Laura Allen’s Blog

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Behind Closed Doors

From the title, you might think this blog is about The Client List, the trashy new show on the Lifetime Channel that gives massage therapy a black eye. No such luck; the event I am referring to is the upcoming Leadership Summit #2, set to take place next week in Chicago.

The first Leadership Summit (to clarify: there were summits in 2003-04 before AFMTE and FSMTB existed) took place last September in St. Louis, with the executive directors and chairs of ABMP, AFMTE, AMTA, the Massage Therapy Foundation, FSMTB, COMTA, and NCBTMB in attendance. It was a historic event in that it was the first time all seven of these organizations had come together in the best interests of the profession. The purpose, according to the press release announcing the meeting, “was to hold a beginning conversation about major structural issues and impediments to profession progress. The desire is to have candid exchange about core challenges, quality concerns, consumer expectations and organizational roles.”

Apparently, one of the hot topics at this week’s meeting is going to be the number of required entry-level education hours. Although this was not on the agreed-upon agenda at the first meeting, it was introduced anyway by ABMP Chairman Bob Benson, complete with a thorough proposal prepared by Anne Williams, Director of Education at ABMP. Basically, the proposal was for a task force to be formed immediately, and using Job Task Analyses that have been conducted by the NCBTMB and the FSMTB, to nail down a definite number of hours that should be required for entry-level education. This was contrary to the facilitator’s recommendation—and the group’s agreement— that they would spend the initial meeting identifying problems, and would address possible solutions for these problems at meetings to follow.

In the interest of the leaders being comfortable in speaking freely, these are closed meetings—no press and no other staff members in attendance—an executive session, so to speak. Certainly not without precedent; boards have executive sessions all the time—usually to discuss personnel matters or other things that would violate someone’s privacy if they were discussed in public.

That’s not exactly the case here; and while I am thrilled that our leaders—some of whom are from competing organizations—are sitting down at the table together, my concern is that a small group of people has the power to decide (or worse, just think they have the power to decide), what is best for the profession on the whole, without getting input from the people it affects—you and me. Practitioners, school owners, teachers, CE providers, the regulatory community, all have a vested interest in the future of our profession, and I don’t think that should be decided by an exclusive group behind closed doors.

Unfortunately, that is just what the ABMP proposal states in no uncertain terms. Verbatim, Williams’ proposal stated: There is no step in this proposal to obtain input from the broader massage profession or from other health-care or bodywork organizations during this project. The reason is simple—the work group is simply performing a work task in writing learning outcomes and objectives for job tasks defined by surveys already conducted by FSMTB and NCBTMB. It doesn’t matter what stakeholders, or other groups think should be taught or shouldn’t be taught. The work group would be responding to what therapists report they do, on a day-to-day basis, in their massage-related environments as part of their jobs.

The sentence that disturbs me there is “It doesn’t matter what stakeholders, or other groups think should be taught or shouldn’t be taught.” Any time you start to think it doesn’t matter what stakeholders think, there’s a problem, in my humble opinion, no matter what the issue. Stakeholders are the ones it will affect, and to think their opinion isn’t important is just beyond the pale.

At the recent ABMP School Issues Forum in Austin, Texas, Bob Benson stated to those in attendance that there was 100% consensus in support of this standards-setting proposal from the organizations that attended the Leadership Summit. That’s not exactly so. COMTA, FSMTB, and AFMTE all expressed concerns after the proposal was introduced in September; they are not petty concerns, and they do not appear in any way to be based on politics or turf wars.
This is bad business for two primary reasons: First, any project that has the potential to affect the entire massage therapy profession should not be designed, approved, and launched in secret. Changing the baseline numbers of entry-level education required for state licensure is a huge thing, as it will affect schools, regulators, and future students.

By contrast, the MTBOK project modeled appropriate transparency, and the massage community had adequate opportunities for input along the way.

Second, it is more important right now that our primary stakeholder organizations learn to work together in an atmosphere of trust and cooperation—than to plunge headlong into a major problem-solving project when consensus has NOT been reached. The end does not justify the means. Some of my own issues are that the MTBOK and the competency-based curriculum standards set forth by COMTA aren’t even being given consideration. This proposal also overlooks the fact that the AFMTE is currently working on a National Teacher Standards Education Project. A huge amount of work has gone into creating both the MTBOK and the COMTA standards; a huge amount of work from some of the best educators in the business is going into the AFMTE project, and for these to be cast aside when they have direct relevance to this proposal is irresponsible to say the least.

During our troublesome economy of the past few years—and it doesn’t appear to be over yet—school owners have been seriously affected already, and having a nation-wide upheaval based on an “official” number of required hours is not the be-all end-all solution to licensing portability. It will just serve to put an additional burden into the mix at the present time. The lack of portability may be an irritant to our field, but it is not causing harm to the public.

The AMTA Board of Directors voted last October to support the project in its present form. As ABMP and AMTA are the two largest professional membership associations, they carry a big stick. That doesn’t mean their agendas should be force-fed to the profession, and I hope that they will reconsider both the timeline, and the very valid concerns raised by the other organizations before barging ahead with this project. I am certainly not saying that it never needs to happen. I am just saying it doesn’t need to happen on speed-dial until all of these issues have been ironed out. I hate to see good intentions canceled out by unchecked enthusiasm for rushing something to market; I hate to see valid concerns from the other organizations swept under the carpet; and I hate to see the opinion that what the stakeholders think doesn’t matter.

