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The Thinking Practitioner Podcast:
Episode 28: Advanced Credentialing and Massage as Healthcare

Broadcast date: 12/09/2020
©Copyright The Thinking Practitioner Podcast, Til Luchau & Whitney Lowe

Whitney Lowe:

Hello, this is Whitney Lowe and welcome to the Thinking Practitioner Podcast and we'd like to thank Books of Discovery for sponsoring our podcast today. Books of Discovery has been a part of massage therapy education for over 20 years, thousands of schools around the world teach with their textbooks, e-textbooks and digital resources. In these trying times this beloved publisher is dedicated to helping educators with online friendly digital resources that make instruction easier and more effective in the classroom or virtually. Books of Discovery likes to say, "Learning Adventures start here", they see that same spirit here on the Thinking Practitioner podcast and they're proud to support our work knowing we share their mission and bring the massage community enlivening content that advances our profession.

Whitney Lowe:

They invite you to check out their collection of e-textbooks and digital learning resources for pathology, kinesiology, anatomy and physiology at booksofdiscovery.com. Thanks again so much for supporting the podcast. So I'm here today, Til is off this week and I'm here with a wonderful friend of mine who's going to join us Cal Cates. And Cal, welcome to the Thinking Practitioner podcast and I want you to just take a brief moment to share a little bit with our audience who might not be as familiar with you. Tell us a little bit about yourself and we're going to get into some fascinating discussions afterwards.

Cal Cates:

Indeed, we always do.

Whitney Lowe:

We do, don't we? Yes.

Cal Cates:

Well, I'm honored to be here, I love your show and I think you guys tackle some important things. And as somebody who doesn't do a lot of technique work, even the technique heavy episodes I always find really interesting. And I love the way you guys agree to disagree and how you talk about, how you just model what I think could make the world a better place.

Whitney Lowe:

Well, that's good to know. Yeah. All right.

Cal Cates:

So as Whitney said my name is Cal Cates, I'm the executive director of an organization that's based in Arlington, Virginia, we're called Healwell. And we do a lot of things, but basically what we do is we try to improve the quality of life for people who are affected by acute, chronic and serious illness. And we specifically wrote our mission as people affected by these things because that really allows us to serve humans because there's really not a person on this planet who isn't affected by acute chronic or serious illness, if not directly then indirectly.

Cal Cates:

So we provide advanced education for not only massage therapists, but other healthcare disciplines. We actually provide massage therapy directly as an integrated member of the team in a variety of hospitals throughout the Washington, DC area. And then we partner with those clinical folks to conduct research to demonstrate the efficacy of massage and really the value of massage therapists as much as massage therapy and that's a whole another conversation, but that's us in a nutshell.

Whitney Lowe:

And I would like to just make a plug too, Healwell has some wonderful resources through your website, you've got a new discussion or community that you've established on Mighty Networks, right? That's over there?

Cal Cates:

We do, yeah.

Whitney Lowe:

So you're bringing together a lot of people from diverse backgrounds not only practitioners, but also you're trying to make outreach to other health professionals as well through your networks and things in there.

Cal Cates:

Yeah, absolutely. We really want to bring people who honestly want to move into a space of discomfort with things that they want to learn more about like racism, and bias, and communication, and ethics, and equity, access, all these things that certainly affect healthcare more broadly. And we have massage therapists in the community, but as you said we've got social workers, and nurses, and physicians, and other people in there really just talking as people who care about people and want to care about people in a more mindful and engaged way.

Whitney Lowe:

Wonderful. So if you're not familiar with that I would certainly encourage you all to check that out, some wonderful stuff that's going on over there. Well today, I had decided I wanted to try to dive into some sticky and messy discussions with you because I love doing this when we get together and have a chance to chat about this. So I wanted to talk today something about advanced practice credentialing in the future of massage in the healthcare system. And just a little bit of backstory on this and also to give some color to the relationship and discussions that we've had before. I wanted to share with everyone a little bit of my memory of the backstory of becoming acquainted with you.

Whitney Lowe:

I don't know if you will remember this, I cannot remember which actual event this was and this was at some national convention or education conference a number of years ago. We were having some public discussion about a number of these particular issues and you stood up and were making some comments and I didn't know you at that point and turned around and I thought to myself, "I got to go meet this person because they really know what the hell they're talking about." So I made a point to go introduce myself and I've loved having the opportunity to discuss some of this stuff with you since that point. So I want to try to dive into it a little more public forum and share some of those things today.

