By Kelle Walsh, Managing Editor for MASSAGE Magazine
are your state
Part One: How
massage therapists have fared in states that have passed regulatory
At the time it seemed like
a good idea. A two-tiered massage regulation system would make everyone
happy: massage therapists who believed that 500 or more hours provided
greater technical skill and knowledge; and therapists who felt they
only needed 100 hours of education to perform safe, effective relaxation
massage. But the real impetus for the Delaware law, and its greatest
benefit, for all massage
therapists, would be freedom from mandatory registration under the
state’s anti-prostitution statute, a law that many practitioners
that sense, the massage law worked. "All massage therapists
were released from the adult-entertainment law," says Deb Jedlicka,
a Delaware massage-school owner who sat on the committee that drafted
the massage-and-bodywork regulation, which went into effect in 1992.
"We finally felt relieved that we were state-approved and that
we [didn’t] have to be worried that [the police enforcing
the registration law were] going to come after us."
and bodywork therapists with at least 500 hours of education became
licensed, while those with 100 hours of education became certified
massage and bodywork technicians. There was just one problem, says
Jedlicka: The law didn’t differentiate between the two tiers,
other than education hours. So, the law was refined in 1996 to include
practice requirements allowing licensed therapists to treat medically
diagnosed conditions, and certified technicians to work on any other
but medically diagnosed conditions.
2000 the number of continuing education unit hours (CEUs) required
to maintain state licensure increased from 12 to 24. Certificate
holders need 12 CEUs.
June 2003, legislation was introduced again, this time to increase
the number of education hours required for certification to 200.
But some massage therapists are hoping to raise that even further,
to 500 hours. If passed, the amended legislation will require that
certificate holders have the same education hours as licensees,
but will not be required to sit for the National Certification Exam
for Therapeutic Massage and Bodywork (NCETMB) and will still need
just half the CEUs. Yet they still won’t be able to treat
therapists pushing for the change say they want to level the playing
field so all massage practitioners will start out with the same
skills and knowledge, and that consumers will be better served.
"Now [all therapists] will have the education to know when
a non-diagnosed medical condition may exist," says Rob Eppes,
member at large of the Delaware chapter of the American Massage
Therapy Association (AMTA).
the perceived need for yet another change, a decade after the first
celebrated legislation was enacted, begs the question that hangs
over every state regulatory effort: What type of massage regulation
will best serve the needs of the massage community and the public?
question, and its myriad scenarios, is being played out on the West
Coast, where a controversial massage law has gripped the state’s
massage community. AB1388 now seeks two tiers of regulation: one
for licensed massage or bodywork therapists, who have 500 hours
of education from a state-approved school, hold a license or certificate
from another state with similar requirements, or have 750 hours
of experience; and another for licensed massage or bodywork practitioners,
who need just 250 hours of education. As of press time, the bill
didn’t further distinguish differences between the two tiers.
to the bill’s supporters, the tier system developed out of
a compromise by the California chapter of the AMTA, to quell opposition
from a consortium of massage schools and other therapists to the
original 500-hour education requirement. "This was complaint
driven, for people who said ‘Why not 250 hours or 150 hours?’"
explains Beverly May, law and legislative chair of the chapter.
"Well, yeah, but some of us want the recognition of our peers
and want portability [to move among states]."
goal is to just get out from under local ordinances," she adds.
Par for the course of regulatory efforts is the decision of whether
to try for licensure, the highest level of regulation that restricts
anyone without a license from practicing massage therapy or from
calling themselves by a protected title; certification, a lesser
form of regulation which allows only those who meet certain education
criteria to use a protected title; or the less-common registration,
which simply provides a listing of therapists who apply and meet
an education requirement. CEUs are often required to maintain the
professional designation under all three.
some states these definitions vary. In Mississippi, for example,
one cannot practice massage without being registered, which requires
700 hours of education and passage the NCETMB or equivalent examination.
The state board of massage maintains the right to seek prosecution
in Delaware, combinations of the above are sometimes believed to
be the best way to meet the needs and demands of all involved parties.
