Model Practice Act Causing an Uproar

Disclosure: I am a peer reviewer for COMTA.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

FSMTB Releases Model Practice Act

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

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

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

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

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

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

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

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

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

 

 

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

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

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

We aspire to have this report influence several profession audiences:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

ELAP Final Report & Entry-Level Education Blueprint Released

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

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

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

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

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

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

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

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

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

 

CE: No Approval is Better than Faux Approval

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

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

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

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

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

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

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

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

Here’s the Rub

A couple of different things are bugging me today, so here’s the rub: The NCBTMB referring to their licensing exams as certification exams. There was a period of time when the licensing exams were referred to as the NESL–National Exam for State Licensing.

National Certification, as it previously existed, was retired on Dec. 31, 2012. People who are currently Nationally Certified under the old paradigm have until 2016 to comply with the requirements for the new Board Certification, or lose their “old” certification. I’m not sure of the date that the NCBTMB decided to drop the term “NESL” which indicated a licensing exam as opposed to a certification exam, but now that they have dropped that and are just referring to it as the NCETM/NCTMB, to me it is confusing the issue of what certification is–and is not. I spoke my mind about this yesterday to Steve Kirin and Leena Guptha, and they promised to take this under consideration. As Leena pointed out, they have a lot of things that have gone wrong over the years, and they can’t all be rectified overnight. I do hope they change back to the NESL…in reality they are the same exams, but using the NCETM/NCETMB acronyms has lead people to believe they are Nationally Certified, when in fact they are not–they have simply passed a licensing exam given by that Board, but it is not a certification.

In another development, AMTA sent out a press release this week announcing their new policy of making chapter fees optional. Previously, each chapter has charged whatever they deemed fit for their members to pay. In my state of NC, that was $15…an amount that I found quite reasonable because our chapter rocks! We have a very active organization.

I heard through the grapevine a month or so ago that this had happened, so I went to the source. In a conference call I had with Bill Brown, Winona Bontrager, and Chris Voltarel, they confirmed that the Board of Directors had made this decision in an executive session at the annual convention held in Dallas/Fort Worth, which I personally felt was improper, but they stated to me that it was not improper because direct competitors were present in the open board meeting. I assume they meant representatives of ABMP. I accepted that explanation. The fact is, ABMP is trouncing AMTA when it comes to the membership numbers. AMTA has been around for 75 years. ABMP has only been around for 27 years, and according to their website, they have over 80,000 members. AMTA claims to have about 56,000, the last I heard, but I have heard rumors of lower numbers.

However, I did inform them that I had also heard that Chapter presidents were upset about it, and that a petition was rumored to be going around protesting the decision. The response was “we’ll cross that bridge when we come to it.” From my reports, the petition does exist but has not yet been sent to AMTA. Other than people grumbling about it on FB, there hasn’t been much said–maybe because most people just didn’t know. I made another phone call this week and complained because they hadn’t put out a press release, and that I thought the membership ought to be informed. Communications Director Ron Precht told me that members were being informed at renewal time, so they hadn’t put out anything about it, but apparently they changed their minds.

I posted the press release on my FB page a couple of days ago, and immediately got a few comments from people wondering if the chapters were going to suffer because of this move. I confess I am wondering myself. I hope not, but I have my doubts about the wisdom of this move. I reported on AMTA’s financial health a few weeks ago, and while they’re certainly not in any financial trouble as a national organization, I can’t speak to the financial health of the individual chapters.

One thing I can speak to is the fact that chapter money is used to pay lobbyists, among other things, and we need government representation now more than ever. The ACA stands to have an impact on the massage therapy profession. There are other things swirling from several fronts that could require legislative changes in many states, such as the Model Practice Act the FSMTB is working on, a continuing education paradigm shift that may or may not happen, and other things that government relations representation is clearly needed for. Although most chapters have a government relations representative, those folks are volunteers, and in all likelihood the vast majority does not have the same political savvy as someone who lobbies for a living. Here in NC, we were paying our lobbyist $20,000 a year the last time I looked. Experienced government relations people need to be on the scene anytime a sunset period is coming up, or anytime statutory changes are being considered. I don’t think the national office has the manpower to be everything to every state when it comes to that.