When you’re meeting behind closed doors, it’s easy to forget who the stakeholders are. I’m one of them. I’m a member of both AMTA and ABMP, a founding member of the AFMTE, a past delegate to the FSMTB, a Nationally Certified Massage Therapist & Bodyworker, an Approved Provider under the NCBTMB, and a current site reviewer for COMTA, so I do indeed have a vested interest. I don’t appreciate our national organizations acting as if my opinion and that of the other thousands of massage therapists, school owners, and others who enable your very existence on this planet don’t matter.

At this week’s Summit, the representatives of these seven organizations have an opportunity to address this issue that has divided the group, and to get their process back on track. I hope that they also remember the responsibility that they have to their own members, and to the profession as a whole. To use ABMP’s own slogan here, we “Expect More” from our leaders.

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CAMTC Responds to “Money Grab” Accusation from Massage Today

Last week, Massage Today President Donald Peterson published an article entitled The CAMTC Money Grab. It cast the CAMTC in a very unfavorable light; to make a long story short, it appeared to expose excessive financial wrongdoing at the organization by stating that the CAMTC was paying the expenses and per diem for no less than 14 board members to attend the American Massage Conference. The AMC is a moveable event that is held each year in a different location, and this year’s event was taking place in San Diego.

Peterson backed up his claims of financial excess with a table showing who voted to spend the money and who didn’t, and also stated that Massage Today Senior Associate Editor Kathryn Feather had actually been on the CAMTC conference call when the vote was taken about spending the money. The criticism was that although it was not unanimous, that for the most part the people who voted to spend it were the people who were going to receive it. In reality, that’s the way it goes on all boards; board members vote on things, and that includes where and when to attend events and how much money will be spent on it, so there’s really nothing unusual about that.

I shared this article on my Facebook page, and immediately started hearing from board members of the CAMTC that Peterson’s story was very biased and not telling all the facts. Since I initially shared it and contributed to giving a bad impression of the organization, I made the offer to them that I would give them equal time on my blog to present their side of the story. The fallout from this has been swift, not the least of which is the resignation of Keith Eric Grant from the magazine, which he has been contributing to since 2002. Grant is a CAMTC board member, and someone I  have admired as a writer, a scientist, and a person from afar. He has been blogging about the politics of massage way before I started. I haven’t had the opportunity to meet him in person, but we have been FB friends for several years, and as I stated on my page, I would believe pigs would fly before I would believe that he would misrepresent the truth.

Grant’s response to the Massage Today article can be read in its entirety here.

I also immediately heard from Joe Bob Smith, another CAMTC board member, whom I have personally met several times. Joe Bob’s response to my sharing the article on FB was this:

Laura, sometimes your quick fingers get something going without hearing from the other side. As a CAMTC board member, I believe that Massage Today wrote a biased piece with missing and incorrect information. I’ll be happy to defend the actions of the board any day. The CAMTC is made up of 20 terrific volunteers, many working massage therapists themselves. They put a lot of their own time (and time is money) into this organization. Many will be losing money by volunteering at the AMC. They deserve to be reimbursed for out of pocket travel expenses when on board business. And the per diem limit is $211/day (standard government established rates) which includes hotel, not just food. The CAMTC has a very proactive, working board that has done a lot to curb prostitution and human trafficking in the two and a half years it’s been in existence. I do hope you’ll seek me out next time you hear of CAMTC news. While we all have differences of opinions, I would like to make sure the other side gets at least equal opportunity.

I also heard from Mark Dixon, Vice Chairman of the CAMTC. His response to my offer to tell the CAMTC side of the story is printed here verbatim, and was actually his response to Kathryn Feather’s questioning him as to why he voted to support the members being reimbursed, and what his duties would be:

The importance of attending this meeting and interfacing with those attending is reinforced by my continuous attendance at national and statewide conventions of this type since 1975. My comments are strictly related to the question asked, and are about my own participation. It’s not hard, though, to extrapolate that purpose to the other volunteers who will attend the AMC.

Regretfully, CAMTC’s CEO, Ahmos Netanel, has been asked to return his attention to more pressing issues affecting CAMTC, and is unable to reply to your offer.

My response to Kathryn:

As I stated during the debate, I’d agree with the two other entities in disagreement if the event were anywhere but in California. But in San Diego there will be roughly 2000 local massage therapists and affiliated bodyworkers in attendance who either provide or manage massage services. In addition, the venue provides a valuable opportunity to network with influential individuals from around the country who have expressed strong interest in California’s unique massage regulation; in short, a chance to learn, teach and network in a setting that rarely comes to our state.

My specific duties include but will not be limited to meeting with counterparts from other state boards and professional organizations, directing participants to the specific part of the CAMTC that is most helpful to them, assisting with coverage of our exhibit, and following up/developing contacts during the years to come. I expect to be on duty from Friday morning to Sunday afternoon and plan to take one three-hour class at my own expense.

