RMT Regulation in Manitoba - Backgrounder

 

2003

Province of Manitoba begins a six year review process in preparation for the introduction of a Regulated Health Professions Act for the province. The Act will be similar to other Acts found in Ontario/BC/Alberta/NWT. All professions are treated equally under the Act and its provisions. 


2009


The RHPA is passed by the Manitoba Legislature in June of 2009 but is not proclaimed.It is designed to provide the ultimate of 'Public Protection' for all Manitobans who receive health care treatments. 22 Health Professions  are identified for a 'Transition' process to the new Act from their current regulations. Two professions are identified as potential applicants. (Paramedics & Massage Therapists)


2011


Sections of the Act are proclaimed establishing an 'Advisory Committee' to the Minister who as part of their mandate will receive applications for self-regulation. Both the Paramedics and Massage Therapists begin their application process.


2012


Paramedics and Massage Therapists complete their application and officially go under review. 


2015


Both the Paramedics and the Massage Therapists are approved for Self - Regulation by the Minister's Advisory Committee. 


In September of 2015, then Minister of Health in Manitoba, the Honourable Sharon Blady, (NDP)  received the report of her Advisory Council regarding the regulation of the profession of Massage Therapy. A report that languished with her appointed Council for almost four years. It has now been two years since the Minister agreed to regulate the profession.


Unfortunately the former Minister requested the applicant , the Massage Therapy Association of Manitoba  (MTAM ) and the Association that opposed regulation - Edmonton based,  the National Health Practitioners of Canada (NHPC) to 'work together' to address core issues to support self-regulation.


The critique of this situation follows: (comments in red are those of the RMTS-MB)


In 2015, the former Minister requested the RMT community to specifically address the following:   


