Tag Archives: Massage

Client-Centered, or All About You?

This morning I saw a FB post from a practitioner mentioning all the things he throws in on a massage…Reiki, toning, spiritual healing, and Qi Gong. When I questioned him, he assured me that his clients know before getting on his table what they’re in for. That is the only way of working in integrity.

My questions about those things, and anything else other than massage that you include in sessions:

1. Did the client ask for it?

I was attending classes in energy work for five years before attending massage school almost 17 years ago. I was taught that you should never impose it on clients who have not asked for it, as many may have religious objections to it or just not believe in it–or just be intent on getting the full hour of massage that they have paid for without other things they aren’t expecting being thrown in. I always adhered to that policy in the interest of being client-centered.

2. Was the client informed before getting on the table that this is the way you conduct all your sessions, and given the opportunity to refuse in the event they just want a massage and nothing more?

If a client books a massage, they are expecting a massage. Particularly in the case of a client who has never had a massage, they are not expecting you to delve into their private spiritual beliefs, or perform rituals that they know nothing about.  If you are an “integrative” practitioner and you throw in other things during your session, that needs to be made clear at the very first contact.

It is the same principle as putting nut oil on a client without asking them if they have a nut allergy, or putting essential oils on someone who may have allergies or just object to the fragrance. Just because you love to use peppermint oil during a massage doesn’t mean the client is going to enjoy it.

People have the idea that I am against energy work. I am not against it. I believe any time you place your hands on people in a compassionate, non-sexual, non-threatening, non-judgmental way, with the intention of soothing their pain, relieving their stress, easing their passing, or whatever, that’s a good thing, and you can do the work without needing some supernatural  narrative that violates the physical laws of the universe to go along with it. A good explanation from Keith Eric Grant, who might be the only physicist in the US who is also a massage therapist of many years, can be found here.

I taught Reiki for ten  years myself. One day it struck me that my drawing a few symbols in the air and blowing a puff of my breath on someone is never going to turn anyone into a healer, and I tore up my master certificate. I came to the conclusion that I can lay my hands on someone without needing a story to go along with it, outside of “I just want to comfort you.”

3. Do you wait until they are on the table to spring your plans for the session on them when they are already relaxed and possibly in an altered state of consciousness?

There is an inherent power differential in the therapeutic relationship that is in our favor, and that clients look at us as the authority figure who knows what they’re doing, and who is supposed to have their best interests at heart.

4. Are you client-centered, or is it all about you?

If a client has booked a relaxation massage, and you start digging in because you
have decided they need a deep tissue massage, it’s all about you.

I gained numerous clients over the years from massage therapists who thought it was all about them. I’ve heard many comments such as “She was just sitting there with her hands on me not doing anything. I thought she went to sleep.” And “He walked around the table banging a little gong and said he was clearing my negative energy.” And “I kept asking him to lighten up because he was hurting me, but he said he couldn’t because this is what I need.” And “I just can’t stand strong fragrances of any kind. Before I knew what was happening, she had doused me in some kind of oil and I thought I was going to choke.”

A therapist who is client-centered is a successful therapist. A therapist who is not client-centered is going to crash and burn a year or two in and wonder why they just couldn’t make a living doing massage. Being client-centered isn’t optional; it’s our obligation.

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Caregiver Syndrome, Part II

December 18 of 2014, we got the official diagnosis of my husband’s Stage IV cancer…not what I wanted for Christmas. In the past 11 months, he has had 118 doctor appointments. He is cancer free at this moment. Just three weeks after he completed 35 radiation treatments and 7 rounds of chemo, he suffered an abdominal aneurysm–and survived. The majority of people who have an aneurysm die. He was fortunate to be airlifted to the hospital, and the vascular surgeon was standing on the landing pad when he got there. He has had the best of care. Although he has lost 40 pounds that he didn’t need to lose, has a bad case of chemo brain fog, and says he has about 65% of the energy he used to have, he is just lucky to be here, and I’m lucky to still have him.

This has been one of the most emotional times of my life. Fear, shock, anger, denial, worry, and every other negative emotion has been my companion for the past year. There have been a lot of highlights, mainly from the outpouring of love, concern, and support we have had from friends and family and even total strangers. I often think of our lives in terms of B.C.–Before Cancer.