AMTA states in the press release that they will offer several new services to chapters, so they won’t be part of chapter expenses. And, if a chapter finds that it needs additional financial assistance to maintain necessary and high-caliber services to members, the National Board will look at providing funding. I hope they look hard at paying our lobbyists and not allowing crappy legislation to take over–particularly sunsetting a practice act.

One of the questions that arose on my FB page was what would happen to the huge donation AMTA makes to the Massage Therapy Foundation every year….usually that’s in the amount of $450,000. If they’re not taking it in, I don’t see how they can give it out. I certainly do not want to see the support for the Foundation fall by the wayside.

There are a number of people out there who aren’t going to pay any kind of fee that’s optional. On the whole, though, I think a lot of devoted AMTA members will continue to support their state chapters.

As a member, I have to say that I don’t think this was handled in the right manner. My own opinion is that instead of an executive decision that was made and then foisted upon us, the membership could have been surveyed, or at a minimum, the state chapter presidents polled. My guess is this we haven’t heard the last of this. I’ll take bets they’ll have to back up and punt.

The Financial Health of Our Organizations: NCBTMB

Thank you for your interest in my annual reports on the financial status of the major non-profit organizations of the massage therapy profession. I am not an accountant or a financial expert. This information was taken directly from FORM 990, the Return of Organization Exempt from Income Tax, which is published on Guidestar. This filing is for NCBTMB‘s fiscal year ending12-31-2012. Non-profits are on a different tax filing schedule than the rest of us.

This has not been a banner year for the NCBTMB. Revenues are down, no big surprise since they have been steadily declining every year since the MBLEx was introduced in 2007. During 2007, the revenue of the NCB was at an all-time high of $8,655,003. During 2012, the revenue was down to $4,616,227, a decline of over 4 million dollars in the past five years. If that isn’t the handwriting on the wall that it is past time for the NCBTMB to get out of the entry-level licensing exam business, I don’t know what is. AMTA, AFMTE, and ABMP have all supported the MBLEx as the licensing exam of choice. They just refuse to give it up.

In the past year alone, since my 2011 report, the examination revenue dropped over a million dollars. Recertification income actually went up by a little over $241K, but fees from the approved providers went down by almost $50K. Sales of their study guide for the exam is down by almost $33K as well. While sales of their mailing list remained stable at just over $40K, the revenue listed as “other” went down by $20K.

Executive compensation reflected then-CEO Mike Williams’ salary of $237,500, about $20K less than Paul Lindamood received on his best year. Board members at the NCB are compensated; the Chair during this period, Alexa Zaledonis, received $33,400. I won’t complain about that. In fact, I haven’t complained about any of the BOD compensation since the day Donna Feeley (now deceased) left office…during her two years at the helm, she got more than $100,000 a year. Legal fees were higher during Feeley’s term (2207-2008) than they have ever been before or since, hitting an all-time high of over $925K during her first term. That is attributable to a number of legal actions they brought against states who chose to use the MBLEx and to lawsuits from former staff members. During 2012, over $531K was spent on legal fees–my guess is for the same reasons.

Marketing and promotion, although it has gone down, seems to be disproportionately high to me, with $356K paid to their marketing firm, The Ohlman Group, and an additional $311K + spent on promotions and advertising. A little over $341K was spent on conferences and meetings.

The major expenditure is the exam administration fee paid to Pearson Vue, which is almost $900K. Another big expenditure is their rent, which is over $178,000–or almost $15K a month. I guess I am ignorant of real estate costs in the Chicago area, but it would have been smart a long time ago for the NCBTMB to purchase a property to house their offices; it may have been paid off by now or at least be building equity.

