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.

24 Replies to “CE: No Approval is Better than Faux Approval”

  1. You have huge issues with the organizations that regulate CEs and you’re trying to get them written out of the states. Yet you still pay your dues each year or whatever so you can use their approval, for which you have such disdain, to make money as a provider? Smacks of total hypocrisy to me.

  2. Estella,

    I have always complied with their policies, and while they are written in the law, I will continue to do so. I don’t get rich from teaching, and very few people that I know do. The majority of people that I know teach, like me, because they love to, and we don’t have any other choice but to get our approval from the NCBTMB in most states. That is the point; it is an improper delegation of state authority to have them written into the law.

    It also undermines the credibility of this organization to approve everything under the sun for CE. People should feel free to spend their time and money taking any class they want, but not everything is appropriate for CE credit. You do not see this in other fields of health care. I’m sure doctors can take a class in “Praying in the OR” if they want to–but they don’t expect, nor do they get, CE credit for that.

  3. Why comply with policies with which you so vehemently disagree though? Why continue to pay an organization for which you have no respect? You have every choice. I teach for the love of it too, but I don’t offer CEs as I don’t want to compromise my values. You kvetch endlessly but still support them with your money.

  4. Estella, I am not sure how you think Laura should work to being about change.

    Are you arguing that she should give up teaching CEs? Why should she have to give up her work, just because they have a chokehold on the industry?

    Are you arguing that she should stop trying to improve the situation by calling attention to the impropriety and unfairness of it? Why should she be silent when she sees something wrong going on?

    I don’t understand what your solution to the problem would be. It seems to me that–if she were to follow your advice–the regulatory problem would just continue uninterrupted in the way it is, *and* a superb teacher would get driven out of continuing education as a result.

  5. I wouldn’t presume to give Ms. Allen advice. But it’s better to be part of the solution instead of adding to the problem with vitriol, surely? Don’t they have committees or liaison people who can be reasonably reached out to?

  6. I’m also not sure any CE approval process can provide complete quality assurance. Even the most over qualified can be lousy teachers. It would be ideal if the governing bodies could do field visits but it’s clearly not practical, imho. I rang the ncbtmb and they said they have an approved provider/CE committee. Maybe a group of us
    Could reach out to them to find out what their future plans are for quality control. I can’t see the states taking on the task individually. Why would they when they have an agency doing it for them?

  7. Estella, you may call Steve Kirin, the present CEO if the NCB, to ask him how many times I have talked with him. And Leena Guptha, the present Chair. And Mike Williams, the previous CEO, and Sue Toscano and Alexa Zaledonis, the previous chairs, and Paul Lindamood, the CEO prior to Mike…..I have discussed it with Bruce Baltz, the current chair elect. I have had face-to-face discussions, emails, individual phone calls and conference calls and expressed my concern about the problems with the NCB. I have gone directly to the source.

    In the blogroll to the right, you can click on the interview I did with Steve, who I personally like and think is a very nice person, where he made the statement that they had no right to say what is real and what is not in the holistic profession. If a certification board is not making that call, who is supposed to?

    The real issue here is the lack of oversight, as I said. The states are farming out CE and entry-level exam to an organization that they have no authority and no oversight over. If you follow the links and read the document on the Improper Delegation of Authority that was prepared by Dale Atkinson, the President of FARB–the Federation of Associations and Regulatory Boards, perhaps that will become clear. Atkinson is also the attorney for the FSMTB. He started advising the Federation several years ago that this needed to happen. The wheels of legislation turn slowly–and they don’t turn at all until they are set in motion.

    I do not want the NCBTMB to go out of business. I want them to do what they should be doing—certification. There are people on staff and on the Board that I count as my friends. This is not personal.

    As for my continuing to teach, my publisher expects me and their other authors to be out there teaching. Among all my colleagues who are textbook authors, I don’t know any who aren’t out there teaching, and many of them are also dissatisfied with the current state of affairs. I just happen to be the one who writes this blog and takes the flak for voicing my opinion.

  8. You take flak because you voice your opinion in such a destructive fashion. Of course it’s personal. When you attack an organization you attack everyone involved in that organization. Attacks aren’t helpful.

    We were told to read your blog by our instructors to get a feel for the industry. Biggest mistake they made, in my opinion. Unfortunately a lot of your blogs and your Facebook posts are negative, not constructive and generally unkind. Not, I have found, indicative of the industry as a whole, thankfully.

    I realize, as you have said it several times, that you don’t give a shit what people think of you and you “say it like it is”. In that vein, I and a lot of my fellow newer therapists (7 years and counting) have been completely turned off by your combative and negative attitude. One of the reasons I don’t offer CEs is because you and your disciples make it look so unattractive and political. I admire advocacy done right. I don’t think that’s what you do and I make it clear to my students that you advocate for yourself, not the industry as a whole, lest they believe your opinion to be the “right” one, just because it is the loudest.