I didn’t know there was any such thing as Caregiver Syndrome before I became a caregiver. Even though he is well at this time, I’ve still got the syndrome. I still worry. I cringe when I go to the mailbox because I know I’m going to find another medical bill that I don’t know how we’re going to pay. I’ve spent the past year fighting battle after battle with our insurance company, filing appeals, and begging them not to deny payment for services and to extend continuity of care after they dropped the Carolinas Health Care System from their network. 6 of the 8 doctors that have been involved in Champ’s care were members of that system. It has been a nightmare.

I’m a control freak, and I hate it when something is beyond my control. His health is beyond my control. Our finances, at this moment, are beyond my control. We will go to our grave thousands of dollars in debt from this experience. I have felt like I’m personally out of control. I’ve never been a crying person, and in the past year have probably shed more tears than I’ve shed all together in my entire life.

Some good things have happened, in spite of it all. We made the decision to downsize at THERA-SSAGE–not close the business–and Champ has been able to start doing massage appointments again. He had to retire from carpentry after 45 years, as the physical labor of it is just too much for him. He still sleeps a lot. Some days he goes from the bed to the sofa and back again, and that’s it. That’s okay. Sleep is restorative. I accepted a new job as the Massage Division Director of Soothing Touch, an international family-owned company that manufactures massage and skin care products. They’re based in New Mexico, but I get to work at home, and I am traveling a lot for them. I love the products, which I had been using for about 7 years before joining the company, and I love the people I work with. I curtailed a lot of my teaching activities this year, but I managed to do three book revisions while Champ was sick…many times I took my laptop to the hospital and worked on them while he was receiving his treatment. Where there’s a will, there’s a way. I hired an office manager to run our clinic so I could bow out and focus my attention on the new job. I have been teaching professional ethics for many years, and I was inspired to create a new class on The Ethics of Working with People with Cancer.

I have a new appreciation for cancer patients, and for their caregivers. One of my friends who beat breast cancer a long time ago said to me that she figured out while she was sick that she would much rather be the sick person than the family members who were caring for her.

When you’re a caregiver, you put everything else on the back burner. I know I did. I stopped getting regular massage. I got depressed. I suffered from anxiety. I alternated between stress eating and not eating at all because I was stressed. I either wanted to cover up my head and sleep, or laid awake worrying. It’s been a journey, and it’s not over. Champ will receive PET scans every three months for the next five years. He will have the camera put down his throat every six weeks for another six months. He goes to have his chemo port flushed out every month. He sees the vascular surgeon for regular ultrasounds. He has appointments just to get weighed so they can make sure he is at least maintaining and not losing any more weight. It’s still a little shocking to me to see his changed appearance, but I’ll take him skinny rather than not having him at all.

Every time I hear of another person who has been diagnosed with cancer, I just cringe…for them, and for their loved ones. All you can do is the best you can do. I just keep putting one foot in front of the other and hoping he stays well and continues to get his energy back, and that the brain fog lifts. I still have moments of fear, depression, anger, and the whole gamut, but those are outweighed by the gratitude of still having my husband. If you’re going through this, or have already been through it, you know what I mean. May peace be with you.

Priorities

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

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

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

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

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

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

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

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

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

 

 

An Interview with Paul Ingraham

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Expanding Our Scope, Protecting Our Future

There have been numerous attempts to come up with a good working definition of  massage therapy. While I certainly appreciate the effort that has gone into them, in my opinion, most have fallen short in one way or another. Part of the problem is that massage therapists are independent-minded and are harder to organize than a bunch of cats. If you look at the 44 state massage laws that currently exist, you’ll find 44 different versions of what is called a scope of practice definition. Add to that the newest definitions found in the MTBOK and the ELAP, and we’ve got a murky mess that makes it nearly impossible to achieve portability of licensure. In fairness to the creators of both of those documents, which were collaborative efforts with support from all of the professional massage organizations, they were put out for public comment, which really didn’t amount to a ripple in the general scheme of things. My attitude is, if you didn’t take time to comment, then don’t gripe about the results.

