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Rethinking Our Approach to Immunization; Coming Together for the Good of Our Patients.
I Felt it in My Fingers First
I'm not afraid to say it. Massage therapists make better acupuncturists. I'll tell you how I know, but first I have a question: What do a microcurrent device, a laser and a hippie massage therapist have in common?
Ringing in the Billing New Year
What are the new modifiers that replace modifier 59? Will they allow doctors of chiropractic to be paid for 97140, manual therapy, when done with chiropractic manipulation?
Environmental Toxins: Cause of Modern Illness, Part 2
In Part I of this article, we detailed the variety of environmental toxins assaulting our bodies. These include pesticides and herbicides; plastics; preservatives; cosmetics; gasoline additives, solvents and glues; and heavy metals.
Show Up and Show Respect
I was recently asked about my chiropractic philosophy. My answer surprised my questioner.
Professionalism and Evidence-Based Health Care
Today's chiropractors are facing a conundrum with the Affordable Care Act and its health care reform requirements, including evidence-based practice and health technology assessment.
Movement Assessments: The DC's Sphygmomanometer
I think back to when I was going through chiropractic school outpatient clinic. I was embarrassed to have my family and friends come in for treatment because initial evaluations took three hours to complete.
News in Brief
While indignation may be your immediate reaction to H.R. 5780, the Protecting the Integrity of Medicare Act of 2014, the American Chiropractic Association suggests the legislation is just what the chiropractic profession needs.
The App Advantage: Get More for Less
You may have noticed the list of "app-exclusive" articles in the directory on the front page of the print issue and in the Table of Contents on page 4. You can't find these articles in print or even in our online archives.
Two for One: The Cervical Distraction Test
In today's healthcare system, diagnoses and treatment plans follow a western medical model - especially if you work with attorneys or insurance companies.
Animal Acupuncture Gaining in Popularity
We have just finished the year of the fire hoarse and now it is time to spend some time alone, daydreaming and thinking outside the box in terms of where our profession is headed. The sheep person is well organized and creative so this should not be difficult to do.
Happy New Year 2015 Gong Hoy Fat Choi
Welcome to the year of the sheep! We begin a new year guided by the sign of a quietly and creatively organized animal.
Fight Colorectal Cancer With Folic Acid
CRC is the second most common cause of cancer mortality in the U.S. and Canada. Although genetic susceptibility plays a role in the etiology of CRC, dietary factors, including certain vitamins, have also been shown to influence the development of the disease in various studies.
The Conscious Evolution of Healing: Importance of Opening the Sensory Portals in Classical Chinese Medicine
The Chinese medical classics are not just clinical guides. They give advice; ways we can awaken more fully into conscious awareness.
Three for One: The Cervical Distraction Test
Taking the time to do an exam is important, but it is time spent. The exam serves as a way to physically validate your clinical impression following a history and clinical consultation.
Taking the Freeze Out of Adhesive Capsulitis
Adhesive capsulitis or "frozen shoulder" is a relatively common condition resulting in severe shoulder pain and global loss of glenohumeral joint range of motion. Incidence of the condition is approximately 3 percent in the general population.
Age and Fertility: Why We Should Worry Less About Age and More About Overall Health
Recently, on one of the acupuncture alumni forums, the topic of age and fertility came up when a practitioner posted a question regarding a patient that was about to turn 40-years-old.
The Static Postural Pelvic Exam
I include a static postural analysis in my evaluation routine whether you are a patient in pain or an elite-sport athlete in training. In my day-to-day practice, I require patients to stand still while I "just look" at them.
Right Back Where We Started?
More than 25 years after Judge Susan Getzendanner issued her historic opinion in the Wilk v AMA anti-trust case, evidence suggests that despite increasing collaboration between doctors of chiropractic and their allopathic medical counterparts, when it comes to organized medicine, we may be right back where we started.
Trouble Down Under: San Zhen Therapy for Lower Jiao Issues
In the last several columns, I have discussed many clinical options for utilizing San Zhen or Three Needle Therapy. In this installment, I will continue this trend and discuss several foundational patterns which can be found in several very common clinical presentations.
How to Use Online Video as a Tool to Market Your Practice
Health care practitioners, including chiropractors, should consider online videos as a key element of their Internet marketing strategy. In the next three years, videos are expected to account for nearly 70 percent of all consumer online traffic, according to Cisco.
