Massage Should Not Be Licensed!

Replies to This Discussion

Permalink Reply by Mike Hinkle on November 2, 2009 at 6:28pm

Yes, amongst themselves they got together and formulated this organization. I have been to their annual meeting. They are the best hope this profession has had yet. They are therapists themselves and understand what this profession needs. They deal with it everyday.

Lisa said:

so they just randomly started to do this or they were prompted?

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Permalink Reply by Keith Eric Grant on November 2, 2009 at 9:04pm

Lisa said:

so they just randomly started to do this or they were prompted?

It was not that random. In order for a federation of state massage boards to make sense, you have to have pass some critical point in the number of regulating states. Once that critical point is passed, state boards start realizing that it makes sense to have some organizational forum for discussion and collaboration. Four to five years prior to the formation of the FSMTB, there was a prior attempt at such a federation called the National Alliance of State Massage Therapy Boards (NASMTB). That effort failed from lack of sufficient initial financing, lack of a ongoing business model, and insufficient administrative help. Scroll down also to see Cliff Korn's comment on Laura Allen's report on the 2009 FSMTB meeting.

With the FSMTB, ABMP helped with initial financing and administration, and the state boards involved created an ongoing business model by floating the MBLEx. Actual control of the FSMTB was turned over to an interim board of state board representatives within hours of starting the first organizational meeting in May 2005. The MBLEx helps to cover federation operating costs. The member fees paid by the states are a form of prepayment on representative travel costs (since states are unreliable about allocating travel expenses). Getting representatives to meetings was another problem experienced by the NASMTB. There was some carryover of knowledge, since some of the same people involved in the attempt to start the NASMTB without outside help, were also involved in prompting the start of the FSMTB with ABMP's help.

The other motivator in this was the NCBTMB itself, which lacks any rigorous outside accountability mechanism. NCBTMB is not any sort of government agency. It is simply a 501(c)(6) "Business League" that has met the procedural requirements of NOCA/NCCA to be accredited by them as a voluntary certification agency. NOCA/NCCA is also a purely private association set up to implement procedural/structural standards for voluntary certification agencies; a less rigorous oversight than legislative oversight of regulatory boards and the requirements of open meeting laws. NCBTMB's service deteriorated to the point that the state boards become frustrated with trying to communicate with it. The NCBTMB also had started changing prerequisites on its own, without demand or desire from the states currently using their exams. That, in itself, created a conflict between the state's responsibility to oversee regulation and set the terms of regulation and the NCBTMB's chosen path. In other words, NCBTMB was not good at meeting the needs and desires of the states, and licensing is the latter's responsibility. NCBTMB wanted to pursue its own agenda whether it matched state desires or not. For the state's, having a licensing exam that was designed solely as a licensing exam and that was administered to match their needs was a logical step, even apart from it's use as a funding mechanism to make an association of state boards viable.

There was also a good model for both association and exam provision with the National Council of State Boards of Nursing -- a model that the FSMTB closely follows.

It was often not the states themselves that felt the need to regulate. More often, the move toward state regulation was prompted by the AMTA, in particular, in a desire to move from local regulation of massage by cities and counties toward more uniform regulation at the state level. Once state law preempts local law, however, occupational regulation is the right and responsibility of the state. The responsibility and oversight cannot be delegated to a private agency although details of implementation can be delegated.

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Permalink Reply by Mike Hinkle on November 2, 2009 at 9:14pm

Thank you, Keith!

Keith Eric Grant said:

Lisa said:

so they just randomly started to do this or they were prompted?

It was not that random. In order for a federation of state massage boards to make sense, you have to have pass some critical point in the number of regulating states. Once that critical point is passed, state boards start realizing that it makes sense to have some organizational forum for discussion and collaboration. Four to five years prior to the formation of the FSMTB, there was a prior attempt at such a federation called the National Alliance of State Massage Therapy Boards (NASMTB). That effort failed from lack of sufficient initial financing, lack of a ongoing business model, and insufficient administrative help. Scroll down also to see Cliff Korn's comment on Laura Allen's report on the 2009 FSMTB meeting.

