NCBTMB Making Major Changes to CE Provider Approvals

Disclosure: I have agreed to pass along comments, questions and concerns to the NCBTMB on this matter, and the management there reads my blog. They are fully aware that I use this blog to express my own opinion whether it is in line with theirs or not. Your comments here will be seen by the CEO, Mike Williams, and the Board of Directors.

The NCBTMB has announced major changes in the works to their Approved Provider program for continuing education. You can read those here.They have also set up a page for Frequently Asked Questions about it, and you can read those here.

As soon as they sent out the press release I started getting emails and FB messages from people asking questions about it, some applauding it, and some complaining about it.The biggest change is that they will no longer be offering organizational approval. Every individual who teaches a continuing education class will need to obtain individual approval as a provider. That’s going to affect a LOT of entities: AMTA, the American Massage Conference, massage schools, and other organizations who have previously been able to take people in under their umbrella.

It’s affecting me, personally. I have organizational approval myself. I normally host a dozen or more teachers at my facility each year, and while 90% of them are approved providers in their own right, a couple are not. I don’t perceive it to be such a big deal for me…it’s not going to be a problem for them to get their own approval, and I have until the end of 2013 to prod them along into doing so. All who are approved as organizations have until the end of 2013 to get your act together and come into compliance under the new rules.

One of the first complaints, naturally, was about money, and people having to pay yet another expense. Organizational approval up to this point has cost $400. In reality, an organization that only has two teachers has been paying the same amount as one that has twenty, and that’s not really fair. Under the new paradigm, approvals will cost $175 and will last for three years. You must also pay a $25 fee for each class you submit to be reviewed. As a clarification to one point that has been brought up, if you have a full class and you teach portions of that, as sometimes happens at conferences and conventions, you are not having to pay $25 for each version of it…just the one fee. That’s good. I teach for a lot of AMTA chapters and I am often asked to cut an 8 hour class down to 6 hours or make a 3 hour class last for 4, so it’s good to know you’re not paying $25 for all derivatives of the same course.

People have also stated issues with them requiring a criminal background check. Some state boards require that, and some don’t. My particular state does, and if memory serves I think the fee is $30 or $35. It may be duplicating efforts for the NCBTMB to require it in some instances, but not in others.

I have personally had discussions with the powers that be at the NCBTMB over the approval of course content. They are now vetting individual courses again–to a point. The first concern I got wind of was from a colleague who was concerned that they would throw out everything that doesn’t fit in the box of Western medicine. Have no fear. My own wish is that they would get rid of some of the more questionable classes that are approved….at least they were questionable to me, and of course, I’m just one person with an opinion in a sea of many.

They have no intent of getting rid of energy work courses and other classes that don’t have any basis in science…as long as the course content shows some connection to or lineage from massage, it will still likely be approved. I say likely because during the vetting process, they are paying more attention to quality, whatever that truly means. For one thing, they are asking you to turn in your complete handouts, which has never been done before and which also has some people concerned about letting their proprietary information out of the bag. I have expressed my own concern that some of these courses people have invented that don’t have any basis in science and in fact have in some instances been proven to be totally contrary to accepted scientific principles are still going to be approved, so I’m not sure how “quality” that is. A lot of people disagree with me on that front. There is obviously a very huge demand for those types of classes, or they wouldn’t continue to exist.

What I would personally like to see happen is a national certification for science-based education. I’m going to keep after them about that; you can count on it. People can do all the unsubstantiated things they like, but there are some who would like to have a credential that is based on the actual evidence-informed practice of massage. I am one of them. Does that mean I am claiming to be better than you? No, it does not. It just means I would like for there to be something out there that differentiates those who want to be known as evidence-based practitioners as opposed to those who don’t.

Other questions I’ve been asked include exactly who is doing this, and the names of the committee members have not been released that I am aware of. They just state on their website (which is new and snappy-looking, incidentally) that it is a team of experienced practitioners and educators.

