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My View From Here

By Ralph Stephens, BS, LMT, NCBTMB

About the Columnist
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A Continuing Problem: Making Sense of Continuing Education

This is my 100th column! I am grateful for this opportunity to write for Massage Today and for the high readership. My sincere thanks to each and every one of you!

As I wrote in my previous column, the massage therapy field is in decline. While there is great demand for our services, there are fewer people who want to be massage therapists, fewer schools providing entry-level training, and an appalling drop-out rate for those who manage to graduate from school and obtain licensure.

This is not the time to make it harder and more expensive for massage therapists to comply with regulations. In particular, I'm talking about continuing education (CE) requirements for license renewal.

In the interest of full disclosure, I am a CE Provider, approved by NCBTMB. I have also served on the Iowa Board for Massage Therapy for eight years — five of those as chair.

Here's the Story

Despite impressive-sounding efforts like the Massage Therapy Body of Knowledge, the Entry-Level Analysis Project and the Massage Therapy Model Practice Act, our field remains a disorganized mess. It has not yet earned the right to be called a profession, in comparison to other disciplines who have worked out differences and created consistent license laws, scopes of practice, portability, and accreditation standards.

kids study - Copyright – Stock Photo / Register Mark We have two competing trade associations — ABMP and AMTA, and six different agencies that accredit massage schools (keep in mind only half of our schools are accredited). We have a national certification board (NCBTMB) that tried to take control of the whole field and got busted down to second-class status by the Federation of State Massage Therapy Boards (FSMTB).

As our stakeholder organizations have been unable or unwilling to address the real problems facing our field, they have been serving up diversions that have an aura of professionalism, but don't translate to safer or better quality therapeutic services delivered to the public.

Over the past two decades, NCBTMB has been the primary agency handling approval of CE providers (with course approval added in 2013). While this approval process was created for the purpose of giving recertification a stronger base, NCBTMB's approval protocol was adopted (in whole or part) by more than 20 state massage boards to determine what courses would be accepted for license renewal.

Separate from this, a half-dozen states have their own CE approval processes. There has been a hodge-podge of requirements on the landscape — no surprise in a field that lacks consistent standards.

Back in 2011, FSMTB announced that it was going to team up with AFMTE to create a new CE approval system. Remember that this was in the period when NCBTMB was still conducting its all-out campaign to kill the MBLEx and keep its certification exam in use by state boards for licensure purposes.

But FSMTB later turned its back on the alliance and announced it was going to pursue the establishment of its own CE approval process that focused on "public safety." FSMTB has been through several iterations of this proposal, all of which have been denounced by the rest of the field.

Let's Work Together

Last year, at a closed-door meeting of the Coalition of Massage Therapy Organizations (comprised of the leaders of ABMP, AFMTE, AMTA, COMTA, FSMTB, the MT Foundation and NCBTMB), FSTMB was given a clear directive to work with NCBTMB to create a single-source CE approval program.

No one — outside of the small circle of people who control FSMTB wanted to see two competing national-level CE approval systems. As it turned out, FSMTB's leaders refused to negotiate in good faith with NCBTMB, and published false and misleading information about the organization.

With no further room to negotiate, NCBTMB broke off communication with FSMTB late last year. So there it stands, with FSMTB plowing forward with its own CE approval program, which will be integrated into a massive database they are creating that will eventually track every licensed massage therapist in yet-to-be determined ways. Shades of Big Brother?

Addressing the Real Questions

All of this dogfighting between organizations has obscured the real questions that must be addressed, "Is mandatory CE in the massage therapy field necessary to protect the public?" Studies conducted by the prestigious Pew Research Center show there is no improvement in public safety resulting from mandatory CE requirements in licensed professions.

Since there is a miniscule amount of actual injury that occurs in the practice of massage therapy, there is no public safety justification for CE. The primary benefit of CE requirements is to improve skills and knowledge.

Over time, professional development tends to improve the quality and effectiveness of treatment provided by licensees. That is the only legitimate reason for state massage boards to require CE.

Another question, "Does the massage therapy field need a formal approval process for CE providers and courses? Is it even possible for an approving agency to promise quality assurance?"

Without the kind of consistent standards found in other professions, it is impossible to build an effective CE approval system in the massage therapy field. Add that to the fact there are no teacher training requirements for CE instructors.

The existing CE approval processes run by NCBTMB and various state boards operate on very limited resources that are insufficient to determine the soundness of a course and the effectiveness of instructors. The truth is we have formal-sounding approvals that give the impression of quality assurance, but fail to deliver the goods. It is a false promise.

So, do the benefits of such an approval program outweigh the costs? In a word, no. Since we're spending all this time and money on CE approval that does not improve public safety, and that does not assure quality to licensees who take CE courses, it's clear that we must abandon this flawed and wasteful system. There is no public safety issue, FSMTB has no place in CE approval. The NCBTMB can handle the task, but the process must be changed.

Taking the Next Step

Continuing education is beneficial for the profession, and those who receive the services of massage therapists. State regulatory boards only need a simple framework to assure that CE courses are relevant, and that CE providers operate according to general ethical principles.

NCBTMB already has a list of acceptable subject matter criteria to evaluate CE courses for approval. This was based on a framework first utilized by the North Carolina Board of Massage & Bodywork Therapy from 2001-04. With some updating, it could readily serve as the primary tool used by state boards to determine what CE courses will be acceptable for license renewal.

The administrative workload and cost for CE providers, and state boards would be reduced, and therapists would have greater flexibility in learning options. In place of the redundant and ineffective CE approval schemes our field has been using, I strongly recommend we adopt the Professional Development Provider Registry model pioneered by the National Board for Certification in Occupational Therapy.

This is a streamlined way to keep tabs on all those who provide CE, while ensuring that courses meet basic standards for license renewal and recertification. I'll give more details on this in a future column.

In the meantime, contact your state massage board and let them know you do not want more regulation that does not provide demonstrable benefit. Inform them if you want to be tracked in a national database, or not. It's enough for them to just enforce the laws and rules they have on the books, to keep the worst actors out of our field.

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