We arrived here because there was no common template that was used during the rush to get state massage license laws passed over the past 15 years. Licensure standards are much more consistent in other healthcare professions because each one has been working from something called a Model Practice Act (MPA). I’m wondering… where can we get one of those?

Well, after nearly a decade after it came onto the landscape, the Federation of State Massage Therapy Boards has finally come up with their own MPA. They’re wrapping up the open comment period on the first public draft of this document, which has been posted to the their website. Much of it is run-of-the-mill legislative kind of language, but some sections really need further work. I’ve sent them my comments, and I hope you have too.

What I’m most concerned about in the FSMTB Model Practice Act is the scope of practice definition. As presented, it could restrict what massage therapists are allowed to do in their practices in the future. That’s a giant problem. If we define ourselves in a narrow way, other healthcare providers and business interests will ensure that we stay in our own little box.

Fortunately, I just heard from my North Carolina colleague Rick Rosen on this subject. He has developed what I think is a much more appropriate definition that strengthens and clarifies the diverse range of massage therapy practice in a way that expands possibilities, rather than shrinks them. By the way, Rosen was one of the co-founders of FSMTB, and was also the founding chairman of our state licensing board in NC, where he contributed to the writing of its laws and rules. Here’s what he said in his comments to the MPA Task Force:

“I am concerned that the definition set forth in Section 103 of the MPA is potentially limiting, as it characterizes the work performed by licensees as only that which relates to the manual application of techniques to the soft tissues of the body. Massage therapists are much more than pressure-delivery technicians. For example, they interact with clients in varied ways and provide assessment, treatment planning, and make recommendations for changes in a client’s ergonomic usage and movement patterns that can reduce chronic muscle tension. In addition, massage therapists can work with body awareness to assist clients in reducing stress and developing a healthier sense of self.”

“During the start-up phase of FSMTB in 2005, we looked carefully at the structure of board federations in other health care professions. I remembered from that research that most health care professions had robust and extensive scope definitions, as compared with the relatively one-dimensional definitions found in state massage practice acts.
With that in mind, I accessed the current model practice acts from the fields of nursing, physical therapy and occupational therapy. Using these templates as a guide, I developed a new definition that is broadly inclusive of the range of treatment models in our field, and establishes an expanded scope that more accurately represents the major areas of application in clinical practice.”

With that said, I’m sharing the full text of Rosen’s proposal for a new scope of practice definition:

PRACTICE OF MASSAGE THERAPY. A healthcare service of the healing arts provided to clients by a person who is licensed pursuant to this Act.

(1) The practice includes:

(a) Assessment of the functional and structural characteristics of the myofascial network and related systems of the body through tactile, visual and verbal methods;

(b) Treatment of the myofascial network and related systems of the body using manual methods, or by mechanical or electrical devices or tools that emulate or enhance the action of human hands;

(c) Active or passive movement of the body within the normal anatomical range of movement;

(d) Application of lubricants and other topical agents to the skin;

(e) Use of hydrotherapy and other adjunctive methods to produce therapeutic effects;

(f) Client education to facilitate body awareness and self-care;

(g) Treatment planning, communicating or collaborating with massage therapists and other licensed healthcare providers, and engaging in research, teaching and administration.

(2) Primary areas of application for massage therapy include:

(a) Wellness/Stress Reduction: treatment that supports the general health and well-being of the client, facilitates the relaxation response, addresses patterns of chronic tension related to stress, reduces pain and discomfort, promotes a more positive sense of self;

(b) Corrective/Rehabilitative: treatment that addresses specific symptoms or conditions, provides rehabilitation from the effects of injury, trauma or surgery

(c) Performance Optimization: treatment that improves the performance of specific activities or occupations, facilitates postural alignment and more efficient ergonomic patterns of use;

(d) Palliative: treatment for clients in recovery from illness or in the end stage of life that focuses on providing psychosocial support and relief from discomfort;

(e) Integrative: treatment that promotes awareness of the connections within the physical, cognitive and emotional aspects of the client, as well as treatment in conjunction with other licensed medical or mental health providers in a coordinated plan of care.

(3) The practice does not include:

(a) The diagnosis of illness or disease;

(b) Medical procedures, high-velocity low-amplitude chiropractic adjustive procedures, or prescription of medicines.