People ought to be aware that the buck doesn’t really stop with the NCBTMB. They, along with numerous other certification agencies,  are accredited by the Institute for Credentialing Excellence (formerly NCCA, National Commission for Certified Agencies).  They are the only national accreditation body for private certification organizations, in all disciplines, to demonstrate adherence to established standards. Among the certifying agencies that this organization accredits include healthcare programs in chiropractic, dentistry, EMT, nursing, medical assisting, nutrition, prosthetics and orthotics, and pharmacy. They also accredit certification programs in the arts, construction trades, and a host of other things. And ICE is accountable to the Council for Higher Education.

Bottom line: changes are coming, and you can either go with the flow or go away…while a few states have their own approval process, the vast majority still depend on the NCBTMB for approving continuing education.

I’d like to state for the record that I personally am acquainted with the majority of the people at the NCBTMB, and I have certainly written my share of criticism of the organization in the past–and patted them on the back when I thought they deserved it. The fact is that if they stand on their head and whistle Dixie, it is never going to suit all of the people all of the time. I think they are a dedicated and hard-working group of people. I certainly don’t agree with everything they do, and I take frequent advantage of my status as a certificant and an approved provider to let them know that.

Here’s your opportunity to comment, so take it. As I said, these comments will be seen by the CEO and Board members.

16 Replies to “NCBTMB Making Major Changes to CE Provider Approvals”

  1. Thanks for the updates and clarification.

    I have also suggested to NCB a long time ago, that mere organized paperwork doesn’t prove a quality class. A small video clip of our teaching abilities may be more beneficial than someone who is a paperwork genius and has the money to pay all these fees.

    I do think a background check is good.

    I do feel changes need to be made because I have seen people who attend my class or yours, etc., ONE time who became providers and they are now offering the same classes. Obviously they lied about their education and teaching ability.

    As a small organization with 2 additional teachers who are just starting out, additional fees are not welcomed. Many of our CE providers are not making big bucks and even though I have been doing this for years I am not in that top bracket either. Perhaps a fairer way needs to be implemented so we don’t lose the quality instructors that are out there. I would hate to see lower income bracket instructors, may not be able to continue if every class they offer gets a charge and/or have to stop teaching all together.

    I am interested in seeing how this goes and glad to see we are going towards quality instruction! It’s about time!

  2. “What I would personally like to see happen is a national certification for science-based education.”

    I agree with everything you said.

    However, this:

    “I’m going to keep after them about that; you can count on it.”

    is going to be an issue, precisely because of what you wrote before:

    “They have no intent of getting rid of energy work courses and other classes that don’t have any basis in science…as long as the course content shows some connection to or lineage from massage, it will still likely be approved.”

    If people are going to trust them to get a national certification for science-based education right, then they have to show that they understand the implications of it.

    But by promoting energy-based explanations on the basis of “lineage”, they undercut their own credibility in demonstrating that they understand the implications.

    As I said in my post that you responded to in your note “The Great Divide”, I have no doubt that they are well-intentioned, good, kind, caring people who want to do the right thing.

    But I think they don’t totally understand how science works, and the meaning that their choices carry. And their choice in promoting energy-based CE courses for board certification is going to cast a lot of real doubt on any subsequent effort they may make to develop a science-based certification.

    I think that job is going to have to fall to some other organization, just for that reason. I agree with you it needs to happen, but I think that coming from NCBTMB, there will be so much work to regain lost trust that it will have to come from somewhere else to have a better chance of success.