Helping to Create the Healthiest Generation
The imperative to create the "Healthiest Generation by 2030," envisioned by the American Public Health Association (APHA), was in full force at the APHA's 142nd Annual Meeting held in New Orleans from November 15-19, 2014.
AWB Makes a Difference in the Yucatan
We are in the sleepy town of Izamal, located about an hour from the Merida airport where our group arrived last night. Later that morning, on a bus winding through the dusty roads of the Yucatan, fourteen acupuncturists, two facilitators from AWB and two tour guides make their way to the small rustic town of Popola.
The Way of Zen Performance Enhancement
Working with elite athletes and implementing various techniques to keep athletes focused and at their optimal performance for a sustained period of time includes incorporating various meditation techniques that counterbalance their sport-specific physical and mental demands, which is an important element of success throughout the years.
Acupuncture and its Place in the Integrative Healthcare Practice: The Need to Move from Modality to Profession
Acupuncture and oriental medicine (AOM) has grown and flourished from its inception thousands of years ago in China. In surrounding regions of Asia, AOM developed as a response to differing cultural, pathological, health and wellness care needs.
August, 2012, Vol. 12, Issue 08
The ELAP Project vs. The Seven Deadly Sins of Massage Education
By Ralph Stephens, BS, LMT, NCTMB
Author's Note: Ralph R. Stephens is a Director of the Alliance For Massage Therapy Education. This article represents his own, personal opinions and not those of the AFMTE.
One of the penalties of not participating in politics is that you will be governed by your inferiors." Plato
Part of political participation is being informed, and if you care at all about the future of our profession, I urge you to read the five page Entry Level Analysis Project (ELAP) description document at: www.abmp.com/downloads/ELAP_2012.pdf. The ELAP stated goal is to standardize educational hours, educational outcomes and improve "portability" – the ability to take licensure credentials from one state to another. All wonderful sounding things; who could be against them? I am not against any of them in principle, however I am extremely concerned about how they might be accomplished.
When you read the document, notice that the project's goal is to determine the minimum educational objectives and Knowledge, Skills and Attitudes (KSA's) needed for an entry-level therapist to pass a licensing exam (MBLEx) and give a "safe, competent" massage. Originally, it was just a safe massage. Competent was begrudgingly added due to the outcry of some concerned stakeholders. Never in the document will you find the term "Massage Therapy" or any other reference to being able to deliver therapeutic or clinical aspects of massage.
A new Job Task Analysis survey (JTA) is being conducted by the Federation of State Massage Therapy Boards (FSMTB) and it contains an add-on section to gather data for the ELAP. The analysis of this data will give more credence to therapists who have been in practice from one to four years and have performed at least 500 hours of massage. (Three years is where the high drop out rate begins.) Doing the math, this is one massage a day for two years or two massages a day for one year. This is what our associations feel is a "functional practice." (From the ELAP Description: "As shown by their persistence for this time, this group has demonstrated perseverance and the skills to develop a functional practice or work productively as an employee.") At two years out, would you define one to two massages a day as a functional practice?
Safety is not a significant problem in massage therapy. The incident rate of actual physical injury caused by massage therapists is miniscule. So, the standards determined necessary to prepare entry level therapists to pass the MBLEx, and give a safe massage, competently are going to be a very lowest common denominator. How is this going to elevate or improve our profession?
It appears the ELAP is a project designed to set another minimal entry-level standard. Why do it again? The data for entry-level KSA's is already on the table and just needs to be recognized and utilized. The danger here is, if this level of training, as defined in the project document, becomes our "standard," the potential exists to reduce/limit our scope of practice. This was tried already by the MTBOK project's scope definition, which fortunately has been mostly ignored. Particularly in states like Florida with a good scope of practice definition in their law, there is a lot to lose. What you might ask? Most likely, the casualty would be the ability to serve the public with the full potential of massage therapy. It could also lead to restrictions in our liability insurance coverage for "therapy," possibly requiring advanced certifications and additional insurance fees and riders to cover therapists doing therapeutic work. As you read the ELAP document, think about this, seriously.
Sadly, the need for the ELAP is based upon a fallacy. Then to begin to argue its minutia becomes an exercise in re-arranging the deck chairs on an adrift ocean liner. We do not need another blue–ribbon panel to set another standard or definition that ignores or papers over the fundamental problems of our profession.