With the FSMTB, ABMP helped with initial financing and administration, and the state boards involved created an ongoing business model by floating the MBLEx. The MBLEx helps to cover federation operating costs. The member fees paid by the states are a form of prepayment on representative travel costs (since states are unreliable about allocating travel expenses). Getting representatives to meetings was another problem experienced by the NASMTB. There was some carryover of knowledge, since some of the same people involved in the attempt to start the NASMTB without outside help, were also involved in prompting the start of the FSMTB with ABMP's help.

The other motivator in this was the NCBTMB itself, which lacks any rigorous outside accountability mechanism. NCBTMB is not any sort of government agency. It is simply a 501(c)(6) "Business League" that has met the procedural requirements of NOCA/NCCA to be accredited by them as a voluntary certification agency. NOCA/NCCA is also a purely private association of voluntary certification agencies. NCBTMB's service deteriorated to the point that the state boards become frustrated with trying to communicate with it. The NCBTMB also had started changing prerequisites on its own, without demand or desire from the states currently using their exams. That, in itself, created a conflict between the state's responsibility to oversee regulation and set the terms of regulation and the NCBTMB's chosen path. In other words, NCBTMB was not good at meeting the needs and desires of the states, and licensing is the latter's responsibility. NCBTMB wanted to pursue its own agenda whether it matched state desires or not. For the state's, having a licensing exam that was designed solely as a licensing exam and that was administered to match their needs was a logical step, even apart from it's use as a funding mechanism to make an association of state boards viable.

There was also a good model for both association and exam provision with the National Council of State Boards of Nursing.

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Permalink Reply by Lisa on November 2, 2009 at 9:27pm

thanks Keith.

I'm sorry if i am frustrating anyone here. as a fairly new MT, i find all these associations and "who's sleeping with who" so to speak rather overwhelming. AMBP is associated financially with FSMTB. and didn't the AMTA have an affiliation with the NCBTMB?

can you see how confusing and a little alarming it can feel as someone new coming into all this?

i have no idea what all these means. i just HOPE that it's not just another means for the state to be involved in more of our financial pockets. and as long as MTs become united, professional and taken seriously i'm all for it.

and what with the rest of the world? we talk about having all states regulated so we can school in one and work in another. is there thoughts or talks of having this cross international levels? (not that i'm planning on leaving TX anytime soon!!) :)

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Permalink Reply by Mike Hinkle on November 2, 2009 at 9:38pm

ABMP simply provided seed money to get going and I think that has been repaid. They are not financially linked. Liked Cliff said, alot of these folks tried this before they were successful. AMTA, I think did the same with NCBTMB. Both Associations, I think are helping in Calif.

But this is the states getting together again, so they can get on the same page with standards.

Lisa said:

thanks Keith.

I'm sorry if i am frustrating anyone here. as a fairly new MT, i find all these associations and "who's sleeping with who" so to speak rather overwhelming. AMBP is associated financially with FSMTB. and didn't the AMTA have an affiliation with the NCBTMB?

can you see how confusing and a little alarming it can feel as someone new coming into all this?

i have no idea what all these means. i just HOPE that it's not just another means for the state to be involved in more of our financial pockets. and as long as MTs become united, professional and taken seriously i'm all for it.

and what with the rest of the world? we talk about having all states regulated so we can school in one and work in another. is there thoughts or talks of having this cross international levels? (not that i'm planning on leaving TX anytime soon!!) :)

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Permalink Reply by Keith Eric Grant on November 2, 2009 at 11:10pm

Lisa said:

can you see how confusing and a little alarming it can feel as someone new coming into all this?

i have no idea what all these means. i just HOPE that it's not just another means for the state to be involved in more of our financial pockets. and as long as MTs become united, professional and taken seriously i'm all for it.

For those, like yourself, just trying to get a handle on regulation, the Minnesota Legislative Auditor's office did a nice review in 1999. The 13 page summary gives a good balance between summary and details. It helps to understand regulation from the state's point of view.

