Should Massage Be Regulated in Vermont?

Replies to This Discussion

Permalink Reply by Kevin Clark on October 25, 2010 at 8:21am

Sheryl,

Voluntary certification/registration is an interesting idea. The main problem I see with it is OPR's inability to investigate--and, if necessary, discipline--uncertified practitioners.

How do you feel about mandatory registration? I could envision a system where all persons who wished to practice would have to register with the State. Registration could be the only requirement--no training or continuing education requirements, no need for grandfathering or exemptions, etc. This would afford practitioners lots of freedom and few hassles, but would provide public protection by giving OPR jurisdiction over registrants.

Kevin

P.S. I don't necessarily endorse mandatory registration. I merely throw it out for consideration.



Sheryl Rapee-Adams said:

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 Sheryl Rapee-Adams on October 25, 2010 at 8:30am

Kevin, good questions! I like that you're thinking about how best to achieve desired results. This is so much more effective than embracing a particular "solution," which may or may not improve the problems it's supposed to address. That's my goal, too.

I point you to Keith Eric Grant, Ph.D.'s excellent article about actual effects of state regulation on massage therapy (http://www.ramblemuse.com/articles/masg_governance_rev.pdf), particularly this section:

p.9-10
4.2 Consumer Protection from Harms of Mal Intent
Apart from the moot issue of harm via technical incompetence, there still can be concerns about unethical exploitation of the professional relationship with clients. Unfortunately, such ethical abuses are prevalent among licensed health professions, indicating that consumer protection is not a matter of training but of following complaints and enforcing disciplinary actions.

Moreover, boards of professional peers appear less effective in taking appropriate action than might be hoped. A 16 June 1998 ABC News report noted that "40%of physicians punished for sex offenses continue to practice" [14]. The same report quoted Minneapolis psychologist Gary Schoener in saying. You’ve got some real clever predators out there. You have to be smart to get through medical school."

The National Psychologist, an independent newspaper for practitioners ran a story about a sixmonth investigation done by The Plain Dealer, a Cleveland, OH newspaper. The investigation revealed that nearly 200 psychologists who "were found to have committed serious ethical violations in the last 18 years nationwide were allowed to continue their practice without ever serving any suspension" [50]. The article went on to say,

The nearly 200 psychologists who were not suspended for even a day were found to have engaged in sexual misconduct with patients, convicted of criminal offenses or committed other major ethical violations. The Plain Dealer looked at records from all 50 state licensing boards and created a data base containing the names of 2,218 psychologists who have been disciplined or denied licensure as a result of ethics violations. The study went back to 1971, although 80 percent, or 1,754, of the disciplinary actions were taken after Jan. 1, 1990 and reported that 27 states have revoked five or fewer licenses. West Virginia, Rhode Island, North Dakota and Montana, which license a total of 1,500 psychologists have taken a combined 15 disciplinary actions, but have never revoked a license. New York, the paper said, has about 14,000 psychologists, and has revoked 12 licenses. In Ohio, where there are 3,900 licensed psychologists, the Ohio Board of Psychology has revoked 16 licenses."

Clearly, such professional boards have created a history of having as much or more interest in preserving professional careers as they do in taking actions aimed at protecting the public.

Although the rate of abuse claims against massage professional liability insurance is extremely low [23], if issues of harm from mal intent are sufficient to motivate state regulation of therapeutic massage, strong consideration should be given to establishment of an independent board under the Department of Consumer affairs. Since the issues are ethical rather than technical, such a board could both provide better consumer protection and substantially reduce costs by serving multiple complementary and alternative health care professions. Such a consolidated board would be similar in scope to that recently created in Minnesota under the MN Complementary and Alternative Health Care Freedom of Access Act [34].

In the context of ethics, however, the 1997 State of Georgia sunrise review of proposed massage regulations noted that there were private sector ethics codes to aid the consumer [22]. The review board, in recommending against state regulation concluded, "The practice of massage therapy requires specialized training but the general public can identify qualified practitioners by existing mechanisms. First, there is a voluntary national certification program administered by an independent, non-profit organization through which massage practitioners may obtain professional certification. Second, there are at least two professional organizations which qualified massage practitioners may join. Both organizations have an impressive code of ethics to which members must adhere. By confirming that a practitioner is certified by the nonprofit organization and/or is a member of one of the professional associations, a prospective client currently can select a qualified massage practitioner."

