Report from the NCBTMB Approved Provider/CE Meeting

I just got back from Chicago, where I participated in the Massage Approved Provider Panel convened by the NCBTMB. I have to say it was one of the best meetings I have ever attended. Everybody left their egos and their agendas at the door…not one single moment of tension or dissension occurred, in spite of the fact that competing entities were represented.

I spent the weekend sitting next to Bill Brown, Deputy Director of the AMTA. I’ve heard through the grapevine that Bill has wanted to strangle me a few times over my blog, and I’m glad he got the opportunity to know me a little better. I might have managed to convince him that I have a few redeeming qualities and I’m not just the crazy blogger he thought I was.

Cynthia Ribeiro, President-Elect of AMTA, was also present, and what a class act she is. I had supported Cynthia during the AMTA election, and there’s no doubt in my mind that was the right move. She is one fine lady who has made many contributions to our profession, and had a lot to contribute to the task at hand this week.

Bob Benson, Chairman of ABMP and Anne Williams, Director of Education for ABMP were there. Bob brought his considerable business acumen to the meeting. I’ve worked with Anne before and she’s just a go-getter who shares my philosophy of “make it happen.” She has a great sense of humor, too. There was a lot of laughing this week, which is always a great ice-breaker and good for the cohesiveness of the group.

The facilitator, Drew Lebby, provided exactly the right balance of keeping things moving, listening, and explaining. We had breakout groups and larger discussions and the whole meeting just had a great flow. Having been in meetings with some very boring facilitators in the past, I thought he was wonderful and I would highly recommend him to groups who are looking for a great facilitator. He has 35 years of experience at it and it shows.

I heartily applaud the Federation of State Massage Therapy Boards for sending Kathy Jensen, VP of the FSMTB, and kudos to the NCBTMB for inviting the Federation to participate. Since the MBLEx has taken a huge chunk of the NCBTMB’s exam market share, and the Federation has also recently announced plans to jump into the CE approval arena, I can think of past administrations at the NCBTMB that would have spent the time sniping about the Federation as competition instead of inviting them to attend, all the more reason why I appreciate their willingness to play in the same sandbox. That theme was reiterated by Ribeiro and several others this week–this isn’t about your organization, or my organization, or who’s the biggest or the best–it’s about massage and increasing the quality of massage education.

COMTA was also represented by Commissioner Randy Swenson. Several state board members were in attendance, as were approved providers and a couple of nationally certified massage therapists.

The AFMTE was not represented, although they were invited to participate, and as a founding member of that organization I personally found their refusal to attend distressing. This meeting was about education, and in my opinion, they should have been there. I contacted Rick Rosen to give him the opportunity to explain their absence, and his response was that since the AFMTE has decided to partner with the FSMTB in developing their CE program, he felt it would blur the issue and divert their focus to attend.

Nice try, Rick, but since the Federation was invited, and in fact chose to participate in the meeting, I don’t buy it. The mere term “Alliance” suggests that you are representing education, and not just one faction of it. The Alliance could have made some great contributions to the meeting and you missed out on a good opportunity to do so. Rosen is of the opinion that the Federation should replace the NCBTMB and the individual states who do their own approvals as the only provider/CE approval entity. We’ll just have to agree to disagree on that issue.

No one has been a more vocal critic of the NCBTMB than I have in the past, and I have defended the right of the FSMTB to offer their competing exam, as I don’t believe that any entity is entitled to a monopoly. I will go further and say that I don’t believe any entity is entitled to a monopoly in any arena, so I am not in support of the Federation having a monopoly on continuing education. They have the undeniable right to jump into the market if they choose, and the marketplace will decide. I am personally not going to be dictated to of which entity I have to throw my CE approval business to unless my state makes it a law that I have to choose one or the other. I’m not going to hold my breath waiting for that to happen.

There are 42 member boards in the Federation and so far, although many states have voted to accept the MBLEx, and some have adopted it exclusively, many others have refused to throw out the NCB exams, and continue to give their licensees a choice in which exam to take. I believe the same thing will happen when it comes to continuing education. Some states will go with the FSMTB CE program, and others will continue to allow providers to make their own choice. It’s the American way. Furthermore, in many places legislative changes will be required in order to switch from one to another or add another approval entity, and we all know that legislation most often moves at the speed of molasses. That is also the American way.

