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.

An Interview with Dr. Leena Guptha, New Chair of the NCBTMB

From Laura Allen: I have skewered the NCBTMB in my blog several times over the years, including very recently. It has been a tradition with me for several years to interview the executives and chairs of the massage organizations as they come on board, so I am interviewing Dr. Leena Guptha. In fairness to her, I would like to state that she had only been the Chair for ten days when I went on my last and most serious rant about the organization, so I certainly do not hold her personally accountable for the things I have complained about. Here is the interview I conducted with her.

1. Dr. Guptha, please tell us about your background, work experience, and education.

Background: Daughter of a Scientist and a Philosopher, Wife of a Physician/Scientist, Mother of two Physicians, Grandmother of a two year old.

Work Experience: (Relating to Holistic Therapies and Lifelong Learning)

  1. Practicing: 23 years of manual therapy across three countries, with my primary interests in basic science, musculoskeletal alignment, ethics, research and business.
  2. Teaching: Science and Hands-On instructor at various Colleges including but not limited to Connecticut Center of Massage Therapy; University of Bridgeport; Chicago School of Massage Therapy; National University of Health Sciences; Pennsylvania Institute of Massage Therapy; Lehigh Valley College; and International College of Osteopathic Medicine.
  3. Administration: Held positions of Director of Education, Dean of Academic Affairs, Campus President in corporate schools.
  4. Research: The Ergonomics of Driving and Back Pain, teaching Research Literacy to graduate students, osteopathic dissertation supervisor.
  5. Volunteerism: NCBTMB, AMTA Chapter, AMTA National Board and the Massage Therapy Foundation.

Education; Massage Therapy (LMT), Osteopathic Medicine (DO), Naturopathic Medicine (ND), Acupuncture/Oriental Medicine (LAc), Complementary Medicine, Hypnotherapy (BCH) and Business (MBA Hons).

2. How did you first become interested in massage therapy?

When I was a child, my father had a hobby of tinkering with cars, (not that I recall any of them actually road worthy, sorry Dad), suddenly one day while under the bonnet (hood) as he lifted the battery and twisted—he suffered an acute low back pain. My three wise uncles advised painkillers, anti-inflammatory medication, and six weeks rest on a wooden door.

This acute phase passed and he was back to work six weeks later. The next time it happened there was no possibility of time off.  I saw him suffer in agonizing pain. I started feeling his back to see what actually hurt and what did not. As a child this lead me to develop a rudimentary sense of palpation and soft tissue.  Then I took my first massage therapy course at age 18 and have studied many modalities since. Interestingly, my father still has not needed the spinal surgery earlier recommended by my uncles and proposed more recently by his physician.

3. What led you to volunteer for service at the NCBTMB?

Through the development of a hospital based program and my own research, I felt strongly that therapists at the hospital should be nationally certified by NCBTMB. I took the exam too, later a newsletter with Cliff Korn on the front page came to our home in Madison, CT and this led me to become a volunteer.

Later, I moved to IL and visited the HQ of AMTA. During that tour, Liz Lucas said “you should become a member of the Association”.  At a similar time I visited the Indiana to present at their state conference and there I learned about volunteerism at the state level. I then discovered the  Illinois Chapter, who welcomed me with open arms, that led to various roles, including the passing of licensure during my Chapter Presidency. The Illinois Chapter encouraged me to meet the National AMTA Board, the first person I met at the meeting Laurel Freeman, encouraged me to run for the AMTA National Board.

A few years passed, and I was invited to be an appointed member of the NCBTMB Board of Directors by Alexa Zaledonis. Her zest for the massage profession and doing what is right was infectious and I was delighted to join the Board.

Today, seeking the Wisdom and the Pioneering Spirit of our founding educators, who turned a trade into a profession, with a solid grounding and deliverables, I volunteer as Chair of the Board. The historical path is inspiring. I volunteer today with Courage of my conviction that there is a rightful place for certification, specialized training, career path options, quality core education and approved providers of continuing education.

4. I know that you have read my most recent blog calling for the other massage organizations to make a concerted effort to get the NCBTMB removed from the statutory language and rules in the states. What is your response to that?

