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Legislative Hullabaloos in WV and TN

As usual, the opinions on my blog are my opinions and not to be construed as the opinions of anyone else.

I  haven’t had much to say on the legislative front for a few months…when the legislators go home for the summer, not much is happening; then there tend to be shorter sessions in the fall before they take a break for the holidays and not much happens then, either. Well, the break is over, and how.

I received a press release from the NCBTMB yesterday announcing what amounts to a win for them in the state of WV. Here it is:

The National Certification Board for Therapeutic Massage & Bodywork (NCBTMB) is pleased to share the news that Nationally Certified Massage Therapists in West Virginia will continue to have their services covered by the Public Employees Insurance Agency (PEIA). Initially, the PEIA Finance Board considered discontinuing massage therapy coverage altogether as a cost-savings measure, but with input from NCBTMB, the American Massage Therapy Association (AMTA) and practicing therapists, it will still cover active employees and non-Medicare retirees who visit massage therapists with national certification.

The new financial plan goes into effect July 1, 2012. Certified therapists must also carry $2 million in malpractice insurance as well as follow treatment guidelines of the AMTA.

“NCBTMB commends the Public Employees Insurance Agency for providing their employees with access to nationally certified massage therapists who commit to a code of ethics, standards of practice and pass a national credentialing exam,” said NCBTMB CEO Mike Williams. “We see this as a win-win situation for both PEIA employees and Nationally Certified Massage Therapists in the state of West Virginia.”

“PEIA has an obligation to state employees to cover necessary medical treatments, but also an obligation to the state of West Virginia to be fiscally responsible,” stated PEIA Executive Director Ted Cheatham. “We stand behind the PEIA Finance Board and its decision to only accept massage therapy claims from therapists who meet the new criteria.”

Disclaimer: I am Nationally Certified myself and have been since 2000. I am not obligated to maintain that; I just do because I want to. When I got licensed, it was also the only option available, as it was in most states for many years, saving those few that have their own exam. As any of my long-time readers know, I’ve had my ups and downs with the NCBTMB, criticized them many times, and applauded them when I thought they deserved it. I am also a  member of AMTA, and due to having  multiple coverage on different policies I have as a business owner and employer, I personally have $12 million of liability insurance. If I lived in WV, I’d be good to go.

My first thought on this was that it will be challenged immediately by the Federation of State Massage Therapy Boards.  I’d  bet the farm on it. West Virginia is a member state of the Federation. The Federation, and thus the member states, own the MBLEx (Massage & Bodywork Licensing Exam) which is accepted by the state of WV, as is the NCB exam. Therapists in that state have a choice of which exam to take in order to get licensed.

This move by the legislature would seem to be an endorsement of the National Certification Exam, as well as an endorsement of AMTA, since one of the other requirements for being able to file insurance is adherence to AMTA treatment guidelines. They don’t come right out and say you have to be a member of AMTA; just that you have to be following their guidelines. It also requires therapists who want to participate in the state employees’ insurance program to have a minimum of $2 million worth of liability insurance.

I personally file a lot of insurance in my own office, and it’s a standard practice for insurance companies not to deal with you unless you carry liability insurance, so no big deal on that front. AMTA’s treatment guidelines are on their website, accessible to the masses, including people who are not their members, so that’s really no big deal either.

What is a big deal here, at least to me, is that even though the state says that passing either exam is adequate for a massage therapist to receive a license, it is now saying that only one of them is adequate for therapists who wish to file state employees’ insurance. To me, that is sending a confusing message to students who haven’t yet taken an exam, as well as to the practicing therapists who chose to take the MBLEx, ignorant of the fact that this new law would be coming down the pike, and even to the massage-consuming public. It’s a statement that basically says “If you’ve taken the MBLEx instead of the National Certification Exam, then you’re good and qualified enough to work on the public, except for the state employees, and you have to be Nationally Certified to work on them and file their insurance.”  It is really stating that one licensee is better than another.

Is there going to be any fallout from this? Absolutely, in my opinion. The Federation, since its inception, has encouraged all member states to use the MBLEx exclusively for licensing purposes, while still stating that certification has its own value as a credential, but maintaining that it should no longer be used as a licensing exam. Since WV has opted not to follow that suggestion, and has kept both exams, massage schools and instructors in WV will now be falling short if they don’t inform their students of this legislation, and will basically be saying “You can take two different exams. If you want to file insurance, take the NCBTMB exam. If you don’t care about that, you can take the MBLEx.”  So two therapists can have the exact same 500 hours of  education that the state requires, and the exact same license that the state issues, but the one who took the MBLEx won’t have the privilege of filing insurance on state employees. The logic here is escaping me. There is one caveat: WV is currently not requiring any continuing education of massage therapists; however, maintaining National Certification requires 48 hours of  continuing education every four years. Still, I don’t think that’s a big factor. As long as you passed the NCB exam last week, you could be accepting the state employee’s insurance, before you’ve ever had a single hour of continuing ed, so I don’t see how that really fits into the picture.

I don’t think this is over, and I’ll try to keep you updated.