There were a number of problems identified with the NCBTMB’s current system. For one thing, some providers have taken advantage of the fact that once they received approval, they could add on classes at will. Some have ignored the fact that there is a prohibition on classes that are based on a product they sell. Some have ignored the fact that there is a prohibition against classes based on religion and/or spiritual practices. Some have ignored the fact that they need to be genuinely qualified to teach in their subject area.

Bruce Baltz, an NCBTMB Board member, mentioned people who teach NMT techniques suddenly throwing in a class in lymphatic drainage needing to be looked at carefully…sorry, but your attendance at a weekend workshop does not qualify you to suddenly start teaching it yourself. The people who have been guilty of these offenses are going to have a little awakening when some of the changes to the program are implemented.

The suggestions for solutions were great and it was interesting to see that when we broke up into small groups to do problem solving, most of the groups were on the same page. Some of the suggestions included requiring providers to submit videos of their classes, a much stricter and more frequent auditing process, an improved evaluation process where students can go online anonymously and evaluate teachers and class content, a required online class for teachers themselves to improve instructor competence…lots of good ideas that the NCBTMB is going to consider and decide which ones to implement.

Every organization and individual at the meeting expressed a genuine interest in assisting the NCBTMB in this endeavor. Even better, they all agreed that all the organizations, not just a choice few, need to come together once or twice a year for the good of the profession. Bob Benson stepped up to the plate on that front and good for him for doing so…AMTA and ABMP can take a few swipes at each other, but in the final analysis, there is room in the sandbox and he knows it.

All in all, I thought it was a wonderful gathering of some of the best and brightest, with the intent of creating a positive outcome, and I was honored to have been included. Paul Lindamood and his team did a great job in organizing the gathering and assembling the best people they could get. And hey, any meeting that includes keeping chocolate on the table at all times does it for me.

14 Replies to “Report from the NCBTMB Approved Provider/CE Meeting”

  1. Laura,

    An important clarification is that the FSMTB is not a random organization arbitrarily entering the framework of CE approval. They are an association of state massage boards and regulatory agencies. Such agencies have had the provision of CE’s, specific to license renewal, thrust into their area of responsibility by state laws. As such, and as with provision of the MBLex, the states have an undelegatable responsibility to determine the adequacy of CE provision within the context of occupational regulation for public protection. That responsibility ends, however, when one goes into the area of CE’s apart from licensing, which would include CE’s as an aspect of specialty certifications. If we didn’t want the FSMTB to enter the arena of CE provision, then we should have kept CE’s apart from state laws and within the context of professional organizations and private certifications.

    NCBTMB, on the other hand, is a purely private entity. It does not have the constraints nor the responsibilities of state law either directly nor under contract to the state boards to implement their will. NCBTMB thus operates under different input and different concerns than the state boards. It also is free to address quality of CE providers in different contexts than that of the state boards and thus the FSMTB. I think it is important to distinguish that there are two different types of entities and that, in comparing them, one is not comparing apples to apples.

  2. That is a valid point, Keith.

    However, in MY state, and many others, the language in the Practice Act specifically states that an Approved Provider is “One who has been granted the designation of Approved Provider of Continuing Education by the National Certification Board for Therapeutic Massage & Bodywork” and changing that will require changing the actual statute. That is not unique to North Carolina. The CE approved by the NCBTMB has not suddenly become inappropriate just because the FSMTB started up five years ago and has decided to get in the approval business.

  3. Laura, I must correct a fact error that you made in the response to Keith Grant’s comment:

    The language you cite about CE requirements for Licensed Massage and Bodywork Therapists in North Carolina is NOT in the Practice Act — it resides in Rule .0702 of the Rules of the Board of Massage & Bodywork Therapy. As a just-retired member of that Board, you should know that changing administrative rules is a much easier and quicker process than having to go back to the legislature for a change to the statutes (laws).