14 Chamberlain, Claudine, 1998: More Docs Punished for Sex Offenses . Breaching a Patient.s Trust, ABC NEWS, 16 June, (http://more.abcnews.go.com/sections/living/dailynews/docsex980616.html).
50 The National Psychologist, 2000: Rehabilitation or Punishment, Newspaper Series Ponders, 13 Apr 2000, (http://nationalpsychologist.com/articles/art_v9n1_2.htm)
23 Green, Loraine, 2002: private communication, IMA Group, (http://www.imagroup.com/)
34 Minnesota, State of, 2000: Complementary and Alternative Health Care Freedom of Access
Act, (http://www.revisor.leg.state.mn.us/cgi-bin/bldbill.pl?bill=S0689.4&...)
22 Georgia Occupational Regulation Review Council, 1997: Review of Senate Bill 300 which
Proposes to Regulate Massage Therapists. (Executive summary at:
http://www.mckinnonmassage.com/articles/ga_opb_masgrev.html).

Permalink Reply by Kevin Clark on October 25, 2010 at 8:52am

In case you haven't seen it, here's a link to the article:

State Considers Licensing Massage Therapists


Kevin Clark said:

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 Kevin Clark on October 28, 2010 at 6:20pm

I am very familiar with the Sunrise Application and supporting documents. I posed my questions in an attempt to make sure that we were all on the same page. Public protection is the immediate issue and the one that will be addressed at tomorrow's OPR hearing. I didn't want us to lose sight of that as other issues (e.g., insurance reimbursement, "raising the bar" for the profession, the details of a massage practice act) crept into the discussion.



Sheryl Rapee-Adams said:

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.

Permalink Reply by Kevin Clark on October 28, 2010 at 6:47pm

I encourage everyone, regardless of which side of the fence they're on, to make their views known to OPR. If you cannot attend the hearing, please consider submitting written comments. Written comments will be accepted until 10 days after the public hearing. Please see http://vtmassage.wordpress.com/get-involved/sample-letters for address and other information.

I will not be able to attend tomorrow's meeting, but I intend to send a letter expressing my support for regulation.

Even though I support regulation, and I appreciate the work done by the Vermont Initiative for Massage Standards, there are aspects of the Sunrise Application with which I disagree. The proposed Massage Practice Act is a major case in point. But that's a discussion for another day; today public protection is the order of business.

Permalink Reply by David Onne on October 29, 2010 at 1:42pm

The meeting was heavily weighted to the side of regulation as AMTA had organized many followers to attend the meeting. Supporters of non-regulation were few in number, and since the meeting organizers only allowed people to speak once, debate and counter arguments were kept to a minimum.

The important points that the Office of Professional Regulation is looking for is:

-The OPR looks to regulate a profession that demonstrates a clear and present harm to the public, not remote or speculative which cannot be addressed or handled by other available means.

-There are three levels of regulation available:
=Roster or list of massage therapists practicing in the State
=Certification - Applicants have to meet a set of minimum requirements
=Licensure - Applicants have to show competency in their field (i.e. a test)

At this point, what I recognized from the meeting is that the OPR is not going to be interested in the effects of regulation on the massage therapy field or whether or not there's a hidden agenda from other organizations behind the push for regulation. The focus was solely on whether or not there was sufficient evidence that the public was being harmed and whether or not there was already a forum for clients who have been harmed to address their issue with the therapist.

At the meeting there were many stories of people being hurt by therapists. I feel that there was sufficient examples brought up that show the potential for harm is present, regardless of how rare those occurrences are. What I think has yet to be demonstrated is the fact that the harm that was done to the public would not have been affected by regulation at all.

There were stories brought up about hot stone incidents, and some other bodily injury cases in VT. However, all of the therapists involved in these cases were shown to have met the minimum requirements of most states (500 hours schooling, etc). The point was even brought up that in other states (in Colorado, I believe the example was) these therapists, if brought in front of a regulatory board, would probably have been allowed to continue practicing, (with the caveat that they take another hot stone course).