As the first meeting of this type attended by the CAMTC, I believe the small investment is a sound one that will place experienced, knowledgeable professionals before an important audience. I’ve been working meetings of this type since 1975, and have learned that a highly concentrated group of individuals in a convention setting affords an excellent opportunity to save considerable expense of travel and lodging.

Even so, as a volunteer I stand to lose considerably more in income than the reimbursement. Moreover, I attended last month’s AMTA-CA Chapter Educational Conference, representing CAMTC in continuous meetings throughout the weekend. I received zero reimbursement.

Although as Dixon said, CAMTC Executive Director Ahmos Netanel was too busy to reply to my offer to personally tell the other side of the story, Massage Today did print an e-mail that he sent to Peterson in response to the article. It is quite lengthy and can be read in its entirety here.

In summary, Netanel accused Massage Today of misrepresenting the facts in a biased and inflammatory way, and withholding information that would have cleared up the accusations to begin with. By the looks of Netanel’s rebuttal, this article would probably have never gone to print–at least not in its present form–had his responses been considered before the magazine went to press.

Since I’ve been accused of being inflammatory myself–and rightly so, at times–and because I shared the Massage Today article on my FB page, I felt compelled to present the CAMTC side of the story. In fact, Keith Eric Grant and Joe Bob Smith have both occasionally called me on the carpet over something, and I don’t resent that. Although I certainly have my own opinions and biases, it is never my intention to be so biased that I can’t see both sides of the story, or at least give them equal consideration. And like a lot of things, there’s one side, there’s the other side, and somewhere in the middle is the actual truth.

I will also state, in the interest of self-disclosure, that during my five years on the North Carolina Board, I was sent to several conventions on their behalf, and they paid my way. Board members on any board generally give up their own time to volunteer when they could be making substantially more money than the per diems allowed by boards (and in fact some don’t pay a per diem at all), not to mention their time away from their own families, businesses and other activities in the interest of service to the organization. I’m the office manager/receptionist at my own office, and every time I attended a board meeting, I had to pay someone to take my place. My per diem ($100 per day) didn’t come close to covering that, or the inconvenience of driving almost five hours both ways to attend a meeting. While it’s true that there is always going to be some abuse taking place somewhere, I believe that’s the exception and not the rule, and I don’t think this particular incident was a case of abuse of board funds. Mark Dixon quoted the late great Paul Harvey, who always signed off by saying “and there you have the rest of the story.”

My blog is my own opinion, and should not ever be considered to be the opinion of anyone else.

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MOCC Proposal: Dis-Organized Chaos

I’ve been criticizing the Maintenance of Core Competency (MOCC) proposal from the Federation of State Massage Therapy Boards since the moment it landed on my radar, and I haven’t changed my mind. I think it’s a terrible plan that doesn’t serve any good purpose other than increasing the coffers of the FSMTB. In its present form, it appears to be a blatant move to put the NCBTMB out of business.

What has been interesting to me is to see the way this thing has unfolded. Right off the bat, I had some criticism of the Task Force assembled by FSMTB that supposedly got this thing together. I say supposedly, because when I saw who was on it, my first thought was “No, they couldn’t possibly have supported that.”

So here we have Immediate Past President of AMTA, Glenath Moyle, whom I know personally and like a great deal. In spite of Moyle’s presence on the Task Force, the national office of AMTA only took a few days to come out with a statement shooting more than 20 holes in the MOCC proposal. In spite of the fact that the FSMTB chose Task Force members who were supposedly representatives of their respective organizations, that apparently didn’t work too well in this case.

AMTA has never allowed an individual officer to speak for the entire organization without their board’s approval; their blanket slam of the proposal seems to indicate that they never saw the proposal prior to publication, much less given the opportunity to sign off on it. I wholeheartedly support AMTA’s condemnation of this far-fetched plan, but I didn’t like to see Ms. Moyle in a position of looking like she had egg on her face. That could have been prevented if this process had been carried out in a more transparent manner.

Then we have Pete Whitridge and Cherie Sohnen-Moe, President and Board Member, respectively, of the Alliance for Massage Therapy Education. Since both of these leaders are well-known continuing education providers, and represent an organization that is largely composed of CE providers and massage schools that sponsor CE, I was shocked at their support of this plan. I felt at the time, and still feel, that if the membership of the AFMTE had been polled about this plan, the consensus would be a big fat NO.

The theory that this plan will not take away business from CE providers is BS of the highest order. Since the proposal calls for newly-created education modules that the FSMTB will put on their website to be the ONLY course work required for state license renewal – with all other CE related to “professional development” becoming optional – it doesn’t take a rocket scientist to figure that out.

The AFMTE issued a statement last week,that frankly, I feel should have been included in the proposal itself. I might have felt better about the whole thing if this was part of the original proposal. The AFMTE has suggested that they support the FSMTB contracting with the NCBTMB to administer the process of approving CE courses and providers, as that is beyond the resources and scope of most state massage therapy boards. The NCBTMB was excluded from the MOCC Task Force, which is petty politics to me. This plan affects them in a major way and they should have been included. They have expressed their willingness to work with the FSMTB, and frankly it’s the Federation that has prevented it from happening.

