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.


Caregiver Syndrome

My husband was diagnosed with Stage IV cancer a few months ago. Last Friday, he had the last of his 35 radiation treatments. Two days ago, he had the last of 6 chemotherapy treatments.

A few moments ago, I Googled “caregiver syndrome.” I wasn’t sure whether or not that actually existed, but I figured I was suffering from it if it did. It does, and I am. According to CNN, the symptoms are depression, anxiety, anger, and declining health. Let’s throw in exhaustion and fear while we’re at it.  While this condition is also referred to caregiver burnout, it didn’t take me any time at all to get burned out. Except for the exhaustion, it was all there for me as soon as I heard the word “cancer” and my husband’s name in the same breath. Within just a few weeks of starting to navigate the cancer maze, exhaustion did in fact set in, and I haven’t had time to get over it yet. It will be three months before the next PET scan to see if the cancer is really gone.  I don’t think my depression, anxiety, and anger are going to magically disappear in the next day or two.

As for my own declining health, I have been suffering greatly from A Knot in the Pit of My Stomach. I don’t think that’s an actual medical condition, but it’s been real to me, accompanied by chronic diarrhea, and by chronic I mean a dozen times a day, with intermittent bouts of nausea when Fear Takes Over. I diagnosed myself with Irritable Bowel Syndrome, although I tried to jokingly think of it as Scared Shitless Syndrome. There’s nothing like hearing that the love of your life is seriously ill and knowing that he might die.

Yes, it made me depressed, anxious, and angry. I am not the crying type. I have gone years at a time without crying over anything, but in the past few months, I’ve probably shed more tears than I have in the rest of my life all put together. I’ve been angry…angry that Champ had cancer, and angry at the insurance company for jacking us around, and angry that people who are already under stress have to have the added stress of dealing with them.

I’ve been paranoid that he wouldn’t get well. I’ve been paranoid that we wouldn’t have enough money to survive the experience. I’ve been paranoid at little things. For instance, naps. For our whole life together, my husband would often come home from work, sit down in his recliner, and take a nap. It was just his habit. But after he was diagnosed, if I came home and he was taking a nap, in my head I would be going “Oh my god, he’s taking a nap! Is he sick? Is he okay? Is he breathing?” I know it’s ridiculous, but I couldn’t help it.

And in the meantime, the world kept turning. Work had to be done. Business had to go on. Deadlines had to be met. Bills had to be paid. Appointments had to be kept. All together, Champ has had a total of 7 doctors involved in his treatment, which was complicated by his life-long condition of having extremely low platelets. Since his initial diagnosis, he has had a total of 75 doctor visits, and I have accompanied him to all of them except two radiations and one platelet transfusion.

I’ve always believed that helping someone else is a good way to get your mind off your own troubles. I started a Cancer Caregiver support group, for the also-selfish reason of having others who were going through what I was going through to talk to. I also got some anti-anxiety medication, but after reading all the side effects, decided not to take it. We’ve gotten a lot of comfort and support from friends and family, and from FB friends. One friend, who is a long-time cancer survivor herself, called Champ one day and said “I just wanted to call and say this is not all about you. Your wife is going through a lot, too, and you need to understand that. ”

Caregiver syndrome is common among those who are caring for their elderly parents or other family members with dementia and chronic diseases. It’s very easy  for other people to say “You have to take care of yourself. You have to make time for yourself.” That’s all true, but there were weeks when that was a joke, and I know the other caregivers out there know exactly what I mean. Since my husband’s medication was causing him to nap all day, he didn’t sleep at night. He kept me awake at night, and I would be exhausted during the day when I was trying to work. I would literally be ready to go to bed at 7 pm because I was just so tired. On the few occasions when I could squeeze in a massage, I just passed out cold on the table. Playing music is my stress relief, and I had some months of not being able to do that due to nerve damage in my hand. That was depressing to me on top of everything else, and I just wanted to stay in bed and cover up my head, or drink myself into oblivion.

When the sick person has to stop working, their disability insurance may not be any where near the amount of money they were used to making, and while insurance may be covering the sick person’s care, there are still deductibles, out of pocket expenses, over-the-counter drugs, various things that insurance will refuse to pay for that you end  up having to pay yourself, special foods and/or supplements, travel to and from doctor’s appointments, and the like that can be overwhelming. You may think you’re saving for retirement, but if your retirement plan doesn’t contain built-in accommodations for a sick family member that you may have to act as the caregiver for, you can be prepared to see a lot of money circling down the drain. Being a caregiver is not a disability, and neither your own insurance nor unemployment insurance is going to be there to help you. Caregivers frequently either have to miss a lot of work, or give up their jobs altogether, in order to provide care. If you’re self-employed, like I am, and you actively work in your business, you may have to pay someone to take your place, like I  have.

