I Need a Little Help from My Friends

Actually, I am asking for help for one of MY friends. She may be one of your friends, too, either in person or you may know her from social media, or her radio show, or the book she’s recently written. Her name is Shawnda Strongfaith Kettles.

I met Shawnda several years ago, when she won a mentoring contest I was holding. I had received many entries for the contest. If memory serves, I chose the ten that spoke the loudest to me, blacked out all the identifying information, and gave them to my staff members to vote on the final selection. She won unanimously. She had been homeless for a while. She had three daughters to take care of. She had gone to massage school, became a licensed therapist, and picked herself up from a bad situation. Her positive attitude in the face of all this just struck me as amazing. Champ and I went down to GA to meet her in person. 415918_347384488608777_1108678625_oShawnda has been working full-time as a massage therapist for the past couple of years, and keeping herself very busy. She is a great writer…she writes poetry, and short stories. She has been hosting poetry slams, making radio appearances, encouraging other poets and writers to share their stuff, taking care of her very accomplished daughters, all three of whom are at the top of their classes in school, being active in her church, and then one recent day, her life changed in an instant. I will cut and paste from her FB page, posted April 29:

April 10, I went blind for 5 days…completely. On April 14, the day my book was released, I became extremely lethargic and my body felt heavy. I walked myself to my bed at 3:30 p.m. and haven’t taken a step since then. On April 15, I woke up paralyzed from my right arm down, my left arm being the only extremity that was moving. Two days later, I got the use of my right arm back, but haven’t gotten my use of my legs. Thursday, April 24, I was admitted in the hospital and was diagnosed with NMO (Neuromyelitis Optica)…an uncommon disease in the MS family. It primarily affects the spinal cord up to the optic nerve. I have infection in my spine that may leave me permanently paralyzed from the waist down. As of right now, I have NO feeling in my legs and can’t feel touch. Day by day, I can feel changes in my body in terms of touch and sensation. I am slowly losing control of my bladder and bowel functions. In case you don’t know what that means, I can’t tell at times if I have to go to the bathroom or even take myself to the bathroom. I am 36 years old and I have to have someone to take me to the bathroom and at times clean me up. There are days that my jaw muscles aren’t strong enough to chew my own food, or my body doesn’t have enough energy to feed myself, so I have to be fed. Do you know how humbling that is? Do you know what kind of perspective that puts your life in?

Shawnda spent a couple of weeks in the hospital, and then was released home with a wheelchair and home visits from the physical therapist. She has been able to slightly move her right toes. She still has no feeling at all on the left side. Due to a very strong course of steroids, the infection in her spine did subside. However, the doctors have warned her that this form of MS is rare and that her paralysis may last for the rest of her life.

966183_851470814866806_6718987686827674630_oIn spite of that, her spirit and positive attitude is just humbling to me. She laughs every day. She encourages other people every day. She shares her testimony every day. She is a testimony every day. I can’t imagine I would have half the sense of humor and grace that she has if this happened to me.

Georgia Regents University/Medical College of GA is a teaching hospital and they covered the cost of Shawnda’s initial treatment because this is such a rare case, they wanted to study it. She will be receiving disability payments from Social Security. However, with three teenage daughters in school, I don’t know how far that will go.

A fund has been set up for Shawnda. If you feel led to help someone, you can click on this link to donate. Or buy a copy of her book. Every little bit helps. There may come a day when your life may change in the blink of an eye, and you’ll need someone’s help. Just pay it forward. Share this post if you will. Thank you very much.

FSMTB Releases Model Practice Act

The Federation of State Massage Therapy Boards released the Model Practice Act a few days ago, just after the third anniversary of the announcement they had formed a Task Force of 8 state board members to work on it. I just had the time to read it in its entirety today, and as a former state board member and former delegate to the Federation myself, I appreciate the huge amount of time and effort that went into it.

I didn’t find much that surprised me. Last week when this was first released, I saw some rumblings from educators and school owners about the requirement for massage therapy programs to be 625 hours. As the publication says, it is consistent with the 625-hour recommendation of the recently-released ELAP (Entry-Level Analysis Project) that was a collaborative effort supported by all of the national massage organizations. Since there are currently more than two dozen states that still have 500 hours as their entry-level requirement, that’s going to require some major changes. Many smaller schools would probably go out of business rather than comply with the change.

The document does not state the name of the NCBTMB or any other entity’s exam in the context of eliminating them, but the definition of “examination” is given as a standardized test or examination of entry-level massage and bodywork knowledge, skills, and abilities that is developed and administered by the Federation of State Massage Therapy Boards. That means the MBLEx, period. About 40 states are currently accepting both the MBLEx and the NCB’s licensing exams. There are also a couple of states that have their own exam–and require much more than 625 hours. I don’t see that those states will want to back up and adopt this.

The MPA does seem to support portability in a good way. There are provisions for therapists participating in planned out-of-state events, temporary assignments such as with traveling sports teams, etc.,and emergency response disaster teams without requiring jumping through hoops. It would also seek to make the title of each state’s act the _____Massage Therapy Practice Act, leaving the term “bodywork” and any other terminology out of it. Licensees would be designated “LMT” (Licensed Massage Therapist) uniformly across the states.

One thing that I was not crazy about was the protocol for choosing board members. The MPA states that 7 members are to be appointed by the governor. I would prefer to see that power spread around a little. I wouldn’t want to see governors of any political party appointing only the people for their own party, for example. In my state, the appointees are made by the governor, the speaker of the house, and the senate pro tem. I think that or something similar is a little better balance of power, personally; even if they do randomly turn out to all have the same party affiliation.

I also wondered about the discrepancy in defining “clock hour” as 50 minutes of instruction and “contact hour” as 60 minutes of instruction. The NCBTMB has traditionally allowed 50 minutes of instruction as a contact hour for the purpose of continuing education.