  3. Thanks, Laura, for helping to clarify this. I have organization status with about 10 instructors. I overall agree with the big picture of what the new rules are trying to accomplish. I’m relieved that we have 2013 to complete the transition to the new rules. I am concerned that I may lose some instructors who choose not to comply. They are independent contractors and that will be their choice.
    I’m very happy to see that I can teach pieces of my larger courses at conferences, etc. I often need to adjust an outline to accommodate the organization’s time slots. I don’t have a problem with the background check.
    At first I was annoyed with the idea of having to resubmit my courses (and pay to do so) that have been approved for years. But I understand if a course or teacher has been approved in the past doesn’t meet the desired standards then the only way to weed them out is to get a fresh start. I agree with Glorias comment about this being a way to prevent course material being taken and offered by less than qualified folks. This happened to me a few years ago- not fun.
    As our profession “grows up” and becomes more mainstream the rules will change. I saw this same thing happen with Occupational Therapy years ago and there was a lot of push back from therapists then, too. But we all survived and I think the profession is stronger.
    I ask NCB to make the process as easy as possible by very clearly listing the steps and how they want the materials sent, etc. This is going to be time consuming and I ask it be structured and clear to value my tiime. I also want to know what happens to the materials such as manuals, etc. I want to be assured that my property is respected. Thank you for having a place to address concerns and questions.

  4. Hi Laura- thanks for the simple but content rich post.

    To the folks at NCBTMB: I would like to second Laura’s plea for a science based credential. Right now, as we all know, the healthcare system is being overhauled. In 2014, certain provisions in Obamacare will be enacted that prohibit insurance companies from discriminating which healthcare providers are reimbursed and which are not. In some places, this tucks massage therapy into the health insurance system, but in many other places, it doesn’t. The reason is is that not every state considers massage therapist to be healthcare providers (such as my own state Hawaii- even though MTs can bill PiP and Workcomp). IF we had a science based credential that distinguished our work from energy work or spa services, then we could leverage that credential in state legislatures to be included as healthcare providers.

    Until then, we will continue to be denied health insurance reimbursements because we are grouped into the same industry as the therapist performing facials and aromatherapy.

    Also, THANK YOU for the hard work and efforts in bettering our profession!! (Also nice shnazzy new website!)

  5. And the way to go about creating the science based curriculum without alienating your other base of therapists is to create a parallel certification. Not an above level and a lower level one, but equally “advanced” in parallel directions. If you want to take the tempers out of the evidence based/non-evidence based argument in massage, then take out the hierarchical structure in which evidence based massage is placed above non-evidence based modalities. The needs are simply different of medical providers than they are of your average consumer and as long as NCBTMB certifies therapists for taking courses in energy work, the needs of the medical community are not being met. Creating parallel certifications with different requirements to meet the different needs of the different markets will allow medical providers to choose therapists that play by “their rules” while giving non-evidence based practitioners the freedom to practice whatever modality they prefer. Doing this would greatly escalate the value of the profession both in the eyes of consumers and in terms of revenues.

  6. With humble aloha,
    Thank you Laura for summarizing the upcoming changes in an easy to read manner. I appreciate this.

    I am a CE provider teaching under the Mana Lomi organizational membership of NCBTMB. I completed all the paperwork for Mana Lomi’s most recent NCBTMB renewal, and I several years ago I also completed all the paperwork for another organization’s initial NCBTMB certification, and their first renewal. I am experienced filling out the paperwork. I don’t enjoy the process.

    Filling out the applications took many, many hours. I did not find that NCBTMB approval improved the quality of the classes offered at all. In completing the paperwork I learned to word class descriptions to fit the thinking patterns of the NCBTMB requirements. These thinking patterns are different than my own, and the teachers I was working with.

    The Mana Lomi organization has 9 instructors who teach in the US. We mostly teach the same set of classes. The new NCBTMB certification requires us all to submit the same classes for approval. This is messy and crazy making. Now all 9 of us will spend time and money completing the application, and hopefully we will stay in sync with each other in the process. Headache potential!

    The previous process allowed the classes to be submitted once, and also required our organization to submit information about each teacher. This process provided NCBTMB with information about each teacher and about each class.