(d) The use of modalities for which a license to practice medicine, chiropractic, nursing, physical therapy, occupational therapy, acupuncture or podiatry is required by law; or

(d) Sexual activity of any kind.

I think Rosen has nailed it here. Without going beyond what we should do, this is more inclusive and a much more accurate description of what we do actually do. This more inclusive definition could save us headaches down the road if we are challenged by other professions for infringing on their scope of practice.

Today, June 15, is the last day for public comment on the MPA. Please pass this around… this should be the start of some interesting and important discussion. There’s nothing less than the future of the massage therapy profession at stake, so we have to get this piece right! Don’t sit on your hands. Take the time to comment, and if you don’t, then you are giving up any right to complain about it after the fact.

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………

Confusion Reigns

I’d like to just steal Sandy Fritz’s blog this week, but instead I’ll post the link to it. She expressed many of the same things I have been feeling in “Beyond Frustration.” Confusion reigns. I get at least a half-dozen questions a day from massage therapists and providers asking me if I understand the latest move from the NCBTMB, or do I know what’s going on with this or that new requirement, or which exam should I take to get licensed, etc. Frankly, I’m confused and frustrated myself, in spite of being relatively well informed about what’s going on.

I see confused massage therapists every day on my social networks referring to their certification from the NCBTMB as a “national license.” There is no such thing as a national license. It would be a lot easier for us all if such a thing existed, but it doesn’t. A few years ago, I noticed that a teacher I had hired to come to my facility to teach a CE class had been ordered by our state board to cease and desist practicing massage without a license. When I called her to see what was going on, she said “But I have a national license!” No, you don’t. None of us do.

My own confusion was compounded again this weekend when I received my certificate proclaiming that I am now Board Certified–the new credential from the NCBTMB. Personally, I think calling it that is a huge blunder on their part. It really doesn’t make any differentiation from the old paradigm of “National Certification” and people are confused about it. The certificate is bigger and a little nicer-looking, but my new certificate says that I have been certified since 2000. Well, yes I have, but this is supposedly a new and different credential, and I didn’t get it until 2013. There is something that doesn’t seem right about that.

I could go on, but I won’t. The tragedy that occurred at the Boston Marathon yesterday has me feeling sad and angry and confused and just out of sorts. It seems ridiculous to focus on whatever complaints I have about the way things are going in the massage world when people are dead and wounded and grieving for their loved ones so I’m going to save the rest of my rants for another day.

In the meantime, Allissa Haines has posted a good blog that describes how many of us feel. I’ll get back on my soapbox in a week or two.

 

 

 

NCBTMB: Quit the Small Stuff and Take the Bold Step

Nearly two years ago, the Tennessee Board of Massage Licensure voted to change its rule pertaining to the examinations approved for licensure of massage therapists. They chose to adopt the Massage & Bodywork Licensing Examination offered by FSMTB as the only approved exam – and sunset the use of the National Certification Examination for Therapeutic Massage & Bodywork offered by NCBTMB.

That decision was entirely within the Board’s authority, and was based on the fact that the MBLEx is owned and administered by FSMTB, which consists of its Member Boards. This structure gives state regulatory boards direct ownership and supervision over this exam, which has never been the case with the use of NCBTMB’s private certification exams for state licensure purposes.

Rule changes can sometimes take a long time to make their way through the administrative process, and Tennessee’s exam rule just came up yesterday for final approval before a committee of the State Senate. This could and should have been a simple legislative rubber stamp of an agency decision, but NCBTMB threw a monkey wrench into the works by sending in a representative to oppose the rule change.

I was told last year by former NCBTMB CEO Paul Lindamood that they were swearing off the battle against the MBLEx, and would no longer challenge state massage board actions around exam approvals. He stated to me at the time that he knew they weren’t making any friends by doing so. The new CEO, Mike Williams, who came on board last September, apparently does not share that point of view.

At the committee hearing, the Senators stayed the decision on the rule change for another 30 days and sent the matter back to the Board for further consideration. According to my sources, the hearing went poorly, with legislators failing to understand the difference in the exams, state board members unable to answer the question about what the pass rate is on the exam, and general confusion leading to the stay instead of a decision.