The states are also still left with more autonomy than I expected. There’s plenty left in their hands, so to speak, with the usual statements about how the board may adopt, amend, and repeal rules. There is also a licensure by endorsement stipulation and a grandfathering accommodation.

There are only five states left without licensing. It would certainly be to their advantage to have this right out of the gate and avoid having to reinvent the wheel. As for the other 45 states that are already regulated, I don’t see that there will be a mad rush to adopt this, unless what they currently have isn’t working for some reason. We have to remember that the FSMTB is not a regulatory body in and of itself, but a coalition of regulated states. They can’t force the MPA on any state, nor are they trying to. It is a blueprint, a collection of suggestions for how to make the states more uniform in the regulation of massage. Too bad it didn’t exist a few decades ago before most of the states got on the bandwagon.

I don’t have any harsh criticisms of the document. Personally, I like the concept of raising the minimum requirement to 625 hours, but then again, I’m not a school owner that would be affected by such a thing. My final analysis: kudos to the people that worked on it. Things like this that are done by volunteers always come under a rash of criticism from people who disagree with the product.

 

 

Getting Rich or Getting By?

I conducted one of my scientific FB polls this week. For the benefit of those of you who may not be on my FB page, it was about how much money massage therapists are making. I obtained 53 usable responses. Here they are. Of those 53:

7 work in a spa
2 work in a “luxury” spa
14 work in a chiro office
18 work in a massage office
3 work at Massage Envy
4 work in an MD’s office
2 work in a hospital
1 works in a nursing home
1 works in a salon

14 are classified as ICs, but 4 of those said they know they are misclassified and should be employees

39 are classified as employees, but only 11 of those people get paid anything when they are not performing massage.

5 of the ICS say they get paid when they are not doing massage, ranging from minimum wage to $9 an hour.

5 of those 39 people say they have benefits, ranging from CEs to full benefits such as insurance and vacation time

18 reported that they are paid on commission, which ranged from 30% to 80%, and an average of 53%

2 people who said they were ICs said they pay a flat rent for the use of a massage room; 1 of those pays $10 per massage, the other pays $25 per massage

28 people reported being paid by the hour, with hourly pay ranging from $7.40-85.00 an hour. The average was 23.41 per hour.

Of those 28 who are paid hourly:

3 report that they make $10 an hour or less
5 report that they make $11-15 an hour
8 report that they make $16-20 an hour
6 report that they make $21-25 an hour
3 report that they make $26-30 an hour
Then the data jumped to $50, with 3 people reporting that they make $50 or more per hour

30 people said they receive tips
23 people said they do not receive tips

21 of the 53 people work more than one job to make ends meet

$$-wise, it appears that the MD’s office and the hospital are the best places to work, with higher pay and more benefits.

I tossed the answers of sole proprietors and contractors who only told what they charge and didn’t account for their net earnings. Sandy Fritz addressed that issue in her blog this week.

When I published the results on my FB page, there was lots of chiming in about the low pay rates, and a few comments about people spending $40,000 to go to massage school and ending up working for a pittance. So I started investigating the cost of schools. In my state of NC, you can get a good education for less than $10,000. In fact, at some long-established schools, including one that’s COMTA accredited (which is not cheap to obtain), you can attend for less than $6000. Of course, that varies all over the country, but it seems like the majority of smaller schools are trying to keep their programs as affordable as possible. School owners from across the country chimed in, as did MTs telling what they had paid to go to school, and I don’t recall anyone going as high as $40,000. Massage school looks like a bargain education, for the most part.

Many of the comments on the results of the payment poll were negative, with the usual accusations toward the franchises for lowering the bar, and criticisms of other employers paying too little and expecting too much. One thing that I have noticed is that very little of that criticism comes from people who are actually employers. The majority of it is from people who have never been on the employer side of the equation.

When I opened my business ten years ago, I prided myself on paying above average. I wanted to do that in order to attract quality therapists and not have staffing problems. That worked pretty well for a long time, and I certainly wasn’t getting rich; I was getting by. I live in a very small town that is very economically depressed. The place where I live has not recovered from the recession, and in fact, in many ways it’s actually gotten worse. They claim the unemployment rate in our town is 12%, but that’s not realistic because it doesn’t include the many people have maxed out their unemployment benefits and all the self-employed people who have lost their businesses and can’t get in that line. Our homeless shelter is full every night. Soup kitchens and food giveaways are keeping a lot of people from going hungry.

A little bit of industry has started to trickle back in, but instead of the big cotton mills that employed several thousand people each, the businesses that are coming in are small companies that employ maybe 25  people. It’s not really making a big dent in the cycle of poverty and foreclosure that is going on here. People I know who have worked hard all their lives have lost their homes and their businesses. It isn’t a pretty picture, and I’m not exaggerating, or dressing it up. It’s the cold, hard facts. If you go on a tour here, you’ll see all the empty factories sitting here and all the empty small-business storefronts in our towns. You can’t begin to document the fallout on small business. The three really nice restaurants in our county–the kind of expensive place you’d go to on your anniversary or another special occasion–have all closed. Anything that is considered a luxury is not doing so well. People have cut down on massage. They’ve cut down on going to the nail salon, the hairdresser, the movies, and other forms of entertainment and eating out.

Over the years that I’ve been in business, expenses have gone up. I haven’t raised the price of massage in a couple of years because of the financial condition most of our county is in, and I feel it would be a nail in the coffin of my business if I raised it right now. The level of pay I used to offer people has gone down, which was a hard decision for me and one that I hated to make, but it is still superior to what anyone else in this area pays. As the owner, I also have to make a living. It isn’t going to serve me, or my staff members, if I can’t pay the bills and have to go out of business.

