This blog post is an AI adapted version of the podcast episode script. (It was proof-read by the human who wrote the script.)
What exactly is regulation? The current political landscape has made it clear that none of us are taught about government or civics anymore. Civics, by the way, is the study of the civil rights and obligations of citizens—a definition I didn't know until I looked it up. So it's perfectly understandable if your idea of regulation is fuzzy and along the lines of "The government makes decisions about things and then makes rules in a mysterious process involving backroom deals and sausage processing."
The Legal Framework: Laws, Legislation, and Regulation
Regulation, it turns out, is part of legislation, which is part of the law. Let's start from the foundation and work our way up.
Laws are the big bucket—all the rules that can be enforced in a location. There are three types:
Constitutional: The foundation a government sits on
Common law: When judges make decisions that are later referenced in court proceedings
Legislation: Laws made by a body like congress or parliament
So laws are enforceable rules, and legislation is one type of law. Legislation creates authority for regulations, which means regulations are a part of legislation. Regulations provide the specific rules for how the legislation is implemented.
If we were talking about food (which we can all agree is more interesting), legislation would be the type of dish and the raw ingredients, and regulation would be the directions for cooking.
Licensing is part of the cooking directions of regulation. Licensing is one way that regulations accomplish the goals legislation designed.
Practice Acts and Administrative Rules
One type of legislation is called an Act. For massage therapy, it's called a Practice Act. A practice act outlines the general framework—the recipe and the ingredients—for the profession. Those ingredients include the scope of practice, licensing requirements, and disciplinary processes.
Most practice acts (but not all—welcome to having 50 states and multiple territories) create a board of massage therapy. The board decides the regulation for the practice act. This regulation is called the Administrative Rules, and they are the directions for making the practice act recipe.
An example of an administrative rule is how many hours of education are required to get a license. It's much easier to change administrative rules than it is to change a practice act. After all, when you're cooking, grating vs slicing the cheese will still get you a grilled cheese sandwich, but deciding you're making cheesecake instead of grilled cheese changes everything.
Administrative rules are decided by the board and can be opened for changes when the board decides. Changing a practice act requires the agreement of the state's congress, because a practice act is legislation made by congress, and only congress can change it.
Why Licensing Matters (And Why We Support It)
You might be wondering why we, as a profession, would agree to licensing. Here's the "too long, didn't read" version: it advances the profession.
The Case for Licensing
Simple reasons to support licensing:
Licensing increases the income of a profession by 16% on average
Licensing adds legitimacy to a profession
Licensing gives the profession a way to establish standards and ensure professionals are practicing safely
Public safety is the number one reason licensing gets passed
Without regulation, there's endless room for harmful actions and no consequences
Real-world example: I recently sat in on a Michigan board meeting where they discussed a case of a man named Charles who was advertising he could cure 90% of autoimmune diseases and cancer using massage therapy. The board was able to take his license and fine him. Will he keep saying he has magical curing hands? Probably, but he won't say he's a massage therapist and he'll be a couple thousand dollars lighter. Should he go to jail? That’s not the board’s decision, that is up to the state. Is this good enough? I don’t know, but it’s better than having no recourse.
The Downsides of Licensing
Less than great results:
Creates a barrier to entering the profession
Costs money for both the people being licensed and the state
Creates paperwork and administrative burden
Can be used to homogenize a profession or make everyone practice the same
For massage therapy, homogenization could be a major issue because the uniqueness of our practices is an important part of who and what we are.
Historical Context: The Flexner Report and Professional Homogenization
Medicine was homogenized around 1910 when the Flexner Report was released. Abraham Flexner had toured medical schools in the US and Canada, cataloging subjects and facilities. The intent was to increase standards in medical education. The unintended result was that facilities educating women, people of color, and osteopaths were closed, ensuring medicine remained the domain of white male allopathic physicians.
I don’t think the moral of this story is to avoid increasing standards, but to be aware of biases and consider possible unintended consequences when choosing an action. Medicine could have chosen to work with the schools to keep them open. Instead, it chose not to improve it’s profession.
Professional Jurisdiction: Getting Your Elbows Out
Medicine has a long history of trying to control everyone else's profession. This connects to a theory called "professional jurisdiction" by Professor Andrew Abbott at Chicago University. Jurisdiction is the idea that professions are in constant battle over territory—what the profession does and who its clients are.
Historical Precedent: Drugless Practitioner Acts
In 1915, legislation called "Drugless practitioner acts" began being passed in the US and Canada. These acts identified target professions as "limited branch of medicine," specifying massage, Swedish movements, magnetic healing, mechanotherapy, electrotherapy, hydrotherapy, suggestive therapy, psychotherapy, and other drugless approaches.
The American Medical Association heavily supported these acts because they carved out the Practice of Medicine as strictly their jurisdiction.
Current Jurisdictional Battles
Today's challenges:
Chiropractors want to be in charge of massage therapy (a subordination tactic)
Physical therapists want to claim the term "massage" for their own use
When a license is created, it claims certain terms for the profession. The terms "massage therapy," "massage therapist," and "massage" can all be protected and only used by practitioners with that specific license. This is why other groups push back when massage therapists try to create licensing.
Licensing Boards: Structure and Function
A licensing board is established by a practice act and creates the administrative rules that make the practice act happen. Where the board sits in government determines if massage therapy is considered healthcare or service in that state.
Examples:
Michigan: Massage therapy is considered healthcare (practice act exists in public health code)
Alaska: Under Department of Commerce, Community, and Economic Development, along with Nursing and Concert Promoters.
Connecticut: No board at all, overseen by Department of Public Health
Board Composition
Boards typically have 7-11 members (always odd numbers) who are a combination of:
Professional members: Practicing massage therapists
Public members: People with no involvement in massage therapy
The mix is crucial—without public members, a board could easily become a place where the profession protects its own instead of protecting the public.
Rule Changes and Public Comment
Boards can't change rules arbitrarily. Rules must be formally opened by a board, and there's a public comment period. When rules open, they're all up for grabs. This is when you should present changes and find people who agree with you to add public comments.
Remember: anything in the practice act legislation (like scope of practice) cannot be changed by the board—that requires state representative involvement.
Enforcement and Discipline
When a licensed professional disobeys rules, the board can discipline them through fines, required education, suspension, or license revocation.
The Reality of Board Resources
Board support varies dramatically by state. Some boards have state investigator support, while others expect volunteer board members to perform entire investigations themselves, on their own time and dime.
The Bias Problem
Biases happen constantly in disciplinary decisions. Board dynamics are affected by biases between the board and defendants, and between board members themselves. I read about a board member who worried about asking for harsh punishments because they were afraid of being seen as an angry black person.
The Unlicensed Practice Gap
If someone practices without a license, boards can't do anything—they can only punish licensed practitioners. Unlicensed practice becomes a law enforcement matter, and punishment varies wildly by state:
Oklahoma: Misdemeanor offense
New York: Felony offense (resulting in people pleading to misdemeanors such as sex work)
Bottom Line
We've covered laws, legislation, regulation, licensing, practice acts, boards, and professional jurisdiction. This regulatory landscape isn't just arbitrary rules made by faceless bureaucrats—it's a dynamic system of claiming territory, protecting the public, and establishing professional standards.
The key takeaway: Licensing isn't a villain or a hero—it's simply a tool. Understanding regulation helps us make informed decisions about our profession's future and helps us think about licensing as more than a money grab or red tape. It's about who gets to define what massage therapy is.
This content explores massage therapy regulation based on experience primarily with Michigan's system, though references to other states are included throughout.
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