I spoke to NCBTMB President Alexa Zaledonis today, who stated that “We didn’t go to Tennessee to fight, but to state our position. There are still people who want to take our exams and we support them having a choice. We never desire to create controversy in the states. We have quality licensing exams, a lot of people do like them and ask us to help keep them available in their states. No malicious intent, just a desire to let those people have a choice and so we try to stand up for them in an appropriate fashion.”

Earlier this year, there was an ugly ruckus in Ohio over a similar kind of rule change. It ended in a Massage Therapy Advisory Committee member being removed after he asked the NCBTMB during the hearing: “How much money will it take to make you go away?” It was deemed unprofessional conduct at best, and an offer of a bribe at worst.

While I hate the way the question was put forth, it has more than a little basis in reality. I personally would paraphrase that to: “How much money will it take for you to get out of the entry-level licensing exam business?” 38 states are still accepting the NCBTMB exams, but all you have to do is look at NCB’s financials (available on Guidestar.org) to see that they’ve had their butt kicked by the MBLEx. The MBLEx is a licensing exam used for licensing purposes. It’s the right tool for the job, and the marketplace has affirmed it by an overwhelming margin. The state boards themselves don’t derive income from the MBLEx; FSMTB is a non-profit organization (as is NCBTMB) and the Member Boards pay annual dues to the Federation.

If you’ve been reading my blog for long, you know that this is a relatively new opinion of mine –that the NCBTMB should get out of the entry-level exam market. I argued against that for a number of years. Rick Rosen, (a fellow North Carolinian and industry thought leader), has argued that point with me here on this blog and in other forums a number of times, as have others, and I resisted that change for a long time. However, I finally came around to Rosen’s point of view. A few months ago when NCBTMB announced the creation of a new post-graduate Board Certification credential and the ending of the current entry-level National Certification credential, I truly felt like it was the best move to be made.

The issue is that ever since the appearance of the MBLEx, the value of being Nationally Certified has largely gone by the wayside. I’ve heard many accusations that the MBLEx is an easier test than the National Certification Exam. This is not a valid argument, because these are two different tests created for entirely different purposes. The real point here is that National Certification no longer distinguishes therapists from the pack like it did back in the days when it was the only credentialing exam in the massage therapy field. I have personally been NCTMB for 12 years. I have always maintained my certification, even after the MBLEx appeared, but I know many therapists who have let it go because they’ve reached the belief that it doesn’t mean anything in the marketplace.

Under the new plan, Board Certification includes the requirements of 750 hours of education, passing a new higher-level exam, 250 hours of hands-on experience, keeping CPR certification current, and a criminal background check. Those who are already Nationally Certified will not have to take the new exam. In our conversation today, Zaledonis stated “Our Board Certification exam is created to test individuals who have achieved 750 hours of education and are at a level of expertise that exceeds an entry level graduate. Over 8000 individuals responded to our JTA, these answers (after psychometric interpretation) along with a panel of subject matter experts were used to differentiate between a entry level licensed practitioner and a certified practitioner. Our Certification test is different from a licensing exam in that it uses more cognitive thinking over just recall using innovative items over traditional. This test, coupled with the other requirements, are the start of a program that truly differentiates licensing from certification.”

I personally know many of the people on the staff and on the Board of the NCBTMB. I have no doubts about their dedication to the profession, and when it comes down to it, the organization isn’t an island. A CEO serves at the pleasure of the Board, and Board members have to reach a consensus. Apparently the members who are currently serving the NCBTMB have agreed to follow this path of continuing to challenge state boards, and that distresses me. I think it is a misguided effort, no matter how good their intentions. Even the name of the organization speaks to that: National Certification Board. It isn’t the National Licensing Board. There isn’t a National License. There is no portability, and the swirling sewer of argument and confusion around the exams is not helping the situation. I think the time is ripe for the NCBTMB to get out of the entry-level market altogether and focus 100% of their resources on the development and rollout of their new post-graduate credential. This IS something that our profession needs, and I urge the NCB leadership to let go of the past and turn towards the future.