The accusations that employers are getting rich while the massage therapists are getting substandard pay is getting old. If that’s happening, it must be the minority, because I am not getting rich, and of the several hundred massage therapy business owners who are also employers that I am personally acquainted with, I can’t name any who are. They are either struggling, or they are making a decent living, but they aren’t millionaires and in all likelihood are never going to be one. The business owner is the one taking the risks. The business owner is the one paying the rent or mortgage, the utilities, the phone and Internet, the advertising, the laundry, the cleaning, the office supplies and janitorial supplies, the bank service charges, the credit card fees, the accounting services, the sales and use tax fees, and if they are utilizing employees instead of contractors or renters, they’re matching Social Security and Medicare contributions and depending on the size of the operation, paying other benefits as well. Franchise owners are criticized all the time, but they also invest a lot of money up front and it takes them years to get it back.

There used to be a middle ground between getting rich and getting by, and that was called the middle class (which is reportedly shrinking on a national level). I think that’s what we have in massage. We have a few people who are making minimum wage. We have a few people who are making big bucks, and the rest are somewhere in the middle.

As for those who are criticizing business owners and claiming that we’re the rich while you’re the poor, I encourage you to put yourself in our places. Go ahead, take a leap, open a business, get a bunch of people you are responsible for, and take responsibility for all the overhead. When the economy is booming, you may be booming along with it. And when the economy sucks, you may be in the same position all owners have been in when that’s the case–trying to cut down expenses without making service suffer and trying to make sure everyone keep their jobs, while still managing to make enough money to keep the doors open and meet your own personal obligations.

Obviously, the economy is booming in some places, and some people are doing very well. To them I say congratulations.

To the estimated 70% of MTs who are leaving the profession after less than two years on the job, I say I hate that you were set up with unrealistic expectations.

To my fellow business owners, I say that sometimes you’re the windshield, sometimes you’re the bug. I’ve enjoyed my role in keeping people gainfully employed and providing a pleasant place to work, and I have always tried to show my appreciation for that in pay and in other ways.

To all those who have criticized employers that have never actually been one, I say you don’t have the slightest idea what you are talking about. If you ever become one, and you can manage to give your therapists top pay, while surviving severe economic downturns without laying people off or letting them go, having disgruntled staff members, personally paying all the bills and bearing all the other responsibilities, then you can criticize to your hearts content.

 

Weekend Update

A lot has happened this past week. First of all, the massage world lost a wonderful person with the passing of Dan Barrow. He was the long-time moderator in the AMTA House of Delegates, among his many other accomplishments, and was just one of the nicest people I’ve ever met. He will be missed. My sympathies go out to his lovely wife Virgina and his family and friends. You can read his complete obituary here.

One good thing happened this week. Steph Lasch was arrested at the Minneapolis-St.Paul airport after she had boarded a plane bound for Beijing, China, with her husband and her son. This has been a long road for a lot of massage therapists. In case you don’t know the background, you can read it here.

Since last fall, I have been communicating regularly with the Lino Lakes Police Department to keep up with what has been happening in her case. I had provided them with numerous pages of FB conversations and other print items where she claimed to be a certified public accountant, a certified fraud investigator, a third-year law student, a tax expert, a marketing expert, and everything except the president of the United States.The dozens of massage therapists who reported her to that department, and also to the FBI, the Attorney General, the Better Business Bureau, and everywhere else they could turn to will hopefully get some justice now. People may never get their money back, but it is my big hope that her actions do not go unpunished.

Although she never got any of my money personally, I had appeared, along with three other women, as a blogger (about professional ethics, at her request) on a massage coaching website she had going on. She had announced far and wide that I was her mentor, and I felt compelled to just keep trying to spread the word about the avenues people could use to complain on account of that. The police report actually focuses on the money she defrauded massage clients of at her business location, and not the dozens of therapists she stole from. In any case, she’s currently in jail. I’d love to attend her trial. You can read about it here. My last piece of advice to her was to get her act together for the sake of her child. I contacted the LLPD again this evening and they told me that her son was handed over to her husband; they were on the plane with Steph but her husband was not charged with anything.

Champ and I attended the NC AMTA Convention in Statesville this weekend. We had a good time visiting with people we don’t see often enough and both of us enjoyed our continuing education. Champ took an ethics class with Felicia Brown and I took a class in teaching and classroom management from Dr. James Zarick. One of the best classes I have ever attended. Desiree Sawyer was elected as our new chapter president. I spent this morning visiting with Mike Hinkle, founder of the World Massage Festival. I am honored to be the keynote speaker at this year’s Festival in Las Vegas. I guess I’ll just try to make as few people mad as possible!

I spoke up at the business meeting about AMTA national office decision to do away with chapter fees. I want it to go on the record that I think this is the worst move this organization has ever made. In my opinion only, this move was designed to make AMTA’s membership fee more competitive with ABMP. The fact is, ABMP has a different business model than AMTA. ABMP does not have state chapters to support. They don’t have hundreds of volunteers. Personally, I think they’re a fine organization with fine people at the top, and they just operate differently. I think AMTA needs to quit worrying about ABMP and focus on doing the best for the massage profession. This is impacting chapter budgets, and while they have rolled out some additional benefits for the chapters, I don’t think it offsets what they’re losing. I’ve seen the budgets from three different states in the last few weeks and it is having an impact, and not a good one. I think they will regret this move in the long run. I’d like to see a massive letter-writing campaign to the Board of Directors describing the negative impact this will have on the chapters’ ability to provide top-notch education experiences on a state level and on chapter donations to the Massage Therapy Foundation. Please do that here.

