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Is it 500? 750? 650? 1200? Which number of hours is the winner?

Recently in Massachusetts where I live, we got state licensure for Massage Therapy. (no golf claps here; raucous Yahoo's! will do thank you very much) After a long struggle, and thanks to our wonderful AMTA for funding a serious voice in the state house, we now do not have to a) pay separate fees to every health department in towns we wanted to work (i.e. if you practiced in 3 towns you could expect to pay one town 100, one town 50, one town 250--whatever the extortioners, oops! health dept. decided), or b) jump through whatever hoop each health department decided was relevant. I've been fingerprinted, VD checked, had to appear before a board to determine my "good moral standing" among other insults. As the State Board struggles in its growing pains, and tries to do right by all of us a big issue has recently come up that is tearing me apart this morning.

The State Board would like to elevate the amount of hours required for licensure from 500 to 650. Some schools in the area have already been training students at a higher level of hours (hello Cortiva!--750) than what the state required. I graduated Ben Benjamin's school, the Muscular Therapy Institute at 1200 hours when Massachusetts only required 500. Incredulously, some schools are balking at having to add another 150 hours to their curriculum. These same schools are arguing against adding the additional hours and are gearing up for a throwdown at the State House this Friday.

I can only throw up my hands in the air and say to those who oppose, "What are you thinking?" Call me opinionated. Guilty! Why on earth would an organization that is dedicated to the art and practice of massage as a profession balk at training their graduates to be even more educated, more prepared, more marketable as contractors/employees/sole proprietors? There's some interesting arguments as to why there is dissent. In my humble and greatly biased opinion, I think it comes down to money. How little has to be offered, and how slickly can it be packaged for people to plunk down their hard earned cash for training? Are the dissenting opinions really interested in graduating excellent practitioners? Are they interesting in eleveating the profession as a whole for all of us to be seen in a professional light? Sadly, no. Granted, I am a businesswoman too. I understand you have to make money to stay in the game. But it's all about the spin folks. When prospective students come to look at schools, it's not about how fast they can get out and get working. They won't be working for long if they're not prepared. Incidence of injury and burn out will be high if proper technique is not covered thoroughly. Having a life long career that is satisfying and frutiful comes from knowledge, preparation and practice.

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Comment by Lisa Santoro on July 22, 2009 at 8:04pm: I'll check the articles out! I've enjoyed some aspects of having a "network" or "family of schools" as Cortiva terms their multiple locations. It is quite a support to be able to contact my colleagues at other schools to say, "Gee, how did you handle this?" The schools that Cortiva chose to acquire were all excellent and I've enjoyed being able to visit and teach at some of them along the way. That would never have happened with a stand alone. The way the curriculum is written is by consensus by a group from all the different schools so most is very well thought out and discussed before rolled out to students. They have a real commmitment to excellence which resonates with me too. It was (is) hard for me to adjust to 750 hours after having taught at 950 for years. Efficiency is the word, and it also gives thought to what kind of continuing ed can support and enhance the current program.

Comment by Keith Eric Grant on July 22, 2009 at 7:00pm: Lisa,

There are several Dept. of Education approved accrediting agencies that are used by career colleges for school-based (as opposed to program-based) accreditation. In addition, community colleges are generally accredited by one of the regional accrediting agencies. From the standpoint of showing adequate resources to qualify for Title IV funds, any ot these is sufficient, program length requirements being met. COMTA is more often used by schools that are massage specific.

As hours have neared or passed the point for accreditation and access to Title IV, a natural consequence has been for new providers to offer massage programs. Cortiva, from my viewpoint, was a competitive response to this trend -- incorporating and having multiple sites to gain similar resources to what a multi-program career college can bring to bear. A few years ago, I pondered a bit on how things may evolve over time in a column titled Ecological Succession. I'd revisited some aspects of this more recently in a column Reflections on Market Share.

Comment by Lisa Santoro on July 21, 2009 at 8:16pm: THank you for weighing in on this Keith, access to Pell grants is a vital resource for students--I thought it was higher hours but thank you for being so specific here. This type of grant as well as other types of student loans are sometimes the break point of whether a student can attend or not. I know that Cortiva is COMTA accredited, but I don't know if that's the kind of accreditation you speak of. I support the AMTA and ABMP (among others) movement toward the Body of Knowledge projet as well. I think nationally it makes sense and gives us a solid collective platform to negotiate in many higher directions in this work.

