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The regulation debate

What is the value of regulation? It’s a question that sparks heated debate when massage therapists address this key issue. With massage therapy currently regulated in only a few jurisdictions in Canada (Ontario, Newfoundland, British Columbia and, most recently, New Brunswick), viewpoints across the country diverge about what forms of regulations should be implemented, and that’s especially so among massage therapists in Western Canada.

The number of RMTs in B.C. has grown from 800 in 1994, when regulation was introduced, to more than 3,000 today.

Alberta has long grappled with this thorny issue. Although the movement to develop a made-at-home regulatory environment in the province slogs along at a glacial pace, at least the province’s massage therapists’ associations continue to dialogue. 

“And dialogue some more,” quips Len Balogh, president of the Remedial Massage Therapists Association (RMTA) headquartered in Red Deer, who sits on the transitional steering committee (TSC) alongside the Massage Therapist Association of Alberta (MTAA), National Health Care Practitioners Association (NHPCA) and the Alberta Association of Therapeutic Masseurs (AATM). 

“The RMTA wholeheartedly supports and endorses the regulation of Alberta massage therapists under the Health Professions Act,” Balogh says.

In 2009, the Minister of Alberta Health and Wellness had recommended to Cabinet that the Health Professions Act be amended to include massage therapists as a regulated profession. 

“The government wants this to happen; so does the MTAA. But after 20 years there’s still no agreement among all the stakeholders. It’s a standoff. And by refusing to compromise and come to terms that will benefit all MTs (in Alberta), we could have the opportunity to become regulated taken from us and freeze the development of our position within the health-care profession,” he says. 

The MTAA (established in 1953, making it one of Canada’s oldest associations for massage therapists) is pursuing a viable way forward in transitioning the massage therapy profession into a self-regulating health profession under provincial legislation. The Entry to Practice standard in Alberta will be based upon that which has already been established by the other regulated jurisdictions in Canada, and the majority of people practicing massage (in one form or another) do not necessarily meet this standard at this point in time, according to Chandra Kastern, massage therapist and spokesperson for the MTAA.

The Entry to Practice Examination Blueprint is based on the Inter-Jurisdictional Practice Competencies and Performance Indicators for Massage Therapists, which was finalized in late 2012 by the three regulatory colleges for massage therapy in Canada (B.C., Ontario, Newfoundland and Labrador). 

“To the best of my knowledge we are the first jurisdiction in Canada to have completed a psychometrically driven blueprinting exercise using this document… and the only jurisdiction to have released a concise blueprint to an Entry to Practice Examination into the public domain,” remarks Kastern. 

Completion of the blueprinting exercise was the kick-off to the redevelopment of the Entry to Practice Examination in Alberta, which is currently underway, slated to be complete summer of 2014. The MTAA has also launched a school/program approval process for institutions offering massage therapy education in Alberta. Going into 2015, it will be mandatory for Alberta graduates wishing to challenge the Entry to Practice Examination to have come from an approved school or program.

“A viable and fair substantial equivalency process is key in transitioning the existing profession into the reality of being a self-regulating health profession under provincial legislation,” Kastern says. 

She explains this process was created to enable existing massage therapists in identifying where their unique level of competence is at, in relation to Entry to Practice standards, to be able to best address deficiencies (if any) or be recognized as “substantially equivalent” to that of a new graduate of a two-year massage therapy diploma program in Alberta. It also provides a pathway for practitioners to become eligible to challenge the Entry to Practice Examination, if they so choose.

“Another Alberta-specific profession-relevant policy would be our professional development program,” Kastern continues. “We recognize that learning occurs inside and outside of a classroom and that all learning opportunities, whether formal or informal, have the potential to be of benefit to the massage therapist. As such, we now use the words ‘professional development’ in place of ‘continuing education’ or ‘continuing competence’ as the new terminology to more accurately reflect the (professional) growth of a massage therapist.”

There may be other means to regulate massage therapy, contends Kathy Wilson with the Natural Health Practitioners of Canada. She wonders if the government should make the ultimate decision about any natural health profession. 

“Many practitioners believe this might not be the best way to represent their practice,” she opines, speaking from her office in Edmonton. “Our organization is governed by a code of ethics, we have an effective complaints process, and liability and malpractice insurance. We believe our members are satisfied.”

Though Wilson admits there are challenges in any health profession, she knows no hurdle is insurmountable. 

“There may be different perspectives on whether regulations are needed or not, but there is no debate about the good work massage therapists do. They are a force to be reckoned with.”

Despite the divide among Alberta’s health associations, provincial policy makers may be trying to nudge the matter forward. Recently, the province met with the associations to explore the possibility of sending out a survey to Alberta’s massage therapists, asking if they want to be regulated. No survey or any official confirmation of a survey, however, has since taken place at the time of this writing.