I’ve had an emotional week myself. I implemented some changes at my business, which never happens without a few growing pains, and the death of an old friend whose funeral I had to miss in order to attend the convention have made me a little whacked out this week. Then hearing the news about Dan Barrow, followed by the news about Steph Lasch, and it has seemed like a roller coaster. The world just keeps turning.

Peace and Prosperity.


CAMTC: Under the Gun, ABMP Says “Declare Victory and Move On”

I’ve spent the past day or so reviewing the CAMTC Sunset Review Report…at over 200 pages, it’s a narrative of the who, what, where, when, and why of the organization, which is now in its fifth year.

California operates differently from the other regulated states. The CAMTC is not officially a state regulatory board. It is a non-profit organization, offering voluntary certification. It is just my opinion that this is a big improvement over the previous state of affairs there, when there was nothing at all, other than each municipality regulating as they chose, which more often that not meant that legitimate massage therapists were classified along with sex workers and treated the same way. I’ve heard horror stories from therapists who have in the past been made to take a test for STDs, along with paying money to each individual town in which one was practicing. Someone doing outcalls may have been looking at a separate license and another financial burden in many different places. The CAMTC aimed to put a stop to this by getting it into the statutes that if you had the CAMTC certification, you were allowed to skip all the local hoops. It was a very hard battle.

During the Sunset hearing process last week, ABMP Chairman Bob Benson testified. Benson served the CAMTC Board for four years, including a term as the initial Vice Chair. He attended 51 of the 52 meetings held during his tenure. His complete testimony may be read here. Benson’s opening remarks referenced the Vietnam war, in speaking to the present state of affairs at the CAMTC, and he urged the organization to “Declare victory and move on.” I have heard from several veterans who were very upset about that analogy and feel that Benson’s remarks showed a great disrespect for the people who served in Vietnam and a cheapening of those who lost their lives there. I have met Benson personally on several occasions and I don’t think he would intentionally insult veterans, but I have to agree it was not the best choice for comparison.

Beyond that opening faux pas, Benson brings up the following points about the weaknesses he perceives in the CAMTC. One is that CEO Ahmos Netanel is wearing too many hats. There is no controller or operations officer or chief financial officer; Netanel is doing all three jobs, apparently. There’s no doubt he’s a busy man; I run into him myself at national meetings.

Benson also points out other problems: the unwieldy size of the Board–20 people (although currently there are only 19); the fact that there is no central office, which leads to communication and control challenges; a lack of adequate information on the website and delays in getting things posted; 5 years in operation and as of yet no customer satisfaction surveys; a lack of data on how much the CAMTC is paying their management company; a lack of salary standards, and unsatisfactory performance metrics for the dissemination about applicants and certificate holders.He also actually refers to their plan to start approving establishments and massage schools as “delusional.”

Benson isn’t one to complain without offering a solution, so his suggestions are the transition of this organization into a formal state regulatory board, as the other regulated states have; to substitute mandatory licensing for voluntary certification; to use 2015 as a transitional year; and to honor CAMTC certificates and allow holders to convert them to a state license on their expiration date without jumping through any further hoops.

I contacted Ahmos Netanel and gave him the opportunity to respond to Benson’s comments. His reply below is verbatim:

In his comments during the March 10, 2014 legislative Joint Oversight Hearing: Sunset Review of CAMTC, Bob Benson, acting as the voice of ABMP (Associated Bodywork & Massage Professionals), advocates for dismantling the current statewide certification program and instituting a state board for regulating massage therapy under the Department of Consumer Affairs (DCA). Bob Benson is certainly dedicated to the massage profession; however, he is a minority voice.  In fact, no CAMTC Board member has ever expressed a position similar to his.

The CAMTC Board has accomplished a great deal.  Yes, as with any new organization, there is room for improvement.  However, in a very short time, by any standard, we have put a statewide infrastructure in place to work closely with police and local government, and there is no doubt that consumers can have confidence that a CAMTC certified professional is educated to safely provide care. 

CAMTC has done more than simply oversee the certification of qualified massage therapy professionals. CAMTC has initiated work with local authorities, local elected officials, professional organizations, other stakeholders and the Legislature to modify its enabling law to correct issues and oversights. Presently, the Sunset review process implemented by the Legislature allows for the substantive amendments needed to control illegal massage parlors.  In doing so, we want to be respectful of the work being done by legitimate massage providers and not return to the era of onerous patchwork enforcement— the kind of control that simply assumes massage is adult entertainment.

CAMTC also investigates and un-approves schools as part of ensuring that certification candidates met strict educational requirements.  Ironically, the state bureau which regulates private post-secondary schools, now BPPE, was allowed to sunset between July 2007 and January 2009.  The lack of an official school oversight body during that time had a significant negative impact on the massage industry and the safety of the public.  Stepping in since 2010, CAMTC, with only minimal resources, has been able to un-approve 47 massage schools that were not meeting minimum standards for massage education and we hope to do more beginning in 2015.

In the ongoing and important effort to eradicate illegal massage parlors, CAMTC is asking the Legislature for the authority to provide statewide registration and investigation of massage establishments.  Many local jurisdictions lack the resources to effectively stem the tide of these illicit businesses and CAMTC is up to the challenge. 

The problems raised by the police chiefs and the cities are our problems, too.  Their complaints and concerns are issues we are addressing with great success in many parts of California.  For example, our training programs have been attended by more than 100 local agencies. And many cities – impressed by our organization – now require CAMTC certification. 

The proliferation of illegal massage parlors is bigger than massage therapy alone, but we are an integral part of the solution.  We propose:

  • Raising educational standards
  • Establishing a registration program for establishments
  • Expending local government control over the use of massage as a subterfuge for prostitution

A state board under DCA has merit. It also has significant drawbacks, including starting a new entity from scratch. It is likely that a new state board would take anywhere from 2 to 5 years to become fully operational.  The cost in terms of time and state resources is not warranted when CAMTC is already in place and functioning successfully. 

