Ahead of the June meeting of the Coalition of National Massage Therapy Organizations, a concerned member of the massage community—Julie Onofrio—created a Change.org petition raising issues about the profession she hoped meeting attendees would address. Onofrio’s original petition can be found at www.change.org/p/massage-therapy-profession and her website goes into further detail at www.massagechangeslives.com/petition-we-have-to-start-somewhere. What follows is Associated Bodywork & Massage Professionals response to that petition, following the Coalition meeting.
Associated Bodywork & Massage Professionals (ABMP) participated in the Coalition of National Massage Therapy Organizations (Coalition) meeting June 10–11, 2024, in Dallas, Texas. Prior to the meeting, a petition—created by Julie Onofrio—was circulated and signed by now more than 400 individuals, requesting the Coalition to address issues raised including educational requirements, licensing laws, continuing education, and professional identity.
The petition and its co-signers are demonstration of the desire for the betterment of the massage therapy profession. We appreciate this group’s investment in the profession and bringing their concerns to our attention.
This response to that petition solely represents ABMP’s views and is not a statement on behalf of the Coalition or its members.
The petition group aspires for consensus and standardization. Aspects of the massage therapy profession benefit from such goals, yet caution is warranted. The logical extension of some of the petition’s language would be unitary federal regulation of massage therapy. That is likely the only way complete standardization could be achieved. There are very few professions historically that have garnered federal regulation.
That said, wisdom in massage therapy focus, structure, and development goals benefit from recognition of complexity and difference, leavening a rush to unity and standardization. Striving for a balance recognizes the roots of massage therapy in individual therapist attention to address each individual client’s unique physical and emotional needs. While some overlap exists among the seven organizations currently comprising the Coalition, they each have unique mission statements and foci, adding to the complexity of standardization.
With that in mind, the petition offers several compelling comments. One that helps frame the current state of the profession and a core challenge it faces is:
“We are at a crossroads with dwindling numbers of people joining the profession and many leaving it, yet a growing demand for massage therapy in every sector: Clinical, spa, hospitals, health care, and more.”
ABMP’s professional population analysis and school programs surveys underline that statement about therapist numbers—the number of graduates from massage programs has declined consistently since its peak in 2008. However, the overall population of massage therapists has declined only slightly in the past five years. Positively, there are real demands for massage therapy. Even static supply can be strained with increased demand.
At a simplistic level, the solution is classic economics: a shortage of supply is addressed by paying more to individuals providing the desired consumer service. It isn’t realistic to transform the weekly hours of in-session work by massage therapists; work patterns that exist reflect physical realities coupled by the desire of many practitioners to work closer to 12–15 sessions a week rather than 30–40.
Improving the value proposition for practitioners would increase interest for what intrinsically is immensely satisfying work to perform.
What Should Be Taught? Entry-Level Education
The Entry-Level Analysis Project (ELAP), released in 2014, was a significant product of the Coalition. It was not a casual effort; 20 months of work by seven well-qualified task force members coupled with profession-wide surveys and comprehensive assessment of previously published materials helped produce the result. ELAP identified the minimum knowledge and skills needed and learning objectives to be mastered for someone to become ready to practice safely and effectively. It then estimated how long it should take a qualified instructor to impart that subject matter to students.
Could it use updating? Yes. Any 10-year-old product could benefit from a fresh look. If it is to be updated, that task needs to be taken seriously and rigorously, matching the care given the original ELAP work product.
Should updating be the profession’s priority? Not in our view. ELAP identified and prioritized learning objectives. It is a road map, but it is not a curriculum. Some programs embraced ELAP and incorporated aspects of it into their teachings. However, no one in the past 10 years has stepped forward to create a comprehensive massage therapy curriculum based upon the ELAP road map, utilizing the full range of new technology and expanded awareness about how the kinds of learners attracted to massage careers today best master material.
That aspiration is easy to articulate but would take hard work to become a reality. Industry publishers would likely have keen interest in such a product. The challenge is the years of work required by a motivated educator-author before a financial reward can be reaped.
ELAP was and is a landmark development by the profession; it simply has not been developed into a contemporary curriculum and then adopted broadly by massage schools.
Compatible Licensing Standards
The petition uses the word “consistent” licensing laws. That implies precise mirroring among all 50 states, D.C., and US territories. Both the creation of ELAP and the soon-following Federation of State Massage Therapy Boards (FSMTB) Model Practice Act guidelines harbored an aspect of “let’s get the standards right and persuade states to move in those directions.” Progress has been slow in the past decade. ABMP, American Massage Therapy Association (AMTA), FSMTB, and National Certification Board of Therapeutic Massage & Bodywork (NCBTMB) can try to persuade, but none of these organizations can dictate.
Ironically, new rules from the US Department of Education (US DoE) have caused an earthquake that may be the impetus to shrink the wide range of state requirements. While the core purpose of the government’s revised “Gainful Employment” standards is to assure that massage therapy (and other vocational programs) provides relevant content to students and prepares them to secure massage therapy jobs after graduation, the new rules tacked on elimination of the “150% rule.” Going forward, all massage programs interested in accessing full federal financial aid for their students will have to offer programs exactly matching state minimum education requirements. No more 750-hour programs in a state that has minimum education requirements of 500 hours—if they want to offer Title IV funding.