Whitney Lowe:

So one of the things I want to start with is... And you and I have talked about this, some of my frustration over the years in looking at massage as being a part of the healthcare system is that I hear frequently from lots of people, "We want to be part of the healthcare system, we want to be part of this process." But then when they learn about what is entailed with that those things change a little bit like, "Oh, I don't want to have to do that or I don't want to have to do that." So I know you've had some experiences in things like that especially through your work at Healwell there and I just wanted to see any thoughts that you want to share about what you've encountered with that particular challenge.

Cal Cates:

It's such an interesting question because I think the more that we do at Healwell, educating and educating ourselves and then trying to share what's useful with people about unconscious bias, the more I understand how we rarely come to any conversation without assumptions and without stories and those stories really inform our perspective on the world. And when you say to someone, when you ask, "Do you consider yourself a healthcare provider?" We could ask 10 different people and the images that come up in their minds about what it means to be a healthcare provider will be 10 different things. And some of them may be based in reality, some of them may be based in stereotypes or maybe just their own negative or positive experiences with other types of providers.

Cal Cates:

So I think part of the hurdle that we have to clear in the massage profession is that we really have to get clear about what do we mean when we say, be a healthcare provider? And we don't mean work in a hospital, we don't mean take insurance, it's not really about how you do your billing, it's not about your practice environment, it's actually about accountability to yourself and the people you serve. So you can be a person who sees clients in your basement while your kids are at school and still be a healthcare provider. And I think that's really hard for a lot of us to square because we think healthcare provider means white coat, sterile environment and I think it really means holding yourself to a higher standard.

Whitney Lowe:

Mm-hmm (affirmative). This is something I've often pondered about, that the fact that massage therapy doesn't really come from a traditional academic background, we come more from the sort of I don't know what you call it, the guru disciple education model of information passed down from generation to generation. More than a traditional academic model that would be in a traditional university type training programs that we see most other healthcare professionals. Do you think our lack of being in that academic preparation model in our schooling is part of what makes it unclear for a lot of people of where we fit? Our roles there?

Cal Cates:

I do. I think that our profession really it is in a hard spot and it puts itself in a harder spot because I think that we are afraid to set a standard, we're afraid to set a standard that will exclude some people. And I understand that, the most human parts of me understand wanting to bring everyone along and the parts of me that know the risks we take when we don't elevate that level of accountability and education wants us to push in a direction of to say that you are a massage therapist, you must know these things. You must understand your responsibility and be accountable to not only to the people that you serve, but to your fellow practitioners and to society at large.

Cal Cates:

And as we talk on our podcast in Massage Therapy Without Borders, which I feel like there's a good synergy, I feel like people who like your show would connect with the things we talk about. And we often have guests from other countries talking about how they've navigated the regulatory landscape and so many of the people that we've spoken to from New Zealand, Australia, places in Europe they have developed some degree of a tiered system. Where you have people who have a very high level of education and I can already feel the bristle in some listeners, right? That's sort of what I'm saying is there's the smart people and the not smart people and it's like, "No, humans need touch."

Cal Cates:

And I think that it should be possible for people with less education to provide a kind, safe touch to people who need that. And that should be available possibly at a lower cost, I mean that's another conversation, but if you have a chronic or serious health condition you should be able to see someone who can touch you kindly and competently and work with your other providers and have a skill set that maybe that person who gives you a basic Swedish massage doesn't have. And that we have to be willing to have a conversation that allows space for both of those types of services to exist, both of those engagements and to do it in a way that if everybody got a Swedish massage once a week, the world would be a different place.

Cal Cates:

It's not about this is more important because I have more education, it's just that it is safer perhaps and more effective for me to be able to direct a patient. If I'm a primary care physician and I want to send one of my patients who's having knee pain or back pain to a skilled practitioner, I want to send them to someone who's not just going to push hard where it hurts. I would want to know that that other practitioner has the training to understand the medications that my patient is on or the surgeries that they've had and to be able to conduct a useful intake to create a session plan and a treatment plan that is more than the very valuable act of rubbing.

Whitney Lowe:

I've spoken about this in a previous episode of our podcast, I know you and I have talked about this extensively. The fact that we do have this split personality in our field of the one aspect of many individuals who view themselves working primarily within, for lack of a better term, the personal care service model and the others that see themselves as working with health conditions. And thinking that, well we do I think a pretty decent job of preparing people in their entry level education for that first group of people that are doing primarily personal care service oriented work.

