And now, the end is near
Could this be the final curtain?
First of all – it is CE (Continuing Education) NOT CE U
. One CE credit is 60 minutes of instruction. One CE hour is 60 minutes of instruction. One clock hour is 60 minutes of instruction. One contact hour is 50 minutes of instruction. One continuing education unit (CEU) is equal to 10 contact hours. Got it?
National Certification Board of Therapeutic Massage and Bodywork
The NCBTMB has a process for CE providers to become ‘approved providers’. Many states require CE classes that are approved by the NCBTMB. There are also many states that do not require that CE classes be approved by the NCB. Here is a list of them on my other site–www.massageschoolnotes.com.
These are the requirements to become an approved provider with the NCBTMB:
Requirements to become an Approved CE Provider:
- Submit a course description,
- Submit a brief description of your learning outcomes,
- Submit a syllabi/outline of course,
- Demonstrate you have taught the course at least one time within the last year to a group of five or more participants, and
- Submit completed feedback forms from five or more participants.
Costs to become an Approved CE Provider:
- $225 for individuals for a three-year period,
- $450 for organizations or conference/tradeshow providers for a three-year period, and
- $25 per new class submitted.
More info on becoming a CE Provider with NCBTMB
The NCBTMB though has been under scrutiny for many years. In my opinion, it was actually doomed from the start. There was no research done at the time of their creation that said it was needed. The article Pro..National Certification…con… a Panel discussion sponsored by the Bay Area Body Therapy Guild June 5, 1990 Massage and Bodywork Journal brought up the many concerns. (See more on the history of the National Certification Board for Massage and Bodywork on my other site www.massageschoolnotes.com)
In the article Calling for Excellence in the National Certification Program, Massage Magazine, May/June 1994, Patricia Benjamin openly questioned the integrity of the program because it was being started by AMTA. “There is a essential conflict of interest when one organization and their employees have inside information about another organization whose interests they are supposed to protect.” In the second part of the article, National Certification Perspectives II also talks about how there was no study or survey done to show that a National Certification Board was needed until AFTER it was created.
The problems we had back then are actually the same that we have now:
- Lack of portability to practice in any state
- A national credential to provide state regulatory agencies a defined standard for the massage profession
- Lack of public recognition and professional respect of massage therapy as an important part of healthcare. (It could be the first response to pain, stress and our ever growing Opiod addiction problems.)
- Lack of public awareness campaigns – commercials, advertising (Oprah Magazine)
- Protecting the consumer from inappropriate touch
- Advancement of the massage profession – what does that even mean?
Their income was drastically reduced when they stopped the National Certification Exam. They do have a Board Certification Exam that is just sitting there (or so it seems to me)… Do health care professionals know what it means? Do employers? Do consumers? NO.
The NCBTMB has been on the brink of financial failure since it released their rights to the national certification exam over to the FSMTB. The FSMTB had to pay the NCBTMB for a year for those rights. They should have held out and requested 5 years of payments since they were in such financial decline. Their past Executive Director who was a financial expert seemed to lack the expertise to hold this organization together which may indicate the severity of financial troubles. They were forced to move out of their office due to lack of rent payments and sold the furniture to stay afloat. Without the national certification exam, the income is down to only CE provider applications.
Also their approved CE classes and teachers have no requirements for being evidenced based and includes many classes on crystals and fairies. The problem is that many state boards require that CE be approved by the NCBTMB and they let them handle the process and approvals. Who is watching the NCBTMB? Where is the money coming from for them to stay afloat?
As of 2016, AMTA is providing financial assistance to the failing NCBTMB. While there is a separate board, we do not know the arrangements and what influence AMTA’s money is having.
Nov 15 2016 – AMTA announces funding for the NCBTMB.
AMTA to Support NCBTMBAMTA has long supported certification as a vital part of the massage therapy profession and we continue to support its value. The AMTA Board of Directors was approached by the National Certification Board for Therapeutic Massage & Bodywork (NCBTMB) and they have agreed to provide operational and logistical support to the organization to safeguard Board Certification.
“NCBTMB will continue as an independent body, as AMTA ensures its long term sustainability through operational and logistical support. As this new collaboration evolves, AMTA and NCBTMB will keep everyone in the profession informed about the process.”
