Opinion: A Big-Picture, Sustainable CE Solution - Massage Magazine

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Lauren Cates, B.C.T.M.B, is an oncology massage therapist and continuing education provider. She wrote this guest editorial for MASSAGE Magazine on the topic of the Federation of State Massage Therapy Boards’ (FSMTB) new proposed continuing education approval program.

I am responding to Whitney Lowe’s guest editorial, “New CE Approval Plan is a Bad Idea for Many Reasons,” published on massagemag.com on April 12.

The entrenchment of the National Certification Board for Therapeutic Massage & Bodywork (NCBTMB) and the Federation of State Massage Therapy Boards (FSMTB) over the issue of continuing education (CE) oversight is deeply disappointing. NCBTMB currently oversees CE, and CE continues to be a considerable revenue stream for that organization. FSMTB has introduced a proposal for CE oversight that includes a national database and greater interaction with consumers of CE.

At present, each side appears to have crossed its arms. (The back-and-forth about exactly where communication broke down is endless, conflicting and irrelevant.) And both sides decided to move forward with its own plan, functionally creating two, essentially parallel, CE oversight programs.

I surrender.

Challenging Times


As a CE provider who has carefully prepared courses and obtained all of the necessary authorizations to do so, I ask–the FSMTB and NCBTMB and anyone encamped anywhere on the issue–to also surrender.

Surrender to your better selves and to the pain that inevitably accompanies real and meaningful change.

Set down the history, the ways each of you feels wronged, the commitment to everything your leaders, past and present, and others in the trenches have personally done for this profession.

The stewardship of any project is thankless work, but here it is: Thank you from the bottom of my heart.

Now get over yourselves.

There are few people outside of our profession (or even inside our profession) who care at all that we are tearing ourselves to bits. Humans will always pay money to be massaged by kind, moderately skilled people, even if those moderately skilled people have no proof of continuing education or a certificate to practice.

Meanwhile, as the executive director of a massage-focused nonprofit organization, I am embarrassed to tell my board of directors that we need to double our professional-fees line item in anticipation of a situation created by two organizations that can’t get along.

My dear, hardworking and good-hearted colleagues at FSMTB and NCBTMB: Aren’t you embarrassed too?

Seven Questions


As I ponder this CE oversight stalemate, I find myself asking these questions:

1. What is a coalition? Merriam Webster says it’s a group of people, or organizations, who have joined together for a common purpose. Any outsider would be hard pressed to look at the actions–or inaction–of the Coalition of National Massage Therapy Organizations, which comprises the Alliance for Massage Education, American Massage Therapy Association, Associated Bodywork & Massage Professionals, Commission on Massage Therapy Accreditation, FSMTB, the Massage Therapy Foundation and NCBTMB) and tell you what its common purpose is.

Listen, I know that the coalition, as it is called, doesn’t have or wield collective power in any official way, and actually, by some accounts, no longer really exists, but if you’re not going to act like a coalition, stop calling yourselves a coalition. And if the coalition has disbanded, that doesn’t mean that the organizations who formerly made up the coalition can act in a vacuum. Please, be reasonable and put the good of the profession before the good of your own organizations.

1. Whose job is CE? As it turns out, nobody’s. NCBTMB’s website doesn’t mention CE at all in its mission, but it is, nevertheless, currently responsible for CE oversight. FSMTB’s mission includes a desire to “Improve the standards of massage therapy education,” but not CE specifically. AMTA has some admirable goals, but they don’t expressly mention CE. We know that CE is not the job of COMTA (or ACCSC, for that matter) or the Massage Therapy Foundation. AFMTE supports CE, but they don’t regulate it; that happens on a state level.

So, is anybody feeling less confused about why we’re so confused?

1. What’s the goal of CE? Consumer safety? Elevation of the profession? Both? NCBTMB offers board certification that is more about elevation of the profession than basic licensing. FSMTB works with the states and works, first and foremost, toward public safety, but it is also dedicated to rigor and elevation of the profession.

We need to be willing to consider that, perhaps we can’t truly certify a person in a hands-on modality they learned in one day or online, even if that means that teachers we know and love have to go back to the drawing board.

We have to be willing to say that being experienced in something doesn’t necessarily qualify you to teach it.

