Massage Regulations

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Permalink Reply by Mike Hinkle on October 19, 2009 at 3:56am

Hi Ivy,

Regulation is on the way that will organize the entire profession. For many years, we have made individual attempts (state by state) to control massage. But with "state rights", it was a patchwork effort at best. Everyone's self interest were paramount instead of the professions'.

State Boards have finally come together with the Federation of State Massage Therapy Boards. This is the organization that was needed to create the guidelines. Working with each other and the industry, a Model Practice Act will be created. It will give one direction and improve the ability of "Portability". Being able to travel between "like-minded" states will enable many therapists to earn more money.

I understand that many therapists want, "to just be left alone"! Sorry! This attitude is why we are still trying, after 5,000 years, to be recognized as part of the undeniable and research proven professional health fields.

Education will increase. Regulations will follow as well. The profession is headed in this direction, not away from it.

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Permalink Reply by Marissa on October 19, 2009 at 9:49am

BRAVO! I believe this needs to happen and that it needs to be our fellow therapist developing this. It is the only way to assure that the "complementary/alternative" treatment approach is not lost. There are too many modalities that are practiced that are "unexplained" or "unaccepted" by the "medical" community that would get lost if we allow any others than ourselves to regulate the profession. Having some form of uniformity throughout the profession would "legitimize" more modalities w/o the red tape.

Mike Hinkle said:

Hi Ivy,

Regulation is on the way that will organize the entire profession. For many years, we have made individual attempts (state by state) to control massage. But with "state rights", it was a patchwork effort at best. Everyone's self interest were paramount instead of the professions'.

State Boards have finally come together with the Federation of State Massage Therapy Boards. This is the organization that was needed to create the guidelines. Working with each other and the industry, a Model Practice Act will be created. It will give one direction and improve the ability of "Portability". Being able to travel between "like-minded" states will enable many therapists to earn more money.

I understand that many therapists want, "to just be left alone"! Sorry! This attitude is why we are still trying, after 5,000 years, to be recognized as part of the undeniable and research proven professional health fields.

Education will increase. Regulations will follow as well. The profession is headed in this direction, not away from it.

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Permalink Reply by Ivy Hultquist on October 19, 2009 at 1:05pm

I agree you hear the "want to be left alone" end a lot, especially on message boards. I have never felt limited or even offended by my state regulations. I feel The State of Iowa has done a great job of regulating and promoting the profession. Since I have been licensed, they have doubled the continuing education requirements. When they did that, they cut our biennial license fee in half. I felt this was a great way to encourage learning and showed they were just not out there to make a buck off me.

I also agree, I see increased regulations and educational standards coming in the future, or possibly a tiered system.

Thanks for the comments, keep them coming!

Ivy Hultquist
Advanced Massage Techniques

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Permalink Reply by Laura Allen on October 19, 2009 at 2:44pm

A movement towards deregulation of massage? That is totally not true in the US; in fact, it is just the opposite. There are MORE states than ever before regulating massage--43 including Washington DC and Puerto Rico, and that's up from 37 last year at this time. In the past couple of years quite a few states that had no board and no practice act have jumped on the regulatory bandwagon. Only one board (AR) has disbanded that I am aware of, and it will in all likelihood be regrouped or their responsibilities placed under another regulatory board. I don't know where you got that it was being deregulated; I am relatively sure none of our trade journals are irresponsible enough to print such incorrect information. You can find the metrics of the massage profession on ABMP's public education website at www.massagetherapy.com

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Permalink Reply by Ivy Hultquist on October 19, 2009 at 3:42pm

Maybe I was unclear here. What I meant is that among massage professionals there seems to be growing number who do not want regulation or feel there is no positive effects from regulations. What I was referring to was the The "Freedom Acts", "Freedom Alliances", or Minnesota's CAP law that we here more of today. Trust me, I am sure there is a group on this website dedicated to those apposed to massage regulation.

Ivy Hultquist
Advanced Massage Techniques

Laura Allen said:

A movement towards deregulation of massage? That is totally not true in the US; in fact, it is just the opposite. There are MORE states than ever before regulating massage--43 including Washington DC and Puerto Rico, and that's up from 37 last year at this time. In the past couple of years quite a few states that had no board and no practice act have jumped on the regulatory bandwagon. Only one board (AR) has disbanded that I am aware of, and it will in all likelihood be regrouped or their responsibilities placed under another regulatory board. I don't know where you got that it was being deregulated; I am relatively sure none of our trade journals are irresponsible enough to print such incorrect information. You can find the metrics of the massage profession on ABMP's public education website at www.massagetherapy.com

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Permalink Reply by Keith Eric Grant on October 22, 2009 at 8:51pm

Massage regulation and attitudes toward it are confusing because there is not a single purpose for it. First, it helps to step back and consider why a state steps in and regulates professions in the first place. Here I'm quoting from a piece I wrote a while back.

