Challenging Sacred Cows
, BS, LMT, NCBTMB
Challenging Sacred Cows
, BS, LMT, NCBTMB
Some big changes are coming in the regulatory and professional development areas of our profession. While we are making these changes, it is time to have an open discussion about several "sacred cows" that tend to come along with regulation.
The first is continuing education. I am a huge believer in continuing education, especially for a profession that has such an abysmally low entry-level education standard. However, there are two ways to go about it, forced and voluntary. Which is best?
In a series of columns some years back (November 2006, January, March, and May 2007 issues of Massage Today), I explained that professional regulation of healthcare professions (licensing) hides under the mantra "to protect the public." The "safety of the public" is supposed to be the reason for licensing. This is utter nonsense and typical government-bureaucrat double-speak. Never has the public gone to the legislature demanding protection from a healthcare profession, or probably from any other profession. It is always the profession(s) going to the legislature begging for a government-granted monopoly to practice their discipline without competition. The "public safety" line justifies regulation and allows government to expand (revenue and staff) and the profession to control entry into the field while mandating professional development (cash flow). Never believe what bureaucrats and politicians say. Carefully observe what they do and its effects. There lies the truth – it's a form of outcome-based education.
The classic and most obvious example of this is the fact that medical doctors and their system, regulated by the state's medical boards, are allowed to kill more than 250,000 people a year through mistakes. This is by their own figures. That's more people killed by doctors than by guns, drunk drivers and wars combined each year. The public isn't being protected at all, the profession is. Try to discipline an MD. You have to go through the medical board. Same for all licensed healthcare providers. Regulation is really to protect the profession from the public. However, if for the sake of discussion we accept the public safety premise, is there ANY evidence out there that mandatory continuing education hours have any positive effect on public safety? The Pew Foundation did a study sometime ago and could find no evidence.
Are some people being injured by massage therapists? Of course. However, there is virtually no documentation of massage related injuries. Many experienced therapists, including this author, report anecdotally helping people recover from injuries received at the hands of other therapists. It is happening. The question becomes, is there any reason to believe that mandatory continuing education will prevent or lessen any of these injuries? If there is no documentation of injuries from massage, no documentation that continuing education would prevent injuries that might be occurring, and no documentation that continuing education protects the public, why is it mandated in our statutes?
The obvious answer is professional development. We have such a low entry level we need further training some say. But do we really "need" it? If a massage school graduate wants to function at entry level and just give nice soothing, general, non-specific massages for the length of their career, do they really "need" continuing education mandated for license renewal? If they cannot do that safely without forced CE Hours, maybe we need to raise our entry-level standard. It is time to have this discussion, factually, and make the decision based on evidence. While I am not a fan of evidence-based medicine, for decisions like this, I am a believer in no more government regulation than necessary. This is a discussion we must have and now is the time.
Why now you ask? Because the Federation of State Massage Therapy Boards (FSMTB) along with other stakeholders in our profession are about to create a new continuing education provider approval process and FSMTB is also writing a model massage law. Also, the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) is currently revising their continuing education provider approval process. Now is the time to review our concepts of regulation before these documents are written, as it will be very difficult to change them once implementation starts.
How much continuing education do we really need to renew a license to practice massage? Is there any public safety reason for mandatory CE Hours? Maybe mandatory CE hours should only be for true public safety issues like CPR-First Aid, abuse reporting, etc.? However, do those courses really improve public safety? Prove it!
How many LMTs have used CPR-First Aid on a patient in their practice? How many people have been "saved"? Is the time and money invested giving any return other than to the providers of the classes? Do we really need CE provider approval at all? If so, why? Virtually every provider that applies gets approved. All that is required is paperwork filled in correctly and money, so what's the point?
While we are at it, do approval processes for continuing education providers in any way protect the public? Where is the evidence one way or the other? Provider approval has become a cash cow for the NCBTMB and some state boards. More and more state boards are getting into the act. It is merely a tax. This time consuming and expensive tax gets passed along to those who take continuing education courses. Is a continuing education class any better at protecting the public or promoting professional development because some instructor or quite commonly a school administrator can fill in a bunch of paper work and submit a fee? Once approved, the worst provider and the best are equal.
Please note, I have not advocated any position on these issues. I will do that in my next column. In this article I want to stimulate your thoughts, your input and your involvement. We can talk about it here in the pages of Massage Today, and I am sure we will, but it will be best, and most influential, if you send your input to: the FSMTB (firstname.lastname@example.org), ABMP (email@example.com), AFMTE (firstname.lastname@example.org), and AMTA (email@example.com) as well as other stakeholder organizations. This is your chance to be heard, to have real input on the future of this, your profession. A stakeholders meeting is coming up soon, in October I believe. Seize the moment and let somebody know your ideas and concerns. If you don't, you have no grounds to complain later. If you are not at the table, you are on the menu.