Each person’s opinion has to be respected and without the benefit of a detailed dialogue with you and a fuller grounding of the contextual relationships, I would be giving an inappropriate response. With that said, I can say that I am confused as to why you would call for the removal. Our licensing exams have been in existence for 20 years, have gone through the profession for vetting four times, and are psychometrically sound testing tools. Most of the states accept NCBTMB’s exams as an option for part of their licensing requirements as a tried and true validation of knowledge to enter the profession safely and competently.  What is wrong with giving therapists a choice in exams to take and a pathway to follow? While, admittedly, NCBTMB has not always done everything right, the value and quality of the NCBTMB exams have never been in question.

In regards to the CE Approved Provider Program, we recognized a few years back that we needed to strengthen the program and review it moving forward. Yes, we held meetings and came out with an advanced program that the profession felt was too restrictive and expensive. So, we went back to the drawing board, we talked to specific groups, held conference calls and put the program out for comment before our re-release last month. We totally understand that the profession is concerned about parts of it and we are more than happy to work through these concerns. This is not indicative of an organization that is not listening or is not responding to valid concerns raised. We are trying. We have to do better and we will.

I am deeply saddened to read disparaging remarks for an organization that was and will remain our alma mater, without whose credentials today, we would not have had the ability to re-invent and elevate ourselves as individuals and as a profession. However, I continue to welcome all critiques, and all constructive recommendations, and call on all serious members of our profession and our stakeholders to be part of the dialogue and solution.

5. What, if anything, does the NCBTMB plan to do about offering specialty certifications, and if they are going to do anything, is there a timeline for that happening?

The NCBTMB Sounding Board was surveyed on specialty certificates and the initial responses appear favorable and supportive. I encourage readers to join the Sounding Board as a mechanism to feed views and input directly to NCBTMB. (The Sounding Board is open to all certificants and can be found on the NCBTMB Facebook page). There appears to be an interest to develop specialties beyond the basic Board Certification, such that an individual could be Board Certified with a specialized concentration in for example Oncology, Sports, Orthopedics, Hospice or Mother and Baby.

Our plan was once the Board Certification credential was established we would continue the discussion and development of specialty certifications with the emerging think tank as well as our constituents.

As an educator myself, I see this as a viable tool for NCBTMB to provide massage therapists who want to grow their skills and abilities. 

6. What do you see as the biggest challenges facing the NCBTMB?

Maintaining and building the confidence of all stakeholder groups despite damaging and disparaging remarks however true or false they may be. Asking the alumni of NCBTMB like you to help us transform with the changing needs of our profession, and join with us to become a leader ahead of the curve.

7. How many people have actually taken the new Board Certification exam, and how many people have been grandfathered in?

When we adopted the Board Certification credential, we understood that its success could only be judged over a period of years. Current certificants could transition into it at recertification time and do not need to take the exam; new graduates would strive to achieve the credential as they became successful in their careers.

The majority of our Certificants are still Nationally Certified and have the option to transition to Board Certification at their renewal time. Currently of those who meet the new standards approximately 3000 have become Board Certified. New graduates with entry level credentials will not be eligible until they have been in practice for at least six months, so we expect these numbers to rise through better communication, outreach and as therapists become eligible and choose to be certified. 

Since our webinar last week and this week, I have become aware of confusion in the profession regarding transition to Board Certification, as well as Board Certification requirements from licensure. We have to do a better job reaching out and communicating both the value and the requirements. Though, our team is working on a daily basis to assist certificants successfully through the transition process, I would like to take the opportunity to address this with the audience here.

The value of Board Certification:

  • Provides a credential higher than entry level licensure
  • It distinguishes the advanced therapist from an entry level therapist
  • Shows a commitment to the profession and to the consumer
  • The medical profession uses and recognizes the Board Certification credential
  • It creates a career pathway as in other healthcare professions.

Requirements to Transition into Board Certification from National Certification:

750 hours of education

Graduate from an NCBTMB assigned school.

