The latest news from the NCB says in their latest news(pdf):

The credential will be the first to enable accomplished practitioners to differentiate themselves in the massage marketplace. It will also make it possible for employers and members of the conventional and integrative healthcare arenas to hire practitioners based on a certified, advanced level of experience and expertise.

Is that what is needed for a massage therapist to differentiate themselves in the marketplace?  What proof is there that an exam will help do that?  What about teaching MT to do just that by learning a specialty and learning to present themselves in a way that differentiates themselves from all of the other massage therapists out there in their neighborhood.  If everyone takes the exam – will they all be differentiated?

Those who earn the advanced credential will be nationally recognized for possessing the critical thinking skills necessary to function in complex situations. In addition, they will be relied upon for their ability to work in a team environment utilizing treatment plans based on research-informed outcomes.

How will they get that training in critical thinking skills and on research when most of the massage therapists out there have little training in research since research is really just in it’s infancy in this profession.

“NCAP practitioners will offer the advanced capabilities increasingly sought out by discerning clients, employers and healthcare providers,” said NCBTMB Chair Neal Delaporta. “The credential will open up new opportunities for therapists in conventional, integrative and clinical healthcare settings. It has the potential to take the entire profession to a new level within the medical community.

Is that what will help us be recognized as a health care profession and be able to work in the medical community billing major medical insurance companies and working with injuries and diseases?  Here in WA State we are already recognized as a health care profession and we are able to work with doctors and insurance companies.  We are able to do that because we had a very savvy insurance commissioner who also had a great massage therapist – Lori Belenski- who is now working for the WA State Chiropractors Association as a lobbyist.  Debra Senn, the insurance commissioner created a law that mandated that insurance companies must pay for massage, Naturopaths and Acupuncturists.  The WA State Legislature adopted the “every category of provider” mandate as part of the 1993, Health Care Reform Act to go into effect in 1996.  The insurance companies fought it and took it into Superior Court and held it up until 2000.  Here is the report done at the time “Issues in Coverage for Complementary and Alternative Medicine Services: Report of the Clinician Workgroup Jan. 2000.  The full report that I have a copy of lists the timeline of events leading to the passing of this law.

Does it take an exam to make massage accepted by insurance companies?  Not based on WA State since we only have the minimum of 500 hours of education required for massage professional licensing.

What will take the profession to a new level is having reciprocal licensing!  Come on already!  That’s a simple one to me anyways.

Chair-Elect Alexa Zaledonis added, “For practitioners with the NCAP credential, it means a potential for increased marketability and heightened earning power. It will help connect advanced therapists of all modalities to rewarding positions with high-level employers.”

How will it do that when the major employer in the massage profession are massage franchises.  There aren’t any higher level jobs or at least very few.  What it takes to find or create higher paying jobs is saying “NO” to low paying jobs and going out there and showing employers just what massage can do and how much you can make for an employer.  It is about having the skills to market yourself and negotiate pay – just like most other careers.  Since most massage therapists are locked in the “Noble Poverty” – “It’s not about the money” – too many Massage Therapists are not standing up for themselves and are looking for what a job can do for them rather than what they can do for a job.

The next step is a job task analysis “that will ask practitioners to determine the knowledge, skills and abilities that an “advanced practitioner” must possess, as well as the level of importance that should be placed on each.”

What makes for an advanced massage therapist?  Is it their skills and training?  Is it the amount of time they last in the field?  With over 250 different kinds of massage and bodywork out there (and that number growing everyday)- how will they come up with skills that all types of massage therapists will be able to acquire?

In 2009, the NCBTMB did a needs assessment survey to ask the profession to help define the criteria for the possible exam.  The survey looked at:

•Defining the Advanced Practitioner
•Identifying the Necessary Characteristics of Advanced Certification
•Identifying the Criteria for Advanced Certification

Personally, I find it interesting that they didn’t ask if they thought an advanced certification was needed.  They just assumed that it was and went on to ask questions about it.   Since I never saw any benefit to the regular certification exam, what will people get out of the massage advanced certification?  I have never in 23 years been asked if I was licensed or certified.  I guess I am lucky to live in an area where massage is accepted more and seems to be ahead of the game in being accepted by health care companies.