Further, a state board simply cannot function as efficiently as a private entity like CAMTC.  Consider, as was discussed on March 10th in the Joint Oversight hearing for the DCA, that the current time for disciplinary actions by DCA boards is 540 days, despite the target of 180 days.  Just scheduling a hearing with the Office of Administrative Hearings takes approximately 200 days (testimony by the Legislative Analyst’s Office). Furthermore, the cost to discipline or revoke a state license is over ten times greater than what it costs CAMTC  to discipline or revoke a certificate holder.  CAMTC provides a high level of due process to certificate holders at a lower cost and in fraction of the time that it takes a state board to do the same.

Whatever the merits of moving to a state board under the DCA, it is not going to happen by magic nor will it happen overnight.  It will be a long, costly process. And dismantling CAMTC won’t benefit California consumers or those individuals practicing massage therapy in California.  Rather, it will leave a gaping chasm for both.  

Legitimate massage providers create jobs, promote a healthy lifestyle, and enhance communities.  We cannot go back to the antiquated and oppressive patchwork regulation of the past.  It won’t solve the problem of illicit massage parlors or correct any of the other issues about which cities are concerned.  Only working together – CAMTC alongside cities – can we protect both the public and legitimate massage providers. 

CAMTC is proud of its successes and we look forward to working with the police chiefs, the local communities and Bob himself to do great things for the massage therapy profession and the public.

Respectfully,

Ahmos Netanel

Chief Executive Officer

California Massage Therapy Council

I do not wish to minimize any of the accomplishments and hard work of the CAMTC. I applaud what they have done. However, I’m in agreement with Benson on this one; I’d prefer to see them with mandatory licensing instead of voluntary certification. It won’t be the answer to every problem; it never is. But I do urge them to make the transition, and hopefully, that can be accomplished without the gaping chasm Netanel mentioned.

 

 

 

Massage Regulation: What is the Point?

Seems like almost daily, on one of my networks, someone will post the question of “what good is massage regulation really doing?” They often throw up points like “prostitution still exists,” and of course it does and it always will. Other complaints are about how much money the state revenue department, or the licensing board, or the Federation, or the testing company is making.Then we’ve got the complaints about taking CE to satisfy the law, and how that’s just a money-making racket. As a CE provider, believe me when I say I’m not getting rich off of it, and very few are. But back to the question, what is the point?

The point of licensing in any profession is basically quality assurance for the public, for their own safety and protection. To get a license, you’re supposed to have x number of hours of education. You’re supposed to pass an exam proving entry-level knowledge . In most places, you’re supposed to get the continuing education in order to keep it. You’re supposed to agree to abide by a code of ethics and uphold standards of professional behavior. You’re supposed to first do no harm. You’re supposed to act in the best interests of the client.

There are now only a couple of states that are the last holdouts with no regulations in the works or already in effect…anyone may call themselves a massage therapist or any other derivative indicating massage, whether they actually know anything or not.

In reality, it’s hard to find out exactly how many members of the public have been harmed by massage therapy. The insurance companies and professional associations don’t like to release that information. Many of the state massage board websites do have license verification online, and some do list disciplinary actions, but in most cases that will only show up if you already know the name of the therapist that has been found guilty of some infraction. It must be said that not every single person who has been found guilty by a board is really guilty…there were times during my own five years of board service that I did not believe the accused person was guilty, but the majority voted that they were. It must be also be said that some therapists who are in fact guilty never ever get reported and thus keep preying on the public. There just aren’t any guarantees, just like with any other walk of life or profession. There are people in every profession that are dishonest or predatory, and massage therapy is no different.

All things considered, I think licensing has been a valuable thing, and personally, I’d like to see it in every single state. Yes, there are still people who will practice illegally. There are still prostitutes who will hide behind massage. But I think on the whole, licensing has brought a healthy amount of awareness and credibility to massage therapy.

I’m not resentful of having to get a criminal record check to get a massage license. If we were being singled out I’d be upset, but every other health care provider in our state has to do it. I’m not resentful of having to take continuing education….I love learning and I actually look forward to taking CE. However, I do think there comes a point in time when that should be optional. Realistically, should someone who has been practicing for 20 years need to attend an ethics class the same as someone who has only been practicing for a year and may not have even faced any kind of ethical dilemma yet?

I’m not happy with the present state of the CE environment, anyway. I think a person who is taking science-based classes or classes designed for public protection deserves more credit than people taking fantasy-based classes. With the long list of inappropriate classes that are currently approved, I really don’t see how attending a class in shape-shifting is doing anything to protect the public.

Some state boards are self-supporting. Some are at least partially subsidized by the state. Some try to educate the public. Some don’t. Some pursue illegal massage more than others. Nothing’s perfect.

The point, to me, is that the majority of us, by paying for that license and jumping through the hoops, are proving that we have at a minimum, the entry-level knowledge to practice massage safely. The majority of us have taken the education, and passed the exam, and meet our CE requirements. The majority of us are practicing ethically. The majority of us are trying to keep massage and sex separated. The majority of us abide by the rules. The majority of us are just here to take care of our clients and do the best we can. There will always be some bad apples, but I think requiring licensing has weeded out a lot that might otherwise be here. Just my opinion.

Free Massage!

Do you ever feel like you have a sign on your forehead that says “Free Massage?” Every day on my social networks, I see massage therapists talking about being asked to do free massage. “Come and do free chair massage at our event and it will get your name out there….” never mind that you’ve been practicing for 15 years and your name is already out there. I recently saw on FB post where a chiropractor wanted someone to come to his office and do a week’s worth of free massage so he could get the client feedback and decide whether or not he would hire the person…I guess he thought she just wouldn’t need any rent money or groceries that week. If he’s located near a massage school that’s turning out graduates or an area that’s saturated with massage therapists, he could feasibly keep the “audition week” going for a long time–and quite probably billing insurance for the massage that he’s not even paying the therapist to perform.

