Rick Rosen, L.M.B.T., was a co-founder and served as the first executive director of the Federation of State Massage Therapy Boards (FSMTB) and the Alliance for Massage Therapy Education. He wrote this guest editorial in response to news regarding the FSMTB’s proposed massage continuing education approval program.

There is broad agreement that continuing education (CE) supports the professional development of those who work in licensed occupations. In the massage therapy field, most of the states that regulate the practice of massage therapy have mandatory CE requirements for license renewal.

I consider that a good thing.

However, there is significant inconsistency in the standards for CE providers and courses, as well as doubts about the effectiveness and value of existing CE approval systems.

What benefit to massage clients, practitioners and CE providers do these requirements actually produce—and what kind of regulation is best? Do we even need these high-stakes approval processes?

These crucial questions have been ignored in the debate that’s been ongoing in our field for the past decade. Efforts to develop a unified solution have been mired in political wrangling between organizations. As a result, we’re faced with the prospect of even more confusion and waste if there is not an immediate change of course.

As the American humorist Will Rogers wisely said, “If you find yourself in a hole, stop digging.”

In that spirit, I will outline the inherent problems with CE regulation, and offer a radically simple solution that will bring the focus back to learning, rather than on bureaucracy.

4 Reasons Why Massage Continuing Education Approvals Don’t Work

  1. At this stage of development in the field of massage therapy, it is not possible to assure the competency of CE providers or the quality of CE courses.

First, it is impossible to verify a provider’s knowledge, skills and abilities from a review of documentation alone. Anybody or anything can look good on paper. The act of filling out forms is not demonstration of quality instruction, or any measure of competence outside of administrative work.

It would take a far more rigorous accreditation-level process, as found in some other health care professions, to verify the competency of every provider and the integrity of curriculum design for each CE course.

Neither regulators nor providers are in a position to administrative costs and demands of such a regimen.

Second, most CE providers in this field have never had formal education in curriculum design or the theory and methodology of classroom instruction. (The same deficit exists with most teachers in entry-level massage training programs.)

Knowledge of the subject matter and clinical experience as a practitioner are important, but these components are no substitute for the lack of training in fundamental teaching skills.

As a result, there is a wide range in the effectiveness of delivery of CE courses.

  1. There is no proven connection between CE requirements and public safety.  

Occurrences of actual physical harm resulting from the practice of massage therapy are exceedingly rare. Death by massage is non-existent. As there is not a demonstrable threat to clients’ health and welfare, using public safety as the primary rationale for high-stakes CE regulation does not pass the evidence test.

The more pressing issue is lack of effectiveness of massage therapy treatment. This is something that can be improved over time with relevant CE for licensees. In general, the public will be better served by better massage, which in and of itself is a sound rationale for the maintenance of mandatory CE requirements by state massage boards.

  1. There are inconsistencies in the standards for acceptable CE subject matter and the processes of CE provider approvals.

State and national CE standards have been developed over the years in a random manner without a guiding template. As a result, the differences in requirements impede portability for licensees and create undue financial and administrative burdens for CE providers.

As well, there is no common agreement on what modalities should be considered within the scope of practice.

For example, Asian bodywork is included in the scope in North Carolina, but is exempt in Illinois. Reflexology is exempt in Utah, but its practitioners in Florida must be licensed massage therapists.

This lack of consistency has made it impossible to determine what CE subject matter should be accepted for license renewal from state to state.

  1. The costs of high-stakes massage continuing education approval programs far exceed the benefits.

As there is no reliable quality assurance from approval programs, and no evidence that such requirements improve public safety, the costs to both massage continuing education providers and regulatory agencies of maintaining approval programs cannot be justified.

Providers would be better off spending their time and money on teacher training and other course work to further understanding of their chosen subject matter. State boards would be better off using their precious resources on the primary mission of rooting out unlicensed and unethical activity.

Moving Beyond Our Struggles

CE regulation is literally all over the map. A handful of state massage boards administer their own approval programs. The National Certification Board for Therapeutic Massage & Bodywork (NCBTMB) has run a CE provider approval process since the mid-1990s and added course approvals three years ago.