The Real Problem
We have a real problem with substandard, inconsistent entry-level education causing poor quality massage to be delivered to the public. The problem with this low-quality massage training and its resulting low quality of massage practice is the unintended consequence of AMTA's policy of working to get 50 state licensure — no matter what the laws look like, with no attention paid to maintaining, much less expanding, our scope of practice or the regulation of entry-level training programs.
Over the past 15 years, the number of institutions offering entry-level massage training programs has expanded in recently licensed states. Most of these new programs were not traditional start-ups by long-time massage therapists who embodied the lineage of the field. For the first time, we saw the unfettered entry of for-profit career colleges and taxpayer-funded community colleges into our sector. It's simply supply and demand. The passage of new massage laws created new demand for the training required for licensure. These entities were in place with both classrooms and the Federal Student Aid eligibility to quickly add programs. The fact that there was not a population of trained massage therapy educators to teach these programs was not an issue, because the regulations for massage schools and instructors were lax or non-existent.
These institutions are opportunistic: they observe what's happening in the workplace and create or remove training programs according to what's hot and what's not. They have no long-term investment in the profession of massage therapy, as it's just another program to provide revenue. It's solely about the money and not about the lineage of massage therapy or who is being put out onto the street to practice it.
These developments have changed the landscape in ways we could not have imagined. In the rush to "elevate" massage to the status of a profession, AMTA (lately working with ABMP) has actually created a serious decline in the quality of massage services provided to the public (the unintended consequence). This problem is hard to get recognized, because most massage consumers don't know what a decent-quality massage treatment is like.
ABMP's latest massage consumer survey showed that 93% of massage clients were satisfied or very satisfied with the quality of massage they received. Does that mean massage therapists are doing a great job? No, it means most people have never experienced a good massage. To use a fast food analogy: a burger made from greasy, undercooked horsemeat is better than starvation, which is why a billion-dollar-a-year empire was able to be built on low-grade massage. Americans are so touch-starved that they will keep coming back for substandard massage, because it's better than not being touched at all.
How do we get the big players to own up to the respective roles they play in this situation? Neither ABMP nor AMTA have been willing to look at this. Not surprising, since students and graduatess from this sector have ballooned their membership rosters. They're both serving up "happy meals," and taking us on important-sounding trips to exotic lands named MTBOK, MOCC and now ELAP, all of which are distractions from the core problems. Despite their ongoing PR messages, these major organizations are interested fundamentally in their own well-being, and not the profession, much less the public. Actions speak louder than words.
At the very heart of the deterioration of massage quality delivered to the public is the lack of a trained teacher corps to staff all massage schools. To its credit, ABMP has created some basic teacher training seminars. However, they have also rejected as unnecessary and excessive the proposals for teacher education standards that have been developed by professional massage educators in a peer review process, which are based on teacher education standards recognized and used by a variety of other professions. Teaching theory and methodology is the issue here, not just knowledge of the subject(s) being taught.
The Seven Deadly Sins
Colleagues, here comes the real truth of the situation that no one has had the courage to put on the table until now. Standardizing the number of hours or the curriculum content (ELAP) will not improve educational outcomes as long as our massage educational institutions are allowed to:
The (ELAP) is a further diversion from the long and challenging work that will be needed to address these "sins." Two things are needed to "heal" the problem, money and moral conviction. ABMP, AMTA and FSMTB must be persuaded to give substantial and ongoing financial support to COMTA and AFMTE to assist them with their respective missions. COMTA because we need a strong accrediting agency dedicated to the field of massage therapy. That is the natural place for educational standards to live. AFMTE because their Teacher Education Standards Project (TESP) is the trail that the entire education sector must follow if we are to truly "elevate" the profession from the sad state in which it currently exists.
These organizations also need to take a public stand - an unequivocal position - that the operational practices listed in the "Seven Deadly Sins" are no longer acceptable in the massage therapy field; that we expect better from our schools and programs. They may not have the force of law, but such moral courage on the part of community leaders, consistently stated, can and will instigate a change in institutional behavior.
We must take up these challenges for the sake of the massage seeking public and for the lineage of our profession. Want to be part of the solution? Get involved. Thank you for your caring for our profession.
Click here for more information about Ralph Stephens, BS, LMT, NCTMB.
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