  • developing an educational standard for applicants and members (This standard has been established for many years at 2200 hours of education based on a curriculum that supports the 'National Competencies' for the profession. Nothing new can be created or Manitoba will be out of sync with the rest of Canada! Labour Mobility principles are at stake for Manitoba as outlined in the 'Agreement on Internal Trade' signed by Canada, Manitoba and the other provinces.) 
  • determining if a single standard of education should be implemented for the profession or whether there should be different levels of competency (This standard has been established for many years at 2200 hours of education based upon a curriculum that supports the 'National Competencies' for the profession. Nothing new can be created without direct impact on these competencies or the Labour Mobility rights of RMT's! But it should be noted that the NHPC, who opposed regulation of the profession, was also an advocate, at the time of application of a 'multi-level' entry to practice that has been rejected in all provinces of Canada who only support the single entry to practice standard, including the Province of Alberta where the NHPC is based. The Province of Alberta created a similar consultation process that the Minister of Health in Manitoba has unfortunately introduced and this group in Alberta is now in the seventh year of deliberation on this key issue. The NHPC will not accept a single entry to practice model without major concessions on their memberships ability to be accepted by the new Regulatory College on par with those who hold 2200 diploma's even if they do not come near to the 'National Competency' standards. The same advocacy position will stall progress in Manitoba as the NHPC have confirmed to their membership that those who do not meet the standard will be accepted into the new College based upon the Minister's consultation initiative. The MTAM has indicated it will not compromise the 'single entry to practice standard' in Manitoba. Ultimately, the Minister of Health and the Government of Manitoba must make the final decision. Which would you choose?)    
  • determining credentials and prior learning assessments that may be needed for membership (This is important work of the new 'Regulatory College', once it is formed by an 'Order in Council' of the Legislature, and once the required 'Transitional Council' is established under the 'Regulated Health Professions Act' of the province,to proceed with implementation required for the new College. The Associations have no jurisdiction in determining this requirement. Particularly when neither have experience in such matters or may be biased in their actions which would undermine the 'protection of the public'  principles required under the RHPA of Manitoba. 
  • considering the development of a bridging program for applicants whose knowledge and skills are assessed as not equivalent to Manitoba educational standards, and (This is another important consideration but neither Association can deliver on this challenge either. Teaching Schools and other Regulatory Colleges in Canada can assist with this issue. Some 'bridging' programs have already been developed and can be utilized. Only 'Teaching Schools' are the most logical place for these programs to evolve as only they can determine if the 'equivalency' meets their standards for issuing of diploma status. The Associations are outside their jurisdiction on this matter and again it is another apparent function of the 'Transitional Council' once established. )
  • conducting a review of the anticipated costs and expenses and determining the fee structure.                                                                                                                                                                                                                    MTAM, the applicant in 2012, proposed an entry to registration fee of $350.00 as a minimum fee when the Regulatory College is established. The Minister's Advisory Council commented on this proposal following consultation with the College of Physiotherapists who noted this fee may be too low to support the work of the new College.                                                                                                                                                                                                                                                                                                                                                                 The Advisory Council did not consult with the applicant or any one else over this matter but now the MTAM and the NHPC are being asked to venture into an area that should be the jurisdiction of the Transitional Council not the two Associations who may have bias in determining the fee based on their interest in retaining members for their purposes and not having the 'Public Interest' in mind when a fee is recommended.                                                                                         
  • It is also interesting to note that when the College of Physiotherapists of Manitoba were consulting with the HPAC Advisory Council, on this matter, it reported it's College operated on an annual budget of approximately $450,000. It noted that it was concerned about the ability of RMT's to support a new College.                                                                                                                                                                                                                                                    Subsequently, the Minister's staff estimates that approximately 1300 Massage Therapists will be registering with the new Regulatory College when it is formed in Manitoba. So if you do simple math on this ... 1300 registrants x $350 = $455,000 the 2012 projection of the MTAM easily meets the concerns of the Minister and the Physiotherapists.
  • The RMTS-MB recognizes that operational costs will have advanced for all regulatory bodies from 2012 and the original fee may indeed have to be increased somewhat to reflect inflation and other issues. But this is the work of the 'Transitional Council' not the Associations. Also, the Minister and the Government do not monitor the fees of the current Regulatory Colleges, why would they have such a high level of interest as this College begins to form.                                                                                                                                                                                                       The original projection on registration fees also recognized that the earning capacity of the average Massage Therapist in Canada is based upon their capacity to treat patients which is driven by their physical strength and endurance and the normal length of a treatment (one hour).
  • Based on this, the average income of an RMT is currently estimated to be between $35,000 to $40,000 per year and this must be factor into their capacity to pay fees for registration. RMT's do not earn the same income as other health professions nor do they the job security that others enjoy. Many who enter the profession carry 'student debt' with them while they establish their practice too as their education costs approximately $20,000 - $25,000 to complete their two year program. 
  • ​Minister wants to call the new Regulatory College ... "The College of Massage Therapy of Manitoba                                                                                                                                                                                                               (This may be the biggest mistake that the NDP Minister and her department made in this discussion on self regulation of the profession of Massage Therapy in Manitoba. Usually, a 'Regulatory College' uses the plural reference of the health profession group. In this case is would be "Massage Therapists" not "Massage Therapy"! Also, a unique situation exists in Manitoba in that a teaching school is incorporated as the 'Massage Therapy College of Manitoba'.
  • So, to avoid public confusion the RMTS-MB has recommended that the new College be known as the 'College of Registered Massage Therapists of Manitoba' similar to the 'College of Registered Nurses of Manitoba' etc.
  • Neither the MTAM or the NHPC have commented on this matter. 


Application History - Details:


In 2009, after six years of review and consultation, the current NDP Government of Manitoba presented the 'Regulated Health Professions Act' to the Legislature and it was passed into law that year. The new Act was primarily designed to 'Protect the Public' wherever and whenever they received health care treatments and services on a uniform and standard basis. It would require all regulated professions to adopt common processes and in particular have a similar 'Complaints & Discipline' hearing structure open to public review and with public members represented. The existing 22 Regulated Health Professions supported the initiative. Non-regulated Massage Therapists supported the process from the very beginning patiently awaiting the approval of the application for regulation provisions found within the Act. (RHPA here)