·        Additional hours can be submitted from courses taken in continuing education or accredited college or university

·         250 hours of professional hands on work experience (25 hours will be accepted in volunteer work)

·         Current CPR Certification, copy of current identification, sign to oppose human trafficking, Agree to the NCBTMB Code of Conduct, and agree to a criminal background check

Requirements for those seeking Certification for the first time:

·         Passing the Board Certification exam

·         Submit the above transition requirements after six months in practice

 

 

8. Please also address how far back the offer to grandfather people was extended, because I have heard from several massage therapists who let their certification expire years ago that they received an offer to be grandfathered, which definitely minimizes the value of this credential.

Whilst, I am not aware that there ever was a true grandfathering period, we did announce that those who were Nationally Certified would have the opportunity to recertify, or transition, to the new program without taking the new exam. All other criteria would still need to be met. Based on that, the transition time period would end 12/31/2016, since all renewals under the old four year renewal cycle will have concluded.

On a case-by-case basis, those whose certification had expired with NCBTMB in the last year were reviewed once all of their information was submitted. If all other criteria were met they could transition to Board Certification because they did not have the new Board Certification available to them.

Throughout the review process, NCBTMB was sensitive to the following past issues:

1.      In 2013, the grace period was changed to 90 days.  Formerly the grace period was three years after expiration.  Therapists that fell into this category and were not aware of the change, were reviewed and could recertify if they met all requirements.

2.      Experienced massage therapist that were disgruntled with NCBTMB in the past and who allowed their certification to expire, welcomed the new changes and wanted to be reinstated.  These cases also were individually reviewed and, if warranted, they could recertify if they met all requirements.

All reviews that resulted in a successful transition to Board Certification were made in the best interest of the certificants, the profession, the community, and in acknowledgement of past mistakes by NCBTMB.

9. I have long been questioning some of the classes that have been approved for NCBTMB that I and many others feel hurts the credibility of the NCBTMB. There are evidence-based practitioners who will not apply to be a provider because of their embarrassment at being associated with some of the classes that have been approved here. Do you share the sentiment that classes that are based on things that have been scientifically disproven, classes that are based on religion, and classes that are based on products that people just want to sell to the public are inappropriate, and if so, what is the NCBTMB going to do about that and when can we look forward to that happening?

This is a good example of a critique that is thoughtful and constructive. We agree that only qualified Approved Providers should be acceptable and we are actively engaged in ensuring this. My Blog on the ncbtmb.org website calls for experienced educators to form a think tank and from that I envision a collective wisdom, with recommendations, to emerge. I am delighted that you have agreed to participate in the think tank to address such issues with CE classes.

I can add that classes based on selling products specifically are inappropriate and do not qualify for CE credit. Our current course criteria can be viewed by going to: http://www.ncbtmb.org/continuing-education-course-criteria
It is my vision that, based on the considerations from the think tank, these will be reviewed and recommendations will be forthcoming.

10. This is your opportunity to say whatever you would like to say as the new Chair of the NCBTMB. Is there a message you would like to give?

As I have just taken over as Chair, my first 90 days will be spent taking stock and gathering support of colleagues like you who are passionate about the educational system of our profession and have authored books for educators. I would like to tap into that positive and constructive energy, to build on the foundations of the alumni of all of our constituents to be by my side and develop a think tank to learn from old mistakes and ensure that we develop a progressive and meaningful organization that continues the advancement of the profession.  Internal “navel-gazing” as well “external assistance seeking”, behavioral modification and reaching out to all stakeholders to work with us in a positive dialogue to find our rightful place in the profession are all priorities. These are some vital initial steps.

As it is still only the first month of my position as Chair, my priority is more about “listening” than speaking. I am still learning, evaluating, and I am inviting collaboration. 

Moving forward, we acknowledge that every organization that aims to be effective and strives to pioneer inevitably takes some missteps.  We acknowledge our mistakes and should we ever forget, we can count on you to remind us! That means we count. We have a role, and we matter.  Let’s take that energy and focus forward. I want us to collaborate and move forward together with positive, constructive dialogue. Trust that we are able to—and want to—learn from old mistakes.  I invite you and all other productive and passionate stakeholders to help us.  