WV isn’t the only place where trouble is brewing this week. Therapists in TN are up against HB 2387 SB/2249, which would take the regulation of massage therapy out from under the health care professions and move it to the Department of Commerce and Insurance. That is almost bizarre that it has anything to do with the department that governs insurance–because most insurance companies will not pay for any health care services unless they are provided by a person who is in a licensed health care profession. This move would basically state that therapists are not health care providers. The Department of Commerce and Insurance regulates trades, not professions. For all intents and purposes, this is a statement to massage therapists that “you are practicing a trade, not a health care profession.”

Quite a few states have been on cost-cutting missions during the past few years of recession, combining public boards and even going so far as to disband altogether–or threatening to–but this cannot be construed as one of those cost-cutting missions. Tennessee’s massage board is self-supporting through licensing fees. They do not cost the taxpayers any money.This is not tied to financial impact on the state in any way. In fact, I’m not sure what it’s tied to or what the logic is behind it, other than a slap in the face to the massage therapy profession.

I urge all TN massage therapists to immediately  contact your legislators. Don’t wait until it’s a done deal to express your opinion.

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It Was a Very Good Year

As I look back over 2011, it was a very good year. For the 8th year in a row, since I first opened my business, I am going to finish the year with a growth in sales and in my bottom line. That’s rather miraculous, considering the unemployment rate in my county has been between 14-16% for most of the year. Many businesses have closed. The foreclosure notices in the paper have far outweighed the job listings for the past couple of years. And still, we have thrived, and we had zero staff turnover. I’m very grateful to be blessed with such wonderful staff members and clients.

This year started out with a bang when we made a trip to Miami to participate in the Massage School Makeover organized by Angie Patrick of Massage Warehouse. What started as a little project of Angie’s snowballed into one of the most magnanimous displays of generosity throughout the massage world. The Educating Hands school ended up with over $80,000 worth of equipment and supplies donated by industry partners. As they were moving into a brand-new building at the time, it was just a fresh start for their well-respected school. It was a joy to participate in it and to see so many of my friends from the profession at the festivities. I also got to visit my youngest brother on that trip, and got to see a dear friend who used to live here in NC that I  hadn’t seen for several years. That one was bittersweet since her husband, who was also a friend and former business partner with Champ, had passed away suddenly a few months before, but it was a wonderful visit.

I was honored at the American Massage Conference this year as the Massage Therapist of the Year…and that wasn’t even the highlight of the conference. Getting up to play a few tunes with Errol N Schroeder at the dinner dance was the high point for me. I had a blast! Scott Dartnall and the rest of those Canadians came out of the gate running and made their first American event a resounding success.

Then the World Massage Festival came along and I was inducted into the Massage Therapy Hall of Fame, which I appreciated, but I was also awarded there for Government Relations, which I’d have to say meant even more to me. I’m no Sally Hacking–whom I greatly admire and who has been working in GR for several decades–I’m not able to go all over the country attending legislative sessions and even if I could, I certainly lack her expertise and experience; the award was for my efforts to keep the masses informed of what’s going on through my blog and social media. My politics aren’t popular with everyone, and that’s okay. I feel good about it if I am able to jolt even one person out of complacency to take up the fight against detrimental legislation. I got to play some music at that one, too. The Hinkles are just some of the nicest people in massage and I always enjoy the World Massage Festival, which I refer to as the Woodstock of massage. Leave your coat and tie at home, and just come and have a great time! The 2012 event will be in Las Vegas.

My annual trip to Ireland was one of the high points of the year. It always is. I enjoy teaching the students at the Obus School of Healing Therapies, hanging out with my Irish friends, visiting a few pubs 🙂 and in general, just breathing the Irish air.

I traveled a lot this year. I was invited by the NCBTMB to come to Chicago for a meeting with a lot of industry leaders to offer input on how they can improve the Approved Provider program. I in particular appreciated that meeting, because that’s where the seed was planted for the Massage Therapy Profession Leadership Summit that took place a few months ago, where for the first time, all of our national leaders came together for the common good. It was attended by the executive management and board chairs from the AFMTE, FSMTB, AMTA, ABMP, COMTA, NCBTMB, and the MTF. Speaking of the Massage Therapy Foundation, it was another red-letter day for me to be included on Rise and Shine, a CD of wonderful music donated by massage therapists to raise money for the Foundation. If you don’t have your copy yet, get on the ball! I am very honored to be in the company of such great musicians. It is truly a great compilation.

The Alliance for Massage Therapy Education meeting in Charleston was one of the best events I’ve ever attended. The annual national convention of AMTA in Portland was probably the best one I’ve ever attended, and I’ve been going to those for quite a few years. Kudos to the Oregon Chapter and to President Glenath Moyle for putting on a heck of a good time in such a lovely city. I also got to make my first trip to New Orleans on behalf of the North Carolina Board of Massage & Bodywork Therapy, and it was a blast. I completed five years of service to that board this year, and while I miss the wonderful staff and friends I made at the board, I don’t miss that five-hour haul to Raleigh or having to participate in disciplinary hearings. I got to make my first trip to Los Angeles to attend the Federation of State Massage Therapy Boards meeting, which was as usual, informative and a good time visiting with so many other board members from across the country.