The net assets of the NCBTMB have declined by about $93K since last year, while their liabilities have increased by over $226K. The bottom line is, the NCBTMB has gone from showing a net of over $227K in 2011 to showing a loss of almost $174K in 2012.

I don’t think their losses are over. They have spent a lot of money during 2013 in rolling out the new Board Certification, which isn’t exactly setting the world on fire. I have heard the rumor that they appealed to the other massage organizations for financial aid at the recent Coalition meeting. As recently as a year or two ago, Rick Rosen and I were both calling on the FSMTB to offer the NCBMTB a financial incentive to get out of the entry-level exam business. It didn’t happen then, and it still has not happened. I doubt if the FSMTB is in any need of the NCBTMB’s test bank, and if they’re not, they really don’t have much to gain, if anything, by paying them off. Although the number of states that accept either the MBLEx or the Entry-Level State Licensing Exam from the NCBTMB are about the same in number, the public has spoken loud and clear about which exam is the exam of choice. The MBLEx is clearly at the head of the pack.

With net assets of a little over $2.5 million, the NCBTMB is not in immediate danger of closing the doors. Neither are they anywhere near being “in the money.”  Any organization needs cash reserves in order to survive–and they also need positive cash flow. If the NCB is going to survive at all, it’s just my opinion that they had better commence with the specialty certification exams and sooner rather than later. If they don’t get on the ball with that, someone may beat them to the punch. The problem is that it takes a lot of money to develop such things, and it looks like they may not have it. Time will tell.

Report from Seattle and Some Further Explanation

I was invited to Seattle by Dr. Ravensara Travillian to speak at a fund-raising dinner this past Monday night, to kick off her efforts to get a university-level certificate massage program started. Dr. Christopher Moyer was the other invited speaker, so I felt like I was, as we say in the South, “in high cotton.” I had a great time visiting with Ravensara and her husband Iain, and Christopher.

Most of our visit was spent discussing the project. Raven invited me on the basis of my knowledge of regulation and legislation, of what our massage organizations are up to, and the state of massage therapy education in the US. Prior to my going out there, I contacted some of our leaders to make sure I had up-to-date information on what’s going on with them. In fact, this week the Coalition (previously referred to as the Leadership Summit) is taking place in Florida…the CEOs/EDs and Chairs of the Boards of ABMP, AFMTE, AMTA, COMTA, FSMTB, NCBTMB, and the MTF are coming together to discuss the state of the union, so to speak.

I truly enjoyed seeing old friends and meeting some new ones that I had previously only met on FB, and some I didn’t know at all. I appreciate the fact that they came to hear more about this initiative. Good conversation was stimulated, good questions were asked. The speakers were videoed and that will be released in a day or two, so I’m not going to rehash everything that happened there; I’ll share the video when it comes out.

I particularly appreciated the presence of Bodhi Haraldsson, who is the Research Director at the Massage Therapists Association of British Columbia. Bodhi was appalled at my report on the financial status of MTs in the US, provided to me in the form of the Annual Report from the FSMTB. Their information was obtained by a survey of MTs in the member states, and compiled from surveys that were sent out by the AMTA and ABMP to their members, and the NCBTMB to their certificants. All in all, about 200,000 MTs were surveyed. The piece of news that shocked Bodhi was that 61% of MTs in the US say that they cannot support themselves/their families with their income from massage.  Only 2% of therapists surveyed stated that they make over $70,000. According to Bodhi, the five busiest therapists in his own clinic make more than that. Personally, I think that’s a direct reflection of the high standards of education and the devotion to research practiced by our neighbors in BC.

Ravensara’s plan to take massage education up another notch has been criticized by people who don’t understand what it’s about. No one is going to be forced into getting higher education. Since I said this was the report on Seattle and a little bit more, I’m going to seize the moment to repeat a little of what I said there and go a little in depth about the environment of massage. There seems to be a lot of confusion about many different things that are currently on the horizon. One of them is the Affordable Care Act, which contains the stipulation allowing massage therapists to direct bill insurance as long as they are licensed as health care providers in their state. I see the comments all the time that “I don’t want the government telling me what to do.” “I don’t want to get bogged down by the insurance companies.” The ACA does not mandate that anyone has to file insurance. If you want to run a cash practice, you can carry on as usual. Those who don’t want to participate in insurance billing should not interfere with those of us who do.