Now, to the “listening”…my questions are:

  1. In what form, format, and media would certificants like to receive information regarding Board Certification?
  1. What would Approved Providers like to see as the approval process and how can that be realistically implemented?
  1. As a school owner/administrator how can NCBTMB create strong sustainable relationships, what do you need and want from us?
  1. To the entire community and profession at large what specialty board certifications do you want to attain and how do you see that curriculum or requirements being integrated together, give examples of courses, activities or other professional models?
  1. We have made some mistakes. We have had our ups, we have had our downs. What do we need to do to build support and collaboration of our constituents and professional stakeholder groups?

In conclusion, I’d appreciate constructive strategies and comments.  We will listen carefully.

Finally a quote from my ultimate mentor “……pilot takes off an airplane against the wind, not with it.……….. and the naval aviator lands despite the pitch and roll………

Calling All Massage Organizations: 911

I’ve seen some ups and downs since joining the massage profession about 15 years ago, but never, in all that time, have I been as disgusted and dismayed with one of our organizations as I am today. I feel as if I have a vested interest in all of them, so I have the right to complain—and to call on them for help.

The National Certification Board for Therapeutic Massage & Bodywork was the only path to licensing in many regulated states for a lot of years. Their exams are written into the statutes of about 40 states, as is the MBLEx, which has soared in popularity as the exam of choice in the past 5 years. The exam revenue at the NCBTMB has been steadily declining ever since the MBLEx debuted. The “National Certification Exams” as they formerly existed are the same exams being used for the NESL.

It used to be that taking one exam gave you the status of being Nationally Certified and being able to use that to get your license, but that’s no longer the case. There’s no attraction there anymore. The Federation has been in a position for several years to help solve this problem by buying out the NCBTMB’s entry-level exams; they certainly have the money and the infrastructure in place, but they have apparently preferred to stand by and watch the NCBTMB die a slow painful death rather than be in collaboration. Although I have favored the idea of such a deal in the past, at this point in time I am not going to blame the FSMTB for their refusal to play ball.

The majority of regulated states also have it written into their statutes that the continuing education required for maintaining licensure must be from a provider of CE that is approved by the NCBTMB.

As a provider of CE, I was not pleased when the Federation brought up their MOCC (Maintenance of Core Competencies) plan, which would have made all CE optional, with the exception of classes related to public protection, put forth online by them. My concern was that it would put a lot of CE providers, including me, out of business. In reality, based on some of the claptrap that is approved by the NCBTMB, there are a lot of CE providers that should be put out of business. The NCB’s response to my own repeated questioning of some of the things they have approved for CE has not been satisfactory to date.

According to FSMTB Executive Director Debra Persinger, they have let go of the MOCC plan, based on feedback from the profession and member boards. Instead, they have put forth a Standardized License Renewal Recommendation. In a nutshell, the language reads: Licensed massage and bodywork therapists will be required to complete six (6) hours of license renewal requirements annually. At least three (3) of the six hours must meet the State-sponsored Ethics and Professional Practice course requirements that specifically address content pertaining to public safety. The remaining three (3) hours could be exchanged for certain Professional Development activities, including but not limited to meeting accredited certification standards, community service, and research.

Bear in mind, that has not been written into the law anywhere yet that I am aware of, and it is what it is—a recommendation.

In my conversation with Persinger this afternoon, she informed me that the online classes pertaining to public protection will roll out in 2014, and that states that require in-person classes will still be able to have that. She also stated that at the annual meeting of the FSMTB held earlier this month, the member states asked that the Federation form a new CE Task Force to look into the possibility of approving continuing education.

I can recall what I thought was the beginning of the downhill slide at the NCBTMB…and it was years ago. I’ve seen an egomaniac that was hell-bent on bankrupting the organization elected to the Chair position. I’ve seen lawsuits filed against them by two of their former executive directors that dragged on for years. I’ve seen the lawsuits they have filed against state boards for getting rid of their exams. Yes, they had the legal right to do that, but in the big picture, it didn’t win any friends for them. I’ve seen the ridiculous, totally un-credible, fantasy-land classes that they have approved for CE credit. I’ve seen the failed plan to turn into a membership organization, which cost them several years of being banished from AMTA conventions.