Without dragging out my calendar, I can’t recall every place I got to teach in this year, but they were all fun and filled with beautiful people. One of the high points–literally–was the Take it to the Top Summit put on by Vivian Madison-Mahoney over in Gatlinburg, TN. The hotel was at the top of a mountain, we were on the 14th floor, and the view was just beautiful. That was one of the best education conferences ever, and Vivian and her husband John certainly know how to throw a great event. A lot of my buds were there–Lynda Solien-Wolfe, Michael McGillicuddy, Irene Diamond,  Mike Hinkle and his wife Cindy and a lot more, and a good time was just had by all. I got to play some music at that one, too. Vivian loaned me her limited edition Martin for the occasion since I came without a guitar. It was great.

I made my first site visit as a peer reviewer for COMTA a couple of months ago. I went to New Bedford, MA to review a community college massage program. It was a good learning experience for me, and the other reviewers were great companions. We had a good time. Our hotel was across from the harbor and a good seafood restaurant, so it was a good time.

I had some great classes at the office this year. Marjorie Brook came down from NY to teach a Scar Tissue Release seminar, and she was accompanied by my friend Allissa Haines. We had a good time visiting with them. Christine Courtney and her husband Colum came over from Ireland for Christine’s classes in Indian Head Massage and Traditional Chinese Medicine, and we always look forward to their visit as well.

On a personal level, lest I just sound like an effervescent fool who never has a bad moment, we’ve had some. My husband’s best friend Brent Stephens passed away this year…he was suffering, so it was a blessing for him to go, but it was still a great loss to both of us. Another dear friend died suddenly this year. Donna Metcalf was the picture of health when I saw her last, and three weeks later, she was gone…an unfortunate case of going to the hospital for a simple procedure that went very wrong. Donna was a force of nature, one of those women who dressed in sparkly clothes and a feather boa, and just lit up every room she ever entered. Her death was a shock. It was also a reinforcement that you ought to live every day like it’s your last. It just might be.

I’ve had some family trauma and drama this year…hasn’t everybody? But I’m pleased to say it seems to be on the upswing. My constant prayer is that those family members who need to forgive each other will just get on with it. One year at Christmas when there were some family divisions, my husband said “Well, we could have two dinners.” He was referring to the people who weren’t speaking to each other and the “I won’t be there if they’ll be there” situation, and my reply was “Hell no, we will not have two dinners. They can sit down and break bread with each other or they can go to McDonald’s.” My fond hope is that they’ll all come to the table. The people we resent feel good. Carrying around resentment is, as someone said, like drinking poison and waiting for the other person to die. It isn’t hurting anyone except the person carrying it around.

One of the last great things to happen this year was my husband Champ passing the MBLEx. He is currently waiting for his North Carolina massage license to arrive. Champ is a builder by trade, and the economy here has been a sudden death to his business. There are so many foreclosed properties here, no one needs to build anything. You can buy a house that was on the market three years ago for a million bucks for less than $200,000. You can buy a perfectly livable house for less than $30,000. In fact, if you only need a small one with one or two bedrooms,  you can find some for less than $20,000. Still, I feel optimistic that things are looking up. Facebook has recently built a new data center in our town, and a couple of other manufacturing businesses have come in on their coattails. Hopefully, the economy is going to turn around and the residents in my county will see their circumstances improve. I certainly hope so.

Another great thing this year was what I have been referring to as The Grand Purge. I have been on a mission the past couple of months to clean out my house and my office. I keep watching the old video clip on youtube of George Carlin and his rant about “Stuff.” I have too much Stuff. Or rather, I had too much Stuff. A lot of it is gone…I’ve donated things, sold things, thrown out some things, burned some things…I’m getting rid of my Stuff. Stuff is like an albatross around your neck. My attitude is if I haven’t used it in a year, I’m not going to use it in another year.  I figured if I was going to move, and wouldn’t want to take it with me, then I don’t really need it. So goodbye, Stuff. It’s been very liberating.

I’ll remember this year. A lot of good things happened. A few bad things happened. That’s the way life goes. But all in all, it was a very good year.

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The Forgotten Flier

Do you use fliers to advertise your business? In this age of Internet marketing, you’re probably overlooking the humble flyer as a way to get the word out. Don’t count it out!

Fliers are cheap and easy to produce. You can make them yourself using Word, Publisher, or many other programs. You don’t have to be an artist to make a professional looking-flyer. Follow a few simple rules and you’ll come up with the perfect one for your business.

First, you want the flyer to attract attention. Bright neon paper will get more attention than a piece of white paper. Bold type that’s large enough for people to read easily is a necessity. A picture or graphic is nice, and it needs to convey the message. This is about massage, so don’t put a picture of a flower or a yin/yang sign–put a massage-related picture. Don’t use your own logo as the main picture unless it truly conveys that this is about massage. I’ve seen thousands of logos that without the wording, people wouldn’t have a clue that it was anything massage-related.

