CE Provider program in the resolution, and there was no mention of NCB when this resolution and the license renewal standards were presented to the Delegate Assembly for consideration. Did they think that no one would notice this sin of omission?
The LAST thing we need is another CE approval program! FSMTB could have easily solved their delegation of authority issue by entering into a partnership agreement with NCB to use their existing program. This should have gotten rolled into the exam deal between the two organizations, so that CE approvals could be consolidated.

It’s hard to believe, but the resolution was passed without any details on how FSMTB actually plans to vet CE providers and classes. Why should we trust that FSMTB can do this in an effective manner? They’ve been offering the MBLEx for six years now, and they still don’t have an online practice exam and exam study guide for massage students. The very worst of it is that FSMTB’s plan for CE and license renewal centers on “public safety”, while minimizing the role of CE for “professional development”. The problem is that there is no evidence that we have a widespread “public safety” crisis in our profession, so there’s no factual basis for what FSMTB is trying to do. (There are a lot of specific flaws in the CE standards and license renewal recommendations FSMTB has adopted. I’ll detail those in a future blog.)

What I can see from all this is a major threat to the existing CE provider and sponsor system in our field. FSMTB’s proposal is so completely out-of-synch with how CE is organized and delivered, and FSMTB stands to consolidate even more money and power if this model is adopted by state massage boards. We’re just coming out of a period where NCB tried to dominate the field. Now FSMTB is acting like they’ve picked up the NCB playbook and are trying to run with it.

The Ugly: FSMTB publishes the Model Massage Therapy Practice Act (MPA).
As I wrote about in my previous blog, the MPA was released after three years of behind-the-scenes work and two rounds of public comment. Most of its content is the kind of standard stuff found in all templates for occupational licensure. However, FSMTB really blew it in a number of key areas, and the final version contains both technical errors and some awful policy decisions. As FSMTB’s leaders had final say, the responsibility for correcting these fatal flaws rests on them.

Judging from how few comments were made on the three blogs I posted about the MPA, it looks like it doesn’t register as all that important. Wake up people! A model practice act is one of the bedrock components of a profession. It contains the Scope of Practice definition and other essential elements that influence both education and practice. If you haven’t taken time to read our new MPA, I urge you to get familiar with it and keep up the pressure on FSMTB to fix it. Remember that it doesn’t become law unless it’s adopted by a state legislature.

Let’s celebrate the Good, and get to work on the Bad and the Ugly!

Final Draft of Model Practice Act Released

The Model Practice Act was released in its final draft this week, after more than three years of work on it and two periods of public comment. The introduction does state that it will be an evolving document as changing times and circumstances dictate, but as of now, it still has many of the school owners on my social media pages up in arms.

The language requiring accreditation from previous drafts (Section 103(B) ) was modified to say “Approved Massage Therapy Education Program means a school or educational program that meets the criteria established in rule by the Board, at a minimum includes 625 Clock Hours, and is both authorized in the jurisdiction in which it is located and that reflects a curriculum acceptable to an accrediting body recognized by the U.S. Department of Education…” While the requirement has been downgraded to a suggestion, the comment section makes it clear that the eventual goal is required accreditation for one and all.

Personally, I have some mixed feelings on this. Accreditation is a process of quality control–to a point. (Disclosure: I am a peer reviewer for COMTA). Obtaining accreditation is not cheap, it’s rigorous and it’s time-consuming. It sends the message that you have voluntarily gone over and above what the state requires. Other health care professions require it. And therein lies the clincher.

There are no other health professions that I am aware of accrediting programs that teach psuedoscience, and many massage school programs, including those accredited by COMTA and other accrediting bodies–and in the case of community colleges, even the regional accrediting bodies–do. So what does that really mean? Is it really a hallmark of excellence when we accredit things that have no basis in fact, just because it’s tradition, and been around for a long time, even though it’s been shot down by science?

I am not a school owner, but if I was, I wouldn’t be hitting the panic button just yet. The FSMTB has no power of legislation and they can’t lobby. In order for accreditation to become the law of the land, that’s what will have to happen: it will have to become the law of the land, literally, through legislative changes. There may be some FSMTB member states who are gung-ho to see it happen, but remember, state boards can’t lobby, either. That is the domain of the professional associations. In my state, our AMTA chapter has paid a lobbyist for many years. Since the chapter fees are now optional, I have heard that he volunteered to continue working at a lesser fee, but I bet some of the state chapters have lost their lobbyist altogether, if they had one to start with. The wheels of government don’t turn that quickly unless they’re greased.