I’ve also seen the failed attempt at an “Advanced Certification,” and the morphing of that into “Board Certification.” The NCBTMB website states that those who are currently Nationally Certified must transition to Board Certification by their next renewal. Unfortunately, I have heard this past week from two prominent massage therapists, both of whom had let their national certification expire 6-7 years ago, that they received invitations to be grandfathered in on the new Board Certification. They declined for ethical reasons. Personally, that makes me feel as if my own certification is about as valuable as a used dinner napkin.

I’ve seen their attempts to present themselves to massage schools and certificants as if they are some sort of regulatory organization by using language that insinuated that. I’ve seen their attempts to replace lost exam income by gouging the hell out of CE providers. It was only when they were faced with a mass walk-out of prominent providers, who said they would give it up, rather than go along with the plan, that they had to back up and punt.

I’ve seen times when people could not get a phone call or e-mail to the organization answered, and times when it took months for certificates and approvals to arrive, if they arrived at all. I’ve seen an example, just yesterday as a matter of fact, of them blocking people, including me, from posting on their FB page because they had the nerve to complain—and that was after the new Chair encouraged people on my own FB page to make their comments there. I’ve seen well-respected, seasoned colleagues who are experts in massage organizations and government relations offer to help them and give them advice about how to pull themselves out of some of the messes they’ve made, and I’ve seen that help refused or ignored time and time again. I’ve seen their adamant refusals to own up to their mistakes. My distress with them is not new. It’s just been festering for a long time.

I think the NCBTMB has reached the tipping point. Some would even say they are long past it. I have, in the past, given them hell about some things, and I’ve also come to their defense many times, including some when they probably didn’t deserve it. I have stated many times that I wanted to see them survive and thrive, and I sincerely meant that.

I am sad to say I am no longer holding out that hope. I am sad to say that I think they have outlived their usefulness. I am sad to say that I think their credibility has been shot beyond repair. I am sad to say that although there are staff and volunteers there that I personally know and like, and believe have the best of intentions, things have gone too far. They’ve had years to turn this ship around, and it hasn’t happened.

Therefore, I am calling on AMTA, ABMP, AFMTE, and FSMTB to immediately pull out all the stops and use all their available resources to help get the NCBTMB out of all statutes and administrative rules, as it relates to approval of their exams and use of their Approved CE Provider program. There are only a handful of states that approve their own CE, and if the NCBTMB were to suddenly go out of business, confusion is going to reign in those states that still have the NCBTMB exams and CE provider requirements written into the law.

Removing them from all statutory language in the regulated states doesn’t necessarily mean the NCBTMB will go away. They may continue to limp along for a few more years. They may someday come to their senses and create some valid specialty certifications, and reestablish themselves as a viable entity, but at this point in time, I doubt if they have the financial resources to do so. They’ve wasted a whole lot of money on their previous missteps.

Lest anyone get the idea that I am happy about making this request of our other organizations, let me assure you, I am not. I am sad to see that one of our national organizations has fallen this far. It’s time for positive action, and since they’re obviously not going to take it, the other organizations are going to have to seize the moment. I would suggest orchestrating a hostile takeover, but one of my colleagues who knows much more about regulation than I do informs me that’s impossible due to their structure, so this is the next best thing.

The FSMTB is able to offer government relations support to their member states, and AMTA and ABMP can afford the lobbyists. As a young organization, they don’t have enough resources yet, but with financial aid from the other organizations, AFMTE could be a great alternative approval body for CE. COMTA could possibly step into that role as well, but again, they don’t have the financial resources that the other organizations have. I call on all of them to set it in motion immediately to get the NCBTMB out of all statutes. We all know how slow the government moves so it won’t happen overnight, but I believe it has to happen. The FSMTB has been working on a Model Practice Act, so the time is ripe.

I also suggest that anyone who is Certified, as I have been since 2000, examine what that really means to you. Personally, I will not be renewing mine. There was a time when I was proud to say I was Nationally Certified. That time has now come and gone.