You want the message to be short and sweet: who you are, what you do, and where you’re located. Leave plenty of white space; in other words, don’t try to pack so much on it that it ends up looking like an overload of information. You want it to be easy to read. Have the headline be a call to action–not the name of your business. Something catchy like “Don’t Put up With Pain!” or “Get Rid of  Holiday Stress!” Your contact information should go at the bottom of the page. Most people are carrying around cell phones and can easily enter your number, or you can also put your name and number on pre-cut tear-offs on the bottom of the page. Don’t forget to use the spell checker.

Now that you’ve got the flier, arm yourself with a box of pushpins. Keep them in a manila envelope in your car. Anywhere you go you see a bulletin board, put up a flier. They’re free, so why not make use of them? It’s a no-brainer.

Is there a university or community college in your town? There’s usually a bulletin board in every hallway. The Chamber of Commerce, the Small Business Administration, community halls, your church, grocery and convenience stores, the library, the health food store–there’s just no end to the places where bulletin boards exist. Visit local schools and ask the receptionist to put one on the bulletin board in the teacher’s lounge–maybe offering a first-time discount or an extra 15 minutes with their first session. Avoid mentioning any short-term sales or discounts that have an expiration date or you’ll need to go around and change them frequently.Works for me!

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The Financial Health of Our Organizations: NCBTMB

Author’s note: This is the third year that I have reported on the financial state of the non-profit organizations of the massage therapy profession. The information I use to write these is obtained from www.guidestar.org, which is a clearinghouse of information on non-profits. If a non-profit does not provide their own Form 990 filing to Guidestar, it will be provided by the IRS, providing the organization meets the obligation of public disclosure. I am not an accountant or a financial expert. I merely offer this series as a source of information.

Just like last year, there’s good news, and there’s bad news for the organization. The National Certification Board for Therapeutic Massage & Bodywork could be the poster child for cutting expenses when revenue drops. They have done a bang-up job of tightening the belt without making services suffer….I say that because people complain to me about any of our organizations all the time, and I haven’t gotten many complaints about the service from the NCBTMB in the past year.

The bad news is that revenue has taken another million-dollar hit, almost the same as the decline last year. $800,000 of that can be mainly chalked up to the MBLEx taking away exam revenue. The good news is that in spite of that, the organization managed to get back in the black, nothing short of miraculous since they were $1.9 million in the hole just a year ago. They reported a net revenue of a little over $469,000. The Approved Provider revenue was actually up by almost $100K over last year. Their assets increased by almost $500K, and liabilities decreased by over $200K as well. I’m very happy to see them back in the positive column.

The belt-tightening that went on at the NCBTMB, to me, is also telling of their getting back on track and letting go of the battle with the FSMTB over the MBLEx. Legal expenses dived by $185,000, since they realized the futility of interfering with the states in choice of examinations.

Marketing was scaled back to the tune of over $260K, another sign of improvement to me…instead of wasting money on an agressive anti-MBLEx campaign, their advertising efforts in the past year have focused on their own positives, and that’s a good thing.

Salaries and compensation went down over $300,000.  CEO Paul Lindamood’s compensation was $228K, down slightly from last year. I’d have to say he deserves it for his pivotal role in cutting expenses and focusing on the good points of the NCBTMB instead of continuing down the path of destruction that led to legal and financial woes for the organization. The Board and volunteers are also to be commended. There were 8 less employees reported in 2010 than there were in 2009, and 10 less volunteers.

Bottom line: I applaud the NCBTMB for turning it around. Even though revenue on the whole was down, I will almost take bets that as I get through this series, I’ll find that the same has happened at some of our other organizations. The recession has affected organizations just like it has affected massage schools and individual practitioners. Kudos to the NCBTMB for adapting to the situation.

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CE Providers: Expenses Going Up, Income Going Down

In January of this year, I blogged Continuing Education Providers: Sink or Swim, and followed up that one with the report from the meeting convened by the NCBTMB, where profession leaders were invited to give input into the revamping of their Approved Provider program.

Last week at the wonderful annual meeting of the AFMTE, one of the presentations was by Debra Persinger, Executive Director of the FSMTB, who talked about the intention of the FSMTB to start approving continuing education. One of the burning questions from the audience was “how much is this going to cost us?”, a question without an answer as of yet, since their program is still in the planning stages. Knowing the folks at the FSMTB, I don’t expect it to be anything I would classify as exorbitant, but unless it’s free, it will still be one more expense for us to pay.

I’ve previously mentioned the states who have their own approval process–and accompanying fees to pay–for continuing education providers. With the exception of Florida, who doesn’t charge you additional money if you are already an Approved Provider under the NCBTMB, these range from a couple of hundred dollars to “you don’t want to know.”  There’s a reason why I’m not teaching in those states…it isn’t worth it to me, at this stage of my career, to lay out hundreds or even thousands of dollars, and in some cases to complete a mountain of paperwork, to teach in a location that I may visit only once.

Another unfortunate trend is all the expense associated with presenting at trade shows, spa exhibitions, and conferences.  At many of these events, not only do you not get paid to teach; in some cases you actually have to pay for the privilege. Big companies who budget thousands of dollars into their advertising plan can afford to pay a big price for a booth. With a few of the heavy hitters being the exception, the average individual provider cannot. It’s a Catch-22 of spending the big bucks to get your name out there, and then rolling the dice to see if you’re going to be able to recoup that in sales–assuming you have anything to sell. Some teachers are just that–teachers–and they’re not necessarily textbook authors or purveyors of DVDs, home study courses, etc.