    Without doing a review of all state massage laws, I can’t say precisely how many have the exact criteria for continuing education providers or courses listed in the statues, versus the administrative rules. I believe there are only a few.

    Once FSMTB has its new national CE approval program ready, it will be up to state massage regulatory agencies to make amendments to their rules, guidelines and/or procedures to adopt this new standard. I’m sure that FSMTB will provide guidance and support to its Member Boards in that all-important transition process.

  4. Laura – Well said! I enjoyed every miniute of the meeting. I can’t wait to see where we go from here. The next generation of CE is going to be a BLAST!
    I really enjoyed speding time with your in our break out session. I would love to run more things by you so we can make it work! You had really great feedback and now I have more to add to my previous idea.

    Lisa Cooper

  5. Laura,

    Here’s a response to provide additional perspective on why the Alliance was not present at the MAPP meeting:

    In January, the Alliance for Massage Therapy Education received an invitation from NCBTMB to attend a meeting of its newly-created Massage Approved Provider Panel. The express purpose of this panel, and the meeting that you and other industry reps just attended, was to revise and improve NCB’s existing approval program for continuing education providers. It was NOT promoted as a global summit conference on massage education. The fact that you and the other attendees may have discussed topics outside of the stated scope of this meeting is interesting, but it’s not a justification for you to heap scorn upon the Alliance because of its absence from this event.

    The Alliance Board of Directors made a conscious and informed choice to not get involved with NCB’s efforts, and instead has declared its intention to collaborate with FSMTB in the development of a new single-source approval program for CE courses and providers. That’s an example of setting a clear boundary.

    The structure of a profession is radically different than the open market system that results in the mix of products found on your local grocery shelves. In that domain, brands rule and preferences determines which products thrive. Coke vs. Pepsi? Consumers choose their favorite flavor.

    What is rightly called a “profession” is an occupational field that has done the long hard work to create a matrix that (most commonly) has the following components: 1) a single accrediting commission that accredits all educational institutions in that field; 2) consistent entry-level curricula and standards of practice; 3) consistent licensure requirements from state-to-state, which includes a single licensure examination — usually owned and administered by the federation of regulatory boards of that given field; and 4) where continuing education is required for renewal of licensure, there is a single agency that administers an approval process for CE providers and/or courses.

    Competition may be “the American way” as you put it, but that open market ideal is not germane to the very specific way in which professions are structured and administered in our country. You’re mixing metaphors here, and that point of view is part of what is keeping massage therapy from being able to progress towards becoming a bona fine profession. We’re not yet there, and mere repetition of the term “profession” does not make it so.

    The Alliance does not want to see multiple approval systems on the landscape for continuing education. NCBTMB has held this function for a number of years, but it’s time to allow the structure to mature past that limited solution. A number of states have already left that process behind, and more are just waiting for the opportunity to adopt a new and improved approval program sponsored by FSMTB.

    Separate from the MAPP process, we would be happy to gather with other stakeholder leaders in our field to discuss the future of massage therapy education. That would be a very different kind of meeting, not held under the banner of NCBTMB.

  6. Rick,

    I have always admired your ability to recall legislation, interpret it, explain it, and quote it off the top of your head, and I still do, so thank you for correcting my boo-boo on the rules vs the practice act issue. You’ve had a few years longer than I have to be good at it.

    If you can take my saying that I found it personally distressing that you refused to participate in the meeting in spite of the fact that you were invited, and that I said you missed out on a good opportunity to participate in a meeting which you could have made some great contributions to, a decision you made based on your intent in collaborating with the Federation when THEY in fact chose to be there, and that I said we would have to agree to disagree, and call that “heaping scorn ” on you, I will have to state that you are getting some exercise jumping to conclusions.

    We didn’t have a “global summit” on education, although education in general got included in the discussion as a matter of course during the evolution of the dialogue process. If you had been there, you could possibly have thrown out the proposals in your white paper, since it does contain proposals that are directed at continuing education, and garnered a little support for it–or not! It seems to me to be in keeping with the nature of the discussion on the whole. The NCBTMB was asking for help in finding solutions to a problem. People showed up and gave it. Everyone had the opportunity to give their opinions whether they agreed or disagreed with the other people there. I daresay you would have been paid the very same polite consideration.

