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.

 

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.

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. 

 

 

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.

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.

Blowin’ in the Wind

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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.

 

 

 

NCBTMB: New Plans for the Future

The National Certification Board for Therapeutic Massage & Bodywork has announced several bold new initiatives for moving the organization ahead. It’s no secret that the NCBTMB has had their ups and downs. The immediate past CEO, Paul Lindamood, had a lot to do with bringing them back from the brink of financial disaster that was caused partially by the MBLEx cutting drastically into their exam income, and partially by a previous administration that seemed hell-bent on bankrupting the organization. In a press release dated March 14, the organization outlined their new directions:

— Beginning in the first quarter of 2013, NCBTMB will end its existing National Certification credential, and will replace it with a new Board Certification credential. This will require passing the new Board Certification exam, which has Eligibility Requirements of 750 hours of education, 250 hours of hands on work experience and passing of a background check. Additional qualifications may be added, based on feedback from the profession. This will elevate the value of “certification” to a true post-graduate credential as opposed to the entry-level status it has held since its inception.

— In the summer of 2012, NCBTMB will launch a new online portal where all interaction with NCBTMB can be accomplished. including applications for all exams, recertification, approved providers, school reviews and payment for all NCBTMB services and products will be accomplished through this new portal. This will streamline their operations and cut down on the amount of time involved for all concerned.

— Beginning in the summer of 2012, NCBTMB’s continuing education approval program will also require courses to be vetted, along with CE providers. Providers will be required to submit their qualifications to teach each course. Previously, once a provider was approved, they could add on courses at will, which has caused some problems with people teaching subjects they are not truly qualified for. There has been some abuse as well concerning inappropriate course content, such as people creating a course just to sell a product they’ve invented. I attended last year’s meeting held by the NCBTMB for the purpose of gathering input and suggestions on how to improve the CE program, and vetting individual courses was at the top of the wish list. It’s good to see them listening and taking suggestions.

— Effective immediately, the current online practice exam is discontinued. In the summer of 2012, NCBTMB will launch a new online education resource offering thousands of questions to help candidates test their knowledge of many specific areas of practice. The old practice exam only had 65 questions, so this is a vast improvement for testing candidates.

— Licensing Exam. The NCETM and NCETMB, currently accepted for licensure in thirty-nine states, will be retained. The exam may now be taken at any time prior to graduation; however, formal notification will be released only upon proof of graduation from a minimum 500-hour massage therapy program. State licensing requirements are dictated by the individual states.  Since most of the existing massage licensing boards in the US have now joined the Federation of State Massage Therapy Boards, and the official line from that organization is to urge all states to exclusively adopt the MBLEx for licensing, this particular move keeps the waters a little muddy.

Since the creation of the Federation of State Massage Therapy Boards and the exploding popularity of the MBLEx, the NCBTMB has found themselves in a difficult position, and not just financially. For about 15 years or so, the exams from the NCBTMB were the sole path to licensure almost everywhere, except in a few states that had their own exam. In states that had no licensure, National Certification has been used as a credential to set educated and legitimate massage therapists apart from the “massage parlor” workers.

With only a few states left that aren’t regulated, most of which are working towards adopting regulations, the MBLEx will probably be used as the licensing exam if and when it does happen. The MBLEx is an entry-level licensing exam. By the NCBTMB’s own admission, the NESL exam they have used for licensing is the same exam they have used for certification–the only difference being the name of it– that has up to this point been a somewhat confusing state of affairs. The NCBTMB is currently seeking item writers and planning to beef up the new exam, so we’ll see which way that goes. In light of the new requirements for National Certification, I think it would make sense now for them to get out of the entry-level licensing game altogether and let the new credential truly mean an increase in value to those who seek a higher credential.

In a paper he authored in May 2011, The Optimal Role of National Certification in the Field of Massage Therapy, Rick Rosen, the co-founder and former Executive Director of the Alliance for Massage Therapy Education, stated the following:

….national certification at the entry level has been rendered unnecessary and redundant as a first credentialing step. To advance the field of massage therapy towards full professional status, NCBTMB must relinquish the task of entry-level credentialing to state licensing boards via the MBLEx. In place of its existing program, NCBTMB has an excellent opportunity to upgrade and repurpose what has been called “national certification” to a graduate-level credential. Decoupling certification from licensure would bring NCBTMB back to its original mission as the provider of a truly voluntary program that allows experienced practitioners to distinguish themselves through testing and demonstration of continued competence. That’s what certification was designed for.

Well, it’s great that NCBTMB has finally listened to what Rosen and other leaders in the field have been suggesting for a number of years.

