Today I welcome Meganne Masko, a fabulous music therapist and new Assistant Professor at the University of North Dakota, to share her thoughts on the potential for the field to move to a Master’s Level entry. This is not something that has been decided upon yet but is going to be presented during each Regional Conference this spring. I have asked a few people to share their thoughts on the potential change as each will have a unique perspective to offer.
I’ve been thinking a lot the past week or so about the vote to move the music therapy profession from Bachelor’s-level to Master’s-level entry. I’ve actually always thought it should be Master’s-level entry, but I never sat down to think about why until the great vote took place. Here are my two cents on the topic. Like all things you read, please take them with a grain of salt.
There are three main reasons music therapy should move to Master’s-level entry: 1) Reimbursement, 2) Employ-ability and 3) Student development. Let’s talk about each of these points.
Point 1: Reimbursement
Reimbursement refers to the way music therapists are paid for the services they provide. Most MTs are paid out-of-pocket by clients (or their families) OR by the agency employing the music therapist. As of today, music therapists are not able to directly bill third-party payment sources such as Medicare, Medicaid or insurance companies on a regular basis the same way a Speech/Language Pathologist (SLP), Occupational Therapist (OT), Physical Therapist (PT) or other allied healthcare professional can. Instead, MT services are paid for on an hourly basis (for contract employees) or as part of a salary that comes from a per diem (per day) rate of reimbursement from an outside source such as Medicare. Here are a few examples of some of the many ways MTs are paid without directly billing an outside payor (such as an insurance company):
Maggie works as an hourly employee for a hospice agency as a MT-BC. Her agency gets paid a pre-established daily rate from Medicare or other insurance companies for each patient they take care of each day. Maggie’s paycheck comes out of the pool of money the agency receives from those third-party sources (as well as some outside grants and community support). The agency cannot directly bill Medicare for music therapy services.
Drew is a MT-BC at a large metropolitan hospital. He is a salaried employee who works in several different units within the hospital. The hospital is reimbursed by insurance companies at a daily rate based on the care patients receive; however, the physicians, OTs, PTs, SLPs and some other allied healthcare providers bill the insurance company (or the hospital bills) separately for the services they deliver to the patients. The hospital is not able to bill directly for the music therapy services, so Drew’s salary comes from the per diem rate paid by the insurance companies.
Katie owns her own private practice in a rural area of the Midwest. Katie is not able to directly bill insurance companies for the services she provides to her clients. However, some of her clients receive Supplemental Social Security Income or other disability payments. They use some of these funds to pay Katie directly at a pre-set hourly rate for music therapy services.
I want to clarify that I do NOT think going to Master’s-level entry will magically make it possible for MT-BCs to directly bill insurance companies with 100% success, but I do sincerely believe it will help. Why? Because all of those other professionals who are able to bill outside payors are at least Master’s-level entry programs.
Point 2: Employ-ability
When we train students to become music therapy professionals we do so in the hopes that they will find gainful employment as music therapists. Unfortunately, due to changes in the Medicare Conditions of Participation (CoP) for particular care providers (I’m thinking specifically of hospice), a Bachelor’s degree and board certification are not always enough to get the job. Let me be clear here: There is NOTHING in the current Medicare hospice regulations that says that hospices are only allowed to hire music therapists who have a Master’s degree. But, the CoPs DO say that about Social Workers and counseling professionals. So depending on the state in which you live and how the agency defines the position of “music therapist,” you may need to have a Master’s degree just to get hired.
Point 3: Student development
In the interests of full disclosure I’m going to tell you about my academic background…
I have a Bachelor of Music degree in vocal performance from Drake University in Des Moines, Iowa. I worked as a professional performer before going back to school and receiving my music education training. I taught private lessons before being hired as a music teacher at a parochial school just outside Milwaukee, Wisconsin. After one year of teaching in a school I began my music therapy equivalency training at Alverno College in Milwaukee. Then, I transferred to the University of Iowa where I completed both my MT equivalency and a MA in Music Therapy. I immediately started working as a full-time clinician once I earned my board certification, and continued to work while I completed my PhD coursework at The University of Iowa. I’ve been a clinical supervisor, a guest lecturer in a college neuroscience department, and a researcher. I am currently a PhD candidate at The University of Iowa, and a new Assistant Professor of Music Therapy at The University of North Dakota.
Do you remember what it was like to be in college? College is hard. Many students are away from home for the first time, they are working on developing their personal identities, trying to manage their time, learning about feeding themselves, navigating personal relationships, dealing with personal finances, and generally trying to survive the transition between childhood and adulthood.
Music majors have it even harder than the average college student. They are working to master a primary instrument, and many of them are formally studying theory and aural skills for the first time. Plus, there are ensemble requirements that sometimes equal massive amounts of time away from other academic activities. Then there’s practice time when it’s just you in a room with your instrument. I used to spend around four hours each day in a practice room, and it wasn’t nearly enough (just ask my piano teacher). Do students get course credit for practice time? No. They get credit for their lessons, but not for the hundreds of hours they spend preparing for those lessons. My point? Being a college student is hard, but being a music major is even harder.
Next, think about being a music therapy major. You have your general education requirements, your primary instrument, your secondary instruments, music requirements, plus courses in psychology, anatomy, sociology, statistics and research methods, music therapy history, techniques and approaches, and about 200 practicum hours to complete. I’m exhausted just thinking about being a music therapy major.
From my perspective, I feel like we ask our undergraduate music therapy students to develop their knowledge and abilities at an unrealistic rate. It works for some students, but other students take a longer time to develop. This second tier of students has the potential to be excellent music therapists given a little bit more time in the classroom, the practice room and supervised clinical setting before they go off to internship.
Now, let’s look at things from a music therapy educator’s perspective. I sit down with my colleague at UND on a regular basis to see how we are addressing the AMTA competencies in our curriculum. We try our best to make sure we cover everything that needs to be covered before a student heads to internship, and we design assessments to see how well students are acquiring the knowledge and skills they need to be competent music therapists. The problem is I often find myself thinking, “I’d really like to talk about [insert topic here], but we just don’t have the class time for that.” Or, I hear myself saying to students, “Yes, I think [insert activity here] is a fantastic idea for you, but I don’t see how you can do that and still leave for internship in four years.” I want my students to study abroad because it’s a great way to gain an understanding of another culture (and lay the groundwork for cultural competence). I want them to participate in campus organizations to gain leadership experience. I want them to take research classes in areas that spark their interest. I want them to stop and smell the roses from time to time so they can practice finding balance in their lives. I want them to concentrate on being the best musician possible so they can then become the best music therapist possible.
This is the part where my bias (and personal background) rears its head: I believe the greatest reason for moving to Master’s-level entry is that it will allow our students time to more fully develop as musicians before we try to help them develop as therapists. My personal belief is that the music has to be second nature in order to be useful as a therapeutic tool. If students are worried about singing or playing the right notes at the right time, they aren’t going to be focused on the behaviors or reactions of the clients to the interventions. Music therapy, to use an old definition, is the use of music to help clients achieve non-musical goals. The way we do that is by focusing on our musical skills first. I hope that moving to a Master’s-level entry program will allow that to happen on a more regular basis.
Bio:
Meganne Masko, MA, MT-BC is an Assistant Professor at the University of North Dakota , a PhD Candidate at the University of Iowa, Music therapist for Hills and Dales Agency providing bi-weekly contractual services for clients in daytime rehabilitation, pre-school, and after-school programs, and a mom to a wonderful pre-teen with Asperger’s. Her research focus is on Music Therapy in spiritual care during hospice and end of life.