Overview - Challenges in Licensing/Regulation/Certification
Perhaps because massage therapy did not broadly etch itself into American consciousness until
the latter half of the 20th century, licensing of the profession has lagged compared to other
healthcare professions. While Ohio initiated state-level massage licensing in 1916, as recently
as the mid-1990s only 22 states had statewide massage licensing statutes on the books. The
following bar graph illustrates the path to 43 state-level massage licensing laws today. Several have passed legislation but are not fully advanced to the licensing stage.
Click image for larger view
In the 43 states with licensing, uniform rules apply throughout each particular state,
though the detailed requirements vary. Requirements in the current seven non-licensed
states vary considerably, from essentially no rules in several states to highly variegated sets
of local requirements in others. The District of Columbia and U.S. territories are not included here but may have regulations of their own.
ABMP believes licensing isn't automatically required. We advocate that lawmakers and members
of the massage profession periodically examine whether public protection and easing of public
confusion trump an instinct for only the government that is necessary. It's an evolving calculus,
but one that should be navigated rather than leaping to a conclusion that "licensing is good"
without examining the factors. Prestige for the profession and gaining insurance company embrace
of bills for massage therapy services are insufficient reasons to create licensing. A sound
licensing foundation addresses public protection and consumer information needs.
When licensing is warranted, ABMP supports consistent rules throughout a state rather than
confusing diverse local rules. Local requirement inconsistency leads to consumer confusion,
massage school curriculum planning that has to try to serve many masters and gross government
inefficiency because each city or county has to develop expertise in reviewing applicant
transcripts. State rules should be developed by a broadly diverse coalition of providers,
consumers and educators operating in a transparent, inclusive manner.
ABMP's government relations professionals have been actively involved over the past
14 years, playing roles in most of the 22 states adopting massage rules for the first time during that
period. In addition to on-the-scene involvement as necessary, ABMP has developed
materials setting forth the organization's
for this arena.
ABMP has also exerted its voice whenever it has felt the balance of regulatory/certification/accreditation forces has gotten out of whack. The National Certification Board for Therapeutic
Massage & Bodywork (NCBTMB) has received its full share of barbs as it drifted away from its
original purpose of voluntary certification for individuals with predominantly core Swedish
ABMP believes that passage of the examination offered as part of NCBTMB's certification regime
should constitute an alternative way of qualifying for a state license rather than be imposed
as a requirement for all licensees. Graduates of massage programs approved by a state department
of education will likely have completed a written and practical (hands-on) evaluation as a
requirement for graduation already, so there is no need to make them reinvent the wheel
(an expensive wheel at that). Requiring the NCBTMB's National Certification Exam (NCE)
does three things:
- Makes the candidate for licensure pay an additional $225.
- Postpones their entry into the profession.
- Undermines the efforts of state-approved schools providing the education, and denies
the incorporation of touch — the essence of massage — into the evaluation process.
In some professions, school accreditation is the norm. Nearly 100 percent of four-year
colleges, for example, are accredited. That is not the norm among massage schools today.
Only 29 percent of the approximately 1,500-plus state-approved massage schools are accredited
by one or more of the six bodies approved by the U.S. Department of Education to accredit
massage programs. Accordingly, we believe the three states that only license graduates of
accredited massage schools are misguided. We believe that the state agency assigned to approve
schools should do its oversight job. When it does, that provides sufficient regulation of schools.
Voluntary accreditation of massage schools has value for the individual school, but requiring such
status should not be established as a barrier to entry.
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