I’ve been an Approved Provider since 2000, and I have organizational approval. I have a classroom at my facility in Rutherfordton, NC, where I teach myself and host other instructors. During the recession of the past three years, I’ve had to cancel classes that some of the most well-known teachers in massage were scheduled to offer. Some of them didn’t receive as much as one inquiry about the class. In addition to mailing to licensees, advertising in a number of venues, my publicizing it to my email lists and social networks and them publicizing it to their own substantial lists, it just didn’t happen.  The classes that did happen have tended to be the ones taught by more local teachers, not as well-known, and not as expensive, as some of the big names.

Some perfectly competent, long-standing, and popular teachers have suffered to the point of drastically reducing the price of classes in order to fill seats and maintain their income. One of the most well-known teachers told me a few weeks ago that his teaching income was down $70,000 last year due to the recession. I know many who have never made that kind of money in any year, and their loss has been proportionate.

All the expense associated with teaching continuing education, in my opinion, is going to have some serious fallout. Some talented, but not necessarily famous, instructors will give it up because they just can’t afford to keep on doing it. By the time you provide handouts, pay your own travel expenses, advertise your class, ship whatever books or products you might have to offer, your profit has flown out the window along with the ridiculous price of your airline ticket.

True, some well-known providers have corporate sponsorship. Those are the exception; not the rule. Corporate sponsorship usually goes to those who are already at the top. They want someone with name recognition whose picture looks good in their advertising and helps sell their products. There are only so many big corporate sponsors. Small, but quality, companies often don’t have that money to spare.

It will be interesting to see how the CE environment changes when the FSMTB gets their program up and running. Their mission is public protection, and during her talk, Persinger addressed that fact. I don’t think the Federation intends to start approving Reiki classes, although I could be wrong. I believe their intent is to approve classes that have a direct bearing on public protection, such as ethics, contraindications and the like.

The lack of income is not just an issue for CE providers. Massage schools are notorious for low pay, and therein lies one of the problems in attracting quality teachers. They may deservedly feel they’re better off doing massage for $60 an hour than teaching for $20 an hour. Most of them don’t do it for the money. They do it because they love to teach.

That’s why I do it. I don’t have a corporate sponsor. I can’t afford to go everywhere I’d like to go. I fit in as many events as I can, and sometimes I have to pass one up. I know a lot of providers in the same position. I had many people say to me last week that they would have liked to attend the AFMTE conference but just couldn’t because of finances. Even when a conference is reasonably priced (as that one was), travel, hotel, meals, missing income when you’re gone from your office, or paying someone to be there covering your office when you’re not, adds up.

I’m hopeful that the education atmosphere is going up, along with income for those who provide it. It really doesn’t have anywhere else to go.

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Massage Regulation: A Comedy of Errors

I’ve spent the last hour reading legislative updates pertaining to the regulation of massage…in the past, I’ve sometimes referred to this as the good, the bad, and the ugly. This time, I’m just going to call it a comedy of errors. I don’t know whether to laugh or cry.

I’m not even going to address all the discrepancies in the number of hours of required education and/or exams required for licensure, or the discrepancies in the hours of required continuing education, or even the wide variances in licensing fees. I’ve commented on that a number of times, and that situation isn’t likely to change at any time in the near future.

Everybody has seen those “outdated laws” posts before, silly laws that are still on the books, like “It’s illegal to ride a horse without a saddle on Main Street after 5 pm every other Sunday.” You get the picture. Some of our massage laws seem about as archaic. You just have to wonder at the logic that goes into some of these things…and you also have to believe that these most assuredly were not proposed by, nor are they likely supported by, massage therapists. It’s the bureaucracy at work.

Many of the statutes that have been proposed or enacted in the past few years are a direct result of the economy and state governments being so deep in dept. Several states are now taxing, or considering taxing services (like massage, hair and nail services, even grass-mowing). Even self-supporting boards have in some cases had their monies raided in the interest of feeding the state’s general operating fund. NH is seeking to abolish their massage board altogether, in the interest of saving money. And in the state of West Virginia, HB 2502 seeks to combine the administrative functions of the massage board with the acupuncture board (not so weird) and with the forestry board (weird), the board of licensed dietitians, and the hearing aid dealers board (at least the last two are still health-related). It makes you wonder what we have in common with foresters. Are foresters out there planting trees while naked or committing some other unethical act? Maybe so.

A lot of states don’t require any fingerprinting and/or criminal record submissions of applicants for a massage license. A convicted rapist or violent criminal can get one. Some states require licensees to provide proof of liability insurance, but most don’t. I personally think that one’s a good idea.

There is so much discrepancy between the states on modalities that have to be licensed. In NC, where I live, Bowen therapy, craniosacral, Rossiter, Zero Balancing, and 24 other modalities are specifically spelled out as requiring a massage and bodywork license.  We don’t regulate reflexology, which I really don’t get. I’ve had plenty of reflexology and I would have to say that there is at least as much tissue manipulation going on as there is during a session of acupressure, which we do require licensing for.  NY licenses both acupressure and reflexology, and Polarity therapy. I know practitioners who will argue that every modality mentioned in this paragraph is energy work and not massage. You might as well agree to disagree and get a license if it’s required of you.

