Licensing Portability: Not in My Lifetime

I get at least two or three questions a week from massage therapists who intend to move to another state–or horrors–have already moved and found out that they can’t practice massage in their new destination. It’s a sad state of affairs. That’s particularly so when the person has been practicing 20 years or so, but they either a) don’t have the proper amount of education, b) haven’t taken the exam required in that state or c) both of the above. As a former state board member who served on the license standards committee, I also spent a lot of time reviewing those applications for “licensing by endorsement,” a procedure that we had in place to address that issue. Sometimes people get licensed; sometimes they don’t.

We have kind of  a weird situation in North Carolina. Our state no longer accepts the National Certification exams for entry-level licensing. We exclusively accept the MBLEx, unless you’re moving in from out of state and you’re already Nationally Certified. In that case, you don’t have to take the MBLEx, but you do still have to prove that you’ve had the proper amount of education. It’s strange to me that the NCBTMB exams are considered okay for citizens from out of state, but not our own citizens.

There are still many states that have the minimum 500-hour education requirement. My state does. However, we’re picky about how that’s broken down. If your 500 hours from out of state doesn’t match up to the breakdown of our 500 hours, you can be refused a license until you bring yourself into compliance by taking additional classes at a community college or through continuing education. While moving is a choice for most people, I feel particularly bad for those therapists who are moving with a military spouse and not able to get licensed in their new state without jumping through a lot of hoops and going to a lot of expense.

The Federation of State Massage Therapy Boards is working towards portability, whatever that means. They would like for all member states to adopt the MBLEx exclusively, and some have. Other states continue to give applicants a choice, and a few states have their own exam. There isn’t any consistency in the number of hours of education that’s required, nor in the breakdown of those hours.

I reposted both of Ralph Stephens’ editorials on “Challenging Sacred Cows” on my Facebook page, where they attracted a lot of comments. Ralph and I have sometimes disagreed and agreed to disagree, but I do agree with some of the statements he made in these articles…namely, that the education hours required for licensing are arbitrary and not any guarantee of competence. The examination system isn’t without flaws; nothing is. The fact is that some people are good at memorizing facts, and good at test-taking, and some people aren’t. Currently, though, it’s the only system we have, and one that is used in nearly every licensed profession.

Last year at the 2011 meeting of the FSMTB, a delegate posed the question, “Who thinks portability is a myth?” I would estimate there were 120 or so people in the room, and if memory serves, myself and one other person–who happened to be a member of the FSMTB Board of Directors, raised our hands. Everyone else was either holding on to the promise of future portability, or they just didn’t want to publicly state that it isn’t going to happen.

In order for portability to work on a nationwide basis, there has to be a nationwide agreement on what’s acceptable in the way of required education and required examinations. It’s as simple as that. In the meantime, massage therapists will continue to have a struggle to cross state lines.

11 Replies to “Licensing Portability: Not in My Lifetime”

  1. The hour thing has to go. If we can agree on a set of core competencies, and the elements of those competencies, we can ditch the hours. There may be other educational fields that use hours, but I don’t know of any.

  2. The schools need to educate students regarding the challenges of licensure from state to state, province to province, and country to country. I find the lion’s share of prospective and eager massage therapy students have this lofty dream that they can lean massage, and be a traveling massage Gypsy… and do massage anywhere. Not. So. Much. We need to educate them about the reality of the profession.

    I’m extremely grateful for the regulation and legislation of massage. This prevents those folks who took a weekend workshop for massage therapy to appease their foot fetish from being able to work with the general public, charging what well educated and ethical therapists charge.

    I do have to say, it has always been a real mystery to me how you can test for massage proficiency with a computerized exam? Weird. Back to the schools…we have to make sure our graduates are worthy before we sign those diplomas!
    My understanding is the reason this Federation exists at all is due to the untimely responsiveness of the National Board and the frustration that ensued by the state boards. There was a period there where the NCBTMB was pretty dysfunctional at the administrative level. My recent experience is that has shifted, and they are on top of processing now. As for the Federation, they are young…and evolving. I love both of these organizations. In the end, I challenge my graduates to “stack” their credentials and do their research so that they don’t end up in a pickle. Its bureaucracy… and we have to be smart and not assume things are going to be easy to negotiate. Thanks for your post Laura Allen.

  3. I believe years as a therapist should be considered also. It makes no sense for a person to be a therapist 10 + years and have to jump through hoops

  4. I think the recent events in Iowa is an excellent example of why portability is going to be an incredibly difficult task for this profession. Collectively, the profession cannot even agree on a definition of massage. We consistently “exclude” specific energy workers, etc., and by doing so we give them a voice in legislative decisions. Our respective organizations expect us to applaud, simply because they can get together for a weekend and not sue each other or argue. We could point the finger at ignorant legislators, organizational leaders, etc., but the real issue is that (generally speaking) our profession is apathetic. The vast majority simply doesn’t care. If they did, they would use their voice, hold their organizations accountable, hold their representatives accountable and demand respect. Of course, you have to respect the profession first, and that’s a topic for a different day.

    As a former nurse educated in Missouri but practiced in Illinois (border state reciprocity) “true” portability did not exist. In Missouri I could do “x,y and z. In Illinois, I could be fined, sanctioned or charged for doing the same.

    Frankly, I’m curious as to the amount of resources that are continually poured into portability..certainly a ton of human resources, and likely quite a bit of financial resources. Just how many massage therapists out of the approximately 270k actually move from state to state? I wonder what would happen to the profession if those resources were allocated to strategic partnerships with other HCP’s? Business skills? What if those creative minds were looking for ways to help MT’s earn a living…what about health insurance??? Now THERE’S an idea.

    Portability on the surface seems important. Personally, I’d like a way to differentiate myself as a 17+ year veteran with specialization experience, etc., from the new graduate. I would like to offer clients the option of billing insurance and not having to explain that insurance companies do not really consider us as a billable option.

    I’m sick and tired of this profession “safely and softly” creeping along. MT’s need to financially survive. People need our services. Other HCPs need our assistance on their team of providers. And we’re focusing on this? How about a scope of practice first? What are we trying to make portable???? Chicken before the egg????

    (Sorry for the rant but I’ve just spent the last few hours in a hospital emergency room and I’m a wee bit disgusted.)

  5. Great post, Laura! Though it’s not what most people would like to hear. I’m afraid you’re right: I don’t see this happening any time soon.

  6. The problem is that there is so very much diversity under the massage category.. Its a huge all encompassing field… I got a taste of the problem thirty years ago when I first got licensed… I trained under a shiatsu therapist… I studied shiatsu… for eight months I worked on the floor(2″futon), without oil, practicing my shiatsu massage… the clients had clothes on… But when I had to get my license in Hawaii.. I had to use oil and work on a table, the clients were nude… I just wish they would make some basic knowledge test for all soft tissue workers.. Then as we move from state to state, we simply pay a fee in order to practice… that way the states get their needed fees, and we can do our work to help our clients… Its a mess now…and the weird thing is brothels operate under the same license I work under now… the system needs radical change…something with a little more common sense. Put me in charge…and I will change things… Who is in charge anyway?

  7. You are correct Laura! As long as every state has a Governmental Relations Group, each with their own mindset, it will never change. Opening Massage Acts, in states should, only be allowed during certain times or/and every state therapist should recieve notice as such. When only certain associations or individuals get the Practice Acts open/effect them and without consulting therapists, it’s wrong. Those doing it should be acknowledged.

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