In these cases, therapists with more education are granted greater
privileges, such as the ability to work in health-care settings
or, sometimes, to transfer their credential to other states with
similar regulation. Those with less education typically are only
allowed to practice relaxation massage in their state.
level has its pluses and minuses. Licensure is considered the most
desirable regulation because of its practice and title protection,
and the police power of the state to enforce the regulation, yet
is also presents the greatest challenge to state legislatures wary
of trade restrictions and of creating more government bureaucracy.
Without proof that massage may cause harm to the public, many states
won’t consider a licensure law.
is often viewed as a fair compromise when licensure isn’t
possible. It verifies that those using the protected title (typically
"certified massage therapist" or some derivative) have
met education requirements and standards, but does not bar entry
into the profession by those who do not use the title. And without
the practice protection provided by licensure, it does not ensure
that only those with a certain level of training are practicing
massage - a key issue for therapists who believe that a 500-hour
minimum education is necessary to practice massage safely and effectively.
is the most innocuous of all regulatory measures. A registrar maintains
a list of applicants who prove they have met a certain education
requirement, and who may use a designated title such as "registered
massage therapist." This kind of regulation, while providing
general guidance to the public as to one’s education level,
does not protect the title or the practice of massage therapy. Like
certification, registration doesn’t have the enforcement mechanism
of a licensure law.
sometimes therapists seeking regulation have little say over what
level they will be granted.
Wisconsin, a 1999 massage-registration act was the first step into
the regulatory arena. "That first time we wanted to go for
licensure but were told by the legislature, ‘No way.’
It’s seen as limiting a profession and employment," says
Betsy Krizenesky, president of the Wisconsin chapter of the AMTA
and its law and legislative chair.
we came before the legislature, the argument thrown at us was, ‘Show
us proof of harm.’ There was very little," she adds.
was, however, a patchwork of local laws under which massage therapists
were treated as prostitutes, Krizenesky says, with fingerprinting
and mug-shot requirements and restrictions that had little to do
with massage therapy.
therapists tried for licensure again, in 2002, they were told that
they could get certification instead. Now to hold the title of "certified
massage or bodywork therapist," one has to have 600 hours of
education from an approved school, and pass the NCETMB or the exam
developed by the National Certification Commission for Acupuncture
and Oriental Medicine (NCCAOM).
initial problems have been addressed, we have relief from being
harassed on the local level. And we are designated as health-care
providers in the statute; that helps on a local level, certainly,"
she admits that the law does not ensure that only those therapists
who meet the requirements are practicing massage. Wisconsin, like
other states with certification laws, does not have a massage board
with the power to enforce the law. Instead it has an advisory council,
made up of governor appointees, that reports to the health division
of the state’s Department of Regulation and Licensing. "There
are people who are not getting the credential who are using the
title of certified massage therapist, which is protected; or using
a different title, like massage practitioner, which is misleading
but technically not infringing [on the law]," says Krizenesky.
problem is common in states with certification laws.
lots of ways for people to skirt title protection" provided
by certification law, says Virginia massage therapist Lee Holtman.
"They can do massage as long as they don’t call themselves
[certified] massage therapists. It’s very difficult to enforce."
Walsh, a certified massage therapist in Annandale, Virginia, agrees.
Although the state law has eased restrictions in her town, which
at one time outlawed home-based massage practices, the problem of
prostitution businesses posing as legitimate massage practices abounds.
And the illicit-business owners are getting savvy. Capitalizing
on the public acceptance and growing popularity of massage therapy,
they often use misleading titles such as "therapeutic massage
if the business does not advertise "certified massage therapy"
it is not infringing upon the state’s massage-certification
law. Furthermore, the statute states that the board of nursing,
under which massage therapy is regulated, "has the authority
to deny, revoke or suspend a certificate issued, or to otherwise
discipline a certificate holder upon proof that the practitioner
has violated any of the provisions of [the law]." Yet disciplinary
measures are not defined for people who are not certificate
think licensure would be a better option for us," Walsh told
MASSAGE Magazine. "It
would give us more credibility and make it easier to shut down these
halfway to the goal of what we want it to be," says Holtman.