So yes, as a caregiver, you do have to take care of yourself, and that’s hard to do when your focus is on taking care of someone else.

I personally found out that what I needed more than anything was just help with every day things, and I think that’s probably true for everyone. A caregiver will appreciate someone cleaning their house, or doing their laundry, running errands for them, or bringing them a home-cooked meal. Some caregivers might appreciate having someone give their patient a ride to doctor’s appointments. Although people offered to do that, I personally did not want that because I wanted to be there for all of my husband’s appointments. Unless the caregivers you know are independently wealthy, gifts of money, prepaid credit cards, or gift cards to gas stations, local grocery stores, restaurants, or stores are always welcomed. A gift certificate for a massage, or a night away in a hotel–even a local one–is a good gift. Volunteering to stay with the sick person for a few hours, if they need constant attendance, is a good idea.

One complaint that I hear repeatedly from other caregivers is along the lines of  “My sister/brother never helps with my mother.” If one of your siblings is caring for your parent(s) or another sibling, and you haven’t been physically participating in that, then you need to do something else to help, instead of leaving it all on your siblings to deal with. Help them financially, or get off your butt and go spend the weekend doing what they do all the time, or pay for a home health care service to do it, so they can have a break. If you haven’t personally been a caregiver, don’t say “I know how it is.” No, you don’t. You don’t have any idea.

I have been very fortunate that my husband has maintained such a beautiful attitude during this entire ordeal. He took it all like the Champ he is. He has always appreciated me and always shown that, and this experience brought us even closer together. It was just six months ago that he was acting as the caretaker for me, when I was very sick with double pneumonia, a UTI that went systemic, and a gall bladder that needed emergency removal. That’s what we do, we take care of each other.

I expect that I am going to continue to have anxiety until his PET scan comes out clear. And the doctors have said he’ll continue to be regularly checked for the next five years. My depression is situational, and I hope to feel better myself as I see him feeling better and better. I’ll probably remain angry at the insurance company, and have to continue spending my time dealing with them. Based on some of what I’ve had to go through with them, I feel sorry for sick people who don’t have a witch like me in their corner to advocate for them. Our almost-daily doctor appointments are over now, so hopefully I will start feeling less exhausted.

I appreciate all the support, encouragement, cards and letters, gifts, and prayers and well-wishes that we’ve received. It has meant a lot to both of us, and were it not for that support, my caregiver syndrome would probably be a lot worse than it has been. Thank you all. And please, do whatever you can to help the people in your lives who are caregivers, and if you are the caregiver, don’t be afraid to say “I need help.”

 

 

 


Priorities

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 therassage@bellsouth.net. 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. https://thera.boomtime.com/lgift.

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 www.PainScience.com, 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 ScienceBasedMedicine.org. 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 SaveYourself.ca. What precipitated your recent name change?

PI: PainScience.com 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 PainScience.com: 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: Painscience.com 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 PainScience.com 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!


Is AMTA Passé?

Maybe or maybe not. But their method of selecting members and officers for the National Board of Directors sure is.

AMTA’s annual online election process just wrapped up on November 30. According to their official report, the number of members who voted during the month-long window hit an all-time low of 2.53%, or just 1,398 out of 55,276 members. That’s down from a whopping 2.66% participation rate in the 2013 and 2012 elections, and 2.83% in 2011.

These numbers sound pathetic, but how to they stack up in comparison to other organizations? In a 2012 study conducted by Votenet Soutions of election and voting trends in 239 non-profit professional and trade associations, the average voter turnout was 32%. That’s more than ten times the involvement of AMTA members over the past four years.

You might think this is a case of “Who cares about these positions–it’s just a bunch of massage people who like to get free trips to out-of-town hotels where they have meetings and party and get to feel important.” Well, AMTA is the largest non-profit in our field, and their Board of Directors controls an annual budget of more than $14 Million Dollars. That’s a lot of green that can  benefit the profession if it is spent wisely. Or, it can continue to be used (as most of it has gone) to keep sending elected officers and committee chairs to national and state meetings where little gets done.

The decline in the voting for AMTA elections is just a symptom of a larger problem. The bottom line is that AMTA is stuck in an old social-welfare model that resists change, while most of the people in our profession have moved into the social media age. Chapters and meetings are less important, strong brand identity and consistent delivery of needed services trumps all. That’s why ABMP has beat the pants off AMTA in the membership race.