The other stories fell into the category of inappropriate touch, and other ethically based harm. In these cases, while the initial harm would not have been prevented, because number of hours of school has no bearing on the ethical actions of a person, the therapists would not have been allowed to continue practicing. In this case, I believe the call for regulation did have a strong point. Some one who has the intention of doing ethical harm to someone will do it if their boundaries are not strong enough. In this case, however, the lowest amount of regulation would be sufficient in preventing this. An updated roster of therapists who are allowed to practice in the state of Vermont as a "Massage Therapist", with their freedom to practice being removed if they violate ethical codes of conduct would suffice. The point was brought up that the Certification or Licensure of other professions hasn't stopped or prevented them from doing ethical harm. However the sense I got from the conversation was that since even certified and licensed professionals hurt people, then if we allow practitioners to not be required to register and be regulated, the potential for harming the public is even greater. However, that being said, people who intend to do harm, will attempt it whether or not they are required to be certified or licensed.

That brings me to one of the other topics, the loop hole of the Massage Therapy title. A person intending to do harm could title themselves differently as long as they didn't call themselves a "Massage Therapist". This point was brought up a few times by practitioners of other techniques such as Structural Integration, Asian bodywork, Cranial Sacral, etc. While they aren't Massage Therapists, the point was brought up by the OPR that since the potential for harm for those practitioners is the same as for massage therapy, they could possibly also be umbrellaed under the regulation for massage therapy.

Anyways, that was my experience of the meeting. I did have to leave before the end, at around 11am, because I had a session to go to, but people were starting to repeat what other people had previously said.

Permalink Reply by Diedre Seeley on October 30, 2010 at 10:18am

Sheryl -- well we most definitely agree on this one. I am also opposed to licensing. Having lived in New York, I've found licensing to be only of value to massage schools, testing orgs and the AMTA (and sometimes AOBTA). Doesn't do anything for the massage therapists but increase tuition fees and CEUs. Any therapist worth their salt will continue to study, whether it's required or not.

Diedre

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 Diedre Seeley on October 30, 2010 at 10:18am

Sheryl -- well we most definitely agree on this one. I am also opposed to licensing. Having lived in New York, I've found licensing to be only of value to massage schools, testing orgs and the AMTA (and sometimes AOBTA). Doesn't do anything for the massage therapists but increase tuition fees and CEUs. Any therapist worth their salt will continue to study, whether it's required or not.

Diedre

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 Sheryl Rapee-Adams on October 30, 2010 at 1:20pm

Diedre, that's my experience, too, having lived in NH where there was licensing. I graduated from an accredited 900-hour school and still had to take 25 hours of "hydrotherapy" for a NH license. NH didn't care whether it was wet spa treatments or PT, so I went with PT and spent the 25 hours (and hundreds of dollars) in a hot therapy pool -- learning things I never, ever used again. NH has since dropped the hydrotherapy requirement. But any requirements will be arbitrary/redundant to many.

Folks, if it's really about protecting the public, a mandatory registry will take care of that. It will give OPR a place to track ALL hands-on practitioners and a way to take action against those who violate clients. That's how Vermont does it for psychotherapy: http://www.leg.state.vt.us/statutes/fullchapter.cfm?Title=26&Ch...

Diedre Seeley said:

Sheryl -- well we most definitely agree on this one. I am also opposed to licensing. Having lived in New York, I've found licensing to be only of value to massage schools, testing orgs and the AMTA (and sometimes AOBTA). Doesn't do anything for the massage therapists but increase tuition fees and CEUs. Any therapist worth their salt will continue to study, whether it's required or not.

Diedre

Permalink Reply by Julie Onofrio on October 30, 2010 at 8:30pm

It is nice to see that people aren't buying the whole licensing thing even at this stage of the game where most states are licensed. I am not a big proponent of licensing. There has not been any proof of harm. Licensing does nothing to protect the public. It does not stop prostitution.

I found this thread because I was actually looking for info on what it is like to be in an unlicensed state and was looking for people to share their stories but it sounds like MT are able to be in business and do so successfully without licensing here.

I am assuming you have to get a regular business license to be in business.