Whitney Lowe:

We're way deficient, in my opinion, in preparing people for being a practicing healthcare professional, but we run into this problem and I've heard you say that I believe on your podcast as well... By the way and I just want to make another plug for the Massage Therapy Without Borders Podcast, for those of you who haven't listened to it Cal was mentioning it's a wonderful show. I've heard you mentioned this, okay, let's say you work at a franchise doing basic relaxation massage or you work at a spa, how do you know the person with a compromised health condition doesn't come in that you need to know something about because massage is not benign, it is capable of doing things adversely to people.

Cal Cates:

We just had a lengthy conversation in the community and also privately on various channels with Ruth Warner about blood clots and blood clot risk and assessment and how the human body is on some level a ticking time bomb for blood clots. And that even if you don't have a chronic health condition there's a chance that you can have a blood clot and what's the line between being over reactive and just not caring? And when it comes down to the fact that a dislodged blood clot could kill a person, I tend to just air on the side of caution because the possible risk is actually death in this case.

Cal Cates:

And this is where I wrestle with this regularly, this conversation of I want to make room for the single mom who massages people in the basement studio that she's created while her kids are at school, and the human body is actually pretty complex. And I think that what happens is that people, the public perceives massage therapists as talk therapists, mental health professionals, aroma therapy experts, dietary people and they come to us no matter what environment they see us in expecting us to know about all kinds of things. And I think that Amanda Baskwill and Niki Munk have done some different research looking at how massage therapists perceive themselves and the more training and experience therapists have, the less likely they are to creep out of their scope.

Cal Cates:

And I think that one of the things that really damages our profession is that people get excited about wanting to help people and I want to be really clear that the intention is good, but the final product is people are receiving not so great advice, the boundaries are not clear and I think that overall it leaves people wondering, "So how could or would massage fit into healthcare?" Because you don't go to your doctor and ask about stretches usually, but if you go to your massage therapist I mean, I've had people ask me if they should keep taking their medication, all kinds of questions that I'm totally not qualified to answer. But it's only because I've had really great education and support in being able to say I don't know or that's out of my scope or to make a good referral. And those are the skills that I do on some level feel are non-negotiable for the practice of massage therapy.

Whitney Lowe:

So what I see is that we end up in this dilemma of we feel like we need to have some additional specific, really higher standard training levels to do some of these types of things and we have a number of individuals who say they... I've even heard this argument from some of the national associations, they don't want to put a barrier to people's being able to work by making the educational hurdles too high. And I understand that yeah, you want to make things affordable and a vocational training program for people to get into, but again, we run into this dilemma of what are they actually going to be doing? We're not just repairing air conditioners here, we're doing some things that have some potential health complications for people somewhere down the line.

Whitney Lowe:

And I think that has led us in the direction of trying to seek out some type of alternative credentialing, that would indicate additional training, if we're not going to be able to crack the egg of maybe beefing up entry level training to that standard. And there have been a lot of efforts to do that before that had been strongly resisted by a big swath of the profession and that seems to be difficult. And so it feels like to some degree well, if that's really not going to be able to get as much support, maybe we do this through some other type of credentialing mechanisms and this is some of the stuff you and I have talked a lot about before.

Whitney Lowe:

And I just want to call back our attention for a moment to something that you mentioned with the recent podcast that you did with Anne Davey, who is the CEO of Massage & Myotherapy Australia. Interestingly, talking about the fact that there wasn't regulation in the individual provinces in Australia, yet they've done a pretty significant job in structuring tiered credentialing processes for being able to access different aspects of the healthcare process and that seems like an interesting model.

Cal Cates:

Well, it's interesting too because when we were talking with Ann I noted that I feel like one of the things that actually holds us back is that there is already a weird hodgepodge of regulatory intervention. And Ann said that they were inspired by the lack of government oversight or intervention and they really wanted to get ahead of it so that when and if the massage therapy shows up on the government's radar, they can say, "We've already created this standard." And government goes, "Great. That's already established? We can run with this." But I feel like we have such a difference between the States and certainly every one of our overseas guests is quick to point out how huge we are. Population wise, number of territories, provinces, whatever, like Canada they've got 15 I think total provinces and territories and Australia have even less than that and you certainly have less population and you have a different sense in the people who live there.

Whitney Lowe:

Yeah, just throw in a little bit of the rugged individualism we love to call it. Is the rugged resistance to being-

Cal Cates:

Yeah, it's rugged resistance. And I do think that when we look at massage compared to other healthcare professions, I don't know for sure, I know this only anecdotally from working in hospitals and working in integrated environments that massage therapy has this weird.... Certainly in the last handful of years the demographic has shifted a bit, but people typically come to massage as their second or third career. They're done with the rules, they're done with the stuff that they did in their other jobs and they are choosing massage because they don't want to deal with that kind of stuff, they don't want more education. So what do we do?

