Manipulative Therapies

Licensing, Certifying and Training Standards for Alternate Modalities

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CHIROPRACTIC MEDICINE:

Training Standards

• Training of chiropractic practitioners takes place at 4-year chiropractic colleges. There are currently 16 such colleges in the United States accredited by the Council on Chiropractic Education (CCE), www.cce-usa.org.
• Prerequisites: Students must have completed 2 years at an accredited institution of higher learning in coursework similar to that of a traditional premedical program.

Licensing Standards

• Chiropractic practitioners can currently be licensed in all 50 states.
• Each state has its own state licensing board to monitor the practice of chiropractic.
• Upon graduation from an accredited program a student applies for licensure in the desired state of practice. The state may construct its own licensing examination or may require successful completion of the standardized series of examinations offered by the National Board of Chiropractic Examiners (NBCE), www.nbce.org. The NBCE functions similarly to the National Board of Medical Examiners.
• Pros and Cons of Licensure: By 1974 all the states had developed a state licensing board for the practice of chiropractic. This helped make the practice legitimate as well as helping to define the scope of practice. Additionally, it is has allowed chiropractic practitioners to expand their practice by increasing insurance coverage of procedures. However, there are those that would still argue that cost of licensing is a limitation of practice. The debate has for the most part subsided, but there is still discussion within the profession.

Training Standards

• Training of osteopathic physicians parallels that of allopathic physicians.
• There are 19 4-year osteopathic medical schools in the United States and coursework is similar to that of allopathic medical school, with an additional 300-500 hours of musculo-skeletal coursework. The schools are accredited by the Bureau of Professional Education of the American Osteopathic Association (AOA), www.aoa-net.org.
• Prerequisites: The prerequisites are the same as those allopathic medical school. Students must complete the traditional premedical program and must take the MCAT before applying for admission.
• Post-graduate Training: After graduation a Doctor of Osteopathy (DO) is required to complete a 1-year general rotating internship before beginning specialty training. Upon completion of the internship DOs may complete post-doctoral training in any specialty at any MD or DO teaching hospital.

Licensing Standards

• Examinations:
  • Osteopathic physicians must pass board examinations administered by the National Board of Osteopathic Medical Examiners (NBOME), which are similar to those taken by their allopathic counterparts.
  • Osteopathic physicians are also eligible to sit for all AOA and AMA certifying examinations.
• Osteopathic physicians are licensed to practice in all 50 states. DOs are licensed by the states in which they practice. Most states have specific licensing boards for DOs. Those that do not use composite and MD boards to license DOs.

Training Standards

• There are numerous schools that teach a variety of styles and approaches. While standards differ training should include: anatomy, physiology, pathology, massage theory and technique, and supervised practice.
• The Commission on Massage Therapy Accreditation currently accredits about 70 schools in the United States.

Certification and Licensing Standards

• Certification and licensing for massage therapy are relatively new and standards differ greatly by state.
• The National Certification Board for Therapeutic Massage and Bodywork (NCBTMB), www.ncbtmb.com, has developed a national certification program that requires:
  • Graduation from an a CMTA-accredited school or equivalent training; and
  • Successful completion of the National Certification Exam for Therapeutic Massage and Bodywork (NCETMB).
• Licensure for massage therapists is currently available in 32 states, although requirements are not standardized. The minimum state requirement for training is 500 hours. Most states use the NCETMB as their licensing exam. The title conferred is Licensed Massage Therapist (LMT).

Note on Licensure and Certification: While these certification and licensing programs exist, national organizations and individual therapists do not agree on their value, scope or appropriateness. The debate is similar to other modalities. While licensure brings increased credibility and consumer understanding, it also imposes restrictions upon practice. As the practice of massage therapy continues to expand the regulations will most likely follow.

Licensing and Training Standards

• The American Dance Therapy Association (ADTA), www.adta.org, was formed in 1966 to establish and maintain standards of professional education and competence.
• Dance/movement therapists acquire their training through graduate master's degree-level programs. The ADTA approves graduate programs that meet ADTA Standards for Graduate Programs in Dance/Movement Therapy. There are currently five such institutions listed on their website.
• Prerequisites: The prerequisites differ slightly by each graduate program but generally require a bachelor's degree in a liberal arts education including some coursework in psychology as well as extensive background in dance and movement.
• The ADTA registers qualified therapists at two different levels:
  • Dance Therapist Registered (DTR): Therapists with this title have a Master's Degree and are fully prepared to work in a professional treatment system;
    • Requirements: Completion of a master's degree program and an internship;
  • Academy of Dance Therapists Registered (ADTR): These therapists have met additional requirements are fully qualified to teach, provide supervision and engage in private practice;
    • Requirements: Completion of 3640 hours of supervised clinical work and 48 hours of supervision by another ADTR, as well as passing a written exam.
      (Please visit their website for specific information regarding these credentials.)
• In certain states dance/movement therapists may apply for licensure as a licensed professional/mental health counselor.