Comment by Keith Eric Grant on July 19, 2009 at 3:44pm: HAs an addendum, this is a question that also recently arose in discussing portability between states. I'd also responded to that discussion. With the Federation of State Massage Therapy Boards (FSMTB), there now is a forum in which the various state boards and regulatory agencies can get together to discuss their responsibilities under law and to work toward some closer consensus on what set of knowledge, skills, and abilities are sufficiently necessary to fulfill those responsibilities. So shifting around by individual states outside of such a greater discussion also has to be considered from the aspect of how it might aid or detract from an approach to portability. In other words, different goals often have to be balanced against each other.

Comment by Keith Eric Grant on July 19, 2009 at 3:18pm: As Kris commented, the discussion makes more sense if it is placed into that of specific outcomes of training. Rather than discussing hours, what should the state guarantee in the way of specific knowledge, skills, and abilities that the graduate is able to carry into practice? There is a tremendous amount of effort being put into competence management in the greater realm of health care. Whitney Lowe recently started another Ning group in which I'd contributed a number of links on these efforts. The number of hours should be derived from the consensus on what the state has an interest in requiring competence in, not a set number of hours being treated as a shopping cart to fill.

There are also other issues. At 600 hours one gains access to federal loans unter Title IV. At 720 hours (if I recall correctly) you gain full access to Pell grants. But such access also requires accreditation, which is both expensive and affects the minimum size of school that can survive. So, while a change in hours make seem small on its face, it can greatly effect both the economic viability of schools and the ultimate cost to the student. This might be warranted if the state is specific about what must be learned because of demonstrable need, but I don't believe we have yet achieved that level of specificity.

Meanwhile, however, technology and the efforts of others are rapidly changing the granularity with which we can track competencies, identify learning gaps relative to specific job requirements or professional responsibilities, and identify learning modules to close those gaps. It make be that the current Body of Knowledge effort, if based on outcomes will lend some insight into such discussions.

Comment by Lisa Santoro on July 19, 2009 at 2:39pm: I also want to specifically address the opinion that I stand to gain financially and with job security should the hours of study required for licensure go up to 650. Cortiva graduates students at 750 hours. I would make no difference to me whatsoever financially. We're already teaching 100 hours above. Let's call it like it is. The people arguing the loudest would have to increase their curriculum by 100 hours. That's more work, more money, more time they have to invest. Let's not manipulate the facts, shall we?

Comment by Lisa Santoro on July 17, 2009 at 8:35am: Your last sentence made me laugh. I'm not sure if anyone else is paying attention! It's fascinating to me that's for sure. Maybe you should understand that I am 90% massage therapist, 10% teacher. Without us ever talking personally (and maybe we should have lunch some time and have a good old fashioned conversation!) you wouldn't know what my perspective is. I speak from the camp of being a massage therapist and a consumer. I get regular massages and I try to go to as varied a location and practitioner as I can to see what's out there. I also truly love energetic work and beneft the most healthwise because of it. So in essence I think I speak from a fairly educated viewpoint; as a national insructor of continuing education, a local one for Cortiva, a consumer of massage, a practitioner. I can't attend today's meeting due to family commitments, but I will look forward to hearing how things play out. Thank you two very much for posting on this topic, and the time you took to present your ideas and thoughts. It has definately given me something to think about (although did not change my mind) and I look forward to meeting both of you somewhere down the road.

Comment by Kris Stecker on July 16, 2009 at 12:18pm: Your commitment to education is very important and the hallmark of everyone who does well in the field. The irony is that we both are committed to educational excellence and yet we are arguing about an antiquated concept; The discussion should be about competencies, not hours.

As educators we are both acutely aware of the wide range of learning styles and disabilities that create the range of performance of each student. I share your experience of session quality varying tremendously, regardless of the hours or program the person graduated from. The interesting part is that the good therapist benefit more from a good training that the mediocre or bad therapists. The good get better and the others improve marginally or not at all.