    I wish our industry had more careful listeners than shouters and dissenters.

  9. Well, if it’s really the politicization that offends you, I would think that you would have a massive problem with how NCBTMB blatantly had itself inserted into state regulation of CE.

  10. You know Estella, I don’t entirely disagree with you. It makes me a little nutty that people still give their money to the NCB. I let my certification lapse (I needed it to get licensed in a nearby state) and I recently left another organization because I couldn’t stomach funding the silliness anymore. I don’t offer approved CE’s either, for the same reasons.
    But that’s MY style of activism. Laura’s is different. And we need all types. Laura is one of the people trying to change stuff from the inside, and that is no less valid an approach.
    I also think it’s cool that you don’t want to read her blog. S’all good, it’s not your style. But you are popping in and passing nine kinds of judgement based on a very small piece of the puzzle.
    Laura does a great job of shining a spotlight on things that need to be fixed. That’s something many leaders in the industry don’t have the courage to do.
    But if you think her stuff is all negative all the time, you are simply wrong. If you were to look at the full body of her work; blogs, books, classes, and the many many facebook posts and comments on other people’s blog, you would find a well rounded, equally positive & negative vibe. You would also find more than one apology, mea culpa and extension of some olive leaves.
    I only agree with Laura about 50% of the time, but to question her dedication to bettering the massage profession, you are most definitely under-informed.

    And not for nothin’ but if these organizations were responding well to quiet listeners and mellow advocates, change would’ve happened YEARS AGO.

  11. I didn’t say it was all negative. I said a lot of it was. Neither did I question her dedication; merely her methods.

  12. I stand corrected. But you’ve been pretty darn insulting and critical of my friend & colleague’s work for someone who doesn’t use their last name, and who I’ve never heard of. But your attitude is not, I have found, indicative of the industry as a whole, thankfully.

  13. What on earth does my last name have to do with anything? If I am critical and insulting, I am merely copying your friend and colleague’s example, surely?

  14. “If I am critical and insulting, I am merely copying your friend and colleague’s example, surely?”

    No, you miss the point entirely.

    You are sniping at Laura–throwing insults like “hypocrite”–simply because she works from within the system to try to fix it.

    Yet she is honest and open about what she is doing; she is not telling Leena Gupta and Steve Kirin one thing, and everyone else the opposite. They know what she is saying; there is no dishonesty or hypocrisy on her part.

    NCBTMB has created a massive problem that is actively interfering with massage’s development as a profession, and she says that to their face, at the same time as she works to change the problem.

    You blame her for sounding political, yet you don’t say one word of criticism about the political actions of NCBTMB that got us into this mess in the first place.

    Laura is engaging with the problem, and working to make it better from within.

    Other than just cherry-picking what you take offense at, and sniping at Laura from the sidelines, by contrast, what are you actually doing to solve the problem?

  15. Ravensara, if one disagrees with a company’s policies and fundamental organization; if one spends considerable amounts of time trolling online about them; if one bitches and kvetches and yet still pays money to that organization so one can sell classes to Mts who need CEs, I call that hypocrisy.

    All of the recent webinars from NCB have been positive. They have openly acknowledged the failings of the past and have set about attempting to fix them, as far as I can see. Continuing to bitch about past mistakes isn’t helpful. I’d love to know what Ms. Allen is doing to actively move things forward with NCBTMB. She says she’s spoken to all the top bods. I’m sure she has. But if she’s merely spoken criticism then her words are fruitless.

    Laura’s trying to solve things from within what exactly? If she wants to have a voice why doesn’t she apply to the board? Volunteer for a committee?

    What am I doing? Observing carefully, speaking gently, watching the organizations of which I am a member and feeling dismay right now, but working steadily, thank you.

  16. “trolling”

    I don’t see her trolling; I see her engaging passionately.

    “yet still pays money to that organization so one can sell classes to Mts who need CEs, I call that hypocrisy”

    NCBTMB has gamed it so that they’re the only game in town for MT CE in many states. If the situation is ever fixed so that they don’t have an inappropriate chokehold on MT CE, then you might have a point about Laura continuing to belong.

    But as long as they’re the only way to CE provider status in many states, it’s unfair to selectively criticize Laura for taking that path, and speaking up about the problems in it.

    “All of the recent webinars from NCB have been positive. They have openly acknowledged the failings of the past and have set about attempting to fix them, as far as I can see.”

    It’s very easy to *say* you’re going to change. If they actually do deliver on their promises to fix the situation, then that will be the point at which pushing for change is no longer necessary.