CE's are another whole story. There is no proof that CE does help keep people up to date on the latest things or that people even need to be. If there are major advancements then there should be major announcements like the old idea that you can't massage cancer. There are still people who think that and don't work on cancer even with CE. It would be more about creating one class that could be taken online to keep up with the latest advancements like that that would affect everyone.

I would love to see more apprenticeship programs created like Keith mentions in his white paper.

I also did see that massage schools just increased the number of hours of training so they could get PEll grants and there has never been any research on what the profession really needs- How can we start looking into that is my main question. I thought by studying the unlicensed states we could learn something as well as from the states that are licensed.

I like the sound of just having to register with the state so that they can stop people if they are doing something illegal and doing harm. You can just peruse the google alerts section and find daily listings of investigations into massage therapists in the US. Licensing isn't the answer. But what is really?
Julie
www.thebodyworker.com
www.massagepracticebuilder.com

Permalink Reply by Sheryl Rapee-Adams on October 31, 2010 at 5:35am

Hi Julie,

As you know from the Body_Work listserv, I agree with you.

To answer your questions: No business license is necessary to practice. We buy malpractice and property liability insurance but neither is required. We also pay business taxes on the 25% of our home dedicated to our practice.

Practicing in Vermont has been wonderful for my husband and me. As I've observed in other states where I've practiced, Vermont's bodyworkers are largely a dedicated, caring group who voluntarily pursue education and self-select into (and out of) the profession.

My sense is that some MTs seek state licensure for recognition, as if state regulation somehow confers greater legitimacy upon the profession and those who practice it. Not surprisingly, MTs who gravitate to professional organizations will also turn out to support even more structure when AMTA/ABMP rallies the troops. However, ABMP's Government Relations Director told me: “This is a lower number than I usually see. We have surveys right now in KS and in ID and they are both 75/35 in favor of licensing. So it is noteworthy that it’s only 60/40 in VT.”

Still, the burden now falls on those of us who are happy with Vermont's bodywork as it is to protect ourselves from mandatory regulation. What a shame.



Julie Onofrio said:

It is nice to see that people aren't buying the whole licensing thing even at this stage of the game where most states are licensed. I am not a big proponent of licensing. There has not been any proof of harm. Licensing does nothing to protect the public. It does not stop prostitution.

I found this thread because I was actually looking for info on what it is like to be in an unlicensed state and was looking for people to share their stories but it sounds like MT are able to be in business and do so successfully without licensing here.

I am assuming you have to get a regular business license to be in business.

CE's are another whole story. There is no proof that CE does help keep people up to date on the latest things or that people even need to be. If there are major advancements then there should be major announcements like the old idea that you can't massage cancer. There are still people who think that and don't work on cancer even with CE. It would be more about creating one class that could be taken online to keep up with the latest advancements like that that would affect everyone.

I would love to see more apprenticeship programs created like Keith mentions in his white paper.

I also did see that massage schools just increased the number of hours of training so they could get PEll grants and there has never been any research on what the profession really needs- How can we start looking into that is my main question. I thought by studying the unlicensed states we could learn something as well as from the states that are licensed.

I like the sound of just having to register with the state so that they can stop people if they are doing something illegal and doing harm. You can just peruse the google alerts section and find daily listings of investigations into massage therapists in the US. Licensing isn't the answer. But what is really?
Julie
www.thebodyworker.com
www.massagepracticebuilder.com

Permalink Reply by The Rev on November 11, 2010 at 5:02pm

It took me a long time to move from being in opposition to licensing to see the need for some kind of licensing.

Maybe Vermont could be the bellwether state for the rest of the states to follow?. Make licensing inclusive of all types of programs rather than restrictive by mandating the unnecessary 500 hour banner put forth by our friends at the Amta. Proposals I made to the CA law makers may be seen here: http://iscaaty.blogspot.com/2007_06_01_archive.html

Good luck to those resisting the continuing onslaught on our profession by the 501(c)6 Amta more interested in advancing the Massage Therapy profession at the expense of those looking to provide other forms of massage and touch than be truly of service to those providing touch to those in need.

Robert
Holistic Bodywork Therapist and Educator
Passer of the NCE
cMT (unused because of the CAMTC stating it would be an unfair business practice)
ULC Minister and advocate of high standards that knows from experience 100 hours of training is more than enough to do massage on a client.

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