These are hotly contested issues that remain unresolved. Our collective inability to see hard issues through to workable, relevant solutions is troubling at best, especially when we avoid these conversations because the best answers may mean that our friends and supporters would have to do something harder or different. These are issues of safety and elevation.

1. Portability is good, right? NCBTMB and FSMTB have both worked toward greater portability in the profession with limited results. Their efforts are laudable, but portability is a tough nut to crack. One of the goals of FSMTB’s proposal involves creating some important infrastructure to support portability across state lines and, ultimately, nationwide.

We must make it easier for practitioners and regulators to track CE if portability is ever going to succeed. Surely, a collaborative discussion can happen around this issue that addresses the concern that this information sharing could be illegal in some states. Other professions have figured this out.

We are not the first people to try this. Our challenges are not unique.

1. How hard or easy do we want to make it for quality, upstanding CE instruction to be taken across state lines? Why are we treating CE like contraband? Why do we ask CE providers to fill out hours of paperwork for NCBTMB approval, to complete another set for Georgia and Florida, meet different requirements in Alabama, go through another set of backflips to be sponsored by NCBTMB in New York, and report CEs in New York, Georgia and Florida using different platforms?

And now because these two organizations can’t get along, CE providers will have to take on yet another approval process? Ludicrous.

In addition, instructors are expected to offer courses that meet conflicting state requirements for hands-on hours–which are similar, but not always equal to live hours, face-to-face hours, and the like.

Given the relative effectiveness of the Florida and Georgia CE tracking systems, why are we not asking for a national registry to do the same? How is that somehow an invasion of privacy? What’s the agenda here?

Clearly, it’s not simplicity, cost effectiveness or supporting massage therapists in meeting licensing requirements.

1. What’s so bad about rigor and standards? When meaningful change happens, everyone is presented with a choice: step up to the change or reject it.

When massage therapy grows up–and I’m still hopeful that will happen–some people won’t want to or even be able to meet that standard. Some will decide to stop practicing, to practice off the grid or fall into some quasi-professional status. We can’t prevent that.

What we can prevent is massage therapy slipping into the fringes, missing the healthcare boat, and becoming a catchall trade of minimally trained people who “just want to help.” We won’t get to be a real, respected profession and make everybody happy.

1. How does a more rigorous, portable CE program–whether led by FSMTB or NCBTMB or, god fuhbid, a partnership of the two–jeopardize board certification or, by extension, massage therapy’s status as a member of the Academic Collaborative for Integrative Health (ACIH)? I have heard some people say that if FSMTB becomes the agency that oversees CE, this will pose a serious financial challenge to NCBTMB, and if NCBTMB folds, massage therapy’s ACIH membership will be in jeopardy.

However, even if the proposal goes through as currently designed, FSMTB is not proposing to take on–or take away–Board Certification.

I fear that this idea of protecting NCBTMB for the sake of Board Certification and ACIH membership is a distraction. We must be careful about the suggestion that concern for an organization’s financial solvency and survival is as-or-more important than what is good for massage therapy as a whole.

What Do We Want?


This CE provider does not want to pay–and can’t afford to pay–two fees to have courses recognized. My board of directors is similarly uninterested in paying two organizations, to have courses recognized because those organizations can’t figure out how to put personal politics and history aside.

A good friend recently told me, “You can have everything you want, as long as you’re willing for it to look different than you thought it was going to look.”

Let’s focus on what we want for the future of massage therapy and less on who gets to call CE oversight their organization’s crowning achievement or primary revenue stream.

To NCBTMB and FSMTB: Stop defending your organizations and start supporting CE providers and massage therapists, both of whom benefit from quality, vetted CE. Our clients are the ultimate beneficiaries.

Meanwhile, massage therapists and educators, it’s time to get in the game. Your professional future is being decided. Make your voices heard. Share your concerns and challenges with NCBTMB and FSMTB.

Ask these organizations to work toward a collaborative, big-picture, sustainable solution that serves your needs and grows, rather than limits, the profession.

Lauren Cates, B.C.T.M.B., is an oncology massage therapist, CE provider and executive director of Healwell, a Washington, DC-based non-profit organization that collaborates in clinical/hospital-based massage therapy research, hands-on service, and education. Cates is Board Certified and was a founder and president of The Society for Oncology Massage from 2007 to 2014.

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