Cal Cates:

What would it look like to create two ways or three ways of practice that could be clear to consumers because I think in British Columbia they've got the registered massage therapist, the RMT and then everybody else. And if you have a health condition you know that you're going to be better off going to an RMT and if you want a relaxation massage you might still want to go to an RMT, but you could get a decent session from someone who is not an RMT. And the agencies in that province have done a great job of educating the public about this is what's available and this is what you can expect from these two types of practitioners.

Cal Cates:

And I think when we look at some of the attempts in our profession at advanced credentialing let's say, that kind of follow through hasn't happened. So as a basic consumer I'm pretty sure that if we surveyed consumers of massage therapy in the U.S, a very small percentage of them would be aware that there's an advanced certificate for insert any one of the things that NCB offers an advanced certificate for and so how do we square that?

Whitney Lowe:

So I also want to come back to something you mentioned just a moment ago and ask your take on this because you've worked in a number of more traditional type of healthcare environments. And there's a lot of instances in those types of environments where you were working with people with some pretty compromised health conditions, where you could see massage potentially having some adverse effects. And I've often heard the argument from a lot of people, "Well, if you look at the statistics, there's not that many problems with what happens with massage." And I've always said, to me there's a little bit of a disconnect there because when I was doing a lot of clinical practice and working a lot more in the orthopedics realm I got a lot of clients coming to me telling me that they've been hurt by other people.

Cal Cates:

Yeah.

Whitney Lowe:

And I've often said, "Well, so if a massage therapist has an adverse incident occurring where does that person go to tell somebody about it?" There might be a reason we don't hear about those kinds of things very often and one of the things is I don't think we have much of a reporting mechanism at all. And I'm curious about your take on that, I mean do you sense that also as an under reported phenomenon of the potential problems that might happen from adverse events with massage?

Cal Cates:

Yeah, I think this is really a multi-layered problem, certainly the lack of reporting structure. I don't have any idea, as a person in the profession I don't know where a client would report that they had been injured or that they had had some adverse effect. I think the other piece is that even people who have gotten a lot of massage let's say, their expectations of massage are not the most educated. So if you are limping for two days after a massage, a lot of consumers I think would say, "Oh, I got a great massage yesterday, they really worked me over." And it's like, "No, you got injured." You didn't have a blood clot dislodged or you didn't get a contusion, but you shouldn't be walking in pain for two days after you get a session.

Cal Cates:

And so I think some of the adverse effects that possibly are related to massage don't get connected in the clients mind as an adverse effect. Where if you have a surgery and your scar doesn't heal or you go to PT and suddenly now you have lots of swelling and pain, you can go straight back and say they stretched me too hard, or the stitches came out, or whatever it is. But if you're sore the next day, if you come to me and you have an undiagnosed blood clot and then you throw a blood clot a day later, nobody's going to say, "Oh, I bet it's because they got a massage." So I think the lack of reporting structure and the lack of education overall allows us to believe that there's no danger here.

Whitney Lowe:

Yeah. When there may in fact be some that we just don't have a way to know about.

Cal Cates:

Exactly.

Whitney Lowe:

Yeah. And again, statistically that's hard to point a finger to give a rationale and a reason for why we need greater standards in both the licensing level and also above the licensing level. Because we do have licensing in most states in the United States for primarily the purpose of protecting the public, but it's pretty basic in terms of the education level of what we're asking people to be able to know how to do.

Cal Cates:

Yeah.

Whitney Lowe:

So after having watched attempts to see this occur a number of different times through beefing up education levels in our profession it often turns into this educational content inflation. Okay, let's add more hours, let's add another 200 hours, let's add another 400 hours to the requirements without any real consideration about what does that actually mean? Or what are those hours about? And so I wonder and this is where I've begun to be putting more attention in the last maybe decade or so, is maybe this solution is not going to live at beefing up our entry level training, but might live somewhere past that point in the world of micro credentialing. And for those unfamiliar with that term, that just means smaller level credentials than things like university degrees or large scale training and certification programs, maybe smaller scale training. So what are your thoughts about that? It sounded like what they've been doing in Australia was more along those kinds of lines, do you think that's something that would fly here in the States?