I agree with you completely that everyone can benefit from more education. The place we disagree is about what is required for entry into the field. I believe the difference is that you are looking at this from the LMT and massage school employee point of view and I'm looking at it from the point of view of new people who want to come into the field. Perhaps if you worked in admissions and heard all the stories of the people who were trying to change their lives you would have a different point of view. I have been a pratitioner and teacher as well as all other positions in the company. The big difference is that I'm in constant contact with the people who are trying to get into the field. These are the people I represent.

Just to clarify, your statement about "leveling the playing field" is exactly what this is about. The schools with longer programs could not compete with the schools offering shorter programs so they are using the regulations to eliminate competition from shorter, lower priced programs. This is completely unethical and strictly benefits the schools, not the public or future students.

The way that you benefit is that it eliminates competition so more people will be forced to go to schools that offer longer programs. Since you work at a school that benefits by eliminating competition from shorter programs, you lose fewer students which increases your job security.

I'm surprised, as a business person, that you don't understand how requiring a school to raise it's teaching payroll by 30% would not translate into higher tuition. Do you teach at Cortiva for free? I know we pay our teachers very well and it is the bulk of our payroll. (Again, at Spa Tech Institute we already offer programs from 200 hours to 1500 hours and have over 70 teachers so we are very familiar with what it costs to offer a program. We already have a 650 hour program for Massachusetts so we are not affected by the increase in hours.)

The part that you seem to miss is that you are increasing the cost to the public by 30%. Is the economic impact on future students of any concern to you? Do you feel that "raising the bar" is more important than making massage available to as many people as possible? Do you have any compassion for the poor single mother or person stuck in a low end job who is trying to live the American Dream and raise their standard of living?

The point is that we are talking about entry level. Once people get started they can and should get additional education. But many of them need to get started before they can go on to take additional training. If you mandate higher hours for entry level, it puts this profession outside the reach of many future practitioners. Is that what you want?

Respectfully,
Kris

p.s. Do you think anyone is following this besides you, me and Tim? It would be interesting to see if anyone else chimes in or if this is an exercise in futility. :-)

Comment by Timothy Starkey on July 16, 2009 at 11:30am: for the past few years at Westborough Spa Tech Institute we have had 95%-100% pass rate. This is with less hours than MTI, now Cortiva. It should be noted that the National Certfication Board considers 500 hours the entry level requirement. If they saw a significant difference in pass fail rates between people with 500 ish hours education versus say 650 or 1000 hours, don't you think they would increase the entry requirements for the exam? Same hold true for the FSMTB exam.
If the regulations are about public safety and welfare then looking at data from the liability insurance companies is the easy place to go. There are states with 500 (most) and a few states that exceed 500. The insurance industry analizes and looks for issues all the time. If they saw a difference in claims based upon states with 500 hours versus states with more. They would be driving the mission to increase the entry level requirements. Other states like Florida did take an objective look at the data and so that their was no reason to increase the hours. While customer satisfaction is critical to individual businesses there is no means for the industry to assess it. Things like an employer not wanting students from a particular school can be based upon quality, bias, and the hiring managers own preferences. It is too subjective.
There is no data to support an increase in hours over the industry standard. All this does is decrease free enterprize, take away customer choices, inrease costs and time for getting licensensed and adversely affect the public

Comment by Lisa Santoro on July 16, 2009 at 9:20am: I think there are statistics to be had based on the pass/fail rate for the National Certification exam by school. I know that MTI had a 93-98% pass rate on the first try for many years. That would be interesting to look at and see what the details are from schools with less hours. It's just one. As to my information being anecdotal, what kind of study would have to take place? What kind of measurable goals would you want to see? How does customer feedback and satisfaction, employer feedback and satisfaction apply as evidence? I remember seeing on particular employer who specifically stated that grads from a particular school need not apply. (It was not Spa tech where Kris Stecker and Tim Starkey are associated with). I think that's pretty clear data and really a diservice to those who studied at that school. Now are those student/grads supposed to go elsewhere and pay even higher prices for continuing ed for material that could have been covered in a basics program?