What makes for an advanced massage therapist?  Anyone who can last more than 3-5 years would qualify in my book!

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They are doing a very short survey to massage therapists but it was only sent out to their current members as far as I know which is also very biased. (Correct me if I am wrong on that.)

Seriously folks – you have to take the survey and/or contact the NCBTMB to tell them your opinions or they are going to waste your money again!

This is the contact information from the press release:

For additional information, contact NCBTMB Director of Exam Development Elizabeth Langston, CAE, at 630-652-0482 or elangston@ncbtmb.org.

A few notes:

anyone can take the survey and anyone can take it multiple times…

The survey was only sent out to NCBTMB members.

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I for one have never seen any value in being nationally certified or in maintaining certification.  Are people being asked to prove their credentials in other states?   I used to hear a few mentions of employers only hiring nationally certified massage therapists in small towns or places where massage is not as well known or accepted but that could easily be gotten around by showing that you were an competent massage therapist.

I for one don’t know how they will determine what makes for an advanced massage therapist with all of the different types of massage out there.  Who will need it?  Who will take the test when you can study different types of massage and practice them effectively without it and you can get actual certifications in different types of massage from each school/program.

I actually have started thinking about the idea that basic massage school needs to move into a 3-4 year program like Canada and Japan.  We also should be studying these other countries to see how it is working there.   I used to be in the camp of less education is better and that you could start practicing massage with 100 hours of training and still think that the right person could do that but because there are more massage jobs out there now than there ever has been in the last 20 years the low pay in those jobs is a problem.

They haven’t even done any market research to see if this is needed as far as I know – have they?

What is next for the massage profession?

Read Laura Allen’s blog post on this at www.massagemag.com

NCBTMB Press Release (pdf)

From their press release:

For additional information, contact NCBTMB Director of Exam Development Elizabeth Langston, CAE, at 630-652-0482 or elangston@ncbtmb.org.

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What makes for a profession is part of the question.  I started looking for answers on how professions are defined but I haven’t come up with anything concrete.

Wikipedia says this about the history of professions.

Classically, there were only three professions: Divinity, Medicine, and Law^[2]. The main milestones which mark an occupation being identified as a profession are:

1. It became a full-time occupation;
2. The first training school was established;
3. The first university school was established;
4. The first local association was established;
5. The first national association was established;
6. The codes of professional ethics were introduced;
7. State licensing laws were established.^[2]

It further goes on to say:  “A profession arises when any trade or occupation transforms itself through “the development of formal qualifications based upon education and examinations, the emergence of regulatory bodies with powers to admit and discipline members, and some degree of monopoly rights.”

A few years ago a white paper on just this topic was written by Rick Rosen called “On Becoming a Profession (pdf)”.  In it he sites his thoughts on what is required for massage therapists to become a profession. He has outlined and talked about in depth these things that need to be done to become a profession.

• Establish a Body of Knowledge
• Improve the quality of massage therapy education
• Reorganize the credentialing process by putting licensure before certification
• Create parity among our state massage laws to increase portability
• Develop and promote a unified professional identity
• Use lessons learned from other professions

The Body of Knowledge is in the works.  Rosen says this:

A Body of Knowledge is defined as “a
compendium of what an individual must know to accomplish work in a specific field.” In our case, this would be described according to the competencies that are required to practice handson therapies in a safe and effective manner. Identifying the knowledge, skills and attributes is a
critical first step in building a profession. It establishes the groundwork for determining standards in education, credentialing, regulation and clinical practice.

Keith Grant has also started a collection of massage competencies to further explain what it is we really do.

The quality of schools is under question with the recent large massage school chains buying up smaller massage schools around the country.  Our massage schools are also looking to younger people to fill their schools when the average age of massage therapists used to be 45.  Currently massage schools report much younger students which requires different teaching methods.  At 45 a person has much life experience to draw from and apply to starting and building a practice.  But with the creation of the many massage franchises massage schools are seeking out younger people to fill those positions because they are most likely to not need much to live on and are quite happy with a job that pays $1-$15 an hour.

Reorganizing the credentialing process is in the works too with the Federation of Massage State Boards working to create a more formal system for licensing.  The NCBTMB will hopefully transition out of the entry-level testing business and redirect its energies toward the development of new and innovative specialty certification programs.