Cal Cates:

Yeah, I think it would. I think the question is the what does it mean for something to fly? I look at the structures that we have in place now and I feel like in a very backward way, the market drives our credentialing. And we know what the credential, I feel like you and I and some of the folks that we talk with when we nerd out about this topic, we know what we need to set the bar, where we need to set the bar. But if I'm a big agency and I'm trying to fund my operations, I'm possibly more interested in what will pay my bills and I'm not going create a hard credential that people won't pursue because I need them to pay for a credential.

Cal Cates:

So I do think that possibly the future really does lie in smaller groups and organizations coming together and saying, "Come study with us, what you will learn will benefit you and the people that you serve." And it probably will make you more money, it will make you more successful in your practice, but it's honestly going to be a self-selecting group of people who for their own intrinsic development want to pursue an advanced level of practice. Because I think that the market, people want rubs.

Whitney Lowe:

Mm-hmm (affirmative).

Cal Cates:

And they will pay as little as possible to get those rubs.

Whitney Lowe:

Yeah.

Cal Cates:

But I think over time, consumers will start to see that there are different levels of practice and that depending on what your needs are, you need to seek out people who do have advanced training. And I think as you and I have talked about a lot of times, I feel like when we talk about advanced training it's so often a conversation of technique. And I do think that there is a lot lacking in a majority of massage education and that even when I just think what I've learned about fascia in the last five years. We didn't even talk about fascia in massage school 15 years ago and now I don't know how I would touch a body without considering the importance of fascia.

Cal Cates:

And so, I do think that there are new scientific discoveries and things that we do need to learn in an advanced practice as we think about advanced practice, but I honestly feel like advanced practice is about self-awareness, communication, creating meaningful safety and boundaries, things that really have nothing to do with the tools of your discipline, like your hands, or your table or your whatever. That it really is about how you understand your relationship with the people you serve and what you can do to really create a therapeutic environment.

Whitney Lowe:

Yeah, and that's certainly been one of my frustrations as a CE provider for several decades of this sort of blind focus or obsession that everybody has with doing something new and different with their hands. Okay, well, I might move them at a 45 degree angle instead of a 40 degree angle and then I'm going to trademark this technique and make it as if that is the thing that marks greater or better education. And one of the problems, I've lamented this with a number of other colleagues that I think one of the most really important things about training people to work as healthcare professionals is developing critical thinking and clinical reasoning. And that is probably one of the most unsexy things to try to sell as a CE course and everybody's like, "Yeah, but what am I going learn how to do with my hands? What new technique am I going to be able to put on my business card?" Sort of thing.

Cal Cates:

Yeah. And I think we also are very wrongheaded about this as people in that what I envisioned as advanced practice and at Healwell we're working right now creating an advanced practice program for an interdisciplinary program. So the content would apply to nurses, social workers, psychologists, chaplains, anyone in a healthcare setting including massage therapists, but that this is actually going to improve your life, it's going to bring more ease to your relationships, to your inner environment, to as we learn about... Because critical thinking I feel like again, this is a place where the more we learn about unconscious bias and how our brains work and the neuroscience of how we interact with our world, the more of an uphill battle it seems to truly teach critical thinking.

Cal Cates:

Because we make assumptions and we make our critical judgments based on assumptions we're unaware of and I feel like we have to completely retool how we look at even teaching critical thinking and decision making. Because we have to make the invisible visible, we have to help humans understand how little control they actually have over their brains and how they work and unteaching has to be the basis of this.

Whitney Lowe:

Right. And then we get back to some of those big problems of talking about well, this all goes back to a lot of what's happening at entry level education. And this is part of the things that I saw occurring with the humongous explosion of massage schools that started around the late '90s and continued through the early 2000s, to the mid part of the teens. That explosion of schools meant that there was a very large percentage of those schools who had faculty in there that didn't really have that good of a training. And many of those people were just put in teaching positions to fill a seat and that has very significant adverse ramifications on the professionals or the individuals who came through many of those training programs for years. And consequently then have exposure to the public who go and have sessions with these people and find this massage thing is not that great. And unfortunately it's because well, their training wasn't that great.

Cal Cates:

Yeah.

Whitney Lowe:

And I don't know how to rectify that although it does seem like we're seeing some unfortunate and challenging economics causing the closing down of a lot of schools and training programs, which we really needed to have. Unfortunately, part of the trend that seems to occur is that not always is it the worst schools that are hit the hardest economically.

Cal Cates:

Absolutely.

Whitney Lowe:

Many of them that were housed within large corporate institutions can weather the storm, where the small mom and pop school that was doing a really good job of training people can't make it. And I'm scared about that in terms of how that may impact our training for the future.