At the massage school I attended, back in the day, we were required to perform 25 hours of community service…free massage on a deserving population. 15 years later, I still don’t mind performing free massage on a deserving population. I occasionally volunteer time to what I think is a worthy cause. I once gave weekly massage to someone for almost a year because he had spent nearly a year in the hospital, his medical bills were in the millions of dollars, and he just plain needed the work and couldn’t pay. One of my staff members has given a lot of massage at an abused women’s shelter. Another did deeply discounted work on someone who was seriously injured and didn’t have any insurance, and many of us have done that kind of thing at one time or another, for nothing other than the warm fuzzy feeling of having helped someone.

If there is an event going on that I think we need to have a presence at, I will pay staff members to do chair massage; I don’t expect people to work for free. We just can’t and/or won’t go everywhere we are asked to go. If the event is more than ten miles away from my office, I’m not really inclined to go there. There are plenty of massage therapists in our county, and if there’s a health fair that’s all the way at the other end of the county and plenty of practicing therapists between here and there, I’d rather let one of them have it.

I have recently been receiving invites to an event in Shelby, NC. That’s 25 miles away from here and I know at least half a dozen therapists that practice there, so I’m not going to go encroach on their territory. The last time the organizer called, I told him he was wasting time by continuing to call me about it and suggested he contact therapists from that area. I also turned one down that was relatively close, but on a holiday. When the woman called me, I said, “thank you, but our staff members want to spend the holiday with their own families that day.” Not only do they want us to do free massage, they also want us to pay them for a booth to do it in.

Sometimes MTs are distressed or hesitant about saying “no,” because “it’s at my mother-in-law’s church,” or “one of my clients asked me to do it, but it’s 30 miles away,” and that kind of thing. If you’re a new therapist, or an old one who’s feeling torn on this issue, then here’s the answer: “Thank you for thinking of me, but I already have clients booked for that day.” Or you can say “Thanks, but I don’t give my services away,” with no excuse. You don’t need an excuse.

If you have the time, and so much money you don’t have to worry about paying your bills, then feel free to give away all the massage you want to. Say yes to everyone who asks. You’ll probably get some business out of it, but keep these thoughts in mind: Some people will do anything just because it’s free, that they would never think of actually spending money on. Some people who are already consumers of massage and already have their own therapist of choice will sit down and get the massage, again, just because it’s free. And many times, people don’t place much value on something they get for free.

If you need an actual return on investment for your time, then you need to pick and choose what you’re going to participate in. Realistically, you stand a much better chance of getting business from an event that’s 5 miles away from your office than one that’s 25 miles away from your office. Some events, like an annual festival, attract a lot of people from out of town that are never going to become clients, but you’ll have to massage them along with any locals who might potentially become clients.

Your dentist isn’t going to do your root canal for free. Your doctor isn’t going to do your appendectomy or deliver your baby for free. The plumber, the electrician, the washing machine repairman isn’t coming to your home for free. You can’t walk into Walmart and load up on free goods, but for some reason, many people seem to expect that massage therapists are always available to give it away.

Here’s the reality check: most of us have overhead directly related to our work. It also costs money to get educated, to get licensed, and to keep up with continuing education requirements. It costs money to run our homes and our lives–just the same as it does for the people who are soliciting us to come and do free massage. We have mortgages, car payments, student loans, and debts to pay. We need food and utilities and medicine and school tuition and child care just like everyone else.

Doing free massage is sometimes a good marketing opportunity. It’s always providing a public service, and you should do it only when you genuinely want to. Don’t allow yourself to be talked into doing it when you don’t want to, and don’t allow yourself to feel guilty for turning anyone down.

ELAP: Now that I’ve Read the Whole Thing…

I spent most of my spare time during the past week reading the Final Report and the Entry-Level Education Blueprint of the ELAP. Again, I will offer my appreciation for the collaboration of the Coalition and the team that actually performed the work on this. It was a big project and obviously, people took time away from their own pursuits to participate in it.

Now that I have read the whole thing in its entirety, I have a few observations on it. I quote from the Coalition statement:

We aspire to have this report influence several profession audiences:

• the Federation of State Massage Therapy Boards, which can use The Core as it builds guidelines for a model practice act;

My comment on that: The press release announcing that the FSMTB was going to create a Model Practice Act first appeared on April 1, 2011. In a letter I received dated Jan.31, 2014, FSMTB Executive Director Debra Persinger stated that the Task Force is currently completing the final revisions before releasing it for public comment.

It’s just my opinion that the ELAP will be a last-minute inclusion in that, if it does in fact get included.

• state licensing boards, which can use The Core in setting education requirements for licensees;

My comment on that: What is the Model Practice Act doing, if not that? It seems very possible that this is a duplication of efforts. While there are of course other things included in a practice act, one of them is spelling out the hours of required education. I don’t know any state board that goes much beyond setting the total number of required hours, and how that should be broken down in a general list of required subject matter. Not to mention changing a practice act requires legislative action.

the Alliance for Massage Therapy Education, which can refer to The Core in creating teacher training standards and curricula;

My comment on that: Aha! And therein lies the clincher and the biggest issue I have with it. Since I couldn’t say it any better myself, I am going to share the comment that Rick Rosen left on my FB page:

“The critical missing element that will prevent the ELAP Core Curriculum from being implemented on a wide scale is the lack of teacher training in our field.