However, following approval of the Act, a moratorium on applications, was placed on the process and was not lifted until 2011. In early 2012 two applicants, Paramedics and Massage Therapists, made their application for regulation and the Minister of Health's Advisory Council began the process of review of both applicants. Paramedics have completed their review process with a favourable final report that was released in December of 2014. However, no action on the regulation of Paramedics has been taken by the Government of Manitoba since that time. Instead their report has become overly 'political' and the focus of attention in a leadership review conducted by the NDP in early 2015. Differing opinions by competing Unions representing Paramedics resulted in split political support. Such a situation does not bode well for Massage Therapy either, as the fate of Paramedics could linger until the next election is completed and block the anticipated normal process for Massage Therapists to finish their application review. It is generally known that in addition to the applicant review the establishment of a Regulatory College can take two to three additional years before it is functioning. 


What Happened?

The application by Massage Therapy languished for almost four years without any meaningful dialogue between the Minister's Advisory Council and the profession, without any public hearings similar to those provided to Paramedics, and with only the broken promises of final reports forthcoming and other excuses being issued in each of the last three years by the Government appointed Advisory Council .


Finally on November 24, 2015 the report was released with a favourable recommendation that the profession of Massage Therapy be regulated. The Minister of Health agreed and made a public statement of support for regulation. This completed step one of the process and it was expected that the College would be formed. That decision was never made and can't be expected for another 2 or 3 year process. Unfortunately, it was not a clean decision and the Minister posed five more items for review ones which had been either previously reviewed or ones that will be addressed in the work of a "Transitional Council' who establish the new College. These new items delayed the work of putting the new College in place and protecting the public. Then the Government was defeated. 


New Government - New Eyes!

The Massage Therapy community had high hopes that the new Provincial Government would proceed with the regulation of the profession and the establishment of its needed 'Transitional Council'. These high hopes have been deflated considerably as the decision on Massage Therapy has been placed behind the decision on regulation of 'Paramedics' which has much more controversy attached to its progress. 

Why is Regulation Important?

Massage Therapists work collaboratively with other Health Professions, (Family Doctors, Nurse Practitioners’, Chiropractors, Physiotherapists’ and Athletic Therapists) and daily referrals between these professionals occur. Despite the announcement on regulation  RMT's still are not officially a part of the regulatory environment in Manitoba until that occurs. Patients and clients will be seeking clarity on the decision and confusion will be found in the marketplace. 


Not only is the final decision important to RMT's in Manitoba but also important to their patients who are currently not able to claim Massage Therapy treatments on their annual Income Tax filings like the majority of other Canadians. As well patients in Manitoba cannot access Massage Therapy Treatments if they are clients of MPI or WCB. Neither of these corporations will recognize Massage Therapy until the province decides on 'Regulation of the Profession'. 


The profession has no ability to 'protect the public' from unqualified and unscrupulous individuals who are not qualified to practice the profession and especially those who have been found guilty of predatory sexual assaults while practicing the profession and especially those who are unqualified and untrained. Without its own 'Regulatory College' the Government on behalf of the profession cannot play a role in protecting the public in the same manner the other 22 health professions can.

The rest of Canada is also waiting for a Manitoba decision on the 'Regulation of Massage Therapy' to then make application to remove the application of GST/HST from these treatments and bring it into parity with Physiotherapy and Chiropractic treatments as an example. Five regulated Canadian Provinces are required before such an application will be heard. Manitoba would become the fifth province. Over 25,000 Massage Therapists practice in Canada and they are keenly interested in the decision Manitoba will make. 

And finally, over 70% of Canadians access Massage Therapy treatments through their employer/employee benefit plans. The companies who underwrite these plans also favour regulation of Massage Therapy and need such formal structure to control the growing cost of insurance fraud within these plans when health care professions are not regulated.  These companies are represented by the Canadian Life and Health Insurance Association Inc. who are on record as being in support of the regulation of Massage Therapy in Manitoba and across the country. (Letter of Support Here)

It has been over 15 years that the profession has been caught in the bureaucratic jungle of 'Regulatory Review’ in Manitoba and if not successfully concluded soon ... valuable volunteer leadership could be lost on this file. The public will not be protected.