Their New Board Certification and specialty certifications are questionable too. Why certify only one school or program and call it ‘Integrative Healthcare” (See More on NCBTMB website). Why can’t anyone trained in ‘integrative healthcare’ take a test and get certified in it???? That’s a whole other blog post…
Rick Rosen in his white paper Continuing Education in the Massage Therapy Field Proposal for an alternative to state and national regulation (Feb 2013) states that:
“Of the 45 jurisdictions in the massage therapy field that regulate massage (43 states plus D.C. and Puerto Rico), 33 require continuing education for license renewal. Five states have regulations under development, and seven states have no CE requirements for renewal. Of those 33 states that currently require CE, 13 of them use the existing NCB Approved CE Provider program to determine what constitutes approved CE. 12 more recognize the NCB program in addition to state approval processes and other CE sources. Five states have their own CE approval process and do not recognize the NCB system, and three states have no specific CE approval standards (other than the course being relevant to the licensee’s scope of practice).”
So not every state uses the NCBTMB anyways. What is happening in the states that do not have it? Are many clients getting injured or is there more claims on liability insurance from therapists in those states?
Here’s the clincher though as pointed out by Laura Allen in one of her blog posts:
As long as the NCBTMB is written into state statutes and rules, the regulatory boards are forced to blindly go along with whatever NCB does.
Federation of Massage State Boards.
The Federation of Massage State Boards (FSMTB) is a group of our state massage boards. State Massage Boards represent the public and work to protect the public from harm. They do not represent the massage therapists or work for the massage therapists.
When the Federation of Massage State Boards came into the picture and created a licensing exam, the NCBTMB lost it’s status as a licensing exam. In 2014, the Federation also started talking about creating a CE approval program. The way that came about was not very straight forward as explained by Whitney Lowe in his recent article in Massage Magazine: Opinion: New CE Approval Program is a Bad Idea for Many Reasons. The Board itself is not clear on how it came about which is very concerning. (That by the way is how the NCBTMB actually started. It was meant to be an entry exam for AMTA and someone ballooned into a full blown National Certification exam which was never really National in that it would allow for portability. There was also a lot of other controversy about the exam and creation of the NCBTMB exam. )
The state boards themselves will decide if they want to use the FSTMB system and if it will meet their needs. The job of massage boards is to protect the public. The amount of harm done to the public comes more in the way of ethics violations – touching them inappropriately and worse. That problem will not be solved by more expensive technique classes. What can help is requiring clinical supervision/peer supervision to help therapists deal with difficult feelings and situations.
So if the FSTMB wants to get into approving CE classes – wouldn’t that be a big conflict of interest – meaning the individual massage state boards would be influencing CE?
Choosing a CE Class
For many massage therapists the process of choosing a CE class is often choosing the cheapest class closest to home and finding online classes when it is accepted by their massage board. Many conventions/conferences/festivals offer short 2-8 hour classes. What can you really learn in that time frame? Most short classes may be giving an overview of a technique or an introduction to a method. More intensive learning experiences are often limited because of cost and not being offered in their area. Sure some therapists will take their CE more seriously, but we actually really don’t know. We don’t have any statistics on any of this. What CE is most effective and gives the therapists the best information to help them be successful massage therapists?
It is difficult to choose a good CE class because there are NO review sites out there for the approved NCBTMB classes or any of the CE providers/classes. While we all know reviews can be problematic, they also can provide good insights into whether or not this class would be for you. There are so many bad teachers and classes, that are providing misinformation on many topics – insurance billing, massage business practices etc. Who knows what we are getting really in hands on classes?
There are no requirements for teachers of CE classes – anyone… ANYONE can teach them. That’s a problem.
Many of the approved courses are not evidence based and don’t have anything to do with keeping up to date with the latest information. As far as keeping up with the latest techniques, they are all optional. If you are interested in a specific technique, that is fine. But requiring people to take technique classes is useless really.
There has been no research on exactly what is needed in the line of CE for a massage therapist to maintain safety and competency.
Ask the tough questions:
Why do we need CE?
Does continuing education fill any problem that we are having in the profession? Does Continuing Education ensure competency of massage therapists? What harm to the public comes from having massage therapy sessions? Are technique classes really needed or do we need more training in clinical reasoning?
Why does CE approval not work?
Rick Rosen, in his article in Massage Magazine has 4 Reasons Why Massage Continuing Education Approvals Don’t Work
- 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.
- There is no proven connection between CE requirements and public safety.
- There are inconsistencies in the standards for acceptable CE subject matter and the processes of CE provider approvals.
- The costs of high-stakes massage continuing education approval programs far exceed the benefits.
What problems do we have that need solving?
Rick Rosen is also asking in his Whitepaper Continuing Education in the Massage Therapy Field (PDF) (2013) with my emphasis in bold:
“Before NCB and FSMTB continue any further down their respective pathways, we must address and get frank answers to these interlocking questions:
1. Should continuing education be mandatory for renewal of state licensure – and is it essential for the ongoing protection of the public?