This national program is utilized by a number of state boards. The Federation of State Massage Therapy Boards (FSMTB), is getting ready to roll out its own approval program for both CE providers and courses, along with a national database for state board disciplinary actions and CE courses taken by licensees.

FSMTB’s proposals to create a separate CE approval program have been met with resounding disapproval from the other stakeholders in our field.

In December 2015, the seven-member Coalition of Massage Therapy Organizations directed FSMTB to negotiate with NCBTMB to create a single-source program. Unfortunately, the two entities were unable to forge a working partnership and NCBTMB ended its participation in this attempted collaboration in fall 2016.

Since that occurred, the two entities have gone their separate ways, continuing to pursue redundant CE approval programs that fail to address the core issues. It’s an ugly mess. The debate is stuck on the question, “Which one should it be—NCBTMB or FSMTB?” My answer is “Neither!”

That’s right, the best choice is none of the above. In addition to the structural problems with CE approvals listed above, both organizations have dubious track records when it comes to integrity, transparency and customer service.

I propose that CE requirements remain for the renewal of state massage licensure, but that we sunset all state and national approval processes for both CE providers and courses.

In approval’s place, state massage boards would adopt a set of subject matter criteria for continuing education pioneered in 2001 by the North Carolina Board of Massage & Bodywork Therapy and used successfully over a four-year span. (Interestingly, NCBTMB has been using a modified version of these criteria as a screening tool for its CE course approval process. It’s a proven model.)

This shift can be readily accomplished by state boards through amending their rules and procedures. I have drafted a generic set of administrative rules for this purpose.  You’ll see that the CE subject matter criteria are based on broad descriptions of content, rather than naming specific modalities.

There are 15 categories of acceptable subject matter, and 9 categories of subject matter considered unacceptable for license renewal.

As one who has been a fervent proponent of licensure in the massage therapy field over the past four decades, you may be surprised to hear me recommend deregulation of CE activities. In fact, it is my accrued experience as a state massage board chair and co-founder of both FSMTB and the Alliance for Massage Therapy Education that has led me to advocate for this solution.

Little to Lose, Much to Gain

Is there a downside to the removal of CE approval requirements? From the state board perspective, I don’t believe there is. However, some CE providers have expressed concern about the elimination of approval designations. Losing the status of “approved CE provider” might feel like a demotion, but it doesn’t limit providers’ ability to develop and promote CE courses. As well, there are concerns about the field being flooded with fly-by-night courses if formal approvals are no longer required.

On that note, I would argue that we already have a surplus of low-grade CE offerings (both in-person as well as online courses) that have made it through existing approval processes.

Licensees currently need to use discretion and due diligence in selecting what courses they take; this would continue to be the case if state massage boards sunset CE approval requirements in favor of this subject matter screening approach.

Market forces will continue to select out the better courses in favor of the weaker ones, and therapists will benefit overall in the proposed new system from having a wider range of professional development activities to use for their license renewal requirements.

From a public protection standpoint, what’s most important is that licensees take CE courses on a regular basis that are relevant to the work they do with their clients. Where and from whom they obtain those courses is of minimal importance at this juncture. Since quality assurance is not achievable on the existing landscape, the fact is that no approval is better than faux approval.

By making this change, we can bring the massage therapy field to a higher level of authenticity and integrity, which will serve us well going forward.

A guest editorial represents the opinion of its author and is not intended to represent the viewpoint of MASSAGE Magazine.

Related content:

“New Massage Continuing Education Plan Met with Opposition,” by Karen Menehan

“Opinion: New CE Approval Program is A Bad Idea for Many Reasons,” by Whitney Lowe

“Opinion: A Big-Picture Massage CE Solution,” by Lauren Muser Cates


Rick Rosen, M.A., L.M.B.T., is the founder and co-director of the Body Therapy Institute in Siler City, North Carolina. He was the founding chair of the North Carolina Board of Massage & Bodywork Therapy, as well as a co-founder and first executive director of FSTMB and AFMTE. He is a 2010 inductee into the Massage Therapy Hall of Fame, and a 2013 recipient of the American Massage Therapy Association’s President’s Award in recognition of his long service to the field.