I simply cannot fathom why the cash-rich organizations in our field (AMTA, ABMP, FSMTB) would spend significant sums of money on a curriculum development project, while they continue to turn their back on providing the financial support needed to carry forward the Alliance’s National Teacher Education Standards Project. Without this long-term investment in teacher development, educational outcomes and the quality of massage therapy services delivered will remain inconsistent at best.

My comment on Rosen’s comment: Nailed it on the head. And it would be another interesting research project to determine what the average training is of teachers in massage schools across the US.

I will repeat Rosen’s sentiments by saying I would like to see all the organizations give this kind of support to the Alliance for Massage Therapy Education and their National Teacher Standards Education Project. 

The Alliance is the youngest organization out there, and does not yet have the kind of cash reserves built up to move this project along at a better pace. The fact is these kinds of projects do require money in order to come to fruition. The Alliance membership is made up of educators and industry partners, and will never have the kind of membership numbers enjoyed by the other organizations by virtue of that fact. I can visualize the ELAP being very useful to the teacher training project–but they need the money to make it happen. I urge our other organizations and industry supporters to put your money into this project.

• the National Certification Board for Therapeutic Massage & Bodywork, which can use The Core as it identifies beginning vs. advanced knowledge and skills for its Board Certification credential;

My comment on that: The Board Certification exam is already out there and is still practically new. I don’t see any major revisions taking place on it any time soon. The NCBTMB is using their “old” certification exam for their entry-level licensing exams, and has been for years. As a certification exam and a licensing exam should require two different job task analysis surveys and one should not be interchangeable with the other, they are already in muddy water, and I don’t really see how this will clear it up. And, as is the case with the MBLEx, the exams that the NCB is using for entry-level licensing are geared to a 500-hour education requirement. Again, this would require major changes to that as well.

• professional membership organizations, which can use The Core in shaping membership criteria;

My comment on that: Pay the money, show proof that you are either a student or a licensee or a practitioner in an unregulated state, and boom! you’re a member. Within the past few months, myself and others made well-documented complaints about an unethical practitioner who was scamming fellow massage therapists and try as we might, we could not get her removed from the membership rolls of AMTA or the massage listing service. She has now finally been removed, after it was reported that she was also scamming her clients. Or she just didn’t pay her membership renewal fee. Either way, she’s no longer listed, but it took months to get any action on that front.

• the Commission on Massage Therapy Accreditation, which can use the Core in evaluating massage and bodywork curricula for programmatic accreditation;

My comment on that: COMTA has had their competencies spelled out for years. The basic difference I see is that ELAP is spelling out the number of hours to be spent in each subject matter area.

• other accrediting organizations, which can use The Core in shaping their accreditation criteria;

My comment on that: COMTA is the only accreditation organization devoted to massage therapy (and they now also include asthetic programs). The other accreditation programs I am aware of approve of all kinds of schools and programs and use the same evaluation criteria for a massage program as they would an engine repair program. I don’t realistically see it having impact on these types of accrediting agencies, although it would be nice if it did.

• school owners, administrators and faculty, who can use The Core to strengthen or validate curricula and to adopt consistent learning outcomes;

My comment on that: I wholeheartedly agree. I encourage all school owners, administrators and faculty to read this document…and I know the majority won’t take the time. I have seen the prevailing attitude of “I’m not going to let anyone tell me what to do at my school,” when I have tried to promote COMTA accreditation (disclosure: I have been a COMTA peer reviewer). It doesn’t matter if it would vastly improve their existing program. Stubbornness is hard to overcome.

• and potential massage therapy students, as they consider where to enroll.

My comment on that: I would be shocked to know that any potential student is ever going to read the 527- page document to help them choose a school. Just my opinion.

More of my unsolicited opinion: I am not critical of this document on the whole. I think it spells out a good foundational education for entry-level massage therapists as it was meant to do, and it requires 625 hours to do it in.

There are still 26 states here with a 500-hour minimum requirement. While it is very true that there are many schools that exceed their state’s hour requirement, there are also a large number of school owners that are determined they are not ever going to do more than the state requires. Neither do I see it having much effect, if at all, in states that already have higher requirements for education.

The ELAP report states that a 2012 survey showed schools are teaching an average of 697 hours. Still, if this were to be legally adopted, which I think is a long shot at best, it would undoubtedly put some schools in the position of “cooperate or close down,” which in the general scheme of things, might not be a bad thing, if their students are not truly well-prepared.

I am just of the opinion that being prepared to pass an entry-level examination, and being prepared for the real world of massage, are two very different things. It also isn’t about hours, per se, but about competencies–a statement, in fairness, made in the ELAP–but it does take a certain number of hours to teach those competencies, and this is what the work group decided on.

Bottom line: I like it, but I do think that in spite of the Coalition statement of support, that there has been some unnecessary duplication of efforts on some of their parts here, and that a good curriculum can only be effective with good, well-trained teachers. I’d like to see an equal amount of time, money, and effort spent on the National Teacher Standards Education Project. 

 

 

ELAP Final Report & Entry-Level Education Blueprint Released

The Entry-Level Analysis Project Final Report and the Entry-Level Education Blueprint were released today, and it’s a whopper…266 pages in the Report, and 527 pages in the blueprint. Obviously, I haven’t read that all this morning. I do want to take the time to express my appreciation for the collaboration among the Coalition (ABMP, AFMTE, AMTA, COMTA, FSMTB, MTF, and NCBTMB) and to Anne Williams of ABMP in particular, for spearheading the project. Both documents were co-authored by the ELAP workgroup, which included Pat Archer, Clint Chandler, Rick Garbowski, Tom Lochhaas, Jim O’Hara, Cynthia Ribeiro, and Anne Williams.

According to the Report, at the initial meeting of the Coalition in 2011, two pressing issues were identified: the inconsistent quality, depth, and focus of entry-level massage programs, and the lack of licensure portability from state to state.