  7. Laura –

    Normally we are on the same page or close and I truly appreciate your work on behalf of the profession. However, if all it takes is chocolate on the tables to get your raving, blanket approval, kudos, and accolades and anyone who choses not to attend the party gets your scorn, you have lost most of your creditability with me.

    I too am a free market advocate and I am not a proponent of monopolies. More on that later. However, professional regulation is by definition the granting of a monopoly. Licensed professional healthcare practices are monopolies, granted by the State. At this time the granted monopoly of massage is a disorganized patchwork quilt that is holding the profession back in its professional development. A certification agency, which was created to be a voluntary certification credential got sidetracked into being a testing agency for licensure and created a nightmare of a CE provider approval process. The MBLEx was created out of a desperate and actually legal necessity. That same legal necessity requires the consolidation of CE provider approval, as Keith eloquently points out above.

    Personally, as a CE provider since before there was a NCBTMB, it is becoming extremely difficult, time consuming and expensive to meet all the CE approval processes that are popping up. Several states have just legislated their own processes, and if this keeps up we are going to lose portability in the CE provider market. This is being driven by two things, money (sadly) and the inadequate NCBTMB process. The MAPP meeting is in my opinion an attempt at re-arranging of the deck chairs on the Titanic and other than a Kumbaya feel good experience, will serve little to move the profession forward. All the things you mention are just adding more layers of administrative complexity and probably expense to an already flawed process. The NCB approved provider process does not determine if someone can teach their way out of a wet-paper bag; never has. It only determines if they can fill in a ridiculous amount of paperwork and pay a fee. Virtually anything has been approved. Techniques and practices that say they are not part of massage, have nothing to do with massage, and are not in the scope of massage are still approved as CE Providers for massage. At one point I had to write out the procedure I would use to fire myself and discipline myself. In the later case I decided to with-hold lunch on Sundays. State Boards are put in embarrassing situations of being forced to accept out of scope CE hours, or selectively reject providers after accepting the program, which causes confusion and much angst.

    It is time for NCBTMB to get on with its intended purpose – providing a voluntary certification credential(s). The FSMTB should handle license testing and CE approval for license renewal. This would be consistent with other healthcare professions and will be a real step toward getting some of the much desired respect from other professions. NCBTMB can chose to maintain a separate approved provider process for its certificants if it choses, although for the good of the profession and for providers one central approval entity would be much better. Yes, this will take time to develop and implement, but a vision to move our profession forward needs to be in place and worked toward. Reinforcing a faulty structure helps no one except that structure and postpones the true advancement and development of massage as a true healthcare profession.

    Oh – and while I am not a fan of the current allopathic based regulation system for healthcare and truly believe there should be no licensing of any profession, if we are going to play the game, and since we are in a regulated society we must, we should play it right. MAPP is not a step in the right direction, but I am glad to hear that at least they have lots of good chocolate.

  8. Ralph,

    I hate to hear that the fact I applauded chocolate on the table cost me any points with you. I know you are against licensing, and I respect your right to that opinion. I disagree with you on that, and I’m relatively certain Rick would disagree with you on that, but it doesn’t make me think any less of you. My comment on the chocolate was just meant to be a light-hearted remark. If I was at any meeting that had chocolate on the table I would enjoy the chocolate, whether I enjoyed the actual content of the meeting or not.

    I will look forward to seeing how the FSMTB handles their process of CE approval. If every class is going to be vetted, not just providers, which is the direction I feel they will go in, it’s going to require a lot of staff and therefore cost money as well. I don’t think any of us expect the process of being approved as providers to be free, do we? Someone has to be paid to handle the paperwork and the time involved in the approval. Maybe their process will be much better, and/or more efficient. Maybe not.