Cal Cates:

Yeah, no, I agree. And I do wonder, I feel like this is very much an art and I don't think that that is unique to us. Again, I think if you talk to the most connected and present nurses or physicians they'll tell you that... We have one of our course offerings on our online platform is a six part thing about pediatric massage in the hospital or clinical setting. And part of that we interview one of the oncologists that we work with and we asked her to tell us, describe your average day. And so she talked all about her day and there was very little stuff of scoping and very little sort of what you imagine and I said, "So it sounds like communication is a really big part of your job."

Cal Cates:

And she was like, "Oh, 90% of what I do I didn't learn it in medical school. It's really about talking to people, listening to what people are really saying, listening to what they're not saying, and being able to really meet this person in a place that your interaction is beneficial, really, for both of you." And at Healwell we are great big nerds, we are huge fans of the science and anytime something new and factual comes out, we gobble it up. And we love all of the stuff that you can't really put your fingers on, and that the only way to become comfortable with it is to sit in your discomfort so regularly, that it becomes the place where you sit and it makes sense to you.

Whitney Lowe:

Yeah. So I'm curious about your take on this too having again, worked in a lot of different capacities within our traditional healthcare system. I hear this statement or argument a lot of times, oftentimes is from other healthcare professionals saying you all as a profession aren't going to be really taken seriously by anybody until you have degree programs for your training. And that is part of this dilemma that we talked about earlier, what are your thoughts about that in terms of is there a pathway or a possible pathway for us that may not travel through the traditional academic degree programs? Or is that a direction that needs to occur eventually in the future?

Cal Cates:

I think I would say yes. I think that we have to also be aware of ways in which people learn and I do fear that some of the people that I know personally who are some of the most incredible therapists wouldn't do well in a community college or like a two or four year program. And that the world would miss the opportunity to receive work from the person who is competent and maybe is quite possessive of the many skills that we just talked about that that go into advanced practice, but I think that if massage therapy becomes something that you have to "go to college for", I think we'll lose some people that we are able to include in the models that we have. And I think that I'd love to just see both of those things exist because I think there's value in both.

Whitney Lowe:

I saw an interesting, short little YouTube video maybe a month, a month and a half ago or something like that which was an interview with a professor from I think he was from NYU named Scott Galloway and it was on Christiane Amanpour show called Amanpour and Company. And he was talking about what he saw as the potential bursting of the higher education bubble that is on the horizon and he was talking about both a number of aspects of financial challenge, which is that tuition costs in traditional universities have risen much faster than healthcare costs over the last 30 years. And we are at a point where it is becoming unsustainable and a lot of people are starting to ask, is the return on investment of me having to pay for a $60,000 undergraduate degree, going to be worth it somewhere down the road?

Whitney Lowe:

And then I'm going to have to go get another $50,000 master's degree or whatever it is on top of that and end up with $150,000 in student loans when I start my career. There's going to become a point at which in many professions the economics doesn't add up. And COVID has just accelerated that process because what's happened is, a lot of these kids are at home in their universities and their parents who are paying the tens of thousand dollars for tuition are watching them sit there take Zoom classes on the web and saying, "This is what I'm paying $50,000 a year for? Where's the value here?" And the schools are saying, "No, we're not giving you a tuition discount for having to sit at home and do Zoom classes, it's going to cost the same amount that would if you were here."

Whitney Lowe:

And I think it was a fascinating discussion about a number of different facets of things that have been percolating on the horizon that I think personally, I have a lot of more pointed opinions about this, that higher education has been able to really get away with a lot for a long time and I think it's going to come time to pay the piper sometime soon. And that makes me wonder about, should we be aggressively pursuing trying to get into that system if there are a whole lot of these impending problems coming down the pike with those traditional structured degree programs? And this is what makes me think more along the lines of pursuing micro credentialing as a more possible valid path for us.

Cal Cates:

Yes, everything you just said I can absolutely see that and it plays into my increasingly frequent post-apocalyptic fantasies of that I do feel like so much has happened this year that has really, if we're willing, shown us, everything we're doing wrong. And everything we're doing that as people on a planet is not sustainable and I think higher education falls into that category for sure. That it is a structure that is too big for itself at this point and I think about all my friends here in the Washington, DC area who worked for these giant corporations that have spent their last 10, 15, 30 years driving back and forth to these great big businesses and they're saying, "I'm getting so much more done working at home and I love that I don't trade an hour and a half of my life every day to get to and from work."

