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My View From Here

By Ralph Stephens, BS, LMT, NCTMB

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History Repeats Itself

The reason we now have the MBLEx is because the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) became intoxicated on their own power. NCBTMB was to be a certification body. It was to create a certification in "massage and bodywork" and then develop specialty certification exams. However, the initial Board saw a need for a "defensible" licensing exam and that would be where the money was, so they became the lowest common denominator instead of an elevated standard. They never developed specialty exams. Once the money started rolling in the party was on. They became cash rich. They refused to listen to input, became arrogant, unresponsive, provided crappy customer service to exam applicants, schools and state massage boards, wined and dined Board members in exotic places, and basically projected the attitude that "we don't care because we don't have to." Their certification meant nothing, just that you had a license, as everyone was "Nationally Certified." It was not working. The market place always wins. If people are not being served, the market will come up with a solution.

That solution was the Federation of State Massage Therapy Boards (FSMTB). Virtually every regulated profession has a similar organization and ours was modeled after the typical pattern. Many of these "board associations" create and own their profession's entry-level licensing exam. It is how they fund themselves and how a fair, unbiased exam is administered – supposedly.

History Repeats Itself - Copyright – Stock Photo / Register Mark The state massage boards were eager to join FSMTB because NCBTMB had become impossible to work with. In addition, there was the legal issue of using an outsourced certification exam for licensure when these boards had no control, input, or oversight of the administration of the NCBTMB test. 

After the launch of the MBLEx in 2008, NCBTMB engaged in a multi-year campaign to kill the test. They sued some state boards to keep NCBTMB's exam monopoly and hired lobbyists and lawyers to visit and intimidate other boards to block them from adopting the MBLEx. Bullying is never a good way to retain customers, and to this day the state boards harbor resentment against NCBTMB from all this.

The MBLEx has been such a smashing success because it was the right tool for the job. NCBTMB's bad behavior only added wind to FSMTB's sails. Left with just a piddling amount of exam business and facing financial failure, NCBTMB signed an agreement with FSMTB in 2014, exiting the entry-level exam business in exchange for a one-time payment. This was intended to give NCBTMB some resources to continue to promote its new Board Certification Credential and create new specialty certification exams. We've seen the former, but the profession is still waiting for the latter.

Once the underdog, FSMTB is now the top dog as it administered a record number of exams in 2015, and their revenues continue to climb. The MBLEx became a cash cow for FSMTB; it took in more than $5 million in exam fees last year and is sitting on a cash reserve of more than $8 million. The Federation pays its Executive Director more than $300,000 a year in a profession where the average therapist makes $25,000 a year. Yes, sadly, power corrupts and absolute power corrupts absolutely. Some state boards have left the Federation, and others are considering it. FSMTB has picked up the old NCBTMB playbook and has become bloated and arrogant, as it wields too much concentrated power and holds posh annual meetings. Why, its another chorus of "Meet the new boss, same as the old boss" (The Who).

In my previous column, I mentioned how FSMTB made a major change to the structure of the MBLEx without providing adequate notice to the profession. As a result, pass rates plummeted and many massage school grads trying to get licensed and get a job or start a practice (to pay off their student loans) were left grasping. It was shameful and FSMTB denied that its changes to the MBLEx could have had any effect on pass rates.

FSMTB will not reveal a list of sources for test questions. It refuses to say if the exam is now based on ELAP standards, which would mean states with 500-hour educational requirements are being tested with a 650-hour exam standard. Hardly fair. Come on, fess up. Inquiries from state boards to FSMTB's Executive Director are not being replied to, in more than six months in one case of which I am aware. School owners are being ignored, or their questions deflected with double–speak. What do they think they are accomplishing by withholding truth from the profession that they are a part of and that they help regulate? Hey FSMTB, ever hear of "transparency?" In case you haven't, it has something to do with honesty and integrity. It "protects the public." Isn't that your mantra?

It's been nine years since the launch of the MBLEx and FSMTB finally got around to releasing an official study guide. For $29.95, we expected a comprehensive resource, but it's another disappointment from this organization. With the millions of dollars it has under its mattress, why can't the Federation provide the printed guides and online practice tests that are standard in every other profession? When there is plenty of money but poor results, the finger points to who is in charge. In this case, it would be the FSMTB Board of Directors, and especially its Executive Director. It's time for the state massage boards and the profession's stakeholders to force change in the administration of FSMTB. Take back the power and put the money to use for the good of the profession.

CE Approval Changes?

The massage field already has a workable continuing education (CE) approval system, administered by NCBTMB since the mid 1990's. FSMTB continues to ignore the existence of this program, which is easy to do when you have all the chips on your side of the poker table.

Over the past several years, FSMTB has been in the process of creating its own CE approval system. In 2012, it proposed a program called Maintenance of Core Competency (MOCC) which was flatly rejected by the profession. Not listening, this was modified and expanded and has reappeared as the Regulatory Education and Competence Hub (REACH). This is an ever bigger attempt to grab power, money, and CE from the rest of the profession, and it makes me want to RETCH. Doesn't matter what the letters stand for: FSMTB must be stopped in this self-aggrandizing effort.

A Better Way

Truth is, it is time to shelve the high-intensity CE approval processes in favor of a National Registry. This is not so far-fetched. The National Board for Certification in Occupational Therapy (NBCOT) runs a Professional Development Provider Registry that gives the more than 200,000 certified OT's and OT Assistants access to a broad range of courses ( I looked at the application process for providers and it is based on a self-determination that their course material meets the stated criteria.

The existing CE approval processes in our profession (and the one proposed by FSMTB) are based upon a myth of quality assurance that cannot be consistently delivered, and a rationale of public protection in the absence of a threat to safety, health or welfare from CE activities. We are only fooling ourselves with the status quo.

It's time to get honest, and put forth solutions that reflect how things actually are in our field. NCBTMB should administer a CE Registry and end all the administrative paper shuffling and computer dancing. They have come to their senses and are operating rationally and responsibly. If not the NCBTMB, then AFMTE, our educational stakeholder could manage it and receive its funding from it. The FSMTB does not deserve to be given any more power or money and cannot be trusted with a CE approval program.

Pretty heavy stuff here for sure. I'll lighten up and share some amazing ways to help people in my next column.

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