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Our Medicare Challenges Aren't an Education Issue; Passion to Succeed: More Pivotal Than GPA?
Acupuncture's Essential Role
Acupuncture should play a more prominent role in U.S. healthcare during and after this post-Affordable Care Act era when chronic care and population health management are key concerns for all healthcare providers.
The Lung Official
The Lung is known as the "Official Who Receives the Pure Chi From the Heavens." The act of breathing in, known as inspiration, brings oxygen into the body from the atmosphere. Each exhalation or expiration removes and releases carbon dioxide, a waste product of the body, into the atmosphere.
HVLA Technique: Addressing Myths
In the annals of chiropractic history and literature, and in the imagination of the public, there is one manual adjusting technique that can produce a wide range of responses, both from patients and casual observers.
University of Bridgeport Acupuncture Students Make Rounds at Sisters of Notre Dame
Nuns are not stereotypical acupuncture patients, Dr. Jennifer Brett acknowledges with a laugh. But then again, acupuncture has gone mainstream, just like cappuccinos and recycling. "It's changed a lot from the '70s and '80s," said Brett.
Comparing Costs of Care: DCs, MDs or PTs - Who Costs More?
In a health care era where evidence is increasingly the benchmark for insurance coverage, patient care and even cultural authority, we get plenty of it courtesy of a retrospective cost analysis spanning 10 years, more than 660,000 "covered lives" and nearly 7.5 million claims from Blue Cross Blue Shield of North Carolina.
Case Study: 2-Year-Old Suffering From Urinary Reflux
A19-month-old female child presented to my office for treatment. Her mother reported the child had been diagnosed with urinary reflux and associated urinary tract infections, recurrent bouts of otitis media and inability to sleep.
Concerns Regarding CDC Guidelines for Pain Management
In response to the epidemic rates of opioid and heroin addiction, the Centers for Disease Control and Prevention (CDC) set new guidelines for physicians regarding treatment for pain.
News in Brief
F4CP MEmbership Milestone Reached; ICA Challenging New California Vaccine Law; TCC Names New President; New Provost at UWS.
NBCE Fumbles Computerized Testing Process
Imagine being a student again, about to take one of the four tests required to become a doctor of chiropractic. You've studied almost nonstop for the past few weeks. You can feel your anxiety level rise as you sit down in front of the computer screen.
Forward Head Carriage and the Feet: What's the Connection? (Pt. 2)
Clinical evaluation of standing posture using relatively low-tech tools has been confirmed as valid and reliable by several studies. The original device used to evaluate posture was the plumb line, which served as a reference line for the effects of gravity on body alignment.
Letter to the Editor
On December 7, 1999, the U.S. FDA reclassified the status of acupuncture needles from class III (investigative devices subject to investigative device exemptions...) to class II (special controls).
Six Things Every Chiropractor Should Know About Opioids
An increase in addictions and deaths due to opioids has raised significant concern and media attention. We offer this brief overview on this important public health problem for the practicing chiropractor.
Dealing with a Pain in the Butt
The patient came into my office with the classic antalgic stoop. She was bent over almost to ninety degrees, leaning on her husband for support and staggering to walk. She had been under supportive care for a long time, but this new pain scared her.
Infertility: Managing Irregular Menses
Infertility is an area where Chinese medicine is particularly helpful. In the main, in women below the age of 38 without organic disturbance, the success rate using TCM (Traditional Chinese Medicine) should exceed 85%.
The Drug Epidemic: Are You Guilty, Too?
Attention-deficit / hyperactivity disorder (ADHD) has become epidemic among children in the United States. According to the Centers for Disease Control and Prevention (CDC), the percentage of school-aged children diagnosed with ADHD has grown from 7.8 percent in 2003 to 11.0 percent in 2011.
CE Regulations Are Hurting Chiropractic
During my 35 years in the chiropractic profession, I have been forced to attend available continuing-education programs that were occasionally incredibly beneficial, but frequently not worth my time.
Why We Need to Fix the Mechanoreceptors (Part 2)
The muscle spindle, a particular type of mechanoreceptor, is located deep within the muscle belly, encapsulated in fascia made up of intrafusal fibers, all within the extrafusal muscle fibers.
The Most Important Vitamin You've Never Heard Of: K2
Imagine if one in every three patients who walked through your door was afflicted with a debilitating, yet completely preventable and treatable disease.
Acupuncture Earns BLS Unique Code
The United States Bureau of Labor Statistics recently announced that acupuncturists will have their own unique occupational code in the 2018 BLS Handbook. The new Standard Occupational Code (SOC) is 29-1291, will be included in the next edition of the BLS Occupational Handbook, which will be published in 2018.
Sacroiliac Joint Fusion: Where's the Wisdom?
