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My View From Here

By Ralph Stephens, BS, LMT, NCTMB

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Mismatched Solutions to Our Most Pressing Problems

In the quest to make massage therapy into a profession, our stakeholder organizations have been engaged in various large-scale projects over the past five years to put some cornerstones into place. These are the kinds of efforts that were done long ago in other full-fledged health care professions, and that have been lacking in our field. It's no secret that massage therapy lacks consistent education, regulations and standards of practice, so the drive to create more consistency seems like it should be a good thing.

That would be the case if the solutions were properly configured to solve the problems and were achievable in the context of the field, as it currently exists. However, each one of these projects has missed the mark in different ways.

MTBOK

The Massage Therapy Body of Knowledge (MTBOK) featured a convoluted scope of practice definition and included a number of competencies that were above or outside of entry-level skills and knowledge, as most massage schools have been teaching their students. The Alliance for Massage Therapy Education (AFMTE) came in behind the MTBOK Task Force to recalibrate the competencies to a level that schools could be reasonably expected to produce. AFMTE also added a bridge between the competencies and curriculum delivery to aid schools in the implementation of the standards. Unfortunately, due to bruised egos, all of this work has been generally ignored by the massage field and is sitting on the proverbial shelf gathering dust.

mismatched - Copyright – Stock Photo / Register Mark ELAP

This was followed closely by the Entry Level Analysis Project (ELAP), which was designed to establish what a foundational massage therapy curriculum should include. This effort, spearheaded by ABMP and AMTA, was conducted in secret by a handpicked group of experts that was selected by the heads of these two organizations. This was another well-intended effort that overshot the mark. Collectively, the 527-page Entry Level Massage Education Blueprint and the 266-page ELAP Core Report are beyond the grasp of most educators and practitioners in our field. As a result, these documents have joined the MTBOK on the back shelf.

MPA

While these projects have been taking place, the Federation of State Massage Therapy Boards (FSMTB) has been developing a Model Practice Act (MPA). This cornerstone piece is supposed to guide massage therapy regulation at the state level, by providing a template for both new massage laws and the revision of existing statutes in states already under regulation. Again, this sounds like a great thing, but the final version of the MPA, released in October 2014, contains numerous technical errors, as well as more dangerous provisions that have the potential to limit the scope of practice for massage therapists Hey, that's you and me!

The work of the MPA Task Force is a classic example of Death By Committee. FSMTB's group of state board reps took 42 months to come up with this all-important document. It would have been far more effective to hand this job to a few administrative law experts who could have delivered a superior product in just a few weeks. Too many cooks spoiled this broth and the result will be toxic for our field if the recipe is actually used at the state level. From my perspective, this is one project that should stay on the shelf, unless it is taken back for significant revision. Here are some of the most serious problems I see in the MPA (section numbers are as listed in the document).

The Scope of Practice definition in Section 104 is too limiting and non-specific. The practice of massage therapy is more multi-faceted than what is presented. If adopted by states, this definition is likely to shrink what massage therapists' are legally permitted to do. Florida would lose ultra-sound; Iowa would lose the ability to treat; no one would have the ability to assess. It is a scope perfect for non-specific, relaxation only massage. It could possibly make clinical, problem-solving massage beyond our scope. I don't think this is by accident or oversight. I will explain that more in my next column.

We have a once-in-a-generation opportunity to go beyond the kind of scope definitions found in current state massage statutes, to establish a new and more expansive model that more accurately reflects the full range and potential of what massage therapists may do in their practices. The FSMTB has blown this opportunity with their MPA and, if adopted, will deny the public access to the full potential of soft tissue therapy in the name of protecting them.

Those outside our field may try to keep massage therapy in a small box, but it is up to us to claim our turf. Remember that the scope definitions in our state massage statutes were developed as massage therapy advocates were trying to get initial licensure laws enacted. Inept compromises were made in many circumstances just to get a bill passed. We must look beyond those existing definitions to envision a truly representative scope for massage therapy. My colleague, Rick Rosen, presented a next-gen scope definition to FSMTB that would have accomplished this, but it and the feedback from many others unfortunately was ignored.

Section 106 of the MPA deals with Title Protection and it strays into muddy waters. The MPA has done nothing to solve the existing conundrum of which modalities should be covered by regulation and which should be exempt. In a few states (like Florida), there are no exemptions and all hands-on practitioners must have a massage license from the state board, as it should be. In states with more recently enacted laws, there is an inconsistent pattern of exemptions where certain modalities are included in one state, but excluded right across the state line. That doesn't make a bit of sense and it both impedes portability and limits our progress toward status as a unified profession. Another opportunity missed by the FSMTB's MPA.

Speaking of portability, Section 302 places undue limitations on Licensure by Endorsement, (Portability), as the MPA requires a massage therapist to hold a license in a state and be in active practice for two of the past three years to apply for licensure in another state. A person would also be required to pass the state's required massage licensing exam, even if a long-time massage therapist came into licensure in that state during grandfathering when no exam was required. Both these provisions are excessive and unnecessary. As long as a therapist has a valid license in one state and a clean record, they should be able to obtain license in any other state without jumping through more hoops. The MPA does nothing to further that. It also requires a temporary license for disaster relief workers (MERT Teams) and for continuing education providers. Again, this stifles the public access to massage in the name of protecting them. It will place a huge burden and expense on traveling instructors and will probably reduce the number of courses available to us. Thanks a lot.

Finally, the Legislative Declaration in Section 102 of the MPA labels massage therapy as a "healthcare profession," which is part true and part wishful thinking (in lieu of all the shortcomings and inconsistencies of our field). The key element that's missing here is any reference to massage therapy as a healing art, which is reflective of its long lineage and its true nature. Not to mention it's the language required in Iowa that provides massage with exemption from sales tax. This is a great error that must be corrected.

Judging from the lack of chatter about the Model Practice Act on social media, it appears that few people have paid attention to this project. While the MTBOK and the ELAP may not come knocking on your door anytime soon to take away aspects of your professional practice, you need to recognize that FSMTB and their misguided efforts on the MPA can and will do that very thing. Read the MPA, see for yourself and take action. Contact your State Board and strongly urge them to ignore and avoid the MPA for the sake of the massage consuming public and your ability to practice.

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