Cal Cates:

And I think what we need, well what we need now, but certainly what we'll need in the future are people who can do things in the world. I have a bachelor's degree and the stuff that I learned in college, I didn't learn in class. I learned how to be around people, I learned how to organize, I learned how to inspire and ask questions and some of that happened as a result of my coursework, but more of it happened from being in the world. We had a gentleman on our show a few months ago now who we were talking with him, he's a First Nations fella up in Canada and we were talking about what his dream would be for cultural competency education. And he said, "Well, my dream will never happen because nobody will pay for this, but I would want massage therapists to go into a First Nations community not for a field trip for three hours, but for this semester all of your clients are going to be First Nations people who live in this community."

Whitney Lowe:

Cool.

Cal Cates:

And I think that's true that we do these samples of things, but we never really have to touch the world in this way that will allow us to create the change that inspires so much of us to do this work in the first place. And I think that the way that higher education has been designed, almost by design prevents that discomfort and the breaking down of barriers that will ultimately lead to all of us moving forward in a different way.

Whitney Lowe:

Yeah. So one more thing I wanted to touch on here and this is again, potentially opening up a huge can of worms and we'll get to dip a spoon into the worm can for a moment. But again, you and I have talked about this extensively that trying to get our national associations to lead on these types of things has really felt like pulling a freight train up a hill numerous times. I'm on something like third or fourth efforts of trying to work on some type of advanced credentialing processes and I'm curious, what do you think we're doing wrong as a profession trying to get our associations to lead us?

Whitney Lowe:

And maybe should we not get them to lead us and should we try to do other things ourselves more as smaller groups or smaller individuals? Because there is an inherent, and you called attention to this earlier, there can be an inherent conflict of interest if an organization wants to keep as many members or keep as many people getting their particular credential or training program. And then you create one that is more exclusive that doesn't have as big a population, the economics around that are certainly not as desirable, but it feels like the profession really needs it.

Cal Cates:

Yeah. Well, I think one of the things we're doing wrong is something that we've done wrong throughout human history and in my less optimistic moments I feel like it's just going to happen again here. But I recently wrote a blog about how we have all through history seen opportunities to see the writing on the wall that we have blatantly ignored and one of the examples I use is the coal mining industry. I know that it's been a way of life and that it's really important to people and that there are legacies and families that people have been coal miners and coal is a finite resource. The same with oil, we're seeing the discussion now about if the election gets certified and Biden becomes the president oil will begin to transition out with how he had said it in various outlets.

Cal Cates:

And oil will not last, we need to prepare for something better and I think that we have the same thing with the profession. Is that we have a great big organization that has to fund an infrastructure and pay people to do the jobs within it. And it makes it really hard with our brains wired the way they are to really decide what's best for the profession and how to make that happen. And that is definitely something I think that points toward micro credentialing as perhaps a better way forward. Because you can have smaller organizations that can scale thoughtfully and I mean, smaller organizations scale, they create a great program that suddenly two years later they now have 50 people on staff and you go, "Oh, man. Okay, we have to keep this going because we have all these people on the payroll," but I think this comes down again to communication.

Cal Cates:

And Healwell we're still relatively small, but every time we grow or add a program or do something, we really do say, "Is this what we want to do? Does this make sense? Are you willing?" With COVID, we had to back in September say, "To stay alive through the COVID we're going to have to cut salaries. Here's what that's going to look like. I will 100% get it if you need to do something else, but here's where we're headed, here's what this cut will allow us to do and here's the plan forward." And everybody gets to say, "Yeah this is a good time for me to roll off or no I'm in." But I think that leaders think, "Oh, we have all these people who are counting on us." They are, they're counting on you to be honest.

Cal Cates:

They're counting on you to say, "This is what I see from my place on top of the horse at the top of the hill, stuff that you can't see. So what do you think given that information?" And let people make choices, but that's just not how we operate.

Whitney Lowe:

Yeah. And so we continue to pull the freight train up the hill.

Cal Cates:

Yeah, or we don't. You know and maybe you'll have to edit this out, but when board certification became a thing, as people practicing in the hospital our organization said, "We need to make sure that everyone who works for us is board certified and this is a new program, it's not going to succeed if we don't support it." And we supported it for four years and it didn't matter, it cost money and we had people we wanted to hire who didn't want to get it. And NCB still their line is that this is the highest voluntary credential in the country and they'll say that, "Well, one of the reasons it's important is because you can say you're board certified and when you're in a hospital setting or a clinical setting, board certification is language that people in that environment understand."