2. Given the reported inconsistencies in the instructional design and delivery of CE courses, is it even possible for an approval process to provide quality assurance?
3. Does the cost of compliance for CE providers (both in terms of time and money) bring an equal or greater benefit to the massage therapy field, and to the public at large?
4. What kind of regulatory process – if any – is needed; and which organizational entity is best suited to perform this function?”
Ralph Stephens on Massage Today is wondering some of the same things:
“All of this dog fighting between organizations has obscured the real questions that must be addressed, “Is mandatory CE in the massage therapy field necessary to protect the public?” Studies conducted by the prestigious Pew Research Center show there is no improvement in public safety resulting from mandatory CE requirements in licensed professions.”
Another question, “Does the massage therapy field need a formal approval process for CE providers and courses? Is it even possible for an approving agency to promise quality assurance?”
Without the kind of consistent standards found in other professions, it is impossible to build an effective CE approval system in the massage therapy field. Add that to the fact there are no teacher training requirements for CE instructors.
Should CE be monitored by the NCBTMB or the FSTMB???
Rick Rosen says Neither! and proposes a set of standards to be used by State Boards in overseeing CE. (PDF) Model Administrative Rules for State Massage Regulatory Boards Continuing Education Requirements for Renewal of Licensure
“State boards craft their own solution based on a common template. Each agency must have a structure that is practical and defensible, and that is not based upon false assertions or undeliverable promises. The model administrative rules for continuing education presented here focus on two important changes: the use of specific subject matter standards to determine what constitutes” approved continuing education “for license renewal, and the elimination of approval requirements for CE provide”
But I still want to get some answers to these questions.
- What is the problem that we are trying to solve?
Protecting the Public from harm?
Promoting the Massage profession to get more recognition and respect?
- Figure out what if any CE is required to protect the public from harm.
- Figure out what CE if any is required to support massage therapists career
- Create a specific criteria of required CE to be adopted by all the states. (Do some sort of study like the ELAP or something to determine what CE is needed and what works best)
- Study the states that do not require any CE – is there a higher incidence of harm or lack of business/career success?
CO; HI; IN; ME; OH; RI; UT as of 2013 as reported in Rosen’s White Paper.
- Study the states that are not using the NCBTMB approved classes. Is there a higher incidence of harm or lack of business/career success?
IL, IA, LA, WA
- Figure out a system for monitoring CE teachers/classes. Could the NCBTMB use what they have already and make some big improvements?
- Who should be in charge of this? The NCBTMB or the FSMTB? Both? None? One or the other?
Proposed CE Requirements
Also, after researching this for a few weeks and having my own personal challenges with the whole system of CE (having been injured in a class in 1999 to the extent that it affected my health TO THIS DAY…), I would like to propose some alternatives. What is it that could help advance our profession to get the respect it deserves? What we have been doing hasn’t been working. There are more law suits and claims against massage therapists for inappropriate touch than injuries by massage therapists (from what I see – we would need a study on that!)
Are all of our required ethics classes helping that? Will more techniques help that? Not from what I see….but yes we should investigate that.
I do know that one of the main reasons I have survived 34 years in the profession is because I have participated in peer supervision and supervision for over 20 years. I would like to see that be a required part of CE if anything…of course we would need studies to back that up!
- Supervision and peer supervision group participation to help students transition from school to practice/job for first 5 years.
- Supervision and peer supervision group participation to work with seasoned therapists (after 5 years of working in the profession)
- The latest research and science for massage therapists – some sort of specific required information in webinar/ebook with test, that will keep us All up to date on the theories and practice of massage therapy. (Yes we can massage people with cancer. No, there are not any toxins cleared out with massage therapy)
What do you think should happen? Do you understand what is at risk and what is happening? It is time to make your voices heard. Contact the NCBTMB and the FSMTB and let them know what you want. Get involved with your local associations and start going to your Board of Massage Meetings. If you are not at the table, you are what is on the menu/what’s for dinner…
Could CE teachers be put out of business? Would more people take CE if it were not required? (I have a friend that teaches in Japan where massage therapy is a 4 year training program with no CE required. He is in extreme demand!)
NCBTMB creates CE provider approval process
2005 – Federation of Massage State Boards Created.
October 3, 2014 – The Federation of State Massage Therapy Boards (FSMTB) and the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) have worked cooperatively to reach an agreement that the NCBTMB will no longer provide examinations for licensure purposes and will now focus exclusively on delivering quality certification programs. NCBTMB announcement. ( There was once a link to the FSMTB announcement on their website but as of 08/05/2018 they have taken it down. There is a story on Massage Magazine regarding this agreement.)