That doesn’t look good to me. When the NCBTMB convened a meeting of diverse stakeholders last year for the purpose of getting input into revamping their programs, they invited the FSMTB to participate. Their exclusion from the MOCC process is, I’m sure, based on the Federation’s party line, “the NCBTMB isn’t regulatory.” Big freaking deal. That is true, but they exist and for 20 years have administered the only national approval process for CE providers. AMTA, ABMP and AFMTE are not regulatory organizations and they were invited to serve on this Task Force. There were people on the Task Force from states that don’t even have any CE requirements to begin with. That dog don’t hunt, as we say in the South.

As the NCBTMB has announced their intent to sunset the existing National Certification program in favor of a post-graduate Board Certification credential, it is obvious that they are phasing themselves out of the entry-level market. At this point, they are not letting go of offering their National Certification Exams for state licensure purposes. However, that use of the cert exams is on a steady path of decline, as the MBLEx is now being used by the overwhelming majority of massage school grads. I think with some negotiation with the FSMTB, they would let it go altogether. The thing is, cooperation is only possible when both parties come to the table. The FSMTB isn’t playing nice.

There will need to be some skilled facilitation to get these organizations to look beyond their own interests, and to work together to achieve broad-based solutions. We need a single national approval program for continuing education, and our field will truly advance when there is just one entry-level exam for state licensure (instead of the current crop of five).

Every professional organization should take a lesson from some of the past troubles at the NCBTMB: all it takes is to get one or two people with a personal agenda in a position of power, and the fallout is detrimental to the organization and the profession on the whole. Board members have the responsibility of checks and balances. To those who sit on their hands and blindly follow the leader, I say get up or get off.

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Cheers and Jeers

I confess to being too lazy to be in depth with my blog this week. It’s Easter Sunday, and quite frankly I need a day of rest, so I’m just handing out a few cheers and jeers. There is usually a swirling sewer of legislation going on somewhere, and I’m sure today is no exception. AMTA keeps their finger on the pulse; you can read the latest here. ABMP also reports legislative updates; you can read them here under News and Information.

Cheers to Idaho for becoming the 44th state in the nation to license massage therapists. Beginning July 1 2013, all therapists will be required to have a license. There will be a two-year grandfathering period for therapists who meet certain qualifications. You can read the entire practice act here.

Cheers to COMTA (Commission on Massage Therapy Accreditation) for their improved website and their new online learning resources. Schools who are seeking accreditation, or thinking about doing so, can access a number of informational courses about the process. I started as a site reviewer for COMTA last year, and will be doing several site visits for them in the next few months. Seeking COMTA accreditation is a voluntary process that is rigorous–and sends a clear message for any school that you are doing more than you have to do.  I would encourage any school owner who wants to uphold standards of excellence to consider seeking COMTA accreditation. Part of the process is a very thorough self-study….it forces the question of “What could we be doing better?” The organization will bend over backwards in order to help you meet your goals.

Jeers to Lifetime television for The Client List, which debuts tonight. Cheers to ABMP and AMTA for contacting the producers of the show, for all the good that did, which was exactly none. Lifetime’s response is that they do not intend to show massage therapists in a bad light. If portraying a massage therapist as a prostitute isn’t casting a bad light on massage therapy, then I don’t know what is.

Jeers to the Federation of State Massage Therapy Boards for their recent proposal on Maintenance of Core Competencies.

Cheers to AMTA for shooting more than 20 holes in it.

Cheers to the Massage Therapy Foundation for their new and improved website.

Cheers to the NCBTMB for their new plan of action. It isn’t perfect but it’s a big step in the right direction.

That’s it from me this week. Even Laura Allen falls down on the job, and today’s the day. If you’d like to add a cheer or a jeer, feel free to do so in the comments. Everyone have a blessed Easter and a peaceful and prosperous week.

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Inquiring Minds Want to Know

I’ve spent the past couple of weekends teaching at AMTA meetings; first in SC and this past week in Alaska. One of the classes I taught at both meetings was “Using Research to Market Your Massage Therapy Practice.” I’ve been on my research soapbox for a while now. The big question is, “Who gives a flip about research?” My answer to that is, inquiring minds want to know.

Except when they don’t want to know. Consider this: IF research validates an idea, a theory, or a belief you’ve had, doesn’t that make you happy? Don’t you want to give a thumbs-up and shout “Yes! I knew it all the time!” That would make anyone feel good, wouldn’t it?

So when research shows something that’s contrary to what we believe, we don’t like that. We don’t want to accept it. We don’t want to listen to it. We want to act as if it doesn’t exist, or that it applies to everyone except us.

I’ve been surfing PubMed this afternoon and reading interesting studies. I don’t have any research to back it up, but my educated guess is that maybe, just maybe, 20% of massage therapists actually read research studies…or even know what the difference is in a peer-reviewed study performed within the parameters of scientifically accepted procedures, as opposed to website hype making all kinds of unfounded claims.

I’ve also been on a roll lately looking at some of the more dubious products that are out there that massage therapists buy into, and foist upon the uninformed public. Some of my favorite (NOT!) claims are: Causes detoxification. Regulates the endocrine system. Flushes your lymphatic system. Gets rid of cellulite once and for all. Causes you to lose weight without making any effort. Contains negative ions. Balances your chakras while simultaneously regenerating your brain cells and your liver and revitalizing your sex drive. Makes your body totally alkaline. Connects more strands of your DNA…I could go on all day, but you get the picture.