We should be very skeptical of the purportedly less invasive version of the already defrocked sacroiliac fusion surgery, "minimally invasive" sacroiliac joint fusion; and concerned this procedure simply represents the device manufacturer's attempt to find yet another new market.
Patience vs. Patients
How long have you been in practice? I began my journey more than 20 years ago and opened my first acupuncture clinic in 2008. Just like you, I've learned a lot over the years. Recently, I sat in an interview and was asked what made me successful.
Physical Examination in an Evidence-Based World
I have always had a fascination with physical examination procedures, particularly orthopedic tests. The origin of my fascination began just after graduation when I began the chiropractic orthopedics program.
December, 2013, Vol. 13, Issue 12
Tremors in the Massage Industry
By Pete Whitridge
Change, challenges and consolidation have created recent tremors in the industry and I have been asked to comment on some current trends in massage education. I will address school sustainability, massage training and accreditation issues here. I will address other school and education issues in future articles.
Over the last 25 years, the number of massage schools has grown to approximately 1,600 schools. The 2008 market collapse and resulting recession have had a dramatic affect on all massage school programs. Whether sole proprietor, career training institute or corporate-owned school, enrollments have dropped significantly.
In summary, we have 300 fewer schools in the massage universe since 2009. Student enrollments are down 18.8% since 2011, and down 50% since 2005. We have 50% more schools then we had in 1998, yet we are educating a similar number of students. More schools and fewer students make for a highly competitive and fractured market.
administrators and teachers, I have identified a few factors that contribute to school closures: State school licensure requirements, Federal Department of Education "gainful employment" and "placement" requirements, lack of quality lead generation, competition with larger massage programs with better financial resources, staff and infrastructure. Practically all corporate, university and career training institutions are accredited. This fact allows these schools to out compete small, owner-operated schools by offering grants and loans.
We have more than 1,300 massage schools in this country. 52% of schools are proprietary, yet only 20% of proprietary schools are accredited. This means proprietary schools have yet to embrace accreditation as a means to stabilize their programs by accessing Title IV funding. It might be time to reassess this situation.
Does being accredited make a difference? The ABMP biennial school enrollment census suggests accreditation does make a difference. When proprietary schools are compared based on accreditation status, accredited schools enroll close to 50% more students than non-accredited proprietary schools. The differences in enrollment between accredited and non-accredited schools could be a market driver in the future.
Additionally, Career Training Institutes enroll more than two times more then proprietary schools according to the census. All CTI's are accredited and have the infrastructure to recruit students for a variety of programs. Maybe it is time to review your long-term sustainability by exploring the value of obtaining accreditation. Maybe its time to explore synergistic trainings that help establish your school as an education hub. Whether esthetics, personal training, or yoga therapy, attracting health-oriented leads may help enrollment at your school.
Is accreditation the answer for small schools? The report shows approximately 60% of massage programs hold some form of accreditation. These programs offer student loans and grants and are able to demonstrate financial stability. Accredited schools report yearly to their commissioners and renew on a five-year cycle. While many of these accredited schools are able "to withstand the bumps of competition and a sluggish U.S. economy," these schools still face limited income potential if they only enroll an average of 20 to 35 students per year!
The ABMP enrollment census outlines the average number of students enrolled per year for each category of school: CTI, college/university, corporate-owned, public and proprietary. Four of the five categories of school enroll 35 or fewer students per year, with CTI's enrolling an average of 85 students per year. Yet, the CTI's have closed programs at a larger rate as compared to proprietary schools. This means CTI's are not as profitable as they need to be and are closed. The CTI's will move on to something more profitable. I speculate that many low enrollment CTI' and corporate schools will move on to offer and focus on more lucrative programs such as respiratory therapy, fitness training or nursing education. Federal placement and gainful employment rules will also force training centers to enroll students for programs that actually provide jobs and career longevity. Education is a business and when the numbers don't warrant having a program, programs will be shuttered. Be ready to absorb market share when a program is closed in your area. CTI's can add and subtract programs based on enrollment and profitability.
Floods of Change
What about the small schools? It's clear there are hundreds of small programs in our field. Can these low enrollment programs last? Is it profitable for a program to have one to five instructors, maintain enrollments and management to compete with larger education corporations, community colleges and the newest players on the scene, the osteopathic and chiropractic colleges such as Bastyr, University of Western States and the University of Bridgeport?
The answer for some small schools owners is decidedly, "No." For example, the Core Institute in Tallahassee, Fla., has shuttered its entry-level program. They are now focusing only on continuing education and specialty certifications. The Atlanta School of Healing Arts (ASHA) was shuttered because the Federal Department of Education demanded a large bond from the school to remain Title IV eligible. The school was not able to meet this requirement and the DOE revoked eligibility. Finally, the loss of a massage school to flooding. Did this owner have reserves to survive until the location can be rebuilt? Will this school be able to re-open, enroll students and survive another day?