    The way we’ll know whether they deliver on it is if they:

    1) offer reality-based courses, instead of the current offerings;

    2) explain what value they add in their evaluation process–currently very unclear, since they’ve said they don’t have the right to say what’s right and wrong in holistic medicine, then they haven’t communicated exactly what their evaluation does; and

    3) start following their own rules regarding board appointments and elections.

    Once they actually follow through on those commitments, then they will have shown that they have fixed the problems.

    “If she wants to have a voice why doesn’t she apply to the board?”

    Christopher Moyer tried to do exactly that, and it didn’t go anywhere.

    You’re assuming that they’re willing, motivated, and able to change. If that’s true, then they’ll demonstrate it over time by actually delivering on the promises to change.

    If and when they do that, I’m sure that at that point, then Laura will no longer push them to change, because it will have become unnecessary.

  17. Let’s get back to the main point of this blog, shall we?

    I wrote these new administrative rules about the regulation of CE for state boards because of five compelling problems:

    1) At the present time, it is not possible to assure the competency of continuing education providers or the quality of CE courses.

    2) There are inconsistencies in the standards for acceptable CE subject matter, the processes of CE provider approvals, and the number of required hours for license renewal.

    3) There is no proven link between CE requirements and public safety.

    4) Reliance on the CE approval program of NCBTMB by state massage boards undermines the foundation of the regulatory process.

    5) The agenda on continuing education put forth by FSMTB fails to meet the needs of state boards and the massage community at large.

    You can read the explanation about each of these problems in my paper. I’m interested in hearing feedback on this from the CE community, as well as state board folks.

  18. Ravensara, you say NCBTMB has “gamed” it that they’re the only organization approved by the states. It seems to me, that at some point at least, they must have had it right for the states to entrust them with the task. I am sure they don’t do it lightly but I am equally sure most states are happy to hand over the responsibility. If NCBTMB is the only agency approved to do this, is this the NCB’s fault? Has any other agency tried? Serious question.

    I’m not sure what you mean by reality-based. One person’s reality is different from another’s so it would follow that one person’s reality might be reiki and another’s might be Rolfing. It’s nigh on impossible to say which has greater value because it depends on the recipient. The scope of practice is very broad, which makes the process difficult. We’re not a black and white profession.

  19. “It seems to me, that at some point at least, they must have had it right for the states to entrust them with the task.”

    Really? You don’t consider the whole “improper delegation of authority” issue relevant at all?

    “One person’s reality is different from another’s so it would follow that one person’s reality might be reiki and another’s might be Rolfing.”

    People have freedom of conscience as an inalienable human right.

    That is very different from an entire embryonic profession burning all bridges to professional healthcare by declaring that, as a group, they reject physics and embrace reiki.

    You accuse Laura of politicizing the debate, yet–whether you realize it or not–you are taking the political stance of advocating for anti-realism on the part of massage.

    I think that’s your perfect right to do so, and I won’t call you a hypocrite or worse for advocating for what you believe in. I think it’s a mistake, and you probably think my realist advocacy is a mistake, as well. That’s how free speech works; we both get to state our opinions without fear of government reprisal.

    But that you can’t or won’t see how selective you’re being in chiding Laura, yet giving NCBTMB and yourself a free pass, for also taking political stances is rather striking.

  20. The ncbtmb is big enough to defend itself. I’m merely asking if any other agencies have ever approached or have been approached as an alternative to ncbtmb?

  21. I agree with Laura, Raven and Allissa. We may not always agree 100% on how to solve the issues at hand, but I think we can all agree that there is a major problem with our industry when it comes to entry education and continuing education. I feel both need to have higher standards and we need to rise above this constant bickering between ourselves. Name calling and disrespecting each other will never solve anything, but will distract and discourage us from having open dialogue about how we can effect proper change. I for one want to have the medical profession as a whole respect what massage therapy can do to help alive pain both physical and psychologically. My stance has always been we need to start with a strong foundation and build out from there. I absolutely agree that continuing education can be a real joke and it undermines those like Luchau, Lowe, Waslaski, Dalton, etc… But for me, CE provider governance is last of the list of SOS. So here’s my 2 cents…..or 3 if you are from Canada… 🙂

    1) Define Massage Therapy away from the Energy/Spiritual and get back to just plain Manual Therapies and stick to the research!
    2) National Standard for Entry Level Massage Therapy
    3) Non-Profit Governing Body that approves colleges and instructors
    4) Nationally accepted and approved continuing education that is overseen by another non-profit organization that offers credentialing for more advanced therapists.

  22. i rarely chime in on blogs (although i am an avid reader of many), but i just wanted to take a moment to say THANK YOU LAURA ALLEN for being the much needed vocal backbone of this industry. you are a true rockstar 🙂 rock on…

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