Should Massage Be Regulated in Vermont?

Replies to This Discussion

Permalink Reply by Chris L. Widlund on October 18, 2010 at 8:30am

Sheryl, Peter and all,

Thank you so much for taking your time to share your thoughts and concerns. As a part to this initiative of regulating massage therapy in Vermont, I want to clearly state that there is no hidden agenda. We are simply interested in protecting the public by:

• Establishing entry-level requirements
• Defining a scope of practice so the public knows what massage therapy is (healthy, healing manipulation of soft tissue) and what is not appropriate massage therapy practice
• Providing an avenue of complaint for the consumer of massage therapy.

The need for protection exists and this has been our job to prove and present to the Office of Professional Regulation. We have done so through the Sunrise Application, and will continue this process at the Sunrise Public Hearing on October 29th in Montpelier.

On a different note, I completely agree with you both that working with insurance companies is a hassle and sometimes a burden. This initiative is not about insurance reimbursement. Please help us to avoid creating confusion around the need to regulate being based on public protection and not insurance reimbursement.

Thank you all for your energy and passion on this matter.

Permalink Reply by Sheryl Rapee-Adams on October 18, 2010 at 9:29am

Hi Chris, I appreciate knowing that the goal is public protection and not insurance reimbursement. I'm hoping you will offer examples of how massage therapy regulation in other states has protected the public. I understand the avenues for protection, such as entry-level requirements and a complaint reporting system, but I seek evidence of actual public protection improvements due to massage regulation.

Also, I want to know how those who promote massage regulation in Vermont will prevent harms to practitioners and the profession including:

1) Onerous CEU requirements, often primarily available from inadequate and/or irrelevant (but nonetheless approved) CEU providers

2) Skilled hands-on practitioners being unable to practice legally because they can't afford school or can't succeed in an academic environment

3) Skilled practitioners of a parallel modalities with competencies not addressed in massage schools, such as Craniosacral Therapy or Trager Work, being prevented from practicing -- to their detriment and the public's. For example, a bodyworker who wants to practice only Craniosacral Therapy cannot practice in states requiring massage school attendance, despite the massage school curriculum being largely irrelevant to Craniosacral Therapists, as well as burdensome expenses of money and time



Chris L. Widlund said:

Sheryl, Peter and all,

Thank you so much for taking your time to share your thoughts and concerns. As a part to this initiative of regulating massage therapy in Vermont, I want to clearly state that there is no hidden agenda. We are simply interested in protecting the public by:

• Establishing entry-level requirements
• Defining a scope of practice so the public knows what massage therapy is (healthy, healing manipulation of soft tissue) and what is not appropriate massage therapy practice
• Providing an avenue of complaint for the consumer of massage therapy.

The need for protection exists and this has been our job to prove and present to the Office of Professional Regulation. We have done so through the Sunrise Application, and will continue this process at the Sunrise Public Hearing on October 29th in Montpelier.

On a different note, I completely agree with you both that working with insurance companies is a hassle and sometimes a burden. This initiative is not about insurance reimbursement. Please help us to avoid creating confusion around the need to regulate being based on public protection and not insurance reimbursement.

Thank you all for your energy and passion on this matter.

Permalink Reply by Chris L. Widlund on October 19, 2010 at 3:22pm

Michelle, Sheryl and all,

Again, thank you all for being a part of this discussion. Your ideas, questions and comments feed what we hope will be a successful endeavor to protect the public.

Michelle, thank you for taking the time to answer Sheryl's well thought out questions. I completely agree with what you stated above. I do want to add one more piece around continuing education.

As part of the Sunrise Application, we were asked to make suggestions for continuing education requirements. We had a lot of discussion around this specific topic. While we felt is was important to provide continued protection for the public via continuing education, we also wanted to be sensitive to the expense to therapists of continuing education. To address both those concerns we asked for specific language that continuing education would be no more than 24 hours every two years. This language allows the massage therapy board/ advisory committee to review what complaints have been made in a two year period and determine what (if anything specific) and how much continuing education is necessary to maintain public protection. This language would allow the system to be self-correcting and attentive to times when the economics of requiring 24 hours of continuing education would be detrimental to the therapist in Vermont.

Permalink Reply by Sheryl Rapee-Adams on October 19, 2010 at 3:55pm

Michelle Robbins wrote:
"Hope that helps!"

Yup! That helps strengthen our opposition to regulation. This especially:

"And while I completely agree there are (approved!) CE opportunities abounding that do not meet the quality standards they "should", that only means that better therapists need to pick the better courses (i.e., stand on our ethics)."