I spoke with CEO Mike Williams and Board Chair Alexa Zaledonis last week to get a few questions answered, namely what has happened to the much-touted plan for an advanced certification. Williams and Zaledonis stated to me that the NCBTMB has cast aside their former plan for the N-CAP (Nationally Certified Advanced Practitioner) exam, based on negative feedback from the profession. I had personally been in favor of the N-CAP; however, I think the new credential is ultimately a much better solution. Another of Rosen’s statements, “Our field would benefit significantly from having a “generalist” credential that is available to massage therapists who have achieved a designated level of professional experience and continuing education beyond their foundational training,” seems to bear that out.

I don’t believe true licensing portability is ever going to happen in my lifetime. I am not sitting around holding my breath waiting for our organizations to all get together and sing Kum Ba Yah, although that would be nice. Turf wars are not a pretty sight, and the one between the NCBTMB and the FSMTB is no exception.  Both organizations have something to contribute, and they just need to get clear on what that is and to conduct themselves in a transparent and professional manner and in the spirit of what is good for the profession on the whole, not just what is financially lucrative for one organization. The recent MOCC proposal from the FSMTB that I have been reporting on recently would be financially lucrative for them, and that’s the only good thing I can say about it. To ignore the organization that has administered most of the continuing education for massage therapists in the country for the past 20 years is a political move that is, in my opinion, aimed at taking more money from the NCBTMB in the hopes of eventually crippling them altogether.

I remember the dark days when I had to report on the shenanigans of some of the previous leaders of the NCBTMB, and the Federation seems to be forcing me to do the same to them with some of their recent actions. I was gratified last week to see AMTA shoot down the MOCC proposal on more than 20 points, while ABMP President Les Sweeney spoke out in favor of it. It will be interesting to see if they have a response to this new plan from the NCBTMB.

Rick Rosen: A Job Well Done

Rick Rosen, MA, LMBT, Founder and Executive Director of the Alliance for Massage Therapy Education, announced last week that he will be stepping down from that position effective November 30.

In his letter to Alliance members, Rosen stated that he is returning to his full-time duties at the Body Therapy Institute in Siler City, NC. He founded the school in 1983 and has co-owned and co-directed it with his wife, Carey Smith, for the past 20 years. Their beautiful school and 150-acre property is for sale, and they intend to move permanently to their new abode on the Big Island of Hawaii whenever it’s sold.

Rosen has been a massage therapist since 1978. There are very few people in this profession who could claim anywhere near the amount of hours he has spent volunteering his time, and working for the evolution of massage therapy – both on the legislative and educational fronts.

I first met Rosen in 2000 when he was a founding member and the first chair of the North Carolina Board of Massage & Bodywork Therapy, a position he held from 1999-2003. He was very instrumental in getting massage regulated in our state and in assisting the Board’s legal counsel in drafting the administrative rules and statutes. As a former Board member myself (2006-2011), I appreciate fully the countless hours of unpaid work, and imagine that to be so much more for a start-up Board.

Rosen has always had a fondness for getting in on the ground floor and helping to lay the foundation for the future success of organizations. He also served as the first Executive Director of the Federation of State Massage Therapy Boards (2005-2006), and wrote the Request for Proposal that led to the development of the MBLEx as the licensing exam of choice.

In 2009, Rosen hand-picked some seasoned educators to help launch the Alliance for Massage Therapy Education. Under his leadership, the AFMTE has made its mark as the stakeholder for education among the professional organizations. Recently, the ACCAHC Board of Directors invited the Alliance to join its Council of Colleges and Schools as the designated education representative for the massage therapy field, further solidifying the Alliance’s role. Not bad for an organization only two years old.

Rosen’s school was the first to offer professional training for massage therapists in the Carolinas, and the first to offer post-graduate training. BTI was also the first school in the Carolinas to receive accreditation from the Commission on Massage Therapy Accreditation. He has presented massage education all over the country and in West Africa. He has been a professional member of AMTA since 1983, helped form the AMTA-NC Chapter, and was Chapter President from 1985-1987. He has authored a number of white papers, and was a contributing author to TEACHING MASSAGE: Fundamental Principles in Adult Education for Massage Program Instructors, published in 2008 by Lippincott Williams & Wilkins.

Rosen’s pioneering contributions to this field over the past three decades have been many, and often unsung. In fact, I contacted him and requested a copy of his resume before I wrote this – and I could write a book about all the things he’s done in the arenas of bodywork, education and government relations that I had no idea about.

I gave a list of “kudos” and “thumps on the head” in a recent blog, and I had included a kudo to Rosen for starting the AFMTE. I’ll repeat that here, along with an additional word of thanks for all he has contributed to the massage therapy profession. It’s been a job well done.

Rosen shared with me that he is leaving the door open to future teaching, writing and consulting projects that can continue to advance the field. I’m curious to see what he gets into next!