Rethinking Education Standards
Spa Elan

Originally published in Massage Bodywork magazine, October/November 2006. Copyright 2006. Associated Bodywork and Massage Professionals. All rights reserved.

The title spa therapist is often generically applied to a wide variety of spa service providers; however, the term is actually a misnomer, as there is no such single licensed spa professional. In reality, the majority of those performing spa treatments are estheticians and massage therapists, each requiring a separate license.

Many of these service providers are drawn to a career in the spa business by what they perceive as a kinder, gentler vocation. But the truth is that along with the growth of the spa industry, competition among spa professionals is becoming fierce, with many looking to expand their role beyond the scope of current licensing regulations.

Before the advent of sophisticated technology and medical spas, most education for spa service providers took place in proprietary career or vocational training schools that prepared students for licensing--a process typically regulated by state boards, such as the Board of Cosmetology. These generally included licensing programs for estheticians, massage therapists, and cosmetologists, each of which required a set number of clock hours to measure competency.
As the crossover between medical and esthetic treatments continues to blur, and the influx of physicians, nurses, chiropractors, acupuncturists, nutritionists, and other allied health professionals penetrate the industry, those entering such programs today are just as likely to have a college degree as they are a high school diploma. This situation has many crying for rules and regulations to enforce stricter professional boundaries and promote increased education.

Esthetics Education
Currently there are twenty-three states that require six hundred hours of training for estheticians, eleven states that require between six hundred fifty and fifteen hundred hours, and eleven states that require less than six hundred hours. There are four states that do not require a separate license for estheticians at all, and one state, Utah, that offers a two-tiered licensing system separating a Basic Esthetician license (six hundred hours) from a Master Esthetician license (twelve hundred hours). With the country pretty much split at the six hundred-hour mark, there is a growing interest in this two-tier structure. Virginia is the most recent to join ranks, adopting similar legislation that is scheduled to take effect July 2007. Many states are expected to follow suit. However, putting such laws into effect is often a long and tedious process that can take years to enact.

Frustrated by the inability to change antiquated state laws, some estheticians and school owners have sought additional credentials from outside organizations to enhance their standing. The Comit International Desthtique et De Cosmtologie (CIDESCO) has been the choice of many estheticians interested in acquiring internationally acclaimed credentials. Founded in 1946, CIDESCO has more than two hundred schools in thirty-three countries around the world that follow their training standards. Because CIDESCO diplomates must adhere to rigorous standards that include at least twelve-hundred hours of practical and theoretical training in a registered CIDESCO school, completion of a written thesis, six hundred hours of work experience, and passing the CIDESCO exam, a number of estheticians have taken this step to set them apart.

The International Therapy Examination Council (ITEC) is another accrediting agency that is quickly becoming popular in the United States. The largest international examination board of its kind, ITEC offers a wide range of qualifications in the fields of esthetics, sports and fitness, and holistic and massage therapies that are being used in more than six hundred fifty colleges today. Annette Hanson, owner of the Atelier Esthetique Institute in New York City, chose ITEC, because of its international clout, to augment the school's basic esthetic education curriculum. "Ensuring the education and employability of our graduates, both international and domestic, required us to seek out a recognized body to evaluate, test, and certify our students," she says. With the option to continue their education in a number of colleges around the globe, students can match their need for expertise and knowledge with specific smaller courses, such as face and body, complementary therapies, sports therapy, and fitness, making it ideal for those looking to concentrate in a particular area of study--another feature that was particularly appealing to Hanson's international student body.

Massage Therapy Education
Like estheticians, massage therapists are also striving to elevate standards and promote national mobility. The battle to obtain state licensure has been one of their biggest hurdles, but with thirty-seven states now retaining a separate massage therapy licensing board, progress is being made. Still, the number of hours needed to obtain licensure can range from three hundred to one thousand hours.

National standards are another burning issue for massage therapists. To date, the only national certification agency for massage therapists is the National Certification Board for Therapeutic Massage Bodywork (NCBTMB). The NCBTMB is also responsible for establishing the National Certification Exam (NCE) for massage therapists, which uses five hundred hours of training as a marker. Although the exam began as a voluntary way to establish credentials, it has actually become a requirement for state licensure in twenty-nine states. While this appears to be a step toward national mobility, it is important to note that it does not actually guarantee reciprocity. Massage therapists who move to another state may in fact find they need to take the exam again.

State Regulations
As state laws continue to be challenged across the country, organizations like the National Interstate Council of State Boards of Cosmetology (NIC) and the Federation of State Massage Therapy Boards (FSMTB) are stepping in to establish guidelines and promote standards of excellence that encourage national mobility and protect the health, safety, and welfare of the consumer.

When it comes to estheticians, Rosanne Kinley, president of NIC, a nonprofit organization that represents all fifty state boards in the United States and its territories, believes that the industry is screaming for an advanced or master esthetician's license. She personally supports two-tier licensing as a more appropriate scope of practice for estheticians. In an industry that Kinley says is "growing faster than regulations and statutes can keep up," she is convinced that such changes are necessary to ensure public safety. Kinley is also working to achieve national mobility, an issue she feels is critical in today's transient culture. NIC offers the only national examination for cosmetologists.

The FSMTB is another national nonprofit coalition, whose mission statement highlights the need to "support efforts among member boards to establish compatible requirements and cooperative procedures for the legal regulation of massage therapists, in order to facilitate professional mobility and to simplify and standardize the licensing process." Enforcement of such regulations would enable massage therapists, who are often subject to outdated laws that in many cases do not recognize the legitimacy of the profession and may also impose costly and cumbersome local regulatory restrictions, to work more expediently.