The negatives: A) virtually all schools utilizing federal financial aid will have to redesign their instructional programs to fit new total hour requirements; B) in some cases subject matter allocation will change, also affecting what instructor qualifications are needed; and C) the rich history of individuality in massage therapy training—teach the basics and then impart a personal touch to additional instructional content—becomes more challenging.
This impending regulation has spurred some states into action. At the beginning of 2024, 23 states had a 500-hour minimum educational requirement; as many as six of those states will increase their requirements to somewhere in the 600–650-hour range this year. At least an equal number of states appear receptive to making an equivalent adjustment in 2025. While not entirely “fixing” the student-aid hole created by the US DoE, movement by up to 12 states to consider adjusting practice requirements to meet the profession’s recognized standards in just a two-year period is unprecedented.
One further suggested adjustment goes back to the use of “compatible” rather than “consistent.” Massage therapists sometimes move between states. Regulation language that allows for “roughly equivalent” rather than “precisely matching” educational background credentials can make a meaningful difference. States have differing criteria and qualifications and historically have not made the pursuit of professionally consistent language a priority.
Which leads into License Portability.
At its initial meeting in 2011, the Coalition identified the two top priorities for the profession as A) improving the quality of massage education and B) enhancing portability. ELAP addressed challenge A; challenge B has foundered. The movement toward 600–650 hours should help, but will not solve the challenges faced by licensed professionals wishing to work in other states.
A more concerted effort to provide relief is the Interstate Massage Compact (known as “IMpact”), a legislative effort sponsored by the US Department of Defense and the Council of State Governments. Within the massage profession, FSMTB has taken the lead with this legislation.
IMpact works differently. A massage therapist who has obtained a state license in Arizona, for example, could be forced to move to Louisiana because their spouse was transferred there. Assuming both Arizona and Louisiana have elected to participate in the massage compact, the massage therapist can obtain a multistate license that will allow practice in Louisiana without the need to obtain a Louisiana license.
The IMpact movement will not solve the entire portability challenge, but it is the most useful attempt to date to provide an ability to practice in more than one state without the burden of meeting the specific standards of each jurisdiction. ABMP supports the adoption of the IMpact.
Massage Professional Education Beyond Initial Base Training
The petition addresses this subject in two aspects. One, pointing out inconsistency in continuing education requirements embedded in state licensing is readily comprehensible. Currently, 40 of the 46 states with massage licensing have some kind of continuing education requirement. Most set an hour total to be attained over a two-year period as a condition of re-licensure. The predominant range is from 12 to 24 CE hours every two-year period.
NCBTMB and now FSMTB approve continuing education for massage professionals; AMTA and ABMP offer continuing education to their members. ABMP’s offerings include more than 700 hours of online education included with membership.
The second aspect noted in the petition is the use of “continuing education” and “professional development” as terms that are suggested to mean different things and that lack of profession consensus about term choice is an impediment that needs resolution.
The petition laments the lack of uniformity in CE requirements, and also states that CE is different than professional development but offers no concrete differentiation or suggested paths for remedy.
It does not seem to us that the massage professionals are lacking opportunities for CE—quite the contrary. Perhaps a logical step is to coordinate Job Task Analyses from NCBTMB and FSMTB and determine if there are areas of practice that aren’t being properly addressed through CE development. Our experience has been that many professionals seek continuing education for their own edification, but there is a subset that does so simply to meet state requirements.
Coalition Transparency and Communication
The above comments do not address every issue raised by the petition. One last subject voiced in the petition was inadequate Coalition transparency and communication of its work and discussions to the full massage community. Typical reports to the profession after Coalition annual meetings tend to be short and anodyne. On a couple of occasions, no statement was issued. This pattern reflects a Coalition tendency to report only what every attending organization agrees upon. Trying to agree even on the content of a one-page press release has in some years been a tortuous process.
This response by ABMP to the petition represents a bit of a departure; we felt a response was warranted, but did not persuade the rest to sign on to this statement. It is ours alone.
Two things that petition signers ask for—profession unity and improved transparency—may not be wholly compatible. Some members of the Coalition compete with other Coalition members on certain aspects of their operations. Competition can be valuable, forcing each organization to sharpen and improve their services. Alternatively, it can lead to duplication of effort. Some of the laments in the petition fail to recognize that basic fact—we seven organizations have pledged to cooperate and share information, but we overlap in our roles and in some cases directly compete. A petition won’t change that.
Gaining full agreement within the massage therapy profession can take longer than one hopes. There is more work to be done. It is important that we each stop to consider a long view—that the massage therapy profession over the past few decades has become more professional, has grown its audience of grateful clients, and offers great value to recipients of massage therapist services. A bumpy road has not forestalled progress.
Associated Bodywork & Massage Professionals
Les Sweeney, President
Bob Benson, Chairman
June 2024