Speaking of NY, earlier this year SB 1030 was proposed, got stuck in the Higher Education committee, and may have expired due to lack of action. It provides that the commission of prostitution offense by any person upon premises at which a massage therapist regularly engages in his or her profession, or the commission of any such offense by a massage therapist constitutes professional misconduct; provides that upon 3 or more convictions of such offenses upon such premises, or any conviction of a massage therapist of any such offense, the massage therapist’s license shall be revoked. So basically, you can prostitute once or twice, but don’t do it three times or you’ll lose your license. You might even lose it if you weren’t personally prostituting but someone else on the premises was. It’s worded a little vaguely, in my opinion.

In the summertime, not much is happening, because legislatures tend to pack it up and go home. Some things are always left on the table for the next session, and some (hopefully) will never see the light of day again. And some things are urgently needed, like regulation in the 8 states that don’t have any. In each of those states, there are therapists working for licensing, and just as many fighting against it.

You can find regular updates about what is going on in the regulatory world of massage on the legislative briefing pages on the websites of both ABMP and  AMTA.

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A Matter of Opinion

Last week, the AFMTE released a position paper authored by Executive Director Rick Rosen, “Alliance Offers New Vision for National Certification.”

The AFMTE also recently announced that it is partnering with the FSMTB in their initiative to begin approving continuing education.

Both of these have attracted quite a bit of discussion on the various social media sites. And like any discussion, people agree, disagree, and agree to disagree.  I’m glad to say there hasn’t been any mudslinging of the nature that goes on at times in some of these venues. I think these discussions are useful and informative.  They sometimes bring to light a lot of misconceptions that people have about which entity does what, and how they do it.

I encourage everyone to read Rosen’s paper in its entirety, but to make a long story short, it is a plea to the NCBTMB to reorganize, and get out of the continuing education business and the entry-level exam business. The FSMTB has been stating the opinion since their founding 5 years ago that NCBTMB exams are inappropriate for licensing purposes, and encouraging the states to drop those exams and use the MBLEx exclusively. That hasn’t happened.  If the map on the FSMTB is current, 33 member boards are using the MBLEx. If the map on the NCBTMB website is current, 38 states are still accepting their exams, meaning the majority of states are accepting both, and offering their licensees a choice. The AFMTE is also supportive of the Federation’s stance, as is AMTA and ABMP. Still, the facts show that either the 38 states are doing the wrong thing, or else they are exercising their undeniable right to conduct their business the way they want to.

I haven’t been in this profession nearly as long as Rosen or some of the other players here. I became a massage therapist in 1999, and it seems like I joined at a time when everything was just really starting to swirl. I was in the first wave of licensees in North Carolina.  Mr. Rosen actually has license #00001…first person licensed in our state. He has seen and been instrumental in a lot of things happening. I would never try to minimize the contributions he has made to this field. I won’t criticize his career, his integrity, or his belief that he is suggesting something for the good of the profession on the whole.

My criticism is this, and it isn’t directed entirely at him; it’s directed at the concept of any organization trying to mandate to another organization how to run their affairs. We get enough of that from the feds, don’t we?

I believe that the FSMTB and their mission of public protection is a great thing. The member boards come together for the purpose of discussing common problems and looking for workable solutions. Anytime people sit at the table together to try to solve a problem, that’s wonderful to me. I also believe that the AFMTE was started with the noble intent of acting as the voice, advocate, and resource for massage schools and educators. What I don’t believe is that either one of them can unilaterally force the NCBTMB to change their way of conducting business, nor do I think they should have that right.

The FSMTB is developing a model practice act, in addition to developing a CE approval program. They can and do suggest to the member boards that their exam is the appropriate exam, their CE approval (will be) is the appropriate approval, their model practice act (will be) the premier example of an appropriate act, and so forth.  It’s part of the quest to streamline things  in a uniform fashion and promote portability.

However, suggestion is the key word. The member states aren’t bound by any legalities to do what the FSMTB offers in the way of suggestions. If they want to keep the NCBTMB exams, they can. If they want to keep their own practice act, they can. If they want to keep NCBTMB approved providers or continue to approve their own, they can. They all have the right to conduct their business as they see fit within the law.

There is certainly room for improvement, on the practice act front, in particular, when you see all the variance that’s out there between the states. Keith Eric Grant has summarized that. You can access it here.

The bottom line, to me, is that all of these entities, including the NCBTMB, also have the right to conduct their business as they see fit. Unless and until there is a federal law governing massage, the individual entities can continue to do whatever they do however they want to do it. The FSMTB and the AFMTE could spend days pointing out past shortcomings of the NCBTMB, but it wasn’t “the NCBTMB” as an entity that had the shortcomings. It was the human beings running the organization.