    If every state suddenly drops the NCBTMB and goes with the FSMTB CE approval process, the Federation will need to move to a bigger building and hire a lot of people to handle the inundation. Will they only approve evidence-based practice classes or those that are taught by people with a master’s degree in education? Are they going to leave out the energy work classes altogether? Or any class that can’t be backed up with hard science? That will certainly cut down the work load by putting a lot of providers out of business. Will the FSMTB personally come and observe every teacher to see if they can indeed teach their way out of a paper bag? How will they know if they don’t? Whatever does happen, I don’t expect any of it to be perfect. Nothing ever is.

    And while I am personally in favor of being viewed as a healthcare profession, not everyone is. Is the person providing chair massage in a mall a healthcare provider? Or the person doing Swedish massage in a hair salon? There are just a whole lot of people out there practicing their version of massage who don’t care a whit about that label. That doesn’t mean they aren’t providing a valuable service, but where do they fit into the healthcare scheme of things? Or even the “profession” scheme of things?

    Things are evolving here, that’s about the only certainty to me. As one of the grandfathers of massage, and I mean that as a compliment, not a commentary on your age, you’ve seen it all unfold over the years. You can personally vouch for the fact that nothing that’s happened so far happened overnight; it has been a slow and sometimes very painful process, and it will probably continue to be for some time. I think solutions are easier to get to when everyone sits down at the table and presents their case face to face in a civil manner. If you don’t come to the table, then you just miss that opportunity.

  9. I appreciate the blog post-and I certainly appreciate and understand the positions articulated by so many of my esteemed colleagues. In reading this thread, I must admit that I’m more than a bit concerned…mostly with the tone. What I took from the blog more than anything was that a group of people came together and worked through a process. Many of these people have, and in some instances continue to be at opposite ends of many positions, and yet, the tone was civil, the intent was good and the outcome was positive. I’m reading posts from Rick and Ralph-AFMTE Executive Director an Board Member….and Keith Eric Grant who is so brilliant that I would jokingly call him a “rocket scientist”….except I think he is! The credentials, respect and history that these three men have in this industry is not only impressive, but the combo has certainly affected and improved the massage therapy profession as a whole. In recent years, the organizations of this profession have, in many ways, retreated in their corners—focused on what “they” thought the profession should do/be/act, etc. All the while forgetting that their opinions on what the profession should do/be/act has in many ways NOT been supported by the professionals in which their organizations are supposedly representing. I’m no one special. I’m no rocket scientist. I’ve yet to write a white paper and it’s doubtful that I will write massage texts or travel across the country for 20+ years teaching massage. I am, however a massage therapist. I walk among the professionals. I hear what their struggles are and I listen to them.

    They say and I agree that we are sick and tired of our organizations feuding and spending so much energy on deciding who is right and wish that they would spend half the time focusing their energy on listening to the professionals. Enough already….

    Michael-thank you for your comments. You train the future of our profession and I appreciate the fact that you’re more interested in the fact that the organizations that participated in the AP/CE event came together and worked together. As a former school owner, I had to face many students and answer many questions about the behaviors of organizations for nearly 15 years. I applaud this direction and thank you for your well stated comment.

    Lisa-on behalf of many, many professionals out here—thank you for participating in this work and thank you for your enthusiasm. Despite several of the comments made in this thread, there are many, many more of us who are more motivated by positivity and enthusiasm. Be true to this work, keep us informed, ask us for help and consider our responses.

    Laura-We’ve agreed, disagreed, agreed to disagree. I’ve had many conversations with you both online and offline and I have consistently found you to be true to yourself, true to the profession and able to keep an open mind. I doubt there is anyone else in the entire massage profession that has had more conversations, more interactions and has spent more time listening to, talking to and responding to emails from therapists and schools all across this country. You certainly do not need my validation, but you must know that your positive feelings regarding these groups coming together is precisely what the professionals want.

    I didn’t hear of any concrete plans being made. I’ve heard of nothing being written in stone. It may turn out that what NCBTMB and this group produces may or may not be what the professionals desire. Until I see something as a “rule, policy, regulation” whatever….I have nothing to agree or disagree with. My mind is open.