Most states, before shifting to state regulation, have undergone a period of local agency licensing. It's not unusual for a city to charge more for licensing that a state agency will. If it weren't for the tendency of local agencies to license massage, then the massage profession could have self-regulated simply by moving to voluntary certification. This would likely have results, as it has in Canada, with a more specifically defined profession aimed at being part of health care. Only a state law, however, can preempt local licensing laws, and that preemption tended to make the definition of massage a much wider net for which it is much harder to define a specific set of "job" tasks.

At the beginning of the 1990's, AMTA spun-off the NCBTMB as an independent agency, loaning them the start-up costs. The loans were later repaid. The need for a separate agency was specified by the NOCA/NCCA stipulations at that time for a voluntary certification agency. When the NCBTMB was created, far fewer states were regulating massage and the original concept was that the NCBTMB would provide a voluntary certification as a credible credential. Use of the NCBTMB's exams as mandatory licensing exams came later, and partly through the lobbying of the NCBTMB itself. On multiple legal grounds, such use was not the best of ideas.

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Permalink Reply by Mike Hinkle on November 2, 2009 at 11:30pm

Keith, you are good at this. I hate to think of all this history being lost again or misrepresented, Wish you had the time to write these short stories into a book. I sure would like to have a correct outline of how all this came about to go into the Hall of Fame, for future generations. Thanks again.

Keith Eric Grant said:

Lisa said:

can you see how confusing and a little alarming it can feel as someone new coming into all this?

i have no idea what all these means. i just HOPE that it's not just another means for the state to be involved in more of our financial pockets. and as long as MTs become united, professional and taken seriously i'm all for it.

For those, like yourself, just trying to get a handle on regulation, the Minnesota Legislative Auditor's office did a nice review in 1999. The 13 page summary gives a good balance between summary and details. It helps to understand regulation from the state's point of view.

Most states, before shifting to state regulation, have undergone a period of local agency licensing. It's not unusual for a city to charge more for licensing that a state agency will. If it weren't for the tendency of local agencies to license massage, then the massage profession could have self-regulated simply by moving to voluntary certification. This would likely have results, as it has in Canada, with a more specifically defined profession aimed at being part of health care. Only a state law, however, can preempt local licensing laws, and that preemption tended to make the definition of massage a much wider net for which it is much harder to define a specific set of "job" tasks.

At the beginning of the 1990's, AMTA spun-off the NCBTMB as an independent agency, loaning them the start-up costs. The loans were later repaid. The need for a separate agency was specified by the NOCA/NCCA stipulations at that time for a voluntary certification agency. When the NCBTMB was created, far fewer states were regulating massage and the original concept was that the NCBTMB would provide a voluntary certification as a credible credential. Use of the NCBTMB's exams as mandatory licensing exams came later, and partly through the lobbying of the NCBTMB itself. On multiple legal grounds, such use was not the best of ideas.

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Permalink Reply by Keith Eric Grant on November 3, 2009 at 11:50am

Mike Hinkle said:

Keith, you are good at this. I hate to think of all this history being lost again or misrepresented, Wish you had the time to write these short stories into a book. I sure would like to have a correct outline of how all this came about to go into the Hall of Fame, for future generations. Thanks again.

Mike, several years ago Massage Magazine did a two-part article on massage regulation. It's a reasonable review.

I also wanted to clarify an issue that somewhere in all the recent discussions you had commented on -- the issue of harm. I totally agree that harm can and should include emotional harm. More often, however, that type of harm arises from malfeasance rather than being an issue of competence. The need is, in that case, not a training need but a need for having an oversight and disciplinary mechanism in which complaints are processed in a timely matter. I've commented on that distinction from harms of incompetence in a number of prior writings.