As the FSMTB is only 5 years old, and the AFMTE less than half that, neither of these organizations have been in business long enough to have been plagued with the personnel problems, inefficiency problems, financial problems and so forth that happened in the past at the NCBTMB. Board members come and go. Executive directors come and go. Priorities of boards and organization come and go. Even organizations come and go. Last week I learned from Dr. Kory Ward-Cook, CEO of the NCCAOM, that there was previously a Federation of State Acupuncture Boards that fell apart.

AMTA and ABMP have their own missions and their leadership has their own opinions. As do we all. And any organization, just like any individual, has the right to run their business as they please, as long as they are not breaking the law. The NCBTMB is not breaking any laws by continuing to conduct their business as they see fit. The other organizations are not breaking any laws by conducting their business as they see fit. They all have that right. You don’t have to like it. I don’t have to like it. One organization doesn’t have to like what the other organization is doing. But until the federal government steps in and says, “you must do this,” they can all do as they dang well please. If any of them don’t do well enough at whatever it is they choose to do, they won’t survive.

Everybody has their own opinion on what’s good (or not good) for this profession, what’s good for licensing, what’s good for certification, what’s good for teacher standards, what’s good for education, what’s good for continuing education. There are just as many opinions on all of that as there are opinions on what kind of massage oil you ought to use.  Everyone is entitled to that. And everyone is entitled to conduct their business the way they choose to, as long as it’s within the law.

The AFMTE posted on LinkedIn that they had posted Rosen’s position paper directly to the NCBTMB. I suggest that if the folks at the NCBTMB are interested in hearing more about it or discussing it that they will get in touch. And if they don’t, then I suggest that the AFMTE, and in fact all organizations, concentrate on being good at what they set out to do for their organization, and leave the NCBTMB to do as their board and their leadership sees fit. Their Board is elected by their certificants, and their ED serves at the pleasure of their board.  They may well thrive and survive by doing things their own way, or they may fail altogether.

Either way, I think the burden to make it or break it is on them, just like the burden that is on all the organizations, and on any of us as practitioners and business people. And any insinuation of the NCBTMB being “uncooperative” is an opinion, not a fact. I can tell you how to run your business, you can decline to take my advice, and I will not refer to you as uncooperative. I will assume that you are exercising your right to conduct your business in the manner that you see fit, whether it suits me or not.

That’s just my opinion.

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You Say To-may-to, I Say To-mah-to

Actually, I’m from the south, where we often say “mater.” A ‘mater sandwich should be on white bread, slathered with an artery-clogging amount of mayonnaise, and eaten standing over the kitchen sink so it can run down your chin and drip appropriately.

Everybody has their opinions…I’m out here regularly expressing mine, and not everybody agrees with them. That’s fine by me. The world would be a boring place if we all thought the same thing, and the world of massage is no different. This morning, as is my habit when I’m drinking my coffee, I looked at the comments on my blog, hung out on FB, checked out the massageprofessionals.com website to see what kind of arguments were brewing, all a part of my usual routine.

There are so many wonderful and dedicated people in our profession.

Some of them think the standards for entry-level education should be raised, and some of them don’t.

Some of them think massage therapy should be regulated to the nth degree, and some think it shouldn’t be regulated at all.

Some think continuing education requirements are nothing but a burden on their time and finances, and some look forward to taking it.

Some think teacher standards need to be raised, and some don’t.

Some think they have good representation from their professional association, and some don’t . Some don’t belong to one at all, nor do they care to.

Some massage therapists think of themselves as health care providers, and some don’t.

Some think evidence-based practice is the only way to fly, while others immerse themselves in energy work and all manner of woo-woo that can’t be proven.

Some get involved in politics, pay attention to what’s going on in regulation and legislation, and some don’t.

Some step up to the plate and volunteer, and some just want to be left alone to practice massage.

People have their own opinions on what constitutes dressing appropriately for massage, whether or not they should discount services, whether or not it’s okay to give away free massage, whether or not it’s okay to massage friends and family, whether or not it’s ethical to retail products, whether or not it’s okay to give undraped massage.

Every morning, during my routine, I am always noticing the differences of opinion. As I just posted on FB this Easter morning, my friends include Christians, Pagans, Buddhists, Muslims, Hindus, Jews, atheists, agnostics, and pretty much every other religion or lack thereof on the planet. It’s the same with my massage colleagues. The fact that you don’t share my opinions doesn’t make me like you any less, anymore that the fact that you have different religious beliefs would make me like you any less.

We’re all here for the same reason: we know the awesome power of touch. We know massage restores and heals. As for the rest of it, take what you like, and leave the rest. I’m going to go have a ‘mater sandwich.

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More Myths of Massage

Last week I wrote a post on Facebook about some of the myths of massage. My statement on this issue was and continues to be that I am not accusing anyone of telling a deliberate lie, nor am I attacking the character of any teacher who has helped to perpetuate these myths. I choose to believe that everyone has good intentions.

Before I became interested in the evidence-based practice of massage, I’ve been just as guilty as sharing some of them myself. There seem to be so many of them, and in my opinion  people tend to blindly accept what they learn in massage school. We view teachers as authority figures, but the fact is, teachers have a tendency to repeat what they were taught in massage school…so they pass that on to their students, who in turn share that false information with their clients, with the best of intentions. Some of those same students go on to become the next generation of teachers, and those same myths just keep being perpetuated.