NCBTMB Call for Comments: 911 for Approved Providers

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

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

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

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

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

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

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

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

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

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

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

MOCC-ERY Redux

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

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

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

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

Blowin’ in the Wind

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

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

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

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

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

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

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

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

An Alternative to CE Regulation (just in the nick of time)

As I’ve written about on this blog, the NCBTMB has been trying to roll out an “upgraded” scheme to regulate the entire world of continuing education. After all, their stated mission is “To define and advance the highest standards in the massage and bodywork profession.” (Doesn’t that give them free rein to tell the rest of us what to do?) Apparently, NCB wasn’t satisfied with just approving CE providers – now they want to require the thousands of CE courses to pass through their hands as well. Go back to my posts from November 18, December 28 and January 8 to read about the many problems that are likely to come up if NCB’s new Board Approved Continuing Education Provider Program comes to pass.

If this wasn’t bad enough, along comes the FSMTB who have announced they are jumping into the CE approval game with their own new approval process. They’re calling for volunteers to serve on three different committees that will build and operate a whole deal that will be separate from what NCB is planning.

We already have too many different CE approval hoops for providers to jump through. It’s just plain crazy for FSMTB to be looking at putting another national approval scheme on the map. The feedback I get is that many CE providers are already struggling with the challenges of the economy and the burdens of CE regulation. If nothing changes, things are about to go from bad to worse in the CE community.

Fortunately, some people outside of these two silos have had their thinking caps on. My NC colleague Rick Rosen has just put out a major white paper on this subject, which will give you everything you need to know to understand this issue (and then some). Most importantly, he has come up with a very interesting and practical alternative to the formal regulation of CE, to be called the National Continuing Education Registry.

In this paper, Rosen poses four big questions that challenge the basic assumptions that have driven our regulation of CE. He says these must be addressed before NCB and FSMTB do anything else with their approval schemes.

He provides a lot of useful background information along with detailed answers to these questions. All of that serves as a lead-in to an overview of the National Continuing Education Registry. It is designed to be an online listing service that will replace all existing national and state CE approval processes:

  • CE providers will be screened by a designated entity to determine that: 1) the provider is a legitimate business entity, and 2) where required, the provider has a valid state-issued massage therapy license, registration or certification. Providers will sign a participation agreement that includes adherence to a code of ethics.
  • Each CE course will be screened to determine that it is within established subject matter standards that are broadly relevant to the professional practice of massage therapy.
  • The Registry may be utilized by state massage regulatory agencies as the means to determine whether a CE course is acceptable for renewal of a licensee’s credentials to practice. In a similar way, NCBTMB (or other certification agencies in the future) could utilize this service to determine whether a course taken by a certificant meets the criteria for recertification.
  • This service will give massage therapists a basic level of assurance that listed courses will be accepted for license renewal and/or recertification, and that the course is offered by a credible individual or institutional provider.

The overall structure of the Registry is similar in ways to the Multiple Listing Service concept in real estate. It will be based on a voluntary participation of CE providers, who agree to conduct their business according to a code of ethics. Like shopping for a house, therapists will have to perform their due diligence to find the courses and providers that meet their learning needs. There are no guarantees, but a provider’s reputation for integrity will be a great asset.

So instead of making CE regulation more burdensome, complex and costly, he is offering a way to simplify, streamline and consolidate the whole process. That sounds damn good to me!

If you care about this issue, I highly recommend that you read Rosen’s paper to get the complete picture, and then contact the leaders of NCB and FSMTB and urge them to set aside their own approval programs in favor of this National Continuing Education Registry. The power of grassroots lobbying is the only tool we have to get the small group of people who lead these two organizations to wake up and smell the coffee on this vital issue.

You can download the white paper from this link:
http://tinyurl.com/NCER-Proposal-FEB2013

There are few people who understand how all the pieces fit together in the massage therapy profession. As someone who was a co-founder of both FSMTB and AFMTE, served as a state massage board chair, and is a school director, CE provider and CE sponsor, Rosen takes the long view in looking at the problems in our profession. Frankly, I don’t know where he finds the time to research and write these papers, but I’m sure grateful that someone cares enough to do it! I urge everyone to share this with their networks.

 

Caught Between Hubris and The Grudge

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

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

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

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

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

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

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

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

 

CE Providers React to NCBTMB’s New Approval Plan

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

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

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

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

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

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

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

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

Let’s look at a few facts.

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

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

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

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

The Financial Health of Our Organizations: NCBTMB

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

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

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

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

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

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

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

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

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

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