On Oct. 3, 2014, FSMTB delegates voted to create a continuing education approval program, based on the recommendation of the FSMTB Continuing Education Task Force.
November 3, 2014 – AFMTE recommends consolidation of CE programs.
2014 – The delegate assembly at the FSMTB Annual Meeting officially voted to create a continuing education approval program to meet the needs of the massage therapy regulatory community. Following this directive, the license renewal committee developed a system to register providers, vet courses, and capture course completion data to be housed in the Massage Therapy Licensing Database. Licensee course completion data will be available to all Member Boards of the FSMTB that participate in the MTLD program. All details of the standards, guidelines, and associated policies will be published prior to the program launch. Providers are required to meet these standards to be eligible to offer courses.
The License Renewal Committee has established standards for the delivery of continuing education. These standards were developed by the membership and formally adopted by the FSMTB board of directors.
March 25, 2016 – NCBTMB and FSMTB release joint statement regarding CE Collaboration:
The National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) and the Federation of State Massage Therapy Boards (FSMTB) announced today the following joint statement:
“NCBTMB and FSMTB are working toward a partnership regarding Continuing Education. We look forward to open dialog and collaboration between the two organizations.”
April 1, 2016, NCBTMB and FSMTB announced a collaboration related to continuing education, but did not offer details about the partnership.
Nov 15 2016 – AMTA announces funding for the NCBTMB.
AMTA to Support NCBTMB
“AMTA has long supported certification as a vital part of the massage therapy profession and we continue to support its value. The AMTA Board of Directors was approached by the National Certification Board for Therapeutic Massage & Bodywork (NCBTMB) and they have agreed to provide operational and logistical support to the organization to safeguard Board Certification.
NCBTMB will continue as an independent body, as AMTA ensures its long term sustainability through operational and logistical support. As this new collaboration evolves, AMTA and NCBTMB will keep everyone in the profession informed about the process.”
2017 – FSMTB has indicated that member boards have challenges that are not currently being met by the existing NCBTMB Approved Provider Program, so they have continued moving forward with the development of their own CE approval program.
Aug 3, 2018: NCBTMB announcement:
NCBTMB announced the following new Board Certification requirements as of August 3, 2018:
1. Graduate from a NCBTMB Assigned School2. Passing score on the NCBTMB Board Certification Exam3. Pass a criminal background check (performed by NCBTMB)4. Verification of current massage therapy state licensure5. Agree to uphold NCBTMB’s Code of Ethics and Standards of PracticeNCBTMB removed its previously mandated 750 hours of education and 250 hours of professional, hands-on work experience.
To top it off, the FSTMB also announced it is creating a CE Registry which if/when it catches on will surely put the NCBTMB out of business.
August 2018. FSTMB announce CE registry.
Following recommendations and input from the massage therapy regulatory community, licensed therapists, educators and professional associations, the member boards of the FSMTB voted to implement a program that provides reliable, unbiased and appropriate vetting of continuing education providers and the courses offered to the consuming public, and to adopt the FSMTB standards for continuing education.
As a result, the CE registry will enter the marketplace in 2018. We look forward to being of service to the regulatory boards, the licensed professionals seeking to maintain competence, and to the providers in the educational community.
08/19/2020 – The Federation of Massage State Boards has implemented their CE Database still with no explanations or information on what will happen to the NCBTMB. Will they still be able to make money by certifying CE Classes and Instructors? If not, they are doomed. (Well they already are struggling to stay in business and are now supported financially mainly by AMTA.)
Jan 12,2021. Healwell (a well known CE provider) cites their frustrations with the NCBTMB approval process. The NCBTMB denied approval of their course on human trafficking’s which is the NCBTMB’s policy. (that needs to be changed!)
Opinion: New CE Approval Program is a Bad Idea for Many Reasons. Whitney Lowe. Massage Magazine
Model Regulations for Continuing Education (PDF) Jan 2014 Rick Rosen
Model Regulations for Continuing Education (PDF) in the Massage Therapy Field. A Simplified and Streamlined Approach for State Boards. Rick Rosen
New Massage Continuing Education Plan Met with Opposition November 2, 2016 Karen Menehan
Originally published: Published on: Apr 16, 2017 @ 21:01 Updated 08/05/2018, 01/27/2021
Stephanie Rena Rodriguez says
Julie, amazing work on this! I would be interested in putting a coalition of CE providers in various states together to work on this!