Most people, if they’re going to buy a new car, do a little research…they want to know the gas mileage, the safety rating, the bells and whistles they get for the money they’re paying. And they wouldn’t buy a house without checking out the foundation and whether or not there’s mold in the basement. But the same people will buy some whacky, over-priced gizmo that doesn’t have any basis in reality and couldn’t possibly do all, if any, of what it claims to do, without doing any research at all, other than reading the hype that appears on the website or listening to the sales pitch at a multi-level marketing meeting.

The sad thing is, I don’t think most of these people are just seeing the dollar signs and thinking about how much money they can bilk clients out of. They just fall into believing these things actually work.

The Code of Ethics states that we are to avoid giving treatment when there is no benefit to the client and the only benefit is our own financial gain. It would serve everyone to think about that the next time they’re tempted to spend money on frivolous products with no proven benefits. If YOU want to lay out the big bucks for something and use it on YOURSELF, that’s one thing, but when you make claims to clients that this (machine, product, supplement, etc) is going to change their life, cure their disease, get rid of their pain, or whatever, that’s a clear-cut violation and one that you ought to be aware of. Do the research. Don’t just fall for every word on the company’s website and repeat that to the client like it’s fact. It isn’t.

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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.

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MOCC-ERY

Last week, the Federation of State Massage Therapy Boards presented their long-awaited proposal for a new national continuing education approval program. They are calling it Maintenance of Core Competencies – or MOCC for short. As I indicated in my previous post, this proposal not only failed to deliver on the original promises made by FSMTB, it has turned the entire professional landscape on its ear by recommending that most continuing education should be voluntary, not mandatory for license renewal.

Under this “MOCC-ERY” of a plan, the only mandatory components of continuing education would be those FSMTB deems to be relevant to “public safety”. If that’s not bad enough, FSMTB is proposing to take control over the design and delivery of these courses. Except it isn’t continuing education … it’s proving that you still know the things you should have learned in entry-level massage training as it pertains to protection of the public.

As a licensed therapist, do you want to be taken back to subjects like Ethics 101, principles of hygiene and sanitation, and the naming of unsafe massage practices – EVERY TIME YOU HAVE TO RENEW YOUR LICENSE? I’ve been teaching professional ethics for 14 years, and frankly, I find this proposal to be an insult to my intelligence.

I was very gratified today to receive the press release from AMTA denouncing the plan. In part, important communication states:

“AMTA reviewed the proposal and has many concerns with the approach of the FSMTB, the proposal itself, its inconsistencies and the lack of support provided for their view. Some of our specific areas of concern are:

  • –Overall, the impact of this proposal is to lower standards for massage therapy practice. It would shift the focus of professional development from building on the entry level education massage therapists receive to that of maintaining very minimal requirements of public protection.
  • –The proposal contradicts its stated intent, previous FSMTB statements on the need for continuing professional education and the mission of FSMTB.
  • –The proposal would take away the freedom of choice of massage therapists to determine their own practice focus and to choose the continuing education providers they prefer to meet their own professional needs by creating a “one-size-fits-all” approach for license renewal.
  • –The proposal provides no empirical data to support the efficacy, efficiency or necessity for a transition to this model.”

AMTA goes on to list 20 objections in their press release.

Although ABMP as an organization has not yet made an official statement, ABMP President Les Sweeney came out in support of the MOCC Proposal in his recent blog. In addition to being a member of AMTA, I am also a member of ABMP. I think highly of Les and the rest of the management there, but this is one of those times when we’ll have to agree to disagree. Les does state that he supports the role of the NCBTMB in the arena of continuing education; but he personally thinks CE should be voluntary. That is a major policy statement coming from the top guy at the largest professional membership association in our field.

The thing that is most outrageous and unacceptable about the MOCC Proposal is not the “public protection” course material that could be mandatory for therapists. It is the fact that leaders of four of our major stakeholder organizations in the field came together behind closed doors and decided that the majority of continuing education should no longer be mandatory.

It looks like there may have been major flaws in the process that led to this consensus document. Was the work of the eight-member Task Force shared with the full leadership of AMTA, ABMP, AFMTE and FSMTB with sufficient time to review and comment on this plan before it was published? Something doesn’t line up when AMTA comes out with a total smackdown of the plan, while their Immediate Past President was part of the team that was responsible for its development. Does that seem odd to you?

What we do know is that the decision making process took place in a vacuum, and there was no opportunity for public comment. Yes, the disclaimer says that “The MOCC is just a proposal and we’re seeking your feedback”, but input should have been sought from a broad range of constituents in the field before such a proposal was even made.

Continuing education classes that actually teach you anything new, under their plan, will become optional. Only the classes from the Federation, which they plan to make available on their website, will be required for license renewal. My opinion is that instead of being satisfied that the MBLEx has taken most of the exam revenue away from the NCBTMB, they would now like to take the continuing education dollars away, too. This plan will not only take dollars away from the NCBTMB, but also away from continuing education providers. (Disclosure: I am an NCBTMB Approved Provider of Continuing Education.)