Yesterday I heard from Lee Kalpin of Ontario, who shared a few more of these massage myths with me. I am presenting them here, and if anyone has any valid research references that will back these up as fact, please feel free to post it for our enlightenment.

– Massage removes toxins from the muscles.

– Lactic acid is responsible for DOMS (Delayed Onset Muscle Soreness).

– Massage can get rid of cellulite.

– It is contraindicated to massage a person who has cancer (or had cancer).

– If you massage a person who has consumed alcohol, it will increase the effects and make them more intoxicated.

– You can strengthen muscles by performing tapotement.

– You can straighten a scoliosis by doing tapotement on the weak side and stretching on the tight side.

– Manual Lymph Drainage causes the lymphatic channels to collapse for 20 minutes so you cannot do any other manipulations after MLD.

– You should never do more than 3 trigger point releases in a treatment (no reason stated for this one – it was just stated as a fact).

– Ischemic compression for trigger point release should be done as deep as possible.

– Only deep massage is therapeutically effective – as deep as possible. Lighter massage is just for relaxation.

– You should not massage pregnant women during the first trimester.

– You should not massage the feet and ankles of a pregnant woman as it may cause her to miscarry.

– Drinking lots of water flushes toxins out of the system – encourage the client to drink water after a massage.

– You cannot massage a person who has “high blood pressure” – definition needed about how high is high, and cause of hypertension.

– You must massage toward the heart or you could damage the heart valves.

– It is contraindicated to massage pitted edema.

I must say that I have heard all of these at one time or another. Where did they come from? I don’t know. As one FB friend said “I heard it from some reputable teachers.” And they probably heard it from their reputable teachers.  So let’s just let the buck stop with us. If the words “research shows” are going to come out of your mouth, then back that up with the actual research reference, and if you can’t produce any, don’t say it–to your students or to your clients. If all the evidence you need is that massage helps people feel better, then let that stand for itself and don’t make wild claims. And please, as I said above, if you have the research to prove any of these statements, share that with the rest of us.

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If You’re Not Moving Forward, You’re Backing Up

There have been several developments in the regulation of massage in the past few weeks that I personally find distressing. Earlier this week, Florida Senate Bill 584 moved a step closer to passage. This piece of special-interest legislation would amend Florida’s massage therapy law to allow graduates of certain board-approved schools to obtain a temporary permit and practice for six months without a license, until such time as they fail the exam or become licensed, whichever comes first. Although the bill states that they must work under the supervision of a licensed therapist, the terms of that are not spelled out. Does that mean the supervising therapist is on the premises, in the treatment room, or giving an occasional phone call? This is where boards frequently get into trouble and spend a lot of time with something bogged down in a policy committee—when something has not been clearly defined—and in this case, “supervision” isn’t clearly defined.

New Hampshire is trying to abolish massage licensing altogether, as a cost-cutting, government-reducing move. That would of course mean back to square one, where anyone who knows absolutely nothing about contraindications for massage, endangerment sites, or professional ethics can feel free to call themselves a massage therapist.

Utah just amended their practice act to remove the key word “therapeutic” from the scope of practice definition and added in the word “recreational”, in what is in my opinion a misguided attempt to thwart sexual activity being conducted in the name of massage. Other than the fact that I think House Bill 243 is a big step back for our profession, I was just as shocked that the government relations folks in the Utah chapter of AMTA supported it to start with. I’m an active member of the North Carolina chapter, and I cannot imagine the leadership of our chapter supporting that.

I was gratified a few days ago to see Les Sweeney, President of ABMP, and a few days later Bob Benson, the Chairman of ABMP, weigh in with the same attitude I have about this legislation. Rick Rosen, who is a former Chair of the North Carolina Board of Massage & Bodywork Therapy, former Executive Director for FSMTB, and currently the Executive Director of AFMTE, made a comment on Bob’s blog that I think nailed the important points of this issue:

The most critical component of the state law for any regulated profession is what’s known as its Scope of Practice definition. The list of prohibited acts in a law is important, but less so than the scope definition. If what you want to do in your massage therapy practice is not listed in the scope, you can’t legally do it.

The Utah action that removed the term “therapeutic” from the scope definition, and added the term “recreational massage” may have the effect of narrowing the scope of practice for massage therapists. At the very least, it takes massage therapy out of the realm of health care and into the murky world of “other business activities”, which includes adult entertainment.

Considerations around enforcement of a Practice Act should not take precedence over the scope itself, and it is not a sound justification for downgrading the law. That’s what has occurred in Utah, and the Licensed Massage Therapists of that state will have to deal with it.

Every single word in statues and rules that regulate the practice of massage therapy is important. What you think it says is not always what it means — or what it will produce in the daily administration of a regulatory program. That’s why we need experienced and competent government relations professionals representing our interests.

I report on the legislation of massage, and I have future aspirations of working in government relations. I’ve spent a lot of time in the past few years doing research on boards and practice acts, and while I’m certainly not as experienced or learned as Rosen, I think I’m at the point of recognizing a piece of bad legislation when I see it. The way I see it, if you’re not moving forward, you’re backing up.