    “….but that open market ideal is not germane to the very specific way in which professions are structured and administered in our country…..” I’m not all that impressed with the way that many things are structured in this country—and I’m less than pleased with the way they have been administered. I would prefer a system in which the open-market decided…..this is, after all, America.

  10. Laura

    I do not believe in licensing in principle. However, I am a very practical guy and the practicality of it is we have to play the game. So, in the real world as it exists today I am fully in favor of licensing and have worked very hard to try to bring about good legislation for the profession. I was a founding member of the IA Board and served as Secretary and Chair over 8 years. I led the legislative effort for Iowa and several later legislative efforts to upgrade the Iowa law, including exemption from sales tax. I have consulted with several states and helped them pass legislation, so I am not against licensing.

    I also like chocolate. I’ll try to bring you some to the WMF. Tough time of the year for it though. Doesn’t travel well in the summer.

    In principle I am against approving CE providers. I think the market place can do a fine job of it. New Mexico gave up approving courses due to the administrative burden and there has been no measurable endangerment to the public noted. Massage is quite healthy there. Of course reality is, there will be an approval process as it is part of the “system.”

    I suspect any process by FSMTB will allow for the full scope of the profession, so don’t jump to extremes like only MA’s and hard science will get approved. There is no basis to make such accusations or speculations. The transition will be gradual and will take some time. FSMTB will be able to handle staffing problems just fine, there is lots of office space available these days and people looking for work.

    Of course I do not think any national approval process will be free. However, multiple processes are the other extreme – expensive and time consuming. I think you are picking some pretty extreme examples to throw against the new FSMTB CE process. Is NCB going to start doing all that as a result of the MAPP meeting?

    As for the healthcare title, where the chair massage and salon therapists fit in is under relaxation and wellness. Absolutely a valuable service. Absolutely healthcare, title or no. So are you implying they should not be licensed and have no formal training requirements? Good relaxation/wellness massage is just as much an art as clinical work. I think the wellness therapists belong at the entry level. Then, if more credential is needed, that is what certifications programs should be for. That is what NCBTMB should be doing; establishing the next “tiers” through a general certification credential and speciality certifications. This keeps licensing accessible to all and keeps entry level regulated while allowing the clear recognition of therapists with advanced skills. This too will take time to accomplish.

    I too am in favor of the various organizations sitting down together, preferably with chocolate, and working together for the good of the profession. It is a fabulous group of people to be around. The MAPP meeting, to my understanding was not promoted as any such thing, it was to gain input to revitalize the NCB CE Approved Provider process. If it spontaneously evolved into something greater and good has come of that – cool.

  11. Laura,

    I understand you point about current rules or laws and I still believe that the massage profession needs greater awareness of the regulatory context. When something is required for licensing, be it an exam for applicants or approval for providers of required CEs, relying on a purely private entity is problematic. It’s problematic from the private organization having priorities and agendas inconsistent with regulatory needs and it’s also problematic from the aspect of use of fees. About the time the the FSMTB was being formed, I wrote one of those white paper thingies (waves at Angela) discussing some of those issues.

    As Ralph suggests, it will take time for everything to fall into place, but I do believe that a mandatory regulatory process needs to be separated from the control or partial control of private entities.

    As a side note, California certification is handled by a private organization 501(c)(3) created specially by law for that purpose (CAMTC). The major reason that this could be done is that the certification, at least at the state level, is voluntary. I think a lot of people don’t realize that moving to licensing would require disbanding CAMTC and moving regulation under a state massage board or a regulatory bureau of the Dept of Consumer Affairs. Given the state of CA fiscal affairs, that scenario would be a nightmare of staff hiring restrictions and travel restrictions. (shudders)

  12. I also wanted to bring up the meta-discussion of the role that state laws should assume versus that of professional and other non-state organizations. This is in the context of the medical and other health care professions taking a deeper look at and distinguishing between requirements for CE’s and having a process of Continuing Professional Development. What falls under a state’s mandate to license for the protection of the public versus the organizational role of development of the profession? What’s effective in improving practice versus what falls flat in that regard?

    I’d encourage looking at the Institute of Medicine’s report on Redesigning Continuing Education in the Health Professions.

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