The Task Force intentionally excluded representatives from the NCBTMB, and that’s another point that disturbs me. The Federation should be working in collaboration with NCBTMB. I was present at the AFMTE 2011 Annual Conference during FSMTB Executive Director Debra Persinger’s initial presentation about the Federation’s intent to create a CE approval program. NCBTMB Chair Alexa Zaledonis was in the audience at this session, and she publicly stated that her organization was willing to cooperate with FSMTB. It’s a shame to me that in light of their 20 years of experience in administering CE provider approvals, they are being left out of this loop. I’m gratified to see they’re not waiting around for an invitation, but instead, have gotten on with the business of making their own improvements.

In May 2011, NCBTMB convened a meeting of the Massage Approved Provider Panel, which was intended to improve and enhance their current CE approval program. Most of the stakeholder organizations in the field were represented there, including FSMTB. Based on feedback from the participants, NCBTMB will begin reviewing and approving CE courses as well as CE providers this summer.

Personally, I did learn what I needed to know about protection of the public while I was in massage school. I am one of those people who enjoy attending continuing education courses. I don’t want it to be mandated to me that I have to take a no-fail test—which isn’t really a test if you can’t fail it, is it, of things that I already know—to meet my license renewal requirements. I don’t think that serves me, as a massage therapist, and I can’t see how it’s going to serve the public. The Federation seems to think this will wipe out complaints of unethical or unsafe behavior. I don’t believe that for one minute. Anyone who is going to act unethically is going to do it, no matter how many classes they take or whom they take them from. Unsafe behavior needs to be addressed in entry-level massage school. I would much prefer to see the FSMTB come up with a model program of public safety education for schools, instead of requiring therapists who have been practicing for years to take a ridiculous no-fail test.

Times are changing, as Les said in his blog, and our organizations are changing with them. It remains to be seen whether it’s for the better or the worse. I have supported the FSMTB in the past, because I believe the state boards coming together in an effort to solve common problems is a good thing. I still believe that’s a good thing. Unfortunately, I do not believe that this is an example of the kind work they should be doing, or the way they should be doing it. You can let them know how you feel about it here.

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FSMTB Unveils Plan for Continuing Education

Last week, the Federation of State Massage Therapy Boards published a document outlining their proposal to jump into the continuing education market. They are calling the new program Maintenance of Core Competency – to be abbreviated as “MOCC”. I don’t know what planet this thing came from, but it sure ain’t from this solar system.

Coming fast on the heels of the unresolved conflict-of-interest mess with the FSMTB President spearheading legislation in her home state of Iowa that would eliminate the education hours from that massage law, the timing of this MOCC release is strange, to say the least.

But let me get to the main event here: When you have a problem on your hands, there’s nothing more aggravating than a solution that is worse than the original problem itself. That’s exactly what has happened.

For many years, those of us who teach continuing education courses, as well as the sponsors of continuing education, have had to put up with an absurd and ineffective system for CE approvals. Most regulated professions have a single national entity that handles this function; we have the national provider approval program run by NCBTMB, as well as individual approval processes operated by about 10 state massage boards. The standards are inconsistent, and it forces CE providers to go through redundant and costly approval processes to be able to offer their courses in more than one location.

There was a cause for hope when we started to see some activity about this last year at the national level. In a press release entitled “FSMTB to Establish New Continuing Education Approval Program” (dated March 29, 2011), the organization announced:

“…the launch of a project to develop a new national program for the approval of both continuing education courses and providers. Once it is established, the program will provide state regulatory agencies with a centralized quality assurance process for all courses taken by massage and bodywork therapists for the renewal of State licensure or State certification.

As the representative for the regulatory community, FSMTB has responded to requests from its Member Boards to create a unified system to ensure that continuing education courses are taught by qualified instructors, relevant to the scope of practice, and meet the needs of the regulatory community.”

This all sounds wonderful, but the MOCC Proposal does not resemble this in any way. What happened to FSMTB’s clearly stated plan?

The MOCC Proposal introduces a totally new concept to our field: that there is a limited group of subjects that are specific to the “core competence” of massage therapists, such as ethics and boundaries, hygiene and sanitation, scope of practice, and unsafe massage practices. These subjects are supposed to be more important to “public safety” than all the other subjects typically studied by massage therapists in CE seminars – which are lumped into a new category called “professional enhancement”.

Based on this concept, the MOCC Proposal makes three recommendations:

1) Requirements for the renewal of state licensure should focus on public protection and maintenance of core competencies. All therapists should complete a required educational program for re-licensure focused on public safety issues. FSMTB would be the provider of this educational program.

2) A transition phase addressing maintenance of core competence as well as current continuing education for professional enhancement will be needed. FSMTB will provide state massage boards with guidelines to assist in the transition phase.

3) After this transition phase, professional enhancement and continuing education is voluntarily attained at the discretion of the therapist and not mandated for licensure renewal.

Instead of working to get broad-spectrum CE mandated for license renewals in all states, the MOCC Proposal recommends doing the opposite. In light of the relatively low number of education hours to enter our field, CE is essential to help practitioners continue to build and strengthen their base of theory and methodology. The narrow scope of “core competencies” suggested in the proposal as the only mandatory elements for renewal do little or nothing to advance levels of skill and awareness of the craft. While looking into how some of the other associations and federations of state regulatory boards of licensed professions handle their CE approval process, I did not locate a single one that imposes a limitation to “public protection” on continuing education the way the FSMTB is proposing to do.