The issue of physical harm arose from what students were being told in schools and via organizations. Namely, that untrained massage persons were likely to cause serious harm. If that were true, I would expect to see identification of specific dangers and mechanisms of occurrence and specific protocols and training requirements. This is a standard hazard mitigation procedure. Yet, strangely, that aspect seemed to be missing. Moreover, reports in the medical literature and a 1998 analysis of medical, chiropractic, and massage insurance statistics by Studdert et al. didn't support such a conclusion. Neither did our insurance rates. Yet, at one point (about 2003-2004), NCBTMB was running a "Massage Safety Week", with the implication that using a NCB certified practitioner reduced the hazards of massage. Yet I could find nothing specific in the training requirements that would lead me to that conclusion. Exactly what harms were being addressed by the prerequisites? Where were they spelled out? Also at that time, Dr. Robert Gotlin, an Osteopath, was making public statements on injuries from massage to the media. The written versions had some statement about insuring safety by seeking massage from members of particular massage organizations.I was able to dig up the Massage Today article on this. Interestingly, Dr. Gotlin never saw fit to write up any such injuries in the academic literature. Also interestingly, this was occurring shortly after Edzard Ernst and myself had published independent literature reviews indicating few reported incidents of harm. Neither Ernst nor I concluded that harm is impossible. The responsible method of handling occurrences, however, is to document them, understand the mechanism of occurrence, and get specific training and procedural changes in place to minimize further occurrence. In other words, as a scientist, I'm going to insist that, if we claim harm, we support the claim with an evidence base and do something specific about it. I also believe that a sufficient case for oversight can be made based on occurrences of sexual predation and other issues of malfeasance. But again, that is not generally a training issue. In short, for me, the issue has been about countering misinformation that was "common knowledge".

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Permalink Reply by Mike Hinkle on November 3, 2009 at 12:13pm

Thanks, Keith, I will search out those MM articles.

Won't the FSMTB's data bank, they are working on, take care of the malfeasance aspects? With all the states cooperating and keeping it updated, i think sexual predation and other issues of malfeasance will be on the decline fast. I worry about states not participating, as the predators may head into these non-regulated states. I think this will address those issues.

The system could also compile a larger view of actual harm done and give insurance companies and associations this data to address specific weak spots in education and training.

Keith Eric Grant said:

Mike Hinkle said:

Keith, you are good at this. I hate to think of all this history being lost again or misrepresented, Wish you had the time to write these short stories into a book. I sure would like to have a correct outline of how all this came about to go into the Hall of Fame, for future generations. Thanks again.

Mike, several years ago Massage Magazine did a two-part article on massage regulation. It's a reasonable review.

I also wanted to clarify an issue that somewhere in all the recent discussions you had commented on -- the issue of harm. I totally agree that harm can and should include emotional harm. More often, however, that type of harm arises from malfeasance rather than being an issue of competence. The need is, in that case, not a training need but a need for having an oversight and disciplinary mechanism in which complaints are processed in a timely matter. I've commented on that distinction from harms of incompetence in a number of prior writings.

The issue of physical harm arose from what students were being told in schools and via organizations. Namely, that untrained massage persons were likely to cause serious harm. If that were true, I would expect to see identification of specific dangers and mechanisms of occurrence and specific protocols and training requirements. This is a standard hazard mitigation procedure. Yet, strangely, that aspect seemed to be missing. Moreover, reports in the medical literature and a 1998 analysis of medical, chiropractic, and massage insurance statistics by Studdert et al. didn't support such a conclusion. Neither did our insurance rates. Yet, at one point (about 2003-2004), NCBTMB was running a "Massage Safety Week", with the implication that using a NCB certified practitioner reduced the hazards of massage. Yet I could find nothing specific in the training requirements that would lead me to that conclusion. Exactly what harms were being addressed by the prerequisites? Where were they spelled out? Also at that time, Dr. Robert Gotlin, an Osteopath, was making public statements on injuries from massage to the media. The written versions had some statement about insuring safety by seeking massage from members of particular massage organizations.I was able to dig up the Massage Today article on this. Interestingly, Dr. Gotlin never saw fit to write up any such injuries in the academic literature. Also interestingly, this was occurring shortly after Edzard Ernst and myself had published independent literature reviews indicating few reported incidents of harm. Neither Ernst nor I concluded that harm is impossible. The responsible method of handling occurrences, however, is to document them, understand the mechanism of occurrence, and get specific training and procedural changes in place to minimize further occurrence. In other words, as a scientist, I'm going to insist that, if we claim harm, we support the claim with an evidence base and do something specific about it. I also believe that a sufficient case for oversight can be made based on occurrences of sexual predation and other issues of malfeasance. But again, that is not generally a training issue. In short, for me, the issue has been about countering misinformation that was "common knowledge".