it right, finally
Martin Chamberlain, a Maryland massage therapist, describes the
long road to regulatory language that seems to finally meet the
needs of his state: "When our bill was first passed, in 1996,
it was a title protection act. We thought we had it nailed down,
but didn’t. As long as someone did not call himself or herself
a ‘certified massage therapist’ they could do anything
they wanted. Our law would not touch them. We went back to the legislators
and had the language changed to become a practice act. Our practice
act put other modalities in jeopardy. Then we came back to the legislature,
and changed the bill once more, allowing space for those other modalities
to exist. We have all worked hard to get it right. And it seems
to be working now. There are still some issues, but things are getting
nearly 10-year journey through the legislative process serves as
an example of what can happen if all of the pertinent issues are
not addressed prior to the submission of a licensure bill. Spurred
by threats from physical therapists on one side and dealing with
onerous anti-prostitution laws on the other, members of the state
AMTA chapter (AMTA-MD) sought a controversial licensure law to protect
a long battle with the state’s physical therapists, and conflicts
with some people from within the massage profession, Maryland now
regulates practitioners under the titles of "certified massage
therapist" (CMT) or "registered massage practitioner"
(RMP). CMTs have 500 hours of education, have passed either the
NCBTMB or NCCAOM, and have at least 60 college credits in any subject.
The latter provision was added at the insistence of legislators
who felt that health-care professionals should have a two-year college
education, according to Kenneth Adler, Ph.D., former AMTA-MD president.
health-care practitioners overseen by the nursing board, CMTs may
work in health-care settings and also give and take referrals from
other health-care practitioners.
massage practitioners also have 500 hours of education and must
pass a national exam, but do not require college credit. They may
not practice in a health-care setting.
this law ideal? Maryland massage therapists acknowledge that the
law may have hurt some practitioners, particularly those who didn’t
have access to 500-hour massage programs, or who fail to pass NCETMB.
But for the 2,500 CMT/RMPs working in the state, the main objectives
have been met.
public can now clearly distinguish legitimate massage therapists
from others who are not. This has contributed to a healthy expansion
of the massage-therapy profession and opportunities for massage
therapists in Maryland," says Justin Frank, a former member
of the AMTA-MD law and legislation committee. "Massage therapy
is recognized as a health-care profession in Maryland, which has
pretty much stopped threats by other professions, such as physical
therapists, against the right to practice massage therapy. Professional
standing as a health-care profession has also led to greater collaboration
with other health-care professions, which has raised the status
of massage therapists in the state."
search of a perfect law
Few massage therapists who support state regulation claim that there
is any one perfect state law. Some therapists in states with laws
that don’t protect the practice of massage therapy say they
long for more stringent regulation. Others, particularly practitioners
of non-massage bodywork therapies, say they feel bulldozed by laws
that don’t recognize their unique educational or practice
standards. But leaders in the massage industry say that important
lessons have been learned along the way - of what works, and what
doesn’t - when it comes to state laws. The result has been
smoother legislative efforts, which, hopefully, will avoid the need
for returning to the legislature later on. "Some of that comes
with experience," says AMTA Immediate Past President Brenda
and others, point to Kentucky’s massage-licensure law as a
model of good legislation drafted out of experience. They say it
meets the needs of massage therapists, protects the practice and
title of massage therapy, grandfathers in those with less experience,
and is perceived to be fair to other bodywork practitioners. The
law passed swiftly through the state legislature in 2003, and requires
that massage therapists have 500 hours of education (to increase
to 600 hours in 2005), and pass a national exam. "It’s
an example of one of the most successful," says Griffith. "There
was a really successful coalition, [the law included] language in
such a way that other groups weren’t impacted, so far it seems
to have accommodated everyone."
The past 15 years has seen tremendous change for the massage-therapy
profession: The public has embraced massage for self-care; a growing
body of research has proven its health benefits; and professional
opportunities abound, from working in spas or on cruise ships, to
taking referrals from doctors in hospitals and collaborating with
other health-care professionals in wellness centers.
to these changes is the perceived need for increased levels of education
and accountability, and a desire among many massage therapists for
recognition of their work as a profession - not as something to
be regulated through local police departments or that can be mastered
in a weekend workshop. Controversial as it has been, in this era
of recognition of massage and all the good it does, massage regulation
has come of age, demanding that today's therapists are up for the
task of this new professional status.
out what your state regulations