With all of the work of the Federation and Body of Knowledge can we come to more of a consensus and accurately define our profession?  Hopefully that will come with all of the work that is being done.

And what can we learn from other professions?  Some say that nursing is the profession that most closely resembles the massage profession.  I don’t know much about the history of nursing but it might be something to look into.

Because of the work we do with clients is so different than most other professions – touching half naked bodies who are in pain and under stress, there is also the other side of this all and how we are trained to deal with client/therapist relationships – We aren’t for the most part trained in basic massage school.   While I have never been a big proponent of more training and licensing for the first time in 20 years I think it might be time to start doing some research and looking into creating 3-4 year programs like Canada and Japan.  When I first started out massage was more of a lifestyle choice- being able to help people and work your own hours and choose who you worked on.  It still is that but the demands of becoming a profession may require more initial training and more continuing education.

The other part of this – the question on is massage a profession? also depends on each individual and how they represent the massage profession and acting in a professional way.  I have always seen it as a profession and take my work and studies seriously.  I work with professional people in downtown Seattle and had to learn about being professional to survive.  Others who don’t take the profession as seriously may not see how it is growing and becoming a profession more every day.  (Did I just contradict myself?)

What can you do today to be more professional?  What does being a profession mean to you?  Is massage a profession or just a hobby for you?

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The latest news it that they will be offering pizza discounts!  Laura Allen reported this info on her massagemag.com blog.   The  NCB has a new initiative in the works to expand their scope from a certifying body into a membership organization and will be offering pizza discounts.

AMTA Views NCBTMB Decision Not in Best Interest of the Profession in their press release on that decision.

Massage Today reports on more of the story and the reply’s by both AMTA and ABMP.

Earlier this year AMTA stopped supporting the NCB because they no longer agreed with their goings on and moved to start supporting the new MBLeX created by the Federation of Massage Boards.

I still am trying to figure out what this all really means.  There has been some talk of the need to be creating advanced credentialing for the massage profession and that is what the NCB should be focused on.  Their past history has led to loss of credibility with the massage profession in general and they are no longer working within their mission statement -  to define and advance the highest standards in the profession through a recognized credentialing program.   They haven’t been able to keep up with running their organization in it’s current state – how are they going to administer liability insurance and pizza discounts?

Who is currently running the NCB and what is their real reasons for doing this?  To me it just all seems like the are trying to defend themselves and keep their head above water rather then focusing on what the profession needs.

Is the NCB on it’s way out?  Do we need a new organization?  What do we need?

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Nearly sixty percent (57.8 percent) of school administrators responded that the average age of students has declined at their school in the past five years, according to the 2008 AMTA Massage School Survey. School administrators estimate that the average student is 30 years old, with 36.6 percent being 25 years old or less.

Previous statistics from both the AMTA and ABMP showed the average age of massage therapists to be around 44.

Why is massage attracting younger people and what will the effects on the profession be from this change?

Massage schools enrollment is declining which means that massage schools are needing massage students.  Massage schools are recruiting high school students to fill their massage schools.  Federal Grants are also available to massage students which allows younger people without much money to go to massage school.

My website www.massage-career-guides.com which used to be www.massagetherapycareers.com was overwhelmed with questions from high school students asking about careers in massage and what was required to get into school.  Their biggest concern was over whether or not you had to take math and how much you could make.

My career in massage has been a lifestyle and journey.  It was and still is a calling – something that I was just meant to do.  Through it I learn a tremendous amount about myself and about what it really means to be a massage therapist.  I became a massage therapist because I love learning about health and I like helping people (which of course was also loaded with learning opportunities!).  If high school students are drawn to the massage profession because they don’t have to take math – what will that do to the quality of massages being done and the massage profession overall?

I also was quite intrigued by this discussion on linked in or facebook  (I can’t remember which or find the post) talking about younger massage students who were always texting during massage school and even during a massage!  They were doing it to prove that they could and they said something like ‘the client won’t know anyways’!!

These younger massage students are also the one’s who are getting jobs at places like Massage Envy that don’t pay much so it is keeping Massage Envy in business (Is that a good or bad thing?  we really don’t know that either- more posts coming!)