The MPA is a template for the states. It isn’t the law and it may never be. For the few unregulated states, should they finally get out of the Dark Ages and decide to regulate, this will be very time-saving for them. It isn’t perfect; nothing is. Obviously a lot of work went into it. Only time will tell what effect it is really going to have.

To the Edge and Back

I’ve been quiet for the past few weeks because I’ve been ill. On August 17, I wasn’t feeling too well, not really full-blown sick, but on the puny side, and I told my husband Champ I wanted him to cover our office the next day and let me stay home. I felt a little worse on Tuesday, and stayed home again. I had terrible diarrhea all night and was constantly thirsty. On Wednesday morning, I woke up in a state of extreme illness and confusion. Champ asked me if I knew the signs of a stroke. Of course I do, but I looked at him blankly and said “no.” He asked if I knew who he was. That was another “no.” He asked if I knew who I was. When I answered “no” to that, he took me to the ER.

After a few blood tests, x-rays and the like, a doctor came in and informed me I was being admitted with a severe urinary tract infection, which I had not had any of the usual symptoms of, and that it had gone systemic. I also had pneumonia in both lungs–something I just went though in March of 2013. They admitted me to the hospital and started pumping me full of antibiotics. The diarrhea lasted four more days to the point where I was reduced to wearing a diaper in the hospital. That’s a rather humbling experience. A friend of ours who is a pharmacist told Champ that another day or two without the antibiotics and IV fluids, and I would have died.

I was released after a week in the hospital, which included two days in the ICU. My mom came to take care of me. She is 75 and I could never in a million years have had a better mother than what she has been to me. I turned 55 while I was sick. She was wiping my butt just like I was baby, so was Champ, and for all intents and purposes, I was one. She made me some homemade soup the day after I came home. I ate a half a bowl (it was delicious vegetable soup). About an hour later, my stomach got very bloated and hard. I was vomiting, and the next morning, I told Champ I thought I had better go to the ER.

Low and behold, another x-ray revealed that I was full of gall stones. They admitted me again and  took out my gall bladder early the next morning. After another week in the hospital, I came home again last Thursday.

My hormones and electrolytes were screwy in the hospital, and I had to go to the doctor for a checkup yesterday. I also spent last night at the Sleep Center–not a restful place at all. I haven’t gotten those results yet, but I had been placed on a BiPap in the hospital because I was retaining too much carbon dioxide. They woke me up in the middle of the night and put me on a CPAP. I expect I’ll hear all about it later today.

On my birthday, all I could say was “55 and still alive.”

I have been overwhelmed at the outpouring of love and compassion from everybody. FB friends I have never even met sent me cards and gifts. Several people sent me money in amounts from $5 to $500, which just made me cry in gratitude and disbelief at the kindness. People sent flowers and fruit baskets. Local people have delivered food to my house. Restaurant owners have refused to take any money when Champ went to get takeout.

Since I’m known for pissing people off with some of my commentaries, I might as well not pass up this opportunity to say thank God for Obamacare. Last year, when I was stricken with pneumonia the first time, we had given up our health insurance. It had gone to over $600 a month. Champ was not working much, our business was struggling in our local economy, which is still very depressed, and we simply couldn’t pay for it anymore. It was either give that up or give up eating. We also had a $5000 deductible. My hospital bill was over $10,000, which I am still working to pay off. On January 1, I got us signed up for Obamacare. We are now insured with a $500 deductible, not $5000, and we are paying $235 a month. My prescriptions have cost me $5 each. The nebulizer I had to get to take breathing treatments at home four times a day was free. Before anyone jumps on taxpayers subsidizing that, let me say that I got my first job at the age of 13, and I have worked every day of my life since, so I have paid my share in taxes and I continue to do so. It feels good to me not to have to worry that I am going to lose my home or my business over healthcare expenses. So there. I appreciate it whether anyone else does or not.