I wonder how you suggest "better therapists" (not sure what this means) pick better courses when there are so few to choose from. Standing on my ethics means spending my time and money on true learning experiences regardless of their being approved, not jumping through arbitrary hoops such as submitting to a certain number of CEU hours from certain providers.

Information about and reviews of classes often fail to adequately inform prospective students whether they are worthy of their time and money. In Vermont, especially, it is difficult to find any diversity of relevant on-site classes. Even traveling to classes and paying top dollar, I can cite countless instances of fully-approved CEUs with poor pedagogy and substandard instructors.

Permalink Reply by Sheryl Rapee-Adams on October 19, 2010 at 4:02pm

Peter, I hope you will submit your comments for the Oct. 29th, 9am meeting on the Sunrise Application for massage regulation in Vermont. Visit this website for updates: http://vtmassage.wordpress.com/ If you can't attend the meeting, you can email your comments Larry Novins at lnovins@sec.state.vt.us.

I believe that bodyworkers who join organizations such as ABMP and AMTA are likely to support regulation, given their acceptance of professional structures. The many skilled Vermont bodyworkers not hooked into "the establishment" may not even know their ability to practice is being threatened. It's important that the Office of Professional Regulation hear from bodywork professionals who don't want this freedom tampered with, especially since it will protect no one and harm many.


Peter Johnke said:

I am also strongly opposed to regulation in Vermont. There is no evidence that it will make things safer for Vermonter and it will greatly limit the practice and cost more money. I also think there is a hidden agenda going on. Once regulated it is hoped that [eventually] massage therapy will be covered by insurance and "certified" therapists can get reimbursement. This will be a huge mistake as many Nauturopathic Physicians have found out. The insurance companies will tell you what you can and cannnot do (what's reimburseable) and then they take forever to pay -- if at all. So initally you see a lot more clients, but no cash, and have to hire staff to deal with the insurance companies. Ultimately less working with clients and more hassles.
Sheryl Rapee-Adams said:

My husband and I are ABMP members who have had a Vermont bodywork business for over a decade. We strongly oppose regulation in Vermont. We have seen no evidence that regulating massage protects public health and safety or enhances the profession of massage and bodywork.

If someone opposes prostitution, let them push for stronger enforcement of laws against it. States with massage licensing such as Florida have just as much prostitution posing as "massage" as they did before licensing. I oppose burdening massage therapists because non-massage therapists may break the law.

We will stay active to prevent yet another state from falling into the licensing trap. Massage regulation is expensive and onerous for good bodyworkers while utterly failing to prevent the problems its proponents claim it will.

Permalink Reply by Chris L. Widlund on October 21, 2010 at 8:39am

Thank you all for your thought provoking discussion. I encourage each of you to attend the OPR Public Hearing on the Sunrise Review for Massage Therapy on Friday, October 29th, in Montpelier. Specific details regarding this hearing can be found at the top of this page.

In the meantime, here are a few links that might be helpful:

http://vtprofessionals.org/ This is the Sunrise Application for Massage Therapy that we submitted to the Office of Professional Regulation. Many of the questions posed above can be answered by reading this document.


http://www.amtamassage.org/regulation/index.html This a listing of all the states that have massage therapy regulation and contact information for the regulation agencies in each state. I suggest contacting the individual agencies regarding specific incidents of how their regulation of massage therapy has created public protection.

http://vtmassage.wordpress.com/ This is an informational blog put together to help explain the unique Sunrise Process in Vermont and how it relates to regulating massage therapy.

Permalink Reply by Kevin Clark on October 22, 2010 at 12:09pm

The Burlington Free Press is planning to run a story on the OPR hearing/massage regulation in Vermont. I'll let you know when I have more details.

Permalink Reply by David Onne on October 23, 2010 at 6:16pm

I guess as a therapist who is pretty new to the field, I am on the fence on whether or not regulation in VT would make it a better place, but I just wanted to ask some questions because I am unclear as to the parts of the arguments on both sides.

Pro-regulation: Specifically, how does regulation make massage therapy safer? Even if someone does pass a written test and/or minimum required class hours, that doesn't necessarily even make them a good therapist. Simply being able to regurgitate information has no bearing whatsoever on their skills as a therapist. Even while a hands on test would be a better gauge of a therapist's skill and knowledge, what's to say that they won't simply make a mistake on a bad day?

How does a regulatory board decide what to do and how are they qualified to judge, after the fact, whether or not the therapist should continue to practice? How do the examples of regulation in other states specifically apply to Vermont? Vermont is not like other states, what makes you think that regulation will work here?