From its origins as a small rebel organization in 1988, ABMP pulled up even with AMTA’s numbers sometime around 2005, and has left them in the dust since then. ABMP now has more than 80,000 members, without the burden of a state chapter system or the complexity of holding conventions. AMTA is hovering below 60,000 members, and can’t seem to get much traction.

In my last blog, I wrote about the elections mess created by some of AMTA’s own officials who couldn’t hold to a clearly-stated policy around not making the whole thing a partisan affair. Since President-Elect Jeff Smoot (who was not up for election this round) felt compelled to publish his own candidate endorsements, the AMTA Commissioner of Elections (which is a position appointed by the President-Elect) threw the doors open for all state and national officers to get into the partisan parade. This is further evidence that AMTA needs to make a major shift in how it selects its governing board.

Since the participation rate in national elections is moving towards zero, AMTA should amend its Bylaws to chuck the election process for the Board of Directors in favor of a leadership development model. The focus would shift to an expanded Commission on Candidacy, which would function like an executive search firm. A call for candidates would be put out in each cycle, and the Commission would be responsible for interviewing and selecting the most qualified individuals to serve on the National Board.

Annually, when a new Board is configured, the members themselves would elect a President, Vice-President and Treasurer. Other changes that need to be made include term limits, and mandatory time-outs after serving, so that the same people do not keep recycling back around.

There are a lot of talented and committed people who belong to AMTA, and I bet that more of them would be willing to step forward to serve in key leadership positions if the old clique system was banished. We need to grow up our profession, and AMTA should be part of the solution, not the problem.


AMTA Election: A Social Media Storm

It’s time for AMTA National elections, and so far, it’s a hot mess. The ruckus all started when Presdident-Elect Jeff Smoot made a post on Facebook announcing his own choices among the candidates.

I have known Smoot for a few years through the association, and I sent him a private message that I thought he was making a tactical error. We had a little back-and-forth but the post remained; he felt it was okay to have posted it and his post said that the Commission on Candidacy Chair and the Chair of Elections have determined that his FB post falls under the realm of “personal conversation.”  As of today, he has 665 FB friends–a lot more than some, a lot less than others, but that’s a relatively good-sized personal conversation.

Some other officers, present and former, and interested readers (including me) weighed in with concerns about the legality and ethics of the post–including some who have gotten in trouble for lesser social media offenses before. And as several people pointed out, other national health care organizations do not allow their board members to endorse candidates who are running for office in their organizations. Others stated they were glad to see it and felt it was overdue for the organization to join the 21st century and get with the social media program. Although I haven’t seen anyone say it publicly on FB, I’ve received a few private messages suggesting that he should resign, and barring that, that the organization should remove him from office.

I personally emailed current President Nancy Porambo and Executive Director Bill Brown about the situation. Porambo was nice enough to call me, and stated that Smoot’s post wasn’t a violation, but she was aware there were some perception problems with it.

However, AMTA’s own Policy Manual seems to be a confusing train wreck on this issue. Under  “Campaigning” (Section XII), Item 4 states

Candidates may:Utilize social networks to inform people of their candidacy, position, or issues, and respond to questions.

Directly under that, Item G states

Volunteers shall not use their current AMTA position to promote a candidate.

Item H goes on to further state

Violations of this section, Campaigning, may result in the removal of a candidate from the ballot, making them ineligible for election.

Obviously, someone is confused. Technically, Smoot’s announcing his choice of candidates could be considered a “position.” But Item G looks pretty cut and dried to me. I think AMTA needs to go back to the table and fix this mess, which was, according to the date on the policy, just revised barely more than a week ago on October 29.

It’s all moot to me. I dropped my own membership in AMTA this past August after more than a decade of being a member. I didn’t like the fact that The Wizard of Oz was hired for a fortune to be the keynote speaker at the national convention, and the chapter fee fiasco is still sticking in my craw. But the main clincher, when I called them on that, was that it was done by the BOD in executive session, without knowledge of the chapter presidents, because “the competition was in the room” (meaning ABMP.) Well, guess what…ABMP is always in the room during the Board meeting at the national convention; at least they have been at the 10 conventions I have attended. That’s mighty convenient for casting aside transparency. I attended the chapter meetings in three different states soon after that change came to light, and it had substantially affected the budgets of all of them negatively; not to mention the fact the budgets  had already been done for the coming year and had to be done again to take the fee losses into consideration. Yes, there are people who will continue to support their chapters, but just as many will probably not pay anything they don’t have to. It’s my opinion that the chapters and the Massage Therapy Foundation are going to suffer from this policy, and I hope it is revisited.

I have always loved participating in my state chapter and have taught classes in many AMTA chapters, and I have loved them all. I wish the organization well, but they need to clean this up immediately.

 

 

 


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!