Another thing that seems to be confusing people is the ELAP (Entry Leval Analysis Project). As I have stated on my blog on several occasions, I had issues with the way that project was rolled out and the way it was presented. However, I do think it will turn out to provide valuable information, and we’ll all know on December 16, which Anne Williams of ABMP informed me will be the unveiling of the 776-page document.

I have seen school owners stating that they didn’t want more regulations telling them what to do and how to run their school. Again, this seems to be a point of confusion. The ELAP is a research project. Period. It is not regulatory in any way. No one will be forced to adopt whatever policy recommendations might come out of it, because they will be just that–recommendations.

AMTA, ABMP, and the AFMTE all have benefits and annual conferences for educators. They have projects going on to educate teachers in research literacy, as does the MTF. AMTA has teacher-track classes and research-track classes at the annual convention. ABMP has an upcoming class in teaching the teachers to write core curriculum. None of these organizations are regulatory. They can show you how to write your core curriculum, suggest what should be included in it, and show you how to teach research literacy. They can’t make you do it, or make you do it their way.

COMTA, which is a strictly voluntary accreditation body and the only one that was founded for the specific purpose of accrediting massage therapy, although they have now also taken in aesthetic accreditation, spells out standards for excellence in education. I hear from school owners that they don’t seek the accreditation because they don’t want anyone telling them how to run their school. The Standards are on COMTA’s website for anyone to see, and I think it would behoove any school owner to do their self-study report to see how you stack up. COMTA does not limit what you can teach to evidence-based modalities, which personally I find unfortunate, but if you’re using that for the argument against it, you’re wrong. If you are teaching belief-based energy work at your school, you’re free to carry on. They want to insure that you are teaching what you say you are teaching and that you are including the subject matter that matters to massage. They spell out standards for good record-keeping, good financial practices, insuring that teachers are competent to teach their subject matter, having and abiding by policies and procedures, and other such things, and they ask you to document it in writing. COMTA is not a regulatory organization. There are other accreditation bodies out there that take in massage therapy, among other things, and they are not regulatory, either. It’s a voluntary process that allows you to say “Here are the standards we have chosen to meet.”

Even the Federation of State Massage Therapy Boards is not regulatory, in and of itself. They are an association of the boards in regulated states. They are soon to unveil a Model Practice Act that they have worked on for the past few years, and they would like for the states to adopt. Notice I said “they would like for the states to adopt.” The purpose of that is to make practice acts uniform and facilitate reciprocity. It could require legislative changes in every state that already has a practice act, should the member states chose to adopt it. I don’t look for that to completely happen in my lifetime. I do imagine it will be discussed this week by the Coalition, along with the ELAP and other issues they are considering.

A couple of months ago, I sent the leaders of all the organizations my blog urging them to pool resources to get the NCBTMB written out of the statutes in every state. I am hopeful that topic will be discussed as well. The NCBTMB is not a regulatory organization–but their exams are written into the statutes in many states. That represents an improper delegation of authority; there is no government oversight and no public accountability there. This is not a vendetta against the NCBTMB; it is an attempt to rectify something that has been wrong all along.

Now I’m down to the function of state boards. I constantly get complaints from people about how long it is taking them to get their exam scores or get their license. There is no true reciprocity in the United States. The fact that you have a license in one state does not include any kind of guarantee that you’ll get one in a different state, regardless of how long you may have been practicing. Most state boards have it stated on their websites that processing out of state requests takes longer. My own experience in serving our state board for five years was that many times, a license is held up because the applicant failed to provide a piece of documentation. Sometimes, the holdup is that they have to check out your transcript to make sure your education in the state your are coming from stacks up to the education required in the state you are moving to. If it doesn’t, you can be denied a license. If you are lacking the documentation, you can be denied a license. They cannot take anyone’s word for it that “I have this, I have that.” If you don’t have the required paper trail of evidence, you’re not going to get it, period.