I imagine that money is a primary factor in the organization hanging on to entry-level testing, and in the decision to continue challenging state boards that are ready to drop them. It doesn’t take a rocket scientist to figure out that states don’t want a private certification organization coming in and telling them how to run their business. State board members are normally unpaid volunteers who give up home, family and work time to serve a board….and to have an outside party come in and tell them they did the wrong thing doesn’t sit very well, (as I personally know). I don’t want to see the NCBTMB crippled to the vanishing point. Going around challenging state agencies is expensive, and it doesn’t win them any friends.

So here we are with a Catch-22. It’s time for NCBTMB to exit the entry-level testing business, but they don’t have the money to sustain them while the new Board Certification program is getting built. They need a bridge to help them get where we would like them to go.

There is a straightforward solution to this situation. Since the lion’s share of revenue from entry-level testing has shifted over to FSMTB, they now have a significant cash reserve. It is in the best interests of their Member Boards to bring a quick and painless end to the “exam wars” and to establish the MBLEx as the single standardized exam for state licensure. The profession as a whole will benefit, and portability for therapists will be improved.

What needs to happen is that NCBTMB declares that it will no longer offer any of its exams for state licensure purposes as of a certain date. In exchange, FSMTB will give NCBTMB a certain amount of money over a period of time to compensate it for this move. The mechanism for this process is called a Transfer Agreement, and there is a clear precedent we can look at.

For many years, the American Physical Therapy Association owned and operated the national exam used by state PT boards for licensure. APTA (like our own AMTA) is a private non-profit membership association, with no accountability to state PT boards. Because of the same inherent problems we’ve finally come to recognize, the Federation of State Boards of Physical Therapy entered into negotiations with APTA, and engineered a Transfer Agreement to take over that exam in the late ’80s. It’s worked like a charm ever since. Physical Therapy has 50-state licensure, and a lot more consistency in their state-to-state regulations than we have in the massage field.

Having one standardized national licensing exam is one of the hallmarks of a profession. We are at a critical juncture, where the opportunity to take a major step towards professional status is within our grasp. This will take the willingness and cooperation of the leaders of both NCBTMB and FSMTB to come together to work out the details of this agreement.

Let’s stop wasting time on the small stuff. Take the bold step, for the betterment of all.

 

 

 

R-E-S-P-E-C-T

Most of the time when the media, or Hollywood, casts a light on massage, it seems to be a paraphrase of Rodney Dangerfield’s classic line, “We don’t get no respect.”

The latest hue and cry is over the upcoming new lifetime series, The Client List, in which Jennifer Love Hewitt is a massage therapist/prostitute who is of course just doing it because she needs the money to feed her kids. Last year it was that picture of a race car driver getting a massage from a skimpily dressed massage therapist, and the year before that it was The View. Last Halloween, I got ticked off about a costume that was labeled “Massage Therapist” and included a skimpy lingerie outfit and fishnet stockings. And always, always, the “massage parlor” busts make the news, while the therapists who work their fingers to the bone actually helping people rarely get on tv. While I hate these things as much as the next legitimate massage therapist, I do try to keep it in perspective. The same shelf in the costume store had a skimpy nurse outfit. There are tv shows portraying crooked cops…it doesn’t mean every cop is crooked, but it’s a stereotype that we’ve bought into, and it’s the same with  us. We’ve been trying to separate ourselves from the sex stereotype for many years, and my guess is we’ll have to continue to do so.

Worse to me than the way the media portrays us is the way our lawmakers stereotype us. Legislation is afoot in several places that just serves to hold us back as a profession. HB 2387/SB2249 in Tennessee, which I first reported on several weeks ago, will remove massage therapy from under the division of health-related boards and move it to the jurisdiction of the commerce and insurance division–the division that regulates “trades.” Bottom line, massage therapy would be a “trade,” not a “profession,” and insurance companies don’t pay tradespeople. They pay professional health care workers. That bill was referred to the Government Operations Committee on Jan. 13 and no further action has yet been taken.

A similar situation is happening in Florida with SB 1860. I just finished reading the latest analysis of this bill, which was updated 02/03/2012. Among other things, SB 1860 removes the right of massage therapists to bill for PIP insurance. The analysis states the following:

The Consumer Advocate’s report found rapid growth in the number of procedures billed from 2005 to 2010. The largest increases were found for “Massage, 15 minutes” and “Therapeutic Exercise, 15 minutes” which each increased by approximately 2.6 million units from 2005 to 2010.  Specifically, “Massage, 15 minutes” increased from approximately 1.42 million units in 2005 to approximately 4.05 million units in 2010, while therapeutic exercise increased from approximately 713,000 units in 2005 to 3.36 million units in 2010. These two procedures are now the two most commonly billed procedures in the PIP system.