Champ’s social security kicks in this month, so we can breathe a little easier on that front, as well. I am taking a few weeks off from work to gain my strength back. I am sapped. I have seen some of my FB friends spreading the suggestion that people buy my books in order to help my finances, and I really appreciate that more than I can say, along with everything else people have done for me during this time. So in a fit of shameless self-promotion, I will list them here in case you are led to purchase one.

The first one is one I finished last year while I was in the hospital with the first round of pneumonia. It’s about death and dying and the wonderful Nina McIntosh, author of The Educated Heart. I watched Nina get her affairs in order while she was suffering from ALS. When I was in the hospital, I had the thought that I might not be leaving there alive, and that I needed to get my own affairs in order. We all do, while we’re able to, instead of leaving it for our grief-stricken family to do. The last part of the book walks you through that. It’s called The Days Still Left.

My most recent book is Excuse me, exactly how does that work? Hocus Pocus in Holistic Health Care. I didn’t question anything I was taught in massage school, and I should have. Part memoir, partly an examination of some of the things that are heavily marketed to massage therapists, who then turn around and market to the unknowing public. Yes, it will step on a few toes, but my hope is that it makes people THINK.

Massage is my second career. In my first life, I cooked for the public for more than 20 years. My little cook book is full of great Southern recipes and funny stories that happened to me in the restaurant business. Nothin’ Fancy, Good Food and a Few Funny Stories.

In 2012, The Massage Nerd, aka Ryan Hoyme, and I collaborated on the Manual for Massage Therapy Educators. This is NOT meant to be a textbook. We were both unceremoniously foisted onto our first class of massage students, and this is just the practical advice of the things we wish we had known when we started out and what we’ve learned along the way.

The Plain and Simple Guide to Therapeutic Massage & Bodywork Examinations 2nd ed.   Get ready to pass the MBLEx or NCBTMB exams. The inside cover has a scratch-off password to a website filled with practice questions and learning games.  Great teacher ancillaries, too. I am very proud to say this book is sold in hundreds of massage schools.

One Year to a Successful Massage Therapy Practice is full of low-cost and no-cost ways to get your practice off the ground or revitalize an older one.

I’m proud of this book because I didn’t try to sell it to LWW; they asked me to write it, and I was happy to oblige. The inside cover has a password for a website with dozens of useful forms. It covers everything from your business plan to retirement and in between.             A Massage Therapist’s guide to Business also has great instructor ancillaries.

That’s it, although I do have a few more in the works. Thank you for your support.

Model Practice Act Causing an Uproar

Disclosure: I am a peer reviewer for COMTA.

I have complained a lot about massage therapists sitting on their hands, not having any interest or involvement in governance, and not caring or being informed about what is going on until it’s too late to do anything about it. I can’t make that complaint about massage school owners in the past couple of weeks. I’ve never seen such a hue and cry over any other issue.

The Model Practice Act is on its second period of public comments, and I’m pretty sure the FSMTB is hearing from a lot of upset people. I had a few issues with the first draft, and I hear it got about 1300 comments. I’m willing to bet this one will get twice that, caused by a one-word change in the following definition, found in Section 103(B):

Approved Massage Therapy Education Program means a school or educational program that meets the criteria established in rule by the Board, at a minimum includes 625 clock hours and is both authorized in the jurisdiction in which it is located and is accredited by an accrediting body recognized by the US Department of Education. Education received outside of the United States must be substantially equivalent to the criteria of this Act and must be recognized by the jurisdiction in which it is located.

In the first MPA draft, this requirement for schools was stated as state authorization AND/OR accreditation. The removal of just one word here makes a world of difference, which has set the massage education community into a tizzy.

My Facebook is buzzing with comments from school owners, teachers, and other interested parties. Overwhelmingly, the feeling is that this is going to put a lot of schools out of business. There are also people that feel that we have about twice as many massage schools in the US as what are really needed, and that this has led to churning out too many graduates, which has led to a glut in the job market, and contributed to the proliferation of franchised massage (or maybe it’s because of franchised massage).