State boards are the ONLY regulating bodies in massage. They are the ONLY ones who can tell us what to do. The other organizations can suggest. The other organizations can lobby legislators to get laws passed or changed–and state boards can’t. State boards exist for one purpose: public protection. They are not here to serve the interests of massage therapists. They are not here to cater to us or to cater to schools. They exist to license therapists, to spell out the requirements for getting a license, to spell out what they expect from schools, and to deal with complaints from consumers.

I hope that clears up a few things for people. I see misinformation spread around on social media all the time, and all that does is perpetuate misinformation. If you are a massage therapist, you are obligated to know the law in your state. If you are planning to move somewhere, you need to learn the law in that state, prior to packing up and going there. I’ll go further and say that a board member recently said to me “I don’t know the bylaws and rules the way you do.” If you’re going to serve a board, then it’s your business to know them up one side and down the other. Ignorance is not bliss and it’s not an excuse, either. You can’t uphold the rules if you don’t know what they are. The burden is on you.

NCBTMB: At Least They’re Consistent in Bending the Rules

I’ll say one thing for the National Certification Board for Therapeutic Massage & Bodywork: at least they’re consistent in bending the rules.

The NCBTMB has a new Government Relations Liason, Billie Shea of Nevada. Shea has been a massage therapist for 14 years. She has previously served as the chair of  the Nevada State Board of Massage Therapy, and has also served as a delegate and later as a board member on the Federation of State Massage Therapy Boards.

I’ve pitched a few fits recently about the NCBTMB ignoring their own bylaws and breaking their own rules, and I feel compelled to pitch one more. The NCBTMB website announcement about Shea being hired as the new Government Relations Liason states that she has been Nationally Certified for 13 years. According to several of my sources, that is not true.

She was initially certified in 2000 and renewed one time before letting her certification lapse. I contacted Shea by email yesterday to ask her how she became Board Certified since she was not currently Nationally Certified, which is one of the requirements unless you are taking the new exam, and she responded to me that she had been contacted by the NCBTMB and offered the opportunity to become Board Certified early this summer. Her response stated that she forwarded my email to the NCBTMB so they could make a response, and they have not responded.

According to the NCBTMB’s website, there are two paths to Board Certification. One of them is to take the new exam and meet the other requirements, which include 750 hours of education, passing a background check, having 250 hours of work experience, and having a current CPR certification. The other path is to be CURRENTLY Nationally Certified under their old paradigm, and meet the new requirements.

Shea isn’t the only one who has been offered this deal; in my previous blogs about massaging the rules, I reported that two other nationally known massage therapists that I have known personally for years were both offered to be “grandfathered in” to the new Board Certification, in spite of the fact that their own National Certification lapsed about 7 years ago. They both felt it was an unethical offer since it violates the rules of the NCBTMB, and declined to do it.

So, bottom line, Shea has not been Nationally Certified for 13 years as it states on their website. That certainly doesn’t mean she will do any less of a job as their GR person, and since at this point in time I am of the mindset that my own Board Certification is worth about as much as a turd in a punchbowl, it’s no big deal to me. The big deal, to me, is the dishonesty about it. Why put a PR spin on something that is not true? Shea knows it, the NCB knows it, and why is it necessary to pad her resume? She has a long record of volunteer service and it wasn’t necessary at all. For the record, my own National Certification was current, and I did meet the other requirements for Board Certification. I was prepared to take the exam and actually somewhat disappointed that they decided to grandfather the current certificants into it instead of having us take it.
I would like to know why the NCBTMB approached well-known massage therapists who have been expired for years and offered them this “opportunity” to be grandfathered in on Board Certification, and why they feel that’s an ethical practice.