My concern over younger people joining the massage profession is also about whether or not a younger massage therapist can really understand what massage really does and be able to understand the therapeutic relationship and create and hold boundaries.  But I guess I didn’t get it either when I first started 20 years ago and many older adults don’t really get it either.

I am also concerned about the level of service that younger people provide (or not provide) just in the way of basic communication skills and customer service.  When I go into spas and find younger people working the appointment desk I just cringe at the things they say – “All deep tissue is the same” is my favorite!

I used to be totally against licensing of any sort and of even requiring massage training beyond 100 hour of education because that is all it really does take to be able to just do an efficient massage (That will be a whole other post soon.)  I now am thinking that it would be best if younger massage students did get 3-4 years of massage school that could add in the extra training in ethics, business and communication skills as well as learning to be present and work with the therapeutic relationship.    If this is going to be a continuing massage trend- students and massage therapists getting younger – we need to keep up with the changes and not let these students be left behind.

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While I am all for TCM and go to acupuncturists myself for many various ailments – can you really learn enough about the meridians in a weekend workshop to be able to know what to do to work with them? Is it really necessary for massage therapists to know about meridians to have a successful massage practice?

To me TCM is a lifestyle and lifelong learning process. It takes a few years to be proficient in something like this. I personally do not anyone working on my meridians after taking a weekend workshop.

While the NCBTMB also has another exam where they don’t require having to know meridians they call the other exam – the National Certification in Therapeutic Massage. You don’t have to know about meridians but you do have to know about posture and alignment.  That to me is what a bodyworker knows since most of my extensive training (about 6 years of my 20 years in the massage profession) were spent learning structural integration.  I became a bodyworker after that. The test that requires knowing the meridians is called the National Certification in Therapeutic Massage and Bodywork. So apparently just because you know the meridians you can call your self a bodyworker.

The whole thing is very confusing because the profession has no clear definition of what the terms massage or bodywork even mean.

Now here is the thing – If you want to study meridians and TCM please so so and study it with all of your heart.  But don’t make me learn it or have anything to do with it.  I have no interest in it or have the time (1 year or more) to put into learning something like that.  It is not needed to practice massage successfully.

Yes it can help you if you are interested in it but making it a requirement is beyond ridiculous.   If you are a TCM practitioner I am not saying your work is not valid or important so please don’t take this personally.

The whole problem lies in the not knowing what is really needed to be a successful massage therapist.  From what I understand the NCBTMB does do surveys on what classes people have taken and they ask if people have studied meridians.  Of course they have studied it because they made it be a requirement!  Is it necessary?  NO.

Basic massage skills do not require knowing the meridians or anything about them or any branch of traditional Chinese medicine.

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The groups that advocate licensing state that the reasons for wanting licensing are to protect the public from harm, create more professional standards of education, reduce the number of prostitutes doing massage to name a few.   The thing is that there is no proof that massage has caused significant harm to people.  Keith Grant has done an initial survey of medline on the cases of harm that are done to massage clients.  How much harm can be done in doing massage?  What is the definition of harm?  Is it harmful to have a massage therapist who says they are doing deep tissue massage when it is really swedish massage?  Is it harmful when a client leaves feeling more sore than when they came in?   Will any amount of education really influence the massage therapists skills and reduce the ability to do harm?

If there were a high degree of harm being done, wouldn’t our liability insurance rates reflect that?  And how much harm do over the counter drugs do?  I just recently had a friend who had excruciating back and abdominal pain for over a year and it turns out it was an over the counter drug causing it.  Is that harmful?

What list of side effects could be created to inform the public and teach the public to take responsibility for what happens in their massage?

