by Emmanuel Bistas

Of the 42 states and the District of Columbia that currently regulate massage therapy, 40 rely on either the National Certification Exam (NCE) or the Massage & Bodywork Licensing Examination (MBLEx) for the purpose of determining if an individual is competent to enter the profession.

The NCE was developed by the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB), an independent, not-for-profit organization. The MBLEx was developed by the Federation of State Massage Therapy Boards (FSMTB), a not-for-profit organization comprised of state licensing boards. Both are reliable and psychometrically valid standardized exams and are even administered by the same third-party test administrator.

The question about which exam—the NCE or the MBLEx—states should use for licensing purposes has been a point of contention in the profession for a while now. The debate is carried out in licensing boards and industry organizations, but also in real life and online forums where puzzled massage therapists try to understand how certification and licensing impact their careers and their wallets. On the other side of this picture are the public and other professions, who expect to find a uniform and understandable credentialing process in massage therapy.

At the core of the discussion lay the concepts of licensure and certification, and the nature of the MBLEx and NCE and their respective organizations.

Licensure grants an individual the permission, or license, to enter a profession. It is intended to protect the public from harm by establishing entry-level standards for a profession and by ensuring that an individual meets those standards. The licensing process is owned by a government agency, which is accountable to the citizens it represents. An examination that is used to assess entry-level competency is known as a licensing exam. The MBLEx was created as a licensing exam from the start, with licensure and the needs of regulatory agencies in mind.

Certification grants recognition, a certificate. It is intended to elevate a profession by setting and upholding professional standards. It is a process owned by a certifying agency, which is accountable to its certificants—not to regulatory boards. Certifying agencies may use examinations to determine if an individual meets certification standards; those examinations are called certification exams.

As the name implies, the NCE was originally created as a certification exam. It was voluntary in nature, but as more states started regulating massage therapy, they came to rely on the NCE for assessment purposes rather than developing their own exam. The NCE has continued to play the role of a certification exam, but is sold by the NCBTMB as a “licensure exam” and in a recent advertisement as an “all-in-one exam.”

Sometimes, certification exams are used in the licensing process. Occupational therapy is an example of a profession that relies on certification and a certification exam for the purpose of licensing. The NCBTMB believes the massage therapy profession should also use a similar model, in which the NCE would be the exam that determines an individual’s competency for entering the profession.

In an e-mailed reply to a question I submitted to the NCBTMB, Paul Lindamood, CEO of the NCBTMB, explained that the basis for this licensure model can be found in a 1971 report by then Secretary of Health and Human Services Elliot Richardson, which “… recommended that, to instill a sense of professionalism in these newly emerging [allied health] fields, certification boards should be created to credential practitioners. The report further recommended that when states license practitioners in these fields, they rely upon certification exams.”

Under a different licensure model, such as that used in medicine and physical therapy, a licensing exam is separate from a certification exam, with the licensing exam securing entry into the profession and the certification exam demonstrating advanced or specialized knowledge.

For example, one becomes a licensed physician after passing a licensing exam and board certified after completing a certification process that includes a certification exam.

Perhaps the words “newly emerging” in Richardson’s quote tell us which licensure model to be used and when. The NCE played the role the Richardson report discussed for the past 20 years, but the needs of the profession have now evolved. Massage therapy has long exited its “newly emerging” stage and a licensing exam is now in place. Perhaps it is time to look toward the future and decide how we can use licensure and certification to advance the profession.

Debra Persinger, Ph.D., executive director of the FSMTB, in a July 10, 2008, communication titled “Response to Stakeholders” called for the NCBTMB to “… recognize that the profession has evolved and that NCBTMB’s true purpose in the industry is with certification.”

The FSMTB has repeatedly referred to the MBLEx as an entry-level exam, to assure everyone that its exam is not intended to replace the NCE. The terms “entry level” do not imply lower standards, but rather explain what a licensing exam does. Such an exam tests if someone is competent to enter a profession.

To define the criteria against which new therapists should be tested, the FSMTB conducted the largest job-task analysis in the profession and received input from 7,646 massage therapists, bodyworkers and somatic practitioners. By contrast, the job-task analysis the NCBTMB used to create the current version of the NCE received input from 567 nationally certified practitioners, a much smaller segment of the profession because it excluded practitioners who may be licensed but not certified. (Note: The NCBTMB conducted another job-task analysis in 2007 but has not yet publicized the results. A new version of the NCE will be implemented starting Jan. 1, 2010, based on that job-task analysis).

There are definite advantages to using the MBLEx as a licensing exam that cannot be matched by using the NCE in its place. For example, because of the FSMTB’s relationship to its member boards, the MBLEx is the first true step toward license portability and reciprocity among states; standards are decided by state boards, rather than an outside entity, and therefore the chance of conflict between standards and state law is lower. Also, excess funds from the MBLEx are used to finance other FSMTB initiatives as decided by state board members.

Perhaps the greatest advantage of using the MBLEx for licensure is it enables the NCBTMB to use its resources for certification and advancement of massage therapy, as it was originally intended. This can alleviate a great deal of confusion in the eyes of the public, other professions and massage therapists who see the line between certification and licensure blurred because of the NCE’s use as a licensing exam.

Associated Bodywork & Massage Professionals and the American Massage Therapy Association, the nation’s two largest massage-membership associations, have publicly expressed support of the MBLEx as the preferred licensing exam.

Whether you believe the MBLEx or the NCE should be used for licensing purposes, it is important to voice your opinion to your licensing board and professional organizations. I have already contacted my licensing board in support of the MBLEx.

Emmanuel Bistas, MASSAGE MagazineEmmanuel Bistas is founder and director of The New School for Massage, Bodywork & Healing in Chicago, Illinois ( He is a licensed massage therapist and has a bachelor’s degree in information and decision sciences from the University of Illinois and a master’s degree in business administration from DePaul University, with a concentration in entrepreneurship. His background includes years of management consulting and strategic planning for medium and large organizations.