Expanding Regulation in a Shrinking Profession

By Ralph Stephens , BS, LMT, NCBTMB

Expanding Regulation in a Shrinking Profession

By Ralph Stephens , BS, LMT, NCBTMB

Trends are important to pay attention to, as they inform us about the status quo and give us a way to view what's coming down the road ahead. In the massage therapy profession, regulation by state agencies have been increasing, while industry growth has seen a plummet; a troubling scenario.

We now have 46 states and the District of Columbia with laws for massage licensure or certification. There is little consistency in regulations from one jurisdiction to the next, and regulation overall has failed to advance the profession. It requires a stretch of the imagination to see how the public has been protected by these laws, when the incidence of harm from the practice of massage therapy is so rare.

According to surveys taken by ABMP, the number of massage therapy schools and programs in the U.S. has decreased from its peak of approximately 1,600 in 2008 to under 1,000 today. We bid good riddance to some bad actors for sure, but sadly, there has also been a loss of a number of very good schools. The average number of graduates coming out of each school per year has dropped by 50 percent over the same period, and fewer people are able to pass the MBLEx to obtain licensure.

All this means is that there are fewer schools, and they producing substantially fewer graduates. At the same time, there are thousands of open positions for qualified massage therapists that cannot be filled, especially in the massage franchise sector. Yet, the franchises keep expanding their numbers of locations, even though the supply of therapists has fallen critically short. That sector may hit a hard limit, once they realize this problem can't be easily or quickly solved.

The remaining schools that have relied on Federal Student Aid to fill seats are struggling with the new Gainful Employment requirements issued by the U.S. Department of Education for direct student loans and Pell Grants. If a school's graduates have too much student loan debt and too little earnings, the institution could face sanctions or loss of Title IV eligibility.

If Federal Student Aid becomes inaccessible for massage programs, we may see a shift back to smaller schools which can operate without accreditation. Problem there is; schools without Title IV funding just can't charge as much for their programs and are limited to students who can afford to pay for all or most of massage school themselves. This will further decrease enrollment and thus the supply of therapists entering the labor pool.

Now, as we face declining enrollment in fewer schools, we are faced with the reality that the public loves and wants massage, but fewer people want to do it. In my opinion this is Karma, as many of the greedy corporations that got into the massage education game actively misrepresented a career in massage as "big, easy money ... that anyone can do ... easier than cosmetology school ... just sign here." There never were big bucks to be made as a practitioner, just the potential to make a good living doing what you loved. Massage was never "easy". Maybe it's enjoyable and very rewarding, but not easy.

Not everyone can perform professional massage and to do so requires a certain level of physical and mental fitness. While there is still a good living to be made, (especially in the private practice, medical-oriented model), most "jobs" in the profession pay $12-$17/hour and require performing more treatments than most therapists can sustainably do each week. The word is out on this and the big lie is coming back to haunt us. A contracting profession is not a healthy profession.

It's Titanic time, yet our stakeholder organizations continue to serve high tea on the pool deck. State Boards (with the support or tacit inaction of our membership associations) are passing ever more restrictive regulations, making renewal and portability for therapists and educators more burdensome and expensive every year.  It's all done under the banner of "public protection," but in reality, they are restricting the public from receiving quality massage. This is no way to attract new people to a profession (or even a trade).

AMTA, which self-righteously promotes itself as a member-driven association, no longer allows direct member input to select its board of directors. Instead, a hand-picked committee selects a slate of candidates and asks the members to approve or reject the slate without providing any meaningful information about the candidates, such as their qualifications or vision for the profession. This is an election process that would put a smile on Vladimir Putin's face. It is an embarrassment to long-time members— but we'll die off or retire relatively soon. You may, too, if the trends continue.

The Federation of State Massage Therapy Boards has also lost its member decision-making authority. Its by-laws and procedures have been manipulated to take away the input of member boards, and FSMTB's executive director has been calling the shots for some time ,at this now-powerful organization.

Talk about conflict of interest! FSMTB has refused to negotiate in good faith with the other stakeholders. It is trying to take over control of massage continuing education and to become the primary provider of such. Its Model Practice Act would restrict our scope of practice to non-specific relaxation massage and further stifle portability. The organization has advised its member boards to disregard input from associations and licensees because those groups have too much self-interest. How arrogant can they get? FSMTB has gone rogue and must be brought to accountability.

Never has the public gone to a state legislature demanding a profession be licensed. It is always the profession that goes to the legislature begging to be granted a monopoly. It is the profession that created the massage licensing boards and ultimately the FSMTB. I can assure you the legislatures in most states (not to mention the allopathic disciplines,) would welcome a movement to end licensing for massage.

The regulatory schemes we have put into place have backfired and are contributing to the decline of our profession. If it is not changed soon and significantly, massage therapy faces another "Dark Age." The next several columns will go into more depth as to how this occurred. They will also provide you with some valuable wellness information and therapy tips.