Legislation

Comment

Comment by Dee Vickers on February 25, 2011 at 1:12am

A new law has been passed in TN requiring massage establishments to post signs at our entrance about a toll free human trafficing hot line!  Please ABMP help us with this new law.  This is just a step back in time for us!

Comment by Carl W. Brown on October 27, 2009 at 3:28pm

Laura, I tend to agree with Keith in that I support letting the free market rule. If what they are doing causes no harm and ultimately the Chiro is responsible then why not? If the work is shoddy then people will not go back to the Chiro. If they can provide a competitive service with less overheard that we need to look are our requirements. Maybe we are making to too expensive to enter the profession and yet deliver no better service. At least our jobs are not going to be exported to India.

We need to set standards that correlate with performance so that the cost to enter the profession is really reflected by the quality of service. If we train to an exam that does not reflect cost effective quality the exam should be changed and we only have ourselves to blame.

If the type of work that is done in the Chiro office is only a subset of what MTs are trained to do then does the extra scope of what MTs do a marketable commodity? If so that again we have no issue because they are not competing for the same service.

If the law goes against free market trends then we need justify the disparity in terms of protection from harm. If we cannot justify the law as public protection we need to consider why we are distorting the market place. Legal protections may sound good but they always have a price to pay. For one they freeze the profession into an artificial format that stifles innovation and diversity. It also diminishes the market because if we actually fit in to the natural market we will get a larger market share.

Comment by Keith Eric Grant on October 27, 2009 at 10:06am

Chiropractors and medical doctors in California as I recall, can both hire unlicensed assistants and train them to suit their particular needs. In many cases, those needs may include duties not covered in massage schools and certainly not something one can assume is covered to achieve competency. Until we have a definitive entry level job description with a clearly defined list of task competencies, we don't even have a solid basis for argument as to whether or not we guarantee the task competencies needed for the job.

I forget whether it was in the 2001-2002 or the 2003-2004 CA legislative session, but a stipulation was passed that those practicing under the supervision and auspices of a chiropractor's license had to be employee's of the chiropractor and not independent contractors. It's worth noting that such person's are considered to be practicing under the supervision and responsibility of the hiring professional's license and that the licensed professional is assuming both liability and professional responsibility. The job performance of the assistant will also reflect on the professional's practice. It is in their interest to train the persons they hire to be competent on the tasks to be performed. Whether or not that occurs, will depend on the quality of the chiropractor and on what they deem to be essential to the quality of their practice. Your mileage may vary.

Comment by Mike Hinkle on October 27, 2009 at 6:00am

Hi Marissa,
We have the same thing in FL, they are called CAs Chiropractic Assistance. A lot of students quit school to take this easy job. It is as tough as be-friending the Chiro.

The reason they can do it is some of the state legislators are Chiros it and they voted for it. They get cheap half trained labor and are legally making bucks. Then when they want to get another one they just fire this one and the student either gets frustrated and quits or goes back to school.

Comment by Laura Allen on October 27, 2009 at 5:44am

In reply to Ariana, it is an ongoing issue in NC with chiropractors getting people off the street and paying them minimum wage to rub people--and that's all I'll call it, not massage. We can't go after them unless they are actually advertising massage, and most of them have figured that out. Our board has tried to stop it, and their response to us was basically that their board has been in existence since 1917 and ours has been in existence since 1999---they laughed at us, to make a long story short.

Comment by Carl W. Brown on October 2, 2009 at 5:09pm

I will move the discussion of practice acts vs title acts in the body of knowledge group to the this group.

If we enact practice acts we need to limit the scope of the body of knowledge to that which is needed to prevent permanent harm. With practice acts we can aim higher and focus on minimum competency.

I also believe that title acts have the best change of being recognized across state lines and even if they are not one can still work without using the title.

If we look to licensing to counter prostitution it is not violating the practice of massage but the title protection portions of the act that they are in violation.

If massage is so dangerous then why are our insurance rates so low?

Comment by Keith Eric Grant on October 2, 2009 at 11:52am

Mike,

Already left a lengthy comment under Carl's BOK discussion earlier this morning. I'm not sure that even that goes beyond just scratching the surface of the issues there. As I noted there, I also direct messaged Edzard Ernst via Twitter to take a look at the draft BOK.

Comment by Keith Eric Grant on October 2, 2009 at 11:48am

Carl,

From what I was reading in Chaitow & DeLany's Clinical NMT (as well as prior learning), there would be some aspect of putting "muscle whispering" under indirect myofascial release and positional release (aka strain-counterstrain). I noted that one point C&D had a statement about "whispering". But that still leaves open the entire question of gaining (or having from life experience) the subtle elements of palpation and sensory refinement that make the work at this level possible. Gary Klein, in his field research on the exercise of expertise, noted that there seems to be both a collection over time of patterns of sensory experience (which are matched at an unconscious level of the mind) and changes in perception. It has an element of what I observe from those directing my older son's H.S. band practice -- there are over 200 on the field with their instruments, but the directors can perceive and point out the individual clarinetist who was a little behind in position or didn't curve quite right and ask them to take responsibility for correcting that. For them, it's as if each anomaly or deviation from the anticipated or desired is highlighted as in an enhanced computer display. Some pick up such abilities from their childhood environment, some from prior learning, so from reflective practice. There's an estimate tha,t in many areas, expertise is the result of about 10,000 hours of reflective practice. It goes without say, that much of or sensory environment is beyond the capabilities of our conscious mind but not of our unconscious processing.