The freedoms of commerce that are implicit in the due process clause of the 14th amendment, guarantee a right to do business except where there is a countervailing public interest imposed by due process. The Supreme Court ruling of Dent v. State of West Virginia, 129 U.S. 114 (1889) set out the principle that the state can limit the practice of occupations when it implements a needed public protection from harms of incompetence and malfeasance. There is thus, embodied in occupational licensing, a fine constitutional balance between freedom of commerce and intrusion of the police power of the state upon commerce for the benefit of the public. In allowing a state to determine public benefit, the standard of rational basis is normally used, except when the law involves a suspect classification that might involve discrimination (e.g. race, gender, national origin). In this case, the more stringent test of strict scrutiny is applied.

Rather than write a bunch more here on motivations, I'll refer to a review of health care regulation that was done for the Ontario Health Professions Regulatory Advisory Council in 2003 as part of their decadal process of regulation review. In both Ontario and British Columbia, by the way, general massage is unregulated. In contrast, massage as part of health care requires 2200 and 3000 hours, respectively and has well-defined outcomes in terms of competency profiles and coexisting co-morbidities. Thus the laws regulating massage in both of these provinces are "title acts", setting scope of practice and restricting use of "Registered Massage Therapist" and RMT. Both provinces also have centralized restricted/reserved acts lists, which are quite short. Practices outside of those lists are not restricted except as to title protection. Massage therapy was not deemed by the BC Health Professions Council to require any reserved acts. Again, the Ontario review of regulations notes the following:

The important principle underlying each of the criteria [for regulation] is that the sole purpose of professional regulation is to advance and protect the public interest. The public is the intended beneficiary of regulation, not the members of the profession. Thus the purpose of granting self-regulation to a profession in not to enhance its status or to increase the earning power of its members by giving the profession a monopoly over the delivery of particular health services. Indeed, although these are common results of traditional regulatory models, they are undesirable results, and the model of regulation we recommend [the RHPA] aims to minimize them.

Regulation of massage in the United States is far less defined as to outcomes and guaranteed competencies. In contrast to the Canadian regulation of massage practice as health care, the U.S. regulatory laws are mostly practice acts (required license for any practice) and were undertaken to move from varying regulations of cities and counties to more uniform state regulations (which are still not uniform). The training requirements are typically stated in hours, are imprecise as to outcomes, and are more hurdle related than competency related. I was recently looking, for example, at an Alabama law requiring 1000 hours, but leaving 600 hours without any specific requirements. Use regulations have also been influenced by federal requirements for Title IV funds, 600 hours for loans and 720 hours for full access to Pell grants. Requirements without defined competency outcomes are not standards and don't address any define public need in competence or safety. The U.S. laws also, in the terms used by a Massage Magazine article, cast a wide net over many varying practices, a factor making it difficult to define massage therapy as a unified and specific health care profession. There is a more general review of these thoughts in a recent paper on guidelines for which I co-authored with colleagues.

I'll note that a recent review of CAM regulation in Canada by the well-respected Fraser Institute concludes that CAM practices may be over-regulated. That is basically following the line that if a practice has low likelihood of severe and irreparable harm, then regulation can be self-handled by voluntary certifications and industry practice rather than government intervention. While the occurrence of significant harm from massage is quite low (as are our liability insurance costs), deregulation of non-health-care massage practices along the BC and Ontario lines is not likely in the U.S. from the aspect of oversight. We have different cultural issues. That said, there are those who would like to see a split between unregulated massage and massage regulated as part of health care, along the BC and Ontario model. The inevitable move to evidence-based massage and outcomes oriented training for inclusion in a health care system, will undoubted further increase tension in the cultural divides currently within U.S. massage practice. The discussion of need for specific competencies and proficiency levels, particularly if carried out by the FSMTB, may help to eliminate some of the state to state variation. It is difficult to argue whether or not an "hour" benefits the public; far easier to discuss the merits of training outcomes and competencies in a set profile.

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