It doesn’t look good when an organization puts something out there, says “here are the requirements,” and then proceeds to blow those off in some self-serving interest. And it doesn’t look good when a therapist accepts that. In fairness, there are plenty of massage therapists who don’t keep up with the rules, including in their own state, much less at the NCB. However, I don’t think Shea falls into that category. She’s been involved in the governance of massage for many years, and if the NCBTMB hired her to be the GR liason, I’m sure they have confidence in her abilities. She ought to know better, and I’m sure she does.

If they are just going to grandfather anybody and everybody who has ever been Nationally Certified, then for crying out loud, just say that up front and be done with it.

Furthermore, I have the idea that there are board members at the NCB, and perhaps even Executive Director Steve Kirin, who do not even have any knowledge of all these surreptitious activities and who would not be in support of them. Whatever else I can say about them, I know for a fact that there are some ethical people there. Apparently there are also some who are not. I would hate to think it was a board decision to put forth requirements, and then throw in the caveat that “but we can ignore these rules for the choice few when it suits our purpose.” I’d rather believe that someone there took it on themselves to act in this manner, but the fact is, it has happened and someone needs to be accountable for it. I have to refer back to that pesky problem, once again, of Improper Delegation of Authority. This is the kind of thing that happens when there is no government oversight and no public accountability.

I will agree with one thing from the NCBTMB’s website: the statement that “a higher credential is needed in the industry.” I agree wholeheartedly, and they need to get it that this is the kind of thing that minimizes the value of the very thing they are trying to promote. Certification needs to mean something. Operating in this manner assures that it does not.

 

NCBTMB Seats New Board Members

The NCBTMB seated their new Board members last week. Bruce Baltz, who has served one term and was not even on the ballot for a second term, was tapped as the new Chair-Elect. Michael McGillicuddy, who was also not on the ballot, was appointed as a therapist member by the Board, and Teresa M. Matthews is filling the remaining therapist member seat. Dr. Stuart Watts has been named the public member.

I wish them all luck, and I feel that they’re going to need it.

To start with, it is my opinion that the NCBTMB is leaving themselves open to a legal challenge of any decision this board might make. I have maintained since his candidacy was announced that Dr. Watts was inappropriately put forth as a public member. I don’t personally know Dr. Watts, but as soon as I read his bio, my thought, and that of several other people who chimed in on my previous blogs about it, felt that he was suitably qualified to be a therapist member, and totally unsuitable to be the public member, based on the bylaws of the NCBTMB. He currently holds a license in two states, although the people trying to defend this decision have said he is retired, and he holds an office in another national organization, which is also against the by-laws, although I was told that he had agreed to quit that position if he was named to the NCBTMB. According to the current bylaws on the NCB website under 6.2 Qualifications. “No Director shall hold a national level office in another competing therapeutic massage and/or bodywork professional or trade organization” and further states………”A Director who is a public member shall not be a Certificant or a practitioner of therapeutic massage and/or bodywork within three (3) years of election, and shall have no material financial interest in the field of therapeutic massage and/or bodywork.” I honestly do not understand how the nominations task force thought he was an appropriate choice for the public member. To me, it’s a big “DUH!”

I also find it less than transparent that the press release did not say he was the public member, but rather put the spin on it that “he has worked for both practitioner rights and the rights of the public throughout his 40-year career.” On a regulatory board, the mandate is indeed to protect the safety of the public. However, this is not a regulatory board in spite of their numerous past attempts to appear as one, and a public member is supposed to represent the viewpoint of a consumer, not be an expert in the field. Watts appears to be an expert in the field with 40 years of experience. I don’t think he is representative of the average consumer and I defy anyone to dispute that. It sounds like splitting hairs, since I would have approved of him as a therapist member. My issue is that I don’t expect a therapist member and a public member to necessarily vote the same way. People have to remember that when you are serving a board, you are not supposed to just avoid a conflict of interest–you are also supposed to avoid the appearance of a conflict of interest.