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Permalink Reply by Jason Fella on November 3, 2009 at 12:35pm

Yah I thought we were away from this mindset from when I started 18 years ago. I used to get some interesting reactions from people when I told them I was a massage therapist. Now I get a much different, and better reaction. It's disqusting that this is even an issue, but all we can do is keep being professionals and education people on what we do. The rest will just work itself out, hopefully.

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Permalink Reply by Mike Hinkle on November 3, 2009 at 1:09pm

Keep the faith! Just the difference you mention lends to the fact that licensing and checking credentials is making a difference in how all therapists are being treated. There is still a long ways to go, but it is making a difference!

Jason Fella said:

Yah I thought we were away from this mindset from when I started 18 years ago. I used to get some interesting reactions from people when I told them I was a massage therapist. Now I get a much different, and better reaction. It's disqusting that this is even an issue, but all we can do is keep being professionals and education people on what we do. The rest will just work itself out, hopefully.

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Permalink Reply by Mike Hinkle on November 4, 2009 at 8:59pm

Hi Keith,

I read both many times. I think anyone, reading these, would come to the same conclusion, licensure is the best solution, if possible.

I hear opposition to licensure argue for proof of "harm done". I gladly give them that platform. Now show me proof, if those same therapists, if grandfathered in and are licensed; how that is harming them or their ability to practice? They are crying for freedoms for those who come behind them and that may themselves want licensure.

These articles, echo both sides of this discussion, almost to perfection. Thank you for providing them.

Keith Eric Grant said:

Mike Hinkle said:

Keith, you are good at this. I hate to think of all this history being lost again or misrepresented, Wish you had the time to write these short stories into a book. I sure would like to have a correct outline of how all this came about to go into the Hall of Fame, for future generations. Thanks again.

Mike, several years ago Massage Magazine did a two-part article on massage regulation. It's a reasonable review.

I also wanted to clarify an issue that somewhere in all the recent discussions you had commented on -- the issue of harm. I totally agree that harm can and should include emotional harm. More often, however, that type of harm arises from malfeasance rather than being an issue of competence. The need is, in that case, not a training need but a need for having an oversight and disciplinary mechanism in which complaints are processed in a timely matter. I've commented on that distinction from harms of incompetence in a number of prior writings.

The issue of physical harm arose from what students were being told in schools and via organizations. Namely, that untrained massage persons were likely to cause serious harm. If that were true, I would expect to see identification of specific dangers and mechanisms of occurrence and specific protocols and training requirements. This is a standard hazard mitigation procedure. Yet, strangely, that aspect seemed to be missing. Moreover, reports in the medical literature and a 1998 analysis of medical, chiropractic, and massage insurance statistics by Studdert et al. didn't support such a conclusion. Neither did our insurance rates. Yet, at one point (about 2003-2004), NCBTMB was running a "Massage Safety Week", with the implication that using a NCB certified practitioner reduced the hazards of massage. Yet I could find nothing specific in the training requirements that would lead me to that conclusion. Exactly what harms were being addressed by the prerequisites? Where were they spelled out? Also at that time, Dr. Robert Gotlin, an Osteopath, was making public statements on injuries from massage to the media. The written versions had some statement about insuring safety by seeking massage from members of particular massage organizations.I was able to dig up the Massage Today article on this. Interestingly, Dr. Gotlin never saw fit to write up any such injuries in the academic literature. Also interestingly, this was occurring shortly after Edzard Ernst and myself had published independent literature reviews indicating few reported incidents of harm. Neither Ernst nor I concluded that harm is impossible. The responsible method of handling occurrences, however, is to document them, understand the mechanism of occurrence, and get specific training and procedural changes in place to minimize further occurrence. In other words, as a scientist, I'm going to insist that, if we claim harm, we support the claim with an evidence base and do something specific about it. I also believe that a sufficient case for oversight can be made based on occurrences of sexual predation and other issues of malfeasance. But again, that is not generally a training issue. In short, for me, the issue has been about countering misinformation that was "common knowledge".

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