Advanced Education
Varying state requirements aside, the struggle to stay ahead of technology has forced many spa service providers to pursue advanced postgraduate training. Filling in the gaps, a number of seasoned professionals are offering education and training to those who wish to work in niche markets, such as medical spas. Lyn Ross, CEO and founder of the Institut' DERMed, began her career as an esthetician before licensing was available in the United States. She opened her own skin care clinic in 1989 with the goal of supporting the medical community. Dissatisfied with the limited medical esthetic education resources available, and driven by what she defines as a spiritual calling to teach, Ross went on to develop a medical esthetic certification course for licensed estheticians, nurses, and physicians interested in working in a clinical spa environment. "I think a lot of pressure is being put on esthetic schools to keep pace with new technologies available today, and a number of them are working hard to ramp up their programs, but the fact we do not have a nationally accredited standard for esthetic education is a big problem in our industry," Ross says.

With the demand for education increasing, larger organizations--like the International Dermal Institute (IDI) founded by Jane Wurwand in 1983 to promote postgraduate education in skin and body therapy--are expanding their efforts. IDI currently offers fifty-six advanced education classes on a variety of topics ranging from skin analysis to thermal detoxification and Chinese acupressure. Linda Burmeister, undergraduate school program training manager for IDI, reports the institute is also invested in supporting students and instructors at the undergraduate level, sponsoring field trips, and making learning programs available to area schools. Numerous industry trade shows, associations, and independent spa consultants have also jumped on the education bandwagon, offering a variety of seminars and workshops on related business and technical topics.

Degreed Programs
There appear to be an abundance of excellent advanced and continuing education training programs; however, reliance on these as a definitive source for education is not likely to win public confidence in today's competitive spa environment. Educated consumers are demanding more from higher priced spa services and, in some instances, are more impressed by a licensed professional with a degree than one with a certificate of higher learning. This has given birth to a new concept: degreed programs in spa therapy.

Endorsement of college level spa curriculums has some vocational training schools revamping their format. Traditionally, career schools of esthetics and massage have used clock hours to measure the length of their educational programs, with licensing requirements held to the same standard. But as competition heats up, more are interested in converting to a credit-hour system.
"In a way, hours stigmatize," says Jan Schwartz, vice president of education at the Cortiva Institute, adding that "other CAM [complementary and alternative medicine] disciplines are not asked how many hours of training they have." Still, making the change is difficult. It takes work, a compliance officer, and a willingness to upgrade standards. Ultimately, the deciding factor for many is often more of a business decision that in most cases also opens the door to increased financial aid.

While degreed programs for estheticians and massage therapists are sparse in the industry, with most coursework falling under the umbrella of natural or complementary health, exercise and physiology, or hotel and hospitality administration programs, they are on the rise.

The Florida College of Natural Health (FCNH), part of the Steiner Education Group, is among those making major inroads in the area of degreed programs with an associate science degree in natural health that offers a choice of concentrations in massage therapy and skin care with built-in programs that also qualify students for state licensure. FCNH offers a bachelor of science degree in natural health with a concentration in spa management as well.

Other degreed programs, like the associate degree program in massage therapy offered at Springfield Technical Community College in Massachusetts and the associate degree in therapeutic massage offered at Forsyth Technical Community College in North Carolina, are popping up in community colleges across the country. "The decision to move toward degree status was a necessary step in lending credibility to the profession and one that was backed by public demand as more of our graduates of the certificate and diploma programs requested it," says Kim Moore, program coordinator for the therapeutic massage program at Forsyth. Increased acceptance of massage therapy as an integral part of mainstream healthcare helped to reinforce that decision, Moore says.

There are several college-level courses available to those interested in a career in spa business management, such as the spa management certificate programs offered at Arizona State University and the University of California at Irvine extension program. For independent learners, there are also Internet options. The Cortiva Institute's eCornell, developed in partnership with Cornell University, gives students an opportunity to engage online in business management courses in finance and marketing.

Continuing Education Credits (CEUs)
With many seeking higher standards and increased levels of training, praise for continuing education is echoing across the country. However, CEU requirements vary from state to state and in fact may not be required for license renewal.

This has not stopped industry associations from taking a stand. The National Coalition of Estheticians, Manufacturers/Distributors
Associations (NCEA) has taken the position that all states that regulate the skin care industry should mandate a minimum of twelve hours of continuing education credits before estheticians can renew their licenses. To be nationally certified by the NCBTMB, massage therapists must acquire a total of twenty-four credits every two years from one of their approved CE providers. CEUs are also mandated by the two largest professional associations for massage therapists--Associated Bodywork Massage Professionals and the American Massage Therapy Association.

New philosophies are permeating the spa industry, making the time ripe to rethink the entire process of educating spa service providers. While some would argue that higher college-level courses promote gentrification of the trade, others view it as a perfectly viable way to level the competition, placing spa therapists on par with other medical and allied health professionals entering the field. But ultimately, it is consumers, unwilling to pay for increasingly higher priced programs that do not adequately meet their professional needs, who are most likely to have the final word on more progressive licensing and education policies.

Author's note: With laws in the industry changing rapidly, readers are advised to check individual state rules and regulations for the most current information.

Janet M. D'Angelo is president of J.Angel communications, a marketing and public relations firm specializing in health, beauty, and wellness, and the author of Spa Business Strategies: A Plan for Success (Milady, 2005). She can be reached at

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