    Finally, I am not in favor of requiring scientific evidence based education. The massage I practice and teach has roots in the indigenous Hawaiian culture which existed for ages outside of Western thought and rules. While scientific testing can prove that massage with indigenous lineage is effective, scientific testing is not necessary to make it effective. I prefer the freedom to think and practice outside the confines of Western thought. For me requiring Western thought limits intuition. I’ve found intuition to often be much more expansive and powerful than rational thinking. I’m not suggesting that we eliminate Western thought; just that we leave other options open too. This is why I stand against requiring scientific evidence based education for certification by NCBTMB.

    Once again, thank you Laura for your write up.

  7. We must continue to educate everyone about the science of energy therapies. There is now much documentation, research and studies about how and why energy therapies work. People like Mehmet Oz, MD and Mitchell Gaynor,MD and Barry Bittman,MD, Alfred Tomatis,MD, Larry Dossey, MD, Richard Gerber, MD, and cutting edge medical facilities have been utilizing guided imagery, Reiki, Healing Touch and Sound Therapy for years. They continued to use them after numerous successful clinical trials proving their efficacy in acutely, chronically and terminally ill patients. When we understand the science of energy, we can understand and endorse energy therapies as valid treatments. Well, at least the ones I know about. 🙂 Massage Therapists I teach are always thankful when they realize there is soo much more healing power to music than just playing pretty music as background relaxation in their practices.

    I totally endorse that there must be standards established. I, too, have seen first hand several people who have little or no experience with clients or patients go on to teach only to parrot the class they took, going so far as to even duplicate the same material without even asking permission.

    I wish the NCBTMB the very best in trying to regulate all of this. It’s a huge territory! Some very valid concerns have been raised here. Thank you, Laura, for this article. Thanks to everyone for your insight.

  8. I am generally in favor of the changes NCB is wanting to implement. I can see their intent, even though the transition will be uncomfortable for all for awhile. A question that arises for me regarding the change around organizations: How does it affect an organization (such as myself) with instructors who are paid to teach my curriculum (not independent contractors)? I am currently in the process of many months of training with two of my graduates who wish to teach for the Academy of Ancient Reflexology. Am I now to just give that information to them to have approved under their own provider numbers? What would prevent instructors from just running with the material themselves with no financial or associative relationship with my organization? I have spent my entire professional life developing my classes and now months training new teachers. Do I want to just give it away?

  9. I feel the need to remind all that much of what is practiced in medicine today is not a proven science by any means. And some of today’s science will be tossed aside in the future as being flawed.
    Massage is a healing art which emcompasses both scientific knowledge as well as the “great mystery”.
    I want high standards…absolutely. Yet, the core of this dialogue is lacking something profound in essence and that is the essence of what touch is all about. I suggest there needs to be a spiritual component to Any and all attempts to further quantify our profession otherwise we will simply eliminate “the art” and become something else. And, that is a big part of what has happened in medicine. Let us learn from their example, and not repeat their errors.

  10. I practice in NY state where a new state mandate requiring continuing education took effect January 1 of this year.

    The fees NCBTMB pales in comparison to NY state:
    NCB: $175
    NY state: $900

    The thing about science… is that there IS science behind some energywork and biofields. But this is not recognized pr talked about in the “Scientific” community.

    Massage therapy is part of a long history of touch tied to energy based modalities that have existed for thousands of years. Go to any indigenous community around the world and you will see healing modalities based on touch and energy. They cannot be separated. I don’t understand how you can separate the two. So KUDOS to NCBTMB for holding to this.

    KUDOS again to NCBTMB for paying the $900 NY state requires for approved sponsor/provider and for what this effort has done to make CE providers, like myself who practice and teach in NY, able to keep teaching CE hours in NY. You see, the massage board will not approve individuals, like myself and hundreds of others. The will only approve entities who are incorporated. This is why you see NCBTMB’s special section for NY state approved providers.

    All in all continuing education is vital to any profession. Life long learning is essential to continued personal growth as well as professional.

    Thank you Laura for your information and for helping to keep conversation like this happening. Though we may not agree on some points, I so value your efforts and respect your opinions.