The proposal also contains a statement that, “It is important to the FSMTB that all stakeholders have a voice in the process. The FSMTB requests feedback on this proposal from the Massage and Bodywork community and other interested parties.”

That’s a very open-sounding invitation, but does it strike you as odd that the MOCC Proposal makes no mention whatsoever of NCBTMB and the Approved CE Provider program they’ve been operating for the past 20 years? I would consider NCBTMB a stakeholder – and I’m relatively certain they’re an interested party. Last May, a rep from FSMTB attended the multi-stakeholder summit held by NCBTMB that looked at improving their CE approval program; it doesn’t appear that the invitation was reciprocated.

As I see it, the recommendations contained in the MOCC Proposal will drive the two organizations further apart, and will make it impossible for a global solution to be developed. This is both foolish and unacceptable. There is general support for continuing education being tied to license renewal, as it benefits both practitioners and their clients. Ongoing coursework in certain key subjects (like ethics) can continue to be written into state standards to ensure that licensees stay current with the behavioral aspects that influence their work.

If we’re going to have a single entity handling CE approvals on behalf of the entire profession, which should it be: FSMTB or NCBTMB? In reality, it could be either one – but it would take new levels of cooperation, along with well-crafted agreements to satisfy all the legal and structural considerations. Creating a unified approval program should be the focal point of discussions between and among the major stakeholders in this arena. Anything else is a waste of time.

When it comes down to it, FSMTB is a collective of the state regulatory boards; it has no regulatory authority in and of itself. They cannot force this plan on any state that doesn’t want it. Any state approving their own providers will be free to carry on, and any state that wants to continue to accept courses taught by the NCBTMB-Approved Providers will be free to carry on. The MOCC Proposal states that another document will be forthcoming that details recommended standards for states that choose to continue their own approval process.

As mentioned above, this is currently just a proposal and FSMTB is seeking feedback. I definitely encourage you to give it to them. Click this link.

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A Disgrace in Iowa

Iowa House File 2342 has been on my radar for several weeks (initially introduced as HF 2126). Yesterday, I received a further communication on it, which stated that “the bill as written will not be brought up for consideration unless Matt Windschitl (the sponsor of the bill) requests it. The understanding is he will hold the bill until next year so there will be time for positive feedback from the profession and new language can be, at that time,  introduced with the support of the massage community.”

That’s good, because at this time, it doesn’t have the support of anyone except the misguided person who set it in motion, nor should it.

I was initially stunned at the poorly-written and  ill-conceived bill that eliminates the education requirement for massage therapy, which is currently 600 hours. The first draft of the bill I saw just struck through the education requirement altogether, although line 25 still says “meets or exceeds Iowa’s educational requirements.” This upset me to the point that I called on several Iowa residents and people in the know, who basically assured me that it was a “placeholder” bill….a simple explanation of a placeholder bill is that “the deadline for introducing any bills is imminent, and we’ve got to get something in there now that we can revise later”….one of those quirks of politics.

As of February 21, I hate to report that the revision doesn’t look any better. The language getting rid of the 600-hour requirement is still there, and nothing to take it’s place.

I have had three reliable sources state to me that this bill was introduced at the request of a school owner who is upset about federal regulations on financial aid, and that the true intent of the bill is to change clock  hours to credit hours. However, that isn’t spelled out. This legislation is a piece of crap in its present form that sends massage right back to the dark ages in Iowa.  It’s being discussed on several Facebook threads, and the consensus is that the Iowa Board of Massage had nothing to do with it, that AMTA has nothing to do with it–other than expressing their displeasure and urging their members to contact their legislators to kill it–and that the Federation of State Massage Therapy Boards–as an entity–has nothing to do with it. Interestingly enough, the bill also places two school owners on the Iowa Board.

Kathy Jensen, the current President of the Federation of State Massage Therapy Boards, who is an Iowa resident and a school owner, and former Chair of the Iowa Board, in direct response to my asking on my FB page if any Iowa residents had a clue on this, stated “Wearing my own hat and not FSMTB hat….. HF 2126 is as Keith Grant mentioned, was a place holder. Iowa has in place in their rules “600 clock hours or the equivalent in credit hour”, that has not changed. The education requirements have not been eliminated or changed for the state. The new language for the bill will support consistency in statute and rules. If the statute requires only clock hours and the rules state both there is inconsistency. I don’t see this as a big change for Iowa since it has been in the rules for a long time without issue. I do see the additional acceptance of credit hours in statute as a step forward for the massage industry.”

That’s well and good–except for one thing: The ongoing sermon from the Federation is portability. Nearly every other state is still operating on the clock hour requirement for massage education, so I don’t see how this is going to serve portability in any way. It’s a common practice in community colleges to use the credit hour system, but in most states, they actually have to convert that to clock hours on their transcripts to prove clock hours to the satisfaction of the state board. If you look at the state requirement charts for licensing that are regularly printed in our trade journals, every one is listed in clock hours, not in credit hours. The one revision that has taken place on the bill doesn’t do anything to clear up the language or the issue. It is just striking the 600 hours and leaving the “education requirements” part, without spelling out what that is.

