Maryland's Two Tier System - RMP & LMT
Saturday, May 23, 2020

Hello Members!

As promised, we have a newsletter entirely devoted to the concerns, frustrations, questions, and possible solutions to the Two Tier System in Maryland.

Your local chapter - AMTA-Maryland is actively engaged in conversations on this topic and have been for many years. We are seeing that there may be ways to move forward in the coming year or two. If this is of interest, please read the full discussion below before you reply.

We welcome your input and thoughts, and please
Many get very upset about this topic, and feel they have been wronged. Please feel free to express your opinion while remembering that you are communicating with a volunteer who is working very hart to support Maryland's massage therapists and practitioners. Getting yelled at is exhausting and does not help.

Beyond that, this newsletter is only going up on AMTA-Maryland's facebook page and our private group. Again, to cut down on both the yelling and misinformation. You are as always welcome to share it.

Take good care and enjoy your holiday weekend,

Amelia Mitchell, LMT, LLCC, BCTMB
Board Member and Government Relations Committee Chair
David Madon, Mark Hamilton, and Chelsea Adams-Cook
Your AMTA-Maryland Chapter Board
LMTs & RMPs - Can we? Should we?
Change the Two Tier System
This is not a new topic in any way shape or form. It is very much in our awareness during the Coronavirus pandemic. The differences between LMTs and RMPs, where they can work, how they are educated, differences in scope of practice are all highlighted right now. A lot of people have feelings, ideas, and opinions, again, respectful and constructive replies and questions are welcomed.
AMTA-MD has invited and participated in discussion on this topic for some time. Amelia Mitchell, government relations chair participated, along with other local and national representatives and the MBMTE in a long conversation on the topic this past Monday.

Where We Are Today

To have this conversation, we need to focus on where we are now, it isn't helpful to debate where we were in the past. We will need to move forward from here. There are approximately 2500 LMTs and 1700 RMPs active in Maryland.

Maryland and Delaware are the only states with a tiered system, in Delaware the lower tier, Massage Technician, is a 200 hour program, more like a Chiropractic Assistant and must work with supervision. You can read the licensing requirements in other states here .

Current Licensing Requirements - Education

Today to receive an RMP one must have 600 hours of massage education from an approved school and pass the MBLEx and Jurisprudence exam. This can generally be completed in less than a year.

An LMT applicant must have all the required massage education as the RMP as above and also pass the MBLEx and Jurisprudence exam, they must also hold 60 college credits and a minimum of 24 credit hours in basic and applied science courses related to health care . This requires at least two years of full-time education.
Yes, in the beginning the only difference was 60 college credits. Now (where we must focus) even if an LMT has earned an Associates Degree in Underwater Basket Weaving, they will need to have completed those 24 credits in science and health care. This is a significantly higher level of education.

Protection of the Public

A foundational point about state licensure and registration is that it exists to protect the public. Most would agree that licensure does protect the public, does the two-tier system further/also protect the public? If so, how?

  • Yes - it allows those with a higher level of education to become LMTs and health care providers, giving the public access to massage from individuals with a higher level of education and within health care settings. The public can also access massage from RMPs in other settings.
  • No- the public doesn’t actually know the difference between an RMP and an LMT - do they ask, do they care?
  • Do clients differ between settings?
  • From our experience clients with complicated medical conditions arrive at all places that provide massage. A fresh RMP is just as likely as an experienced LMT to have to pour through a long history and discern whether massage is safe and how to proceed. That client or the front desk person who scheduled them isn't choosing based on licensure.
  • There is an ethical mandate to refer out if one is not qualified to see a client, however workplace pressure has been known to override professional judgement.
  • Would it be better for all to have a higher level of education to more safely meet client's needs?

Comparing Current Education Levels

While many argue that we all have the same massage education, that is no longer the case. There is a real difference between the educational standards that an accredited community college must meet compared to a trade school, those awarding college credit are held to a much higher standard. A quick way to compare is to consider the MBLEx pass rates for different schools. Maryland's massage students are not all receiving the same education.
Many want a one-tier system of LMTs
These are some considerations and points of debate

To get there, many in a leadership position agree that going forward the education standards set for LMTs would need to stand as the minimum requirement for licensure . This is needed to maintain our qualification as a Health Care Providers and continue to elevate our profession .

  • Future students would need to meet these standards and earn 60 college credits, generally completed as an Associate’s Degree.

Or do we want to relax the standards and make everyone an RMP without standing as a health care provider?

  • How then does the profession move forward and gain footholds in healthcare and insurance reimbursement?
  • How can we move so many LMTs backwards and remove the standing that they have earned?

Many seek their massage education through trade schools. This does not meet the LMT standards because such schools are not accredited to award college credits.

  • To grant college credit for massage school education received at a trade school the community colleges require something called an Articulation Agreement. This means that the trade school's curriculum, educational standards, instructor credentials, lab/hands on requirements are all fully vetted and compared with what is available at the college level.
  • When this portfolio review has been completed for many students in the past few years, they often need to re-take many of the massage courses to meet the higher educational standard.
  • Many of these students do report learning a lot more in the community college setting than they had learned at the trade school.
  • Trade school students will also need to earn the rest of the 60 college credits in general education and other areas of focus. While there is a lot of benefit to taking English, writing, math, and other courses, many don't think it is necessary.
  • This will increase the time, and possibly the expense for future Maryland Massage Therapists to gain licensure.
What about the existing 1700 RMPs in Maryland ? What happens to them? Most want them to be granted LMT status through a legacy program.

  • While many who were licensed years ago do have the same level of massage education, many do not have the college education. Should they be moved up anyway?
  • Do years of experience or many hours of continuing education count towards anything, could that be considered to move RMPs to LMT status?
  • Could this be a gradual change?
  • Can some who prove a level of education or experience be granted LMT status?
  • Could others maintain their RMP status for as long as they are licensed in Maryland?
  • Other professions have raised their educational standards while allowing those who are already credentialed to keep it without additional education, could this apply here?

In Closing - Creating Change

We know there is more to this conversation, the economics, the future of the profession, and how this impacts each of us is important.

There will never be a solution that is perfect for everyone, however what would support the safety of the public, the profession, and each of us most effectively?

Any change must be made through carefully crafted legislation with a broad base of support. No legislation exists in a vacuum, and the 2021 Legislative Session is expected to be very different with the impact of the coronavirus pandemic.

If this is a direction that AMTA-MD members want us to move forward with, when the time comes we will need you to step up to write letters, make phone calls, educate the public to show their support, and we will need some of you to show up at hearings to support our testimony.

We welcome your considered input.