I have briefly met Matthews a couple of times when I attended the FSMTA convention. She has been a school owner and instructor for 18 years. Baltz and McGillicuddy are both people I know and I am a big fan of both of them. However, I also question the way their appointments came about. Neither were on the ballot sent to certificants. The sudden departure of the previous Chair, Sue Toscano left a therapist seat empty that needed to be filled, so I will assume that was part of the reason. However, I am aware of several other people who had thrown their name in the hat for the election, and I do question that none of them were tapped to fill the empty seat. I have asked both Steve Kirin and Leena Guptha questions in the past about the election process, and they have both replied to me that they are not privy to the goings-on of the nomination committee.

I’ve been nationally certified since 2000, and it seems that there has been controversy on their election process many times….including one time years ago when I threw my own name in the hat. I was interviewed on the phone, and later notified that I had been chosen as a candidate. I was told to write a candidate statement and that it had to be X amount of words; I forget the number. When the ballots came out, the first thing I saw was that my own candidate statement looked ridiculously short compared to the others. I called them on the phone and asked why I was singled out for a short statement. Initially the person on the other end of the phone argued with me that I had misunderstood the instructions. When I sent him the email I had received from them proving my point, he had to back up and apologize, and said that I had received the first draft of the letter by mistake. He said “there’s really nothing we can do about it now.” I was not surprised when I wasn’t elected, because my statement looked idiotic compared to the other candidates. My attitude now is that it was a blessing in disguise that I wasn’t chosen; that particular regime was fraught with management trouble, board trouble, and lawsuits.

I have referred back to my own blogs from past years that had links to the NCBTMB website for the press releases that were put out about some of their major mistakes, and they have all been removed.

The NCBTMB has been dysfunctional for a very long time. Their financial revenues have fallen greatly since the introduction of the MBLEx. Their 990 for 2012 was just posted on Guidestar a couple of days ago and will be the subject of my next blog.

Dr. Leena Guptha stepped into the Chair position about a month ago. Leena is a positive person, and refers to herself as an ambassador for the organization. She has previously served as the national president of AMTA, and I have no doubts that she has the best of intentions. I have no doubts that the new board members, and any of the other people there have the best of intentions. I actually have no doubts that the immediately previous board and management had good intentions…but that has not yet turned things around. Dr. Guptha has stated to me that since she has a three-year term, she will have time to make a real difference and positive changes at the NCBTMB. Time will tell.

I feel that the NCBTMB is on their last chance to get it right. They do not have the financial resources to keep making mistakes. The PR spin that has been put on the new Board Certification doesn’t fly. People want advanced certifications in specific areas, and that hasn’t happened. Developing such things requires a lot of money, and I don’t know that they have it. Leena Guptha is organizing a Think Tank to gather input about the CE Provider program, and I initially agreed to serve on it. However, I’ve taken so much criticism for that in the past few weeks I have decided to back up and punt. I have publicly announced many times that I would not serve an another board as long as I am writing this blog, and even though a committee is not the same as a board of directors, people seem to be concerned that my impartiality will fly out the window. I had even stated to Dr. Guptha that my presence on the CE committee would not prevent me from blogging about them, and she said she didn’t expect it to. It’s a moot point now; I have withdrawn. Even though I am not on the board–it was one of those appearances of a conflict of interest that I referred to above.

I have also served on a previous CE revamping project at the request of Paul Lindamood. About 30 educators came together to discuss it, and the resounding theme was “go back to vetting the individual classes.” That advice has so far been ignored. Ergo, there are a lot of classes approved for CE that are in blatant violation of their own bylaws and that are an embarrassment to the profession and that should be an embarrassment to a board that holds itself out as “defining and advancing the highest standards.” Approving classes in flower fairies and shapeshifting  just doesn’t hold up to that mission statement. There is no need to wait for a Think Tank to start taking care of that situation; the new board needs to start taking care of it immediately.

As I said, I wish the new members luck, and I feel sure they’re going to need it. As always, you’re free to disagree with me; this is my blog and my opinion.