The Consumer Advocate’s report also presented data on increases in the average charge per claimant by provider. Average charges by massage therapists saw the greatest increase, increasing from $2,887 in 2005 to $4,350 in 2010. The second largest increase was by acupuncturists, whose average charge increased from $2,754 in 2005 to $3,674 in 2010. In contrast, the average charge by an orthopedic surgeon only increased $126 from 2005-2010, billing on average the comparatively smaller figure of $2,810 in 2010. As of 2010, massage therapists and acupuncturists issue the largest average charges of any medical provider that bill within the PIP system.

This bill is really about fraud. Another part of the analysis states that the number of “staged” car accidents in FL doubled in a year’s time. People are milking the system. And while it’s nice to know that their favorite thing to milk it for is massage therapy, that’s really working against us here.

How do we get the respect we deserve? And do we really deserve it? Some of us think we do. Some of us want to advance massage therapy and integrate it into the full realm of mainstream health care. The way to accomplish that is by acting like health care providers, by becoming research literate and supporting the evidence-based practice of massage. It’s just my opinion that is the key to massage therapists earning respect. Others say if we want to be thought of as health care providers we should just become PTs instead. I don’t buy that. I think what we do is good enough to be considered in and of itself.

We can complain to Lifetime TV and The View when the situation arises, but it’s much more important to complain to our legislators. I’ve been preaching this sermon for years, and I’ll continue to preach it until I’m gone. If all the people who holler about stereotypes on television and write letters to Lifetime would write one to their lawmakers and insurance commissions, it would be a great thing.

And now for a shameless solicitation: The Massage Therapy Foundation is working to fund research in the massage therapy profession, to teach research literacy, and to advance the evidence supporting massage therapy as a vital part of health care. For Valentine’s Day, I am asking everyone to show some love and to donate $14 to the Massage Therapy Foundation. You can do that by clicking here.

Legislative Hullabaloos in WV and TN

As usual, the opinions on my blog are my opinions and not to be construed as the opinions of anyone else.

I  haven’t had much to say on the legislative front for a few months…when the legislators go home for the summer, not much is happening; then there tend to be shorter sessions in the fall before they take a break for the holidays and not much happens then, either. Well, the break is over, and how.

I received a press release from the NCBTMB yesterday announcing what amounts to a win for them in the state of WV. Here it is:

The National Certification Board for Therapeutic Massage & Bodywork (NCBTMB) is pleased to share the news that Nationally Certified Massage Therapists in West Virginia will continue to have their services covered by the Public Employees Insurance Agency (PEIA). Initially, the PEIA Finance Board considered discontinuing massage therapy coverage altogether as a cost-savings measure, but with input from NCBTMB, the American Massage Therapy Association (AMTA) and practicing therapists, it will still cover active employees and non-Medicare retirees who visit massage therapists with national certification.

The new financial plan goes into effect July 1, 2012. Certified therapists must also carry $2 million in malpractice insurance as well as follow treatment guidelines of the AMTA.

“NCBTMB commends the Public Employees Insurance Agency for providing their employees with access to nationally certified massage therapists who commit to a code of ethics, standards of practice and pass a national credentialing exam,” said NCBTMB CEO Mike Williams. “We see this as a win-win situation for both PEIA employees and Nationally Certified Massage Therapists in the state of West Virginia.”

“PEIA has an obligation to state employees to cover necessary medical treatments, but also an obligation to the state of West Virginia to be fiscally responsible,” stated PEIA Executive Director Ted Cheatham. “We stand behind the PEIA Finance Board and its decision to only accept massage therapy claims from therapists who meet the new criteria.”