I encourage all small school owners to work together to support high standards of entry-level education, qualified teachers in these programs and financial responsibility so that the school has reserves to cushion a blow to enrollment. Institutional accreditation may solve some of these issues by providing guidance, support and peer review. Eligibility for Title IV funds is also an important consideration when applying for accreditation.
Will accreditation help my school? Isn't it expensive? How much paperwork is required? The Commission on Massage Therapy Accreditation (COMTA) is working to help schools wishing to obtain accredited status by formulating a pre-accredited status where a school would work toward full accreditation over a two year period by applying with COMTA, demonstrating activity in alignment with a Self Study Report and reporting back to the commission yearly. The COMTA commissioners met on October 23, 2013, and I understand the group is very interested in supporting schools in this area.
I encourage all school owners, administrators, CE providers and LMTs to volunteer as peer reviewers with COMTA to experience the process of traveling for a site visit and evaluating fellow school programs. Peer review volunteer opportunities are available throughout the year. You can apply as a volunteer whether you are an educator, LMT or compliance wonk like me. COMTA also has three commissioner positions open for election this year. They are recruiting commissioners in the areas of esthetics practitioner, an employer position and a public member. If interest, visit www.comta.org/about-comta/commissioners-elections-appointments/.
Want more students? Need to compete with within your market? Accreditation could make the difference. Evaluate your school curriculum and administration compared to the COMTA standards. Using these standards will help you as you plan for future sustainability. Even if you just volunteer as a peer reviewer, you will have a better understanding of the process and can evaluate the pros and cons for your school.
A historic school closes and sends shock waves across the education community. The Boulder College of Massage Therapy announced in June 2013, that they would be closing their doors. Many educators and therapists shuddered deeply. Even after an angel investor helped temporarily reopen the school, BCMT permanently shuttered its doors on September 26, 2013. For more information, visit http://bcmt.org/.
This is a big issue in our field. The reasons stated on the BCMT site are chilling and unfortunately, familiar.
"...This is the second closure of BCMT in the last six months. The first closure was the result of multiple factors related to the financial health of the school over the past several years. However, in the last 18 months, BCMT had increased enrollment, revamped its curriculum, raised job placement rates and improved its financial solvency. Despite these efforts, the school was unable to overcome a constellation of issues related to the previous years of financial losses and the decrease in value of the real estate asset, the BCMT campus. Multiple attempts to reach an agreement with the real estate bondholder, as well as multiple attempts to be acquired by larger educational entities, were unsuccessful."
We would be wise to reflect further on what forces brought such a fine program to close. "As a founder of the International School of Bodywork (IPSB), I find BCMT's recent closure especially troubling. My school was born of a similar ilk of human potential and spiritual seekers. Both schools have attracted individuals wanting a top-notch vocational education balanced by artistic and humanistic values. Both schools have similar approvals, institutional objectives, established and award-winning faculty," said Carol Osborne.
Carole also outlined more issues all massage schools face:
Despite these challenges, many schools have adapted and enhanced their programs to meet the needs of the 21st century student and the current marketplace. Yet, many graduates still struggle to establish an economically viable practice in these weak financial times. Interestingly, we also hear from many spa and massage franchise owners that there are not enough quality massage therapists. The somewhat contradictory nature of these developments can be bewildering and they merit some meaningful discussions between schools, educators and employers.
How can we have so many schools, yet so few "quality" therapists? Looking over the data from the 2013 survey, four of the five categories of schools have less the 25 students per year and even the career schools average only 85 graduates per year. I speculate that these smaller programs have only one or two teachers in the classroom and the teachers may not have extensive teacher training but are rather content experts; a successful therapist in town.
This scenario has played out many times over the past decade as massage schools expanded into Corporate/CC/University settings. These schools tend to hire content experts with some experience in the field and then recruit from alumni when seeking replacement teachers or teaching assistants. Teacher pay is not known to be more than $25/hour at most colleges and universities. Teachers in these small career training or community colleges are operating without much peer support and tend to have a high turnover rate.
Growth within the massage education industry has ended. Will your school thrive, survive or close? Could acceptance of voluntary accreditation and the imposition of strict standards for licensure, training and enforcement create more consolidation, weed out weak schools and force the remaining schools to step up their game? Massage as a "growth" center peaked back in 2010, and has been on a downward trend ever since.
In future articles, we'll look at entry-level education, an ongoing issue for the last few years. I will offer a report on the ELAP project, the recommended standards and their ramifications for massage schools, teachers and administrators.
Pete Whitridge currently is the President of the Alliance for Massage Therapy Education (AFMTE). He is a faculty member and former Director of Education for the Florida School of Massage in Gainesville, Fla., and past chairman of the Florida Board of Massage Therapy, and past legislative chair for the Florida State Massage Therapy Association.
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