Rick Rosen is the co-owner of Body Therapy Institute in Siler City, NC, one of only two schools in our state that are accredited by COMTA, shared some of his comments on it with me:

There are two primary reasons this accreditation requirement is inappropriate and potentially damaging: First is the fact that about half of all massage schools in the U.S. are not accredited. In general, these are smaller proprietary institutions that only offer massage programs. It is doubtful that most of these schools could qualify for accreditation even if they wanted it, because of the lack of financial resources. Smaller schools that are undercapitalized are unlikely to be able to meet the financial ratio requirements of COMTA and the other accreditors, not to mention the initial and ongoing costs of accreditation.

These massage-only institutions embody the lineage of massage therapy and the healing arts, as contrasted with for-profit career colleges and publicly-funded community colleges where massage is one program among dozens (if not hundreds). Mandatory accreditation WILL cause many of these smaller schools to close, which would be a tremendous loss for our field.

Second, COMTA is the only specialized accreditor in the massage therapy field, and the only agency with competency-based curriculum standards. Institutional accreditation by the other six vocational accreditors and the seven regional higher education accreditors fails to provide a meaningful measure of quality assurance for the massage program itself.

Therefore, it makes no sense for FSMTB to include an institutional accreditation requirement in its Model Practice Act when such accreditation (in the case of non-COMTA-accredited schools) ignores the elements that are critical to producing a well-trained massage therapist. It is the integrity of the program’s curriculum, the competency of the instructors and the consistent application of admissions criteria that are the critical elements that make a sound massage therapy program — far more so than the financial and operational standards that comprise the bulk of institutional accreditation.

So, if roughly half the massage schools in the U.S. cannot qualify for accreditation, and the other half (minus the 67 schools and branch campuses that are under COMTA accreditation) are accredited under institutional standards that do not reliably produce skilled and employable massage therapists who last more than two years in practice — where does that leave us?

We need a regulatory structure for schools that can satisfy the minimum requirements of state massage statues for protection of the public, while preserving the ability of our smaller massage schools to exist. In addition, we need a mechanism to bring all massage programs under single set of programmatic standards to establish consistency of entry-level training that is impossible to achieve within the current system.

Rosen’s solution is for COMTA to add a non-accreditation level program approval to its scope, which would require the blessing of the USDE. In addition, all massage schools with institutional accreditation from other agencies would also need to seek programmatic accreditation from COMTA – a structure that is common in other regulated professions. The language in Section 103(B) of the MPA would then need to be changed to include programmatic accreditation OR approval by COMTA – along with approval or licensure by the educational authority in the jurisdiction in which the school operates.

There are a lot of other school owners out there that don’t feel any accreditation should be required at all, particularly owners of small schools who have long-standing, successful programs that have lasted for decades without accreditation. Accreditation is not cheap. It’s time-consuming to initially obtain, and time-consuming and expensive to renew. While I have heard many small school owners talk about the expense as a deterrent to getting accreditation, I’ve heard as many others say “I’m not going to have anyone telling me how I have to run my school.”

Sandy Fritz, who has owned a school (not accredited) for more than 30 years and is a well-known author and advocate for massage education, stated on her blog that accreditation was a good thing–and then it moved away from a process to determine excellence and became a hurdle to jump across to access the cash cow of financial aid.

Actually, institutional accreditation has always been about being a financial gateway rather than a hallmark of excellence. When COMTA came on the scene, it was the first accreditor to offer programmatic standards that were meaningful to massage education. Unfortunately, they’re also the smallest player on the accreditation field and have no real ability to affect the whole.

I can’t speak to the other accrediting agencies, for my experience as a peer reviewer for COMTA is that a school that seeks the accreditation is sending a powerful message: “I do more than the state requires me to do.” Accreditation involves an in-depth self-study, and documentation, documentation, documentation. If it isn’t in writing, it doesn’t exist. But that’s a good thing. It ensures that policies and procedures are in place that are for the good of the student, the good of the school, and the good of the profession.

COMTA has been criticized for including pseudoscience (energy work) amongst the things that are acceptable for curricula in accredited schools. Without have read the standards of the other accrediting agencies, my guess is that they do, as well. The NCBTMB condones it, the AMTA and ABMP both condone it, the FSMTB condones it, so COMTA is hardly the lone ranger. It just goes to show, once again, that massage therapy accreditation is not being held to the same standards as medical professions do with their accreditation, which is why we’re still a vocation and not a profession.

The period of public comment ends on August 15. If you want your voice to be heard, you should seize the opportunity by clicking here.