RMTA’s Balogh is cautiously optimistic. “We’re rallying our troops for the ‘yes’ side,” he says, adding there’s enough momentum to bring in a positive vote. But if less than 50 per cent want regulation, he warns, “the issue is dead.”

Smith hopes that won’t happen. “This is a time when we have a chance to make a positive change, a change that may even make moving from province to province easier for those who wish to relocate and stay within their profession,” she notes. 

For the majority of massage therapists who are highly trained, professional individuals, regulation will not change what they do. In the background, it very well may open up the doors to new jobs in multimodality clinics and health-care facilities. 

“The insurance companies have already dictated that to bill we must have 2,200 hours training and our clinic supports this, so for us regulation will not be a problem.”

Further west
By contrast, British Columbia has designated massage therapy as a health profession under the Health Professions Act since 1994, regulated by the College of Massage Therapists of B.C. Practitioners here think regulations are generally a good thing.  

“The current regulations definitely impact my practice and how I deliver my care,” says Eugene Liang, a strength and conditioning coach and registered massage therapist with the Canadian Sport Institute Pacific (CSIP), a leading Olympic and Paralympic training facility, based in Vancouver. 

“The largest impact is in patient care. Due to the fact that massage therapy does not have a clear and defined ‘directive of care,’ many RMTs are left to their own devices.”

Liang believes this can lead to what he characterizes as “a permeation of ‘sham’ or ‘niche’ treatment modalities into the field.” Further, he argues, even though the College of Massage Therapists of British Columbia (CMTBC) specifically states there are no specializations in massage, “this does not limit a massage therapist from creating a market for a ‘niche’ or a ‘sham’ treatment.” 

In his eyes, it’s basically a free market. “And it’s directly tied to the limitless and ‘wild-west’ environment of the continuing education courses. As an RMT who wants to provide the least invasive and most effective treatment for my patients, I spend much of my resources educating patients and students on navigating these pitfalls.” 

Liang says he’s privileged to work in an environment surrounded by academics. He also views regulation as a positive thing. 

“Regulation, as I used to say to my students, is what makes massage health care. Without it, we are a trade. Being regulated, and being able to provide health care, is a privilege not a right. With that thinking in mind, regulation is the ‘ticket’ to a profession’s growth and evolution. 

“Even though B.C. RMTs are often polarized on their viewpoints on how they see the profession evolving, most if not all agree to regulation. That says more than any one opinion.”

Regulation also serves the public interest, says Annette Ruitenbeek, registered massage therapist and deputy registrar for the CMTBC. 

“We are accountable to ensure that each individual who hangs up his or her shingle as an RMT is truly ready to begin practicing as an entry-level health professional.”

Noting the number of the Vancouver-based College’s registrant base has blossomed from 800 when the CMTBC opened in 1994 to more than 3,000 today, Ruitenbeek says in order to continually evolve the profession, the College is reaching out across the nation. The CMTBC has adopted the newly developed Inter-jurisdictional Practice Competencies, reflecting a joint effort with other regulated provinces – Ontario and Newfoundland and Labrador – to create a single, national standard for entry-to-practice regulation. She explains that not only do the Practice Competencies harmonize the three duplicate processes in each of the jurisdictions, “they offer a standard of regulation for other jurisdictions to adopt as they move to self-regulation.” 

The approach enables regulators to confidently abide by national labour mobility laws that require them to grant full registration to active RMTs from other regulated jurisdictions without additional assessment, testing or educational upgrading, other than testing for knowledge of local jurisprudence.   

Working in high performance sport, Liang sees himself as a pragmatist and a realist. He looks for options. 

“The way I would like to see it go is that it continues to evolve politically, professionally and academically. As a 10-year instructor, I definitely have seen a shift in the student body coming into massage therapy education. The students are more educated, more experienced, more worldly and more critical.  

“I see the profession diversifying within itself with registrants being truly qualified to not only be clinicians but academics, researchers and policy makers,” he says. 

In all provinces, regulated or unregulated, clients of RMTs belonging to any reputable association have generally been able to claim their massage treatments for reimbursement by insurance companies. Insurance firms, such as Manulife, Sunlife and Great West Life, have asked all RMTs regardless of province to have a minimum of 2,200 hours of education and/or belong to a recognized association that sets certain requirements at a level comparable to those practitioners who are licensed in regulated provinces. 

“And he who pays the bills will have a big say in what happens and how our profession will evolve,” Balogh cautions. “The bottom line: insurance companies will set the tone for the profession moving forward.”

Jack Kohane is a Toronto-based freelance journalist writing for several national health-care magazines and the National Post.

Related articles in the Regional Focus series:

Ontario(Summer 2014)
Onward and Upward

Prairie Provinces (Fall 2014)
There’s an ad for that

Eastern Canada (Winter 2015)
To have and have not