  11. I have no problem paying their new fee structure.
    I have no problem with the background checks.
    I think that their intent is to get rid of lesser quality programs and instructors and focus the attention on 1) providers that can afford to provide quality resources and materials to learners 2) providers that can afford site arrangements and pay their site sponsors ON TIME and 3) providers that are willing to make the investments necessary (both time and asset resources) to provide quality.

    It seems to me that a lot of people are “up in arms” (no pun intended) over the costs affiliated with additional assurances that the Board intends to provide. If you’re a provider, and are making money from instruction, you can expect to pay some oversight authority, whether it be government or an authority board, fees for providing these types of assurances to the general public.

    I see a lot of massage therapists just trying to meet their quota of requirements with the cheapest CEs they can get just to get by. Is that quality education? I think some of it is, some of it isn’t. There are a lot of providers out there trying to make a quick buck and enterprise off of requirements that massage therapists have to abide by. The Board simply wants to make the process of becoming an approved provider more tight, and remind people that anything of value is going to cost money. Even to the providers.

    Just my take.

  12. As with so many of you, I have worked diligently & for years in order to attain what status I have as a CE provider. If I were to put a label on my organization, it would be “boutique”. What we have is a co-op of sorts, with a wide diversity of instructors—the agreement being that we don’t teach what another instructor in the organization offers so that we can cross-promote each other. The decision to invite an instructor into the organization is taken very seriously & we all take great pride in maintaining high standards. While I do understand the need to “police”, I have sincere & serious concerns that this decision by NCBTMB will cause financial hardship to small organizations such as ours. We already pay many individual states to be approved for both provider & program status.
    I, personally, have chosen to attend classes that were substandard because the marketing/advertising was very misleading—for that specific reason, our organization does not mass market ourselves. We rely on networking, word of mouth & repeat students for our reputation.
    This actually saddens me to think the organization that we’ve worked so diligently to build might now no longer be effective by the end of 2013.
    And, for those of you who feel investment of revenue equals quality of class, I respond….who will pay for this investment in the end? Personally, I feel it will be passed on to the student & I have, with great pride, been able to keep my classes affordable. I feel this will also be changing in the near future, directed at a population who are already seriously experiencing the stresses of making ends meet. Some of the best classes I’ve attended were organized on a shoe string budget, while some of the worst had all of the bells & whistles.

    Thank you Laura & all who have shared, as it has been very enlightening to me.

  13. Although the paperwork required to support every single class is annoying and time consuming, I understand the purpose and can live with it. I imagine it will weed out some sloppy and/or substandard courses.
    What is deeply troubling to me is that all of my presenters have to be NCB-certified teachers themselves. That works fine for teachers who regularly teach CE, but I work with some amazing instructors that don’t teach massage CE that often because they have such busy practices and such full professional lives. For example, I sponsor an instructor who is an advanced Rolfer and PhD researcher whose research has been on the properties of various kinds of connective tissues under stress. His courses are innovative and brilliant, much better than a typical bodywork CE class, and there are waiting lists to get into them. But he only has time to teach 3 or 4 classes a year because of his full Rolfing practice and research position.
    Another instructor I work with has been a licensed counselor and psychotherapist for over 35 years, and he teaches a small 4-hour class on what happens developmentally in the first 4 years of life, and how that can show up on the massage table, and basic ways to recognize it and respond appropriately. What’s in it for him to get certified? He’s not interested in recovering his investment by going on the massage convention circuit, nor does he have the time.
    I have a number of excellent instructors that have started teaching under my school’s NCB number and will probably be willing to become NCB-approved instructors at this point in their development. But in the early stages, they needed an opportunity to develop their course outlines, course materials, and instruction under my guidance. I doubt any of them would have made a cold-start jump to NCB approval before they offered their first class.
    I fear that this requirement, which is being made in the name of improving instructional quality, will actually snuff out a lot of innovation, and favor those who make a living working the convention circuit and/or teaching the same classes over and over.

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