How long have you been in Vermont? I ask this last question because if you've been here long at all, you'd know that Vermonters don't really care whether or not someone is licensed, they only care about whether or not their pain or issue is being addressed. If you don't do a good job as a therapist, you won't get clients, it's already a self regulating field. A person's reputation is more important to a Vermonter than a piece of paper that 'certifies' them. Vermonters are subscribers to the referral system, it doesn't matter what someone's credentials are, clients who are satisfied will refer to their family, friends, and co-workers and that holds more weight with people here than fancy letters after someone's name or marketing gimmicks.

Prostitution is a problem regardless of whether or not a state regulates "Massage Therapy", that's why prostitution is illegal. How does the regulation of massage therapy even affect prostitution? It's already illegal so why is that even an issue being brought up? If people want to prostitute themselves under the guise of 'massage' they are going to do it regardless of whether or not the massage field is being regulated.

The intention of continuing education credits is to ensure that therapists are continually up-to-date on the latest breakthroughs in massage research, correct? Why should that be a requirement? A good therapist would want to continue his/her own education in order to set themselves apart. The better someone is, the more clients would come to see them and their success is a good indicator of their education and skills. The human body isn't changing very quickly. Perhaps evolution might be changing us, but for the most part, massage techniques that worked thousands of years ago are still very effective today, and certainly some drastic change isn't going to happen to the human body that therapists should be required by a regulatory board to take classes every couple of years so that techniques that have worked for years don't suddenly start harming people.

Why are we as massage therapists trying to model our field after the medical profession? Is the only way to make a name for ourselves really by attaching ourselves to a health care model that is so detached from healing? At a hospital, doctors see how many patients for how long? Nurses and aides do most of the work while doctors prescribe treatment based, for the most part, on 2nd hand information. This issues should probably be a discussion topic debated in the medical forum, but in my opinion the western medical model might not be the best to shape the massage therapy field around, the healing and connection we experience with our clients would suffer.

Anti-regulation: I can see how the intention of the regulation of massage therapy is to further the entire field, supposedly raising the bar so that not everyone can open their own massage practice. What are your apprehensions against it? I know it's hoops to jump through, red tape, bureaucracy, and extra fees. When I first started practicing in CO, I had to get registered and pay lots of fees (that I couldn't even afford) just so I could pretend to start making money to feed, shelter, and clothe myself (not to mention start paying back the huge student loan from massage school). But honestly, I feel that because I am so dedicated to my profession, I would do anything to be able to help people the way I do. It's a hassle, sure, but it's what sets me apart from the average joe / jane therapist.

Regulation of massage therapy supposedly would only hold jurisdiction over people who claim to do "Massage Therapy", correct? So if someone does "Bodywork" or "Somatic Healing" they wouldn't necessarily have to get registered and they could continue practicing as such.

All in all, having grown up and lived in VT for so long, I can tell you that local Vermonters don't really care about red tape and the micromanaging of people. If there is someone who is a "Registered Massage Therapist" and someone who is a "Somatic Healer" they don't give a hoot. They will go to the person who actually helps them address their pain.

Vermonters are also simple and loyal people. If the regulation of massage therapy does indeed happen, clients would still continue to see their 'therapist' whether or not they are licensed.

I guess what I'm trying to say to people who are against regulation is that in VT, whether or not this regulation of massage therapy starts, locals won't really care and it won't make an impact on the day to day occurrences. Sure it'll be more of a hassle, and therapists who are just starting off will have an even tougher time meeting minimum requirements, but the dedicated therapists will do whatever it really takes even if it bankrupts them. The heart is really what drives our field, and a regulatory board won't affect the intentions of therapists who put their heart and soul into their treatments, it will only affect how much we have to charge our clients because even therapists with the biggest hearts have to eat to survive.

Permalink Reply by Sheryl Rapee-Adams on October 23, 2010 at 8:21pm

David, I'm glad you wrote in. Your assertions and questions look deeply into this issue from more than one perspective and that furthers the discussion. Thank you for that. I'm addressing a few things you said:

"Pro-regulation: Specifically, how does regulation make massage therapy safer?"

An apt question, and one that it is the applicants' burden to answer in order for Vermont's OPR to consider recommending regulation, according to procedure. Here's an article, researched and documented, that answers your question and several other issues you raised:

http://www.ramblemuse.com/articles/masg_governance_rev.pdf

Spoiler alert: Regulating massage therapy does not make it safer from what little harm there is anyway.