The number of hours of education varies greatly as well as the topics of courses.  I for one started in 1987 doing massage after having 250 hours of massage school.  I was the last year of students to become a massage therapist at that number of hours.  The number of hours of training was going up to 500 hours in a few months and for no reason at all as far as I could see – no testing to see if it was needed… no research…no case studies, no statistics that showed that having more education would help create a more successful massage therapist.  The one thing I did notice was that once they did raise the number of hours, the massage schools increased their hours of training to exceed that 500 hours so that they could get more grant and loan funding for students.  I would love to see if the number of students/graduates jumped at that exact time!   The thing is that we have no information on what it does really take to be a successful massage therapist.  It is more than just doing a good massage.  You also have to be a business person.  But massage can be learned in a basic 100 hour massage class.  Keith Grant also has some information on that topic in his white paper “Issues in Massage Governance” (pdf).  He also noticed the same coincidental increase in the number of hours and the number of grants/loans.  He also talks about how people learn and sites that people learn better in smaller training programs and the preferred method is apprenticeship programs.  There are a few states that do allow apprenticeship programs to be counted as massage training – WA State being one of them.  It was actually the whole reason I started this website -www.thebodyworker.com but the thing is that you can only teach one student at a time unless you want to make it into a formal school, which doesn’t make it profitable.

This is the only information that I have seen that gives any insight into the issues that we are dealing with.  If there are some other studies, information, proof that more hours of education are needed to be a successful massage therapist then I would love to see it.

CA also has the highest number of massage therapists despite them having this licensing problem.  I think that most can become a massage therapist with 100 or 250 hours of training – correct me if I am wrong.  So is it the number of hours of training that make a successful massage therapist?

The thing is that when people hear that after taking 1000 hour training classes I think that they somehow think it to mean that they didn’t need to take that many hours or that it is implied that they aren’t knowledgable or that more training is not beneficial.  It could be beneficial to people who take it but it is not needed to be a successful massage therapist – that is all that it is saying.

The idea that massage therapists need all this medical training etc is really not true.  It doesn’t mean that it could help to have extra classes and training.  It does not mean that more training can give you more confidence and skills but they are just not needed to do a basic relaxation massage which is also very therapeutic.  After 20 years of doing massage and learning structural integration, triggerpoint therapy and many other things I actually am going back to studying the affects of touch on healing.  I once thought as an overzealous massage student that if everyone got a massage once a week (now I would say 3 times a week!) there would be world peace and now I would add – a great reduction in the number of diseases and health conditions that are on the rise.

So I actually don’t care much about licensing these days anymore despite this long post.  I just write to hopefully inform someone and to inspire others to seek the truth.  I am more than open to hearing any more on this topic, but quite frankly – I just want to do massage! (and write about it!)  I sometimes get tweaked and think I should join AMTA or get ABMP more involved especially when I think about the state of insurance billing for massage therapists here in WA State – which talk about a mess!  That’s a whole other category here.

So do you think you could do a really great massage just having 100 hours of training just on doing massage?   I have lots of friends who have that number of hours because it used to be that number a long time ago.  They are all still in business but it seems the more recent grads with 1000 hours can’t seem to make it.  What does it take to be a successful massage therapist?  Is it the number of hours of training?  Is it some secret method?  Is it just about the person and who they are and what they want in their lives?

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1. The insurance companies are constantly reducing the allowable fee (what they pay you and that you accept when under contract with insurance companies.) When I first started in about 2000 accepting insurance one company paid me about $90 an hour which was a very acceptable rate. Within a few years they reduced that rate to less than $70 and it continued to be that same rate until this year when they gave us a $.40 raise – yes that is forty cents when the price of gas is sure to go over $4.00 a gallon.
2. The insurance companies are also constantly reducing their benefits in their policies with people. For example – one company who used to allow 45 sessions of massage and PT combined a year now only allows 14 sessions a year.
3. The insurance companies are constantly making it harder to get paid. One company in particular will ask that we prove medical necessity after 4-6 sessions of massage and then deny any further treatment no matter what it seems.
4. The insurance companies set the allowable fees and usually send out a rate chart in the beginning of the year or when you first contract with them. Although it hasn’t happened to me yet as a massage therapist, I have heard from a few chiropractors and an acupuncturist that they change their mind in the middle of the year and say they are paying too much and reduce the rates and MAKE YOU PAY BACK THE DIFFERENCE – yes I am yelling- and there is nothing that can be done except to pay them back or they will take it out of future payments. I do know of one Naturopath who almost went out of business because of it.
5. Out of network providers may often get paid more than in network providers- yes this is a fact too. There is one company doing just that. If you are out of network they only pay a percentage of the bill usually, but they pay contracted providers so poorly that even the percentage of the full bill which usually is about $132 (UCR) works out to be more than they pay contracted providers
6. One such health network includes a list of auto insurance companies who are using provider networks and rules to pay for services rendered. This means that you have to accept a reduced rate of pay.
7. Most of the companies have not increased their allowable fees since I started with them in 2000. So no raise for a contracted provider -not even to reflect a cost of living increase.
8. Insurance companies are also creating educational requirements for credentialing meaning they are saying what training and education is required to become a member with them. It doesn’t matter that we are licensed by the State Board of Health. The insurance profession is defining the massage profession.
9. Affinity networks are discount networks that some massage therapists unknowingly join thinking that they will get more clients not understanding that they are also taking a big cut in fees.