The big recommendation is that 625 hours of education are needed just to give students the core basics that they need for entry-level competency. According to the report, currently 28 states only require 500 hours; 7 require between 570 and 600, and 10 states require more than 625 hours. In my opinion only, no matter how wonderful the Blueprint, those states that already have higher standards won’t be inclined to dumb it down for the rest. New York and Nebraska, for example, both have 1000-hour requirements. I don’t see portability happening there–ever–unless every other state decides to come up to that level. However, the Report does reference a 2012 study that states the average massage program in the US is 697 hours–so maybe even in the states with the 500-hour requirement, there is a tendency to do more than required–and that’s nice.

For those schools that are less than 625 hours, this recommendation would undoubtedly increase financial costs to the owner that would have to be passed along to the student.

The shocking news, to me, is the statement that 40-50% of graduates are leaving the field within two years of graduation! I would be interested to know exactly how those figures were arrived at.The Report cites unrealistic expectations about the physical demands of massage and compensation, and the evolving life circumstances of 20-somethings. I’m personally not sure how relevant the 20-somethings are; it’s been my own experience in the past 15 years that there are as many middle-aged people (whatever that is, nowadays) that take up massage as a second career as there are young people who jump in right out of high school.

The workgroup would like to encourage everyone to pay more attention to the core curriculum than the hours. According to the document, this can serve everyone:

  • The Federation can use it as a guideline for the Model Practice Act
  • The state boards can use it in setting hours for education
  • The AFMTE can use it in setting teacher standards
  • COMTA can use it in evaluating massage and bodywork criteria for accreditation
  • the NCBTMB can use it for identifying entry-level vs. advanced knowledge for Board Certification
  • Professional membership associations can use it in shaping membership criteria
  • School owners, administrators and faculty can use it in validating curricula and adopting consistent learning outcomes
  • Potential massage therapy students, as they are deciding where to enroll.

There is, within the document, the subtopics of Eastern bodywork, TCM, concepts of qi and all the accompaniments to that, with the caveat that schools may choose to integrate that according to their own philosophy. The focus is on the application of Shiatsu, tui na and Thai massage, which I will not argue the efficacy of, without personally buying into the theory behind them. I’m not going to have this argument here because it wears me out, and frankly, I’m outnumbered.

There is no doubt that a huge amount of work went into this project. Personally, I gave a lot of feedback on it during the calls for comments that happened some months ago, as did several other educators I know. I wasn’t crazy about this idea when it was initially introduced, and I was further distressed by the way the review and comment process was set up…I didn’t think it was good to have such a piecemeal approach to it, but in reality, I feel that the chance that many more people would have responded to the whole thing is probably relatively slim…it would have been just as long in any case. Anne Williams stated during one of the presentations on it that I attended last year that it isn’t perfect, but what is? I sincerely do commend everyone who gave of their time and effort on this huge undertaking. I plan to say more about it after I’ve read every page.

 

CE: No Approval is Better than Faux Approval

This is hardly the first time I’ve had gripes about the state of continuing education for massage therapists in the US. I’m not happy, and I haven’t been happy for a long time. I’m a CE provider myself, approved by the NCBTMB. That approval is accepted in many places, but there are some states that run their own CE approval processes. Sometimes, the cost and the amount of paperwork just can’t be justified to teach one class that may or may not fill. The CE environment, at least in my state of NC, is also very competitive. It seems there’s a provider on every corner here.

I’ve been distressed with the NCBTMB as an approval body for a long time, due to the total claptrap that they have approved. I also didn’t care much for the MOCC plan proposal from the FSMTB, which would have made all CE voluntary, except those classes that are about public protection, put forth by them on their website. I feel that has the potential to put a lot of good CE providers out of business.

I think it’s time to do away with two prevalent myths that have been used as the rationale for CE regulation: one, that the public is being seriously harmed by massage therapy, and two, that the current CE approval processes are able to provide quality assurance. It’s impossible to guarantee the competence of CE providers or the quality of their courses when it may not be there to begin with. Our field will never advance, and we will not be taken seriously by other health care professions if we continue to operate under these false pretenses.

I recently called for the other organizations to pool their resources to get the NCBTMB written out of the exam requirements in all states. North Carolina set an important precedent for that five years ago by choosing to accept only the MBLEx (except for a limited use by out-of-state applicants). This has simplified the testing process for schools, graduates and that board, and put the regulatory program on solid legal ground.

Rick Rosen has proposed a couple of alternative solutions for CE regulation, the first of which was a National Registry. He has now tweaked that into new template entitled Model Continuing Education Regulations: A Streamlined and Simplified Approach for State Boards.

I don’t agree with Rosen on everything, but I think this is a good plan. Ultimately, I would like to see states refuse acceptance of CE that is not science-based (other than classes such as marketing, ethics, etc.) one of the points Rosen and I disagree on. However, I’m being realistic when I say that probably is not going to happen in my lifetime.  

My main beef here is that  state boards need oversight of what they accept for CE, and they need to have control over entry-level examinations. As long as the NCBTMB is written into state statutes and rules, the regulatory boards are forced to blindly go along with whatever NCB does. As Rosen has pointed out many times in the past, that is an improper delegation of authority—and I definitely agree with that. FSMTB is not even following the advice of its own legal counsel in getting state boards out of this troubled relationship with NCB. Instead of hanging on to so-called “licensure” exams and a failed CE approval program, I would prefer to see the NCBTMB developing specialty certifications, which IMHO is what they should be doing.

It all boils down to this: no approval is better than faux approval. For all that it currently means, we could just do away with CE approvals altogether let the market deal with the good, bad and everything in between. As long as Flower Faerie Healing is acceptable for CE credit, that’s pretty much what we have anyway—except we’re paying for the privilege.