"How long have you been in Vermont?"

I've lived here since 1996 and have practiced massage here since my arrival. My husband has lived here since 1977 and has practiced massage here since 1982.

"Anti-regulation: I can see how the intention of the regulation of massage therapy is to further the entire field, supposedly raising the bar so that not everyone can open their own massage practice. What are your apprehensions against it?"

If the goal is furthering the field of massage therapy and conferring some kind of official recognition on practitioners who seek it, I would support a voluntary certification or registration. That is, to call oneself a Certified Vermont Massage Therapist, one would need to meet certain standards. Vermont;s bodyworkers should develop those standards collaboratively, drawing on best practices and results-based strategies (not a set of standards imported and imposed by two huge national organizations).

My apprehension against regulation is that it does cause undue hardship that benefits no one. I refer you to the article I linked above -- regulation is shown to reduce diversity in practitioners and modalities while failing to increase safety from harms that are minimal and, in any case, irrelevant massage therapists' regulatory status.

"But honestly, I feel that because I am so dedicated to my profession, I would do anything to be able to help people the way I do. It's a hassle, sure, but it's what sets me apart from the average joe / jane therapist."

Your dedication is wonderful. You're right -- it's a profession of heart and I would hate to see bodyworkers deal with the awful culture that is driving wonderful caregivers from our medical system. (I have a good friend who is a physician that no longer practices because she could find no way for her to do so that is both healthy for her and financially viable. She's far from alone.)


"Sure it'll be more of a hassle, and therapists who are just starting off will have an even tougher time meeting minimum requirements, but the dedicated therapists will do whatever it really takes even if it bankrupts them."

How unnecessary. I certainly hope it doesn't come to that.

Permalink Reply by Sheryl Rapee-Adams on October 24, 2010 at 5:10pm

Michelle, I think you've raised some important issues. My sense is that there are now far more bodyworkers in Vermont, as well as more people utilizing bodywork, and therefore there are more complaints.

My experience from living in a licensing state and from research is that regulating massage therapists does not improve the issues you described. I hope you will research actual results (or lack thereof) from states that regulate massage. I hope you will utilize your energy and devotion to the profession to seek effective ways of achieving laudable goals. I don't believe regulation is among them.

Again, I offer my services to help formulate a voluntary registration or certification system that will prevent no one from practicing (including those who have taken a single class -- or no classes) but will allow only those who meet certain qualifications to call themselves Certified Vermont Massage Therapists.

Permalink Reply by Kevin Clark on October 25, 2010 at 8:00am

Just for clarification: OPR is in the process of determining whether it is in the public interest to regulate the practice of massage therapy. The sole purpose of regulation would be public protection.

Am I right so far?

As part of the Sunrise Application, sample statutory language was provided (e.g., definition of massage, grandfathering provisions, exemptions, continuing education requirements). None of this is written in stone. If OPR decides to pursue regulation, then what will and will not be in statute is open for discussion, debate, modification, etc.

Am I also correct in this regard?

Permalink Reply by Sheryl Rapee-Adams on October 25, 2010 at 8:12am

Kevin Clark said:

Just for clarification: OPR is in the process of determining whether it is in the public interest to regulate the practice of massage therapy. The sole purpose of regulation would be public protection.

Am I right so far?

Kevin, not only are you right, but the OPR's application Application for Sunrise Review states:

"8. What harm or danger to the health, safety, or welfare of the public can be demonstrated if the practice of this profession/occupation were to remain unregulated? (Note: The potential for harm must be recognizable and not remote of speculative.)"

Take a look at the app filed by AMTA/ABMP:
http://www.vtprofessionals.org/downloads/sunrise/mtsunriseapprpt.pdf

The applicants include an exhaustive list of harms that touch can potentially inflict. Nowhere, though, do the applicants offer any evidence of 1. these harms' prevalence among massage clients being treated by (regulated or unregulated) MTs or 2. regulating massage preventing these harms. Instead, the applicants offer unsubstantiated claims such as:

“Most sources agree that, because massage therapy is practiced on the soft tissue and is less invasive than chiropractic adjustments or physical therapy for example, it is relatively safe if performed by a trained and qualified individual. (http://nccam.nih.gov/health/massage/)”

and

"It has been noted that when licensure of massage therapy in present, there is less desire to attempt to offer illicit services that could be associated to, or advertised as massage."


What "sources"? Who has been doing this "noting"? I contend that the applicants' assertions cannot be proved and are, in fact, untrue.

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