Disclaimer: I am Nationally Certified myself and have been since 2000. I am not obligated to maintain that; I just do because I want to. When I got licensed, it was also the only option available, as it was in most states for many years, saving those few that have their own exam. As any of my long-time readers know, I’ve had my ups and downs with the NCBTMB, criticized them many times, and applauded them when I thought they deserved it. I am also a  member of AMTA, and due to having  multiple coverage on different policies I have as a business owner and employer, I personally have $12 million of liability insurance. If I lived in WV, I’d be good to go.

My first thought on this was that it will be challenged immediately by the Federation of State Massage Therapy Boards.  I’d  bet the farm on it. West Virginia is a member state of the Federation. The Federation, and thus the member states, own the MBLEx (Massage & Bodywork Licensing Exam) which is accepted by the state of WV, as is the NCB exam. Therapists in that state have a choice of which exam to take in order to get licensed.

This move by the legislature would seem to be an endorsement of the National Certification Exam, as well as an endorsement of AMTA, since one of the other requirements for being able to file insurance is adherence to AMTA treatment guidelines. They don’t come right out and say you have to be a member of AMTA; just that you have to be following their guidelines. It also requires therapists who want to participate in the state employees’ insurance program to have a minimum of $2 million worth of liability insurance.

I personally file a lot of insurance in my own office, and it’s a standard practice for insurance companies not to deal with you unless you carry liability insurance, so no big deal on that front. AMTA’s treatment guidelines are on their website, accessible to the masses, including people who are not their members, so that’s really no big deal either.

What is a big deal here, at least to me, is that even though the state says that passing either exam is adequate for a massage therapist to receive a license, it is now saying that only one of them is adequate for therapists who wish to file state employees’ insurance. To me, that is sending a confusing message to students who haven’t yet taken an exam, as well as to the practicing therapists who chose to take the MBLEx, ignorant of the fact that this new law would be coming down the pike, and even to the massage-consuming public. It’s a statement that basically says “If you’ve taken the MBLEx instead of the National Certification Exam, then you’re good and qualified enough to work on the public, except for the state employees, and you have to be Nationally Certified to work on them and file their insurance.”  It is really stating that one licensee is better than another.

Is there going to be any fallout from this? Absolutely, in my opinion. The Federation, since its inception, has encouraged all member states to use the MBLEx exclusively for licensing purposes, while still stating that certification has its own value as a credential, but maintaining that it should no longer be used as a licensing exam. Since WV has opted not to follow that suggestion, and has kept both exams, massage schools and instructors in WV will now be falling short if they don’t inform their students of this legislation, and will basically be saying “You can take two different exams. If you want to file insurance, take the NCBTMB exam. If you don’t care about that, you can take the MBLEx.”  So two therapists can have the exact same 500 hours of  education that the state requires, and the exact same license that the state issues, but the one who took the MBLEx won’t have the privilege of filing insurance on state employees. The logic here is escaping me. There is one caveat: WV is currently not requiring any continuing education of massage therapists; however, maintaining National Certification requires 48 hours of  continuing education every four years. Still, I don’t think that’s a big factor. As long as you passed the NCB exam last week, you could be accepting the state employee’s insurance, before you’ve ever had a single hour of continuing ed, so I don’t see how that really fits into the picture.

I don’t think this is over, and I’ll try to keep you updated.

WV isn’t the only place where trouble is brewing this week. Therapists in TN are up against HB 2387 SB/2249, which would take the regulation of massage therapy out from under the health care professions and move it to the Department of Commerce and Insurance. That is almost bizarre that it has anything to do with the department that governs insurance–because most insurance companies will not pay for any health care services unless they are provided by a person who is in a licensed health care profession. This move would basically state that therapists are not health care providers. The Department of Commerce and Insurance regulates trades, not professions. For all intents and purposes, this is a statement to massage therapists that “you are practicing a trade, not a health care profession.”

Quite a few states have been on cost-cutting missions during the past few years of recession, combining public boards and even going so far as to disband altogether–or threatening to–but this cannot be construed as one of those cost-cutting missions. Tennessee’s massage board is self-supporting through licensing fees. They do not cost the taxpayers any money.This is not tied to financial impact on the state in any way. In fact, I’m not sure what it’s tied to or what the logic is behind it, other than a slap in the face to the massage therapy profession.

I urge all TN massage therapists to immediately  contact your legislators. Don’t wait until it’s a done deal to express your opinion.