My five years of service on the North Carolina Board of Massage & Bodywork Therapy ended last year. I’ve never owned a school, but there were a few times when I had to recuse myself from a disciplinary hearing, vote, or discussion, because of a conflict of interest or something that could be perceived as a conflict of interest. People who are serving on public boards need to recall at all times that not only are you obligated to avoid a conflict of interest, you are obligated to avoid the appearance of a conflict of interest. Yes, you have a life–and rights–as a private citizen, and as a school owner. When that is in conflict–or appears to be in conflict–with the obligations you have agreed to carry out for the Board you are serving, you have a choice. You either recuse yourself, you resign and get out altogether, or you put yourself and the entity you serve at risk. I would urge whatever school owners who serve the Iowa Board, and anyone who serves any board, to remember that fact.

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R-E-S-P-E-C-T

Most of the time when the media, or Hollywood, casts a light on massage, it seems to be a paraphrase of Rodney Dangerfield’s classic line, “We don’t get no respect.”

The latest hue and cry is over the upcoming new lifetime series, The Client List, in which Jennifer Love Hewitt is a massage therapist/prostitute who is of course just doing it because she needs the money to feed her kids. Last year it was that picture of a race car driver getting a massage from a skimpily dressed massage therapist, and the year before that it was The View. Last Halloween, I got ticked off about a costume that was labeled “Massage Therapist” and included a skimpy lingerie outfit and fishnet stockings. And always, always, the “massage parlor” busts make the news, while the therapists who work their fingers to the bone actually helping people rarely get on tv. While I hate these things as much as the next legitimate massage therapist, I do try to keep it in perspective. The same shelf in the costume store had a skimpy nurse outfit. There are tv shows portraying crooked cops…it doesn’t mean every cop is crooked, but it’s a stereotype that we’ve bought into, and it’s the same with  us. We’ve been trying to separate ourselves from the sex stereotype for many years, and my guess is we’ll have to continue to do so.

Worse to me than the way the media portrays us is the way our lawmakers stereotype us. Legislation is afoot in several places that just serves to hold us back as a profession. HB 2387/SB2249 in Tennessee, which I first reported on several weeks ago, will remove massage therapy from under the division of health-related boards and move it to the jurisdiction of the commerce and insurance division–the division that regulates “trades.” Bottom line, massage therapy would be a “trade,” not a “profession,” and insurance companies don’t pay tradespeople. They pay professional health care workers. That bill was referred to the Government Operations Committee on Jan. 13 and no further action has yet been taken.

A similar situation is happening in Florida with SB 1860. I just finished reading the latest analysis of this bill, which was updated 02/03/2012. Among other things, SB 1860 removes the right of massage therapists to bill for PIP insurance. The analysis states the following:

The Consumer Advocate’s report found rapid growth in the number of procedures billed from 2005 to 2010. The largest increases were found for “Massage, 15 minutes” and “Therapeutic Exercise, 15 minutes” which each increased by approximately 2.6 million units from 2005 to 2010.  Specifically, “Massage, 15 minutes” increased from approximately 1.42 million units in 2005 to approximately 4.05 million units in 2010, while therapeutic exercise increased from approximately 713,000 units in 2005 to 3.36 million units in 2010. These two procedures are now the two most commonly billed procedures in the PIP system.

The Consumer Advocate’s report also presented data on increases in the average charge per claimant by provider. Average charges by massage therapists saw the greatest increase, increasing from $2,887 in 2005 to $4,350 in 2010. The second largest increase was by acupuncturists, whose average charge increased from $2,754 in 2005 to $3,674 in 2010. In contrast, the average charge by an orthopedic surgeon only increased $126 from 2005-2010, billing on average the comparatively smaller figure of $2,810 in 2010. As of 2010, massage therapists and acupuncturists issue the largest average charges of any medical provider that bill within the PIP system.

This bill is really about fraud. Another part of the analysis states that the number of “staged” car accidents in FL doubled in a year’s time. People are milking the system. And while it’s nice to know that their favorite thing to milk it for is massage therapy, that’s really working against us here.

How do we get the respect we deserve? And do we really deserve it? Some of us think we do. Some of us want to advance massage therapy and integrate it into the full realm of mainstream health care. The way to accomplish that is by acting like health care providers, by becoming research literate and supporting the evidence-based practice of massage. It’s just my opinion that is the key to massage therapists earning respect. Others say if we want to be thought of as health care providers we should just become PTs instead. I don’t buy that. I think what we do is good enough to be considered in and of itself.

We can complain to Lifetime TV and The View when the situation arises, but it’s much more important to complain to our legislators. I’ve been preaching this sermon for years, and I’ll continue to preach it until I’m gone. If all the people who holler about stereotypes on television and write letters to Lifetime would write one to their lawmakers and insurance commissions, it would be a great thing.

And now for a shameless solicitation: The Massage Therapy Foundation is working to fund research in the massage therapy profession, to teach research literacy, and to advance the evidence supporting massage therapy as a vital part of health care. For Valentine’s Day, I am asking everyone to show some love and to donate $14 to the Massage Therapy Foundation. You can do that by clicking here.

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