Comment by Keith Eric Grant on October 2, 2009 at 9:52am

My September column for Massage Today also delves into the question of purpose of CE courses and effectiveness toward a purpose.In saying that "most CE courses are dead on delivery" I'm not making a condemnation of well-planned learning, but or requiring courses without a defined objective. Required CE makes sense where there are little used but critical skills that require periodic refreshing or in which specific knowledge and protocols are regularly being changed. CPR training is a good example.

I am an advocate of people following what ever interests they may have in pursuing life-long learning. If we are requiring CE units, however, I am more critical. Have we set specific goals that such CE is to accomplish? Are we assessing that the use of CE is achieving these goals? Is the use of CE increasing skills and knowledge in applied practice? Is there a consumer/client benefit to the financial and time outlay we are requiring? In general, I don't believe this questioning is occurring nor is the assessment being done. It should be. We may simply have adopted a broken model of learning without sufficient reflection.

This questioning of CE comes both from the references in my September column and from what I have seen from years of looking at articles on learning, of more general application. Increases in skills and abilities brought to practice require application as well as listening and, most often, iteration and reflection. This is a separate issue from student learning in verbal, visual, and kinesthetic modes. I am well aware of the diversity in how different people best assimilate knowledge (e.g. visual-spatial versus verbal-linguistic learners). Practitioners need well-defined goals for learning that fit into the overall context of the person's practice and learning plan. Most CE courses, particularly as applied to meeting organizational or licensing requirements, do not, from what I have seen, meet these goals. I also differentiate CE from life-long learning. One is a requirement, the other an internal process.

Over some 17 years, I have looked at a lot of research on effectiveness of learning and the nature and development of expertise. What I wrote in the article and above is consistent with what I have seen in research on teaching and learning in both general and technical contexts. It is also consistent with my experience as both a massage instructor and as a physicist over this period. There is, in general, a clear differentiation of learning to answer academic questions and the ability to carry information into a deeper context and ability to use. I've provided some of the basis for these conclusions in the references below.

I will note first, however, that "home study" does not have the implication it once did. It is difficult to teach kinesthetic vocabulary remotely, but once that vocabulary and the perceptual changes that go with it are developed, much can be taught. With modern technology a course taught remotely can now exceed a classroom taught class in opportunities for interaction, feed-back, and reflection. A consortium of government, business, and academic players has and is continuing to invest considerable resources in the development of methodology and tools. One outgrowth of this, for example, is the MedBiquitous consortium. This rides on the coattails of the Advanced Distributed Learning (ADL) initiative, a consortium of government defense agencies, business, and academia. Another aspect has been the use of virtual worlds, such as second life for medical education.

• Medical Education in Second Life
• Strengths and Weaknesses of Medical Education in Virtual Worlds
• The Future of Healthcare: 3 questions for Dave Taylor of Imperial C...
• The 2009 Medbiquitous conference also provides a number of examples.

The development of Sloodle further extends the Moodle distance learning environment (DLE). Another such DLE is provided by the Sakai Project. Both Moodle and Sakai are developed and maintained by substantial academic/business consortiums. Massage industry perceptions of remote learning are increasingly becoming laughably archaic. The world is changing rapidly.

Selected Learning References

• John Seely Brown, Allan Collins and Paul Duguid. Situated Cognition. Educational Researcher; v18 n1, pp. 32-42, Jan-Feb 1989. (also see other papers)
• Patricia Benner, RN, PhD, FAAN; Christine Tanner, RN, PhD, FAAN; Catherine Chesla, RN, DNSc, Expertise in Nursing Practice -- Caring, Clinical Judgment, and Ethics, Second Edition, 2009.
• Benner's Stages of Clinical Competence,
• Gary Klein, Sources of Power - How people make decisions. MIT Press, 1999.
• Bill Breen, 2007. What's your Intuition -- An interview with Gary Klein. Fastcompany,
• Howard Gardner, The Unschooled Mind, 1993. (Review/summary)
• Marc Prensky, Digital Natives, Digital Immigrants On the Horizon (MCB University Press, Vol. 9 No. 5, October 2001)
• Edward F. Redish, "Implications of Cognitive Studies for Teaching Physics" American Journal of Physics,62(6), 796-803 (1994)
• Edward F. Redish and Richard N. Steinberg Teaching Physics: Figuring Out What Works Physics Today , Vol. 52 (January 1999), pp. 24-30.
• Frederick Reif,Millikan Lecture 1994: Understanding and teaching Important scientific thought processes. Am J. Phys. 63(1), January 1995
• 
  Hake, R. 2002. Lessons from the physics education reform effort. Conservation Ecology 5(2): 28. [online] URL: http://www.consecol.org/vol5/iss2/art28/
  
  
• Richard R. Hake. Interactive-engagement vs traditional methods: A six-thousand stude... American J. of Physics

Comment by Carl W. Brown on October 1, 2009 at 8:10pm

I have started a discussion group on massage therapy body of knowledge in response to the MTBOK group’s first draft. We are actively discussing several issues.
Because this relates to legislative issues, some of you may want to contribute to the discussion.

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