Cal Cates:

And we went to one of the hospitals where we work and we said, "Listen, we're not going to make sure that our therapists are board certified anymore. Who do we have to talk to, how do we remove this from our re-credentialing packet?" And they were willing to let us do that, but the doctor who was the head of the committee said, "You are so lucky, all of our doctors wish that they could not be board certified too because it's just a racket." They pay money and they don't get anything, but as a patient you feel like you wouldn't want to go to a person who's not board certified. But board certification for a physician doesn't actually mean this person is competent, it means they had the money for annual dues and they submitted some level of CE.

Cal Cates:

And I think that that's where we are with our board certification here is that it doesn't necessarily mean that this person is more competent, or safer, or accountable.

Whitney Lowe:

Exactly. And I think this is one of those things where again, this is probably a whole another can of worms for another day, but there in my opinion really needs to be a much stronger correlation between the credential and the educational program that gets the person to that credential. And that's something that board certification programs don't do well because the nature of a certification program means that there's multiple paths that a person can get to and may be able to just do okay in passing the test, but not really have the good comprehensive education program. That's what you want the credential to designate is okay, you went through this training program, and you really did get all this stuff, and you met these competencies, and you are at this level of skill and ability that we really want to see. So yeah, that is an inherent flaw in the models I think of those types of large scale certification programs.

Cal Cates:

Yeah. And I think we have to be willing to recognize the value of interdisciplinary education and honestly, to recognize the imperative of it. Especially as a profession that has not been traditionally recognized as healthcare, if I go take a class at a nursing school that should count toward an advanced credential in my discipline as long as it's... Obviously, I'm not going to go learn you know about the chemistry of medications, but if I go and take a nursing course in charting, or a nursing course in ethics, or if I go to a physical therapy program and take an anatomy review course, that should all count as me beefing up my credentials and my competency. And the way that it sits now at least it can count, but you got to jump through a lot of hoops for it to count.

Whitney Lowe:

Yeah.

Cal Cates:

And it's not worth it because you've already spent the money and you've already gotten training that doesn't count as other types of CE so yeah, I think it's really not designed to support people coming in through multiple avenues. And as you say, I think that's a really important part of it.

Whitney Lowe:

So in a nutshell we still have some work ahead of us to do, but I for one I'm forever grateful and thankful that there are people like you out there working on this and holding the light and shining a pathway forward for us. So I thank you for all the work that you're doing over there with Healwell and in your life and in everything as well. So can you just recreate or just repeat real quickly for folks how they can find out more about Healwell again, just your contact information here?

Cal Cates:

Absolutely. So you can find our website at healwell.org and Whitney mentioned our private community, you can join it's community.healwell.org and there's a smartphone app as well as a desktop interface with Mighty Networks depending on how you want to work that. And it is a subscription based platform, so you can try it out for a month or you can decide to dive in for a year, but it's content that you might not find in other places and it's certainly conversations with a variety of providers and perspectives that you won't find in other places. And the more thoughtful, self-aware folks who join the community, the more we all learn and the more we all move forward together.

Whitney Lowe:

Great. Well, thank you so much. And I really appreciate your indulging me and just got you on here just to give me another excuse to be able to have more great conversations with you again which I always enjoy. So thank you again so much for that. We would also like to say thank you to Handspring Publishing for sponsoring the Thinking Practitioner Podcast. Their catalogue has emerged as one of the leading collections of professional level books written especially for body workers, movement teachers, and all professionals who use movement or touch to help their patients achieve wellness. Handspring also has a new instructional webinar series called Moved to Learn, which is a regular series of 45 minute segments featuring some of their amazing authors, including a recent one from Til over there.

Whitney Lowe:

So take a look at that and head on over to their website at handspringpublishing.com to check those out. Be sure to use the code TTP at checkout for a discount. So thanks again Handspring. We'd also just like to say thanks again to Cal once again for joining me here today and we appreciate our sponsors supporting the podcast and of course, all of you listeners. We really appreciate your continual supporting of the podcast. You can stop by our sites for show notes, transcripts and any of the extras. You can find that on my site over at academyofclinicalmassage.com and also over on Til's side at advanced-trainings.com. Please do feel free to send us questions or things you'd like to hear us to talk about, you can send an email to us at info@thethinkingpractitioner.com or look for us on social media.

Whitney Lowe:

Please do if you will follow us on Spotify, rate us on Apple Podcasts, Stitcher, Portable Walkman, whatever it is you're listening to these days. Tell a friend and share the good news and everybody keep doing what you're doing and we look forward to seeing you again in two weeks. So thanks again Cal, we'll talk again soon.