So does that make you still want to join a provider network and be able to bill insurance companies for your massage services?

See also the Insurance Billing Section on www.thebodyworker.com

2005 Guest editorial in Massage Magazine

Issues and Ethics in Billing Insurance Companies

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ABMP reports in their metrics section at www.massagetherapy.com that :

Average massage-related income for massage therapists in 2005 was $18,950, with a median income of $14,500 (2005 ABMP Member Survey)

Total earnings by massage therapists, including their earnings from other employment, were $32,506 (2005 ABMP Member Survey).

First-year practice average income was $9,589, reflecting the challenges of establishing a professional-service practice (2005 ABMP Member Survey).

ABMP estimates some 50,000 massage therapists leave the profession each year.

The average age of ABMP members graduating in 2007 and entering the profession is 44. The median age is 45.

Close to 83 percent are women and 54.5 percent are married.

As massage therapists look for other ways of making a living they are choosing to take low paying jobs just to get by. Massage Envy was one of the top franchises last year and this I just found online so I am not sure how true it is “As of this month, Massage Envy, which was founded in 2002 and reported nearly $100 million in sales last year, has 120 locations and 248 more under development in 30 states.” They pay their employees $12-$15 an hour from what I have heard -plus tips.

They are choosing to accept insurance as payment or join discount insurance networks just to get by. I am a provider here in WA State and have been since about 2000 when they started allowing massage therapists to be contracted providers with insurance companies. When it first started there were a few companies who paid fairly well but some who paid poorly -(less than the average of $60 for a massage in the US). I have yet to see them raise their allowable fees and most are reducing what they pay and also the allowable benefits. Each year it gets less and less and gets harder to get paid. Managed care makes it harder to make a living.

Since the median age of massage therapists is 45 according to the recent ABMP survey, where does that leave massage therapists as they move into their retirement years? Most massage therapists are coming into the massage profession as a second or third career and thinking of it as a way to supplement retirement or slow down until they retire. They are seeking a more fulfilling career working with others.

And where are all the men in the profession? With low paying jobs how can men support their families? With men as a minority in the profession it shows that there are still many preconceived notions about touch. Women don’t want to be massaged by men and men don’t want to be massaged by men. With this challenge men are leaning away from the massage profession for better paying jobs where they are more accepted.

With such struggles along with the physical, mental and emotional demands of being a massage therapist, many see this as a part time profession. They also perceive it to be more of a calling than a way to make a living and lack a clearly defined business model. Is massage a hobby or a business?

I also have been receiving many communications through my website www.massagetherapycareers.com in the frequently asked questions section from high school students looking into careers in massage. They ask about what jobs pay and where can they get a massage but their main questions are things like “Do I have to take math or science classes?” which makes me think they are just looking for an easy career (which massage is not.) Since most massage schools are just looking to fill their classes they tend to make massage careers look glamorous and appealing. While in the past most massage therapists have started their own business, many more are now taking those low paying Massage Envy jobs which will be affecting the whole massage profession and changing it from one of healing, compassion and learning to just another job.

The massage profession also is in the midst of a big controversy over licensing and legislation issues. How much training and education is required to become a successful massage therapist? How is massage and medical massage defined? We have yet to define these things for ourselves so now insurance companies are doing it for us. (In WA State there is one insurance company creating a special massage credential that defines how much education is required for a massage therapist in their provider network.)

So what is in our future? How can we take more control of where we are going as a whole and not let the economy and money over-ride client/patient care?

The Future of Massage – Whitney Lowe

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