TY - JOUR
AU - Pizzi, Meredith, Roman
AB - Abstract While all music therapists look to the Code of Ethics as a guiding document, music therapists who are self-employed or managing teams rely heavily on this document to create sound business and administrative policies. This article articulates how the 2019 Code of Ethics informs the music therapy entrepreneur or manager to make thoughtful, accountable, and ethical decisions, decreases confusion about specific business practices, and addresses significant concerns related to aspects of the previous AMTA Code of Ethics that were in conflict with federal anti-trust regulations in the United States, including the Sherman Anti-Trust Law. To address the legal and ethical issues inherent in expanding a service business, a discussion guided by the 2019 Code of Ethics and the Markkula Center for Applied Ethics (2009) model is provided as a way to think through potential ethical dilemmas when considering subcontracting music therapy services. entrepreneurship, private practice, business model, anti-trust laws, employees, subcontracting, ethics In the rapidly changing environment of service delivery models, an increase in the types of populations seeking music therapy, and exponential growth among music therapy practices across the United States, there continues to be a high need for a guiding code to support decision making and promote principles that are “responsible, fair, and accountable” (AMTA, 2019a). Because music therapists work in a wide variety of settings and environments, the American Music Therapy Association (AMTA) Code of Ethics must be applicable to all practicing music therapists. This article presents some of the changes in the code that impact music therapy administrative and business practices, and uses the new AMTA Code of Ethics (2019a) and the Markkula Center for Applied Ethics (2009) model to consider when expanding a music therapy service delivery business model. A Guiding Code for Business Owners and Managers The number of music therapy businesses and self-employed music therapists continue to increase in the United States. Business models may include for-profit and nonprofit entities, sole proprietorships or private practices, and larger practices, often referred to as music therapy agencies or businesses. According to the AMTA 2019 Workforce Analysis Report, “Approximately 23% of survey respondents reported being the owner of a music therapy business” (AMTA, 2019b). Generally, these business models provide contractual work for individuals, agencies, schools, medical facilities and other community programs and may provide services in their own location(s), through outreach in the community, or both. As recognition and demand for music therapy increases, small private practices are frequently expanding to include additional music therapists to deliver services. Music therapists leading or working for private music therapy businesses may rely heavily on the AMTA Code of Ethics as they do not have facility procedures and standards to follow, and they may have limited knowledge of best practices in business when they start out. It is therefore essential that music therapy managers familiarize themselves with the new Code of Ethics (2019a) and understand how it can be a useful tool as they address the ethical concerns and dilemmas that often occur within an independent business model. The previous AMTA Code of Ethics (2014) could be interpreted as limiting potential business expansion, for it addressed the “do’s and don’ts” of a constantly changing business and practice environment in a broad and sometimes vague way. For example, Code 10.0 in the previous code stated “The MT will adhere to professional rather than commercial standards in making known his or her availability for professional services. The MT will offer music therapy services only in a manner that neither discredits the profession nor decreases the trust of the public in the profession” (AMTA, 2014). As commercial and business standards change in the environment, this statement did not provide clarity regarding announcing services or guide our thinking in terms of ethical practice, which is one of the purposes of the new Code of Ethics. Additionally, Code 9.8 in the prior AMTA Code of Ethics (2014) stated, “The materials or products dispensed to clients should be in the client’s best interest, with the client’s [sic] having the freedom of choice. The MT will not profit from the sale of equipment/materials to clients. Charges for any materials will be separate from the bill for services.” This provided a level of detail and specificity that did not guide a music therapist in providing resources to the community or to clients in a way that created a sustainable business model. New language of the AMTA Code of Ethics (2019a), section 3.4, reads the MT will, “seek remuneration that is fair and reasonable, and fully disclose any financial interest in products or services recommended.” This shift in language provides guidance which informs the music therapy entrepreneur or manager to make thoughtful, accountable, and ethical decisions as they approach payment for any product or service. Anti-Trust Laws and the Code of Ethics In addition to decreasing confusion about specific business practices, such as announcing services or charging for materials and services, the new code also addresses significant concerns related to aspects of the previous AMTA Code of Ethics that were in conflict with federal anti-trust regulations in the United States, including the Sherman Anti-Trust Law. The Sherman Anti-Trust Law, the first federal anti-trust act passed by Congress in 1890, and the Federal Trade Commission (FTC) Act, passed in 1914, are in place “to protect the process of competition for the benefit of consumers, making sure there are strong incentives for businesses to operate efficiently, keep prices down, and keep quality up” (FTC, 2017). The red-lined version of the 2014 Code of Ethics (AMTA, 2018) identified seven codes that were in direct violation of the Sherman Anti-Trust Laws and were therefore unenforceable. Having them in our professional Code of Ethics created a liability to our professional organization as the Federal Trade Commission had “successfully challenged professional associations’ ethical guidelines and membership requirements restricting their members’ contractual or commercial practices” (FTC, n.d., p. 6). The Federal Trade Commission has argued: Restrictions on the business or commercial aspects of professional practice do not always benefit consumers, a conclusion that is supported by economic studies that have found little relationship between such restrictions and the quality of care provided, and also can limit professionals’ ability to compete effectively with each other. (FTC, n.d., p. 8) The FTC strongly argues and advocates for “the elimination of restraints on conduct, such as advertising, discount pricing, and contractual and commercial practice” and believes that these efforts have “increased competition, providing substantial welfare gains for consumers” (FTC, n.d., p. 11). Moving to the new Code of Ethics has provided business owners with articulated values and ethical principles that may guide our discussions and thinking, and paints a picture of the virtues that we can strive towards. As we live out these ideals, we can continue to examine how we work to increase quality and access for consumers, while encouraging healthy competition between music therapy businesses for the benefit of consumers. Consumer Choice of Providers Under the old code, questions about the rights of clients to choose their providers were common. The old Code of Ethics (AMTA, 2014) gave the impression that therapists had a right to maintain their caseload and client relationships. Statements such as “10.2—The MT will not solicit clients of other MTs,” or “4.2—The MT will not offer professional services to a person receiving music therapy from another music therapist except by agreement with that therapist or after termination of the client’s relationship with that therapist” (AMTA, 2014) created conflicts when a client or agency administrator requested a quote from new service providers or for an additional service that was not currently being provided. General advocacy and outreach were also impacted. Concerns about potentially infringing on someone’s current, established client list by sending out a general mailing announcing services prevented consumers from knowing about other providers in the area. This restriction unnecessarily limits competition and choice for agencies and consumers seeking services. As recognized by the FTC: Private professional associations and State boards traditionally imposed restrictions on advertising and solicitation by professionals, claiming this was necessary to protect consumers from false or deceptive advertising or marketing practices. The agencies have examined whether these restrictions are so broad that they also unnecessarily restrict the provision of truthful information to consumers that could enhance competition. (FTC, n.d., p. 2) If a current provider is meeting the needs of the contracting agency or music therapist and providing exceptional services at a reasonable market rate, then there would be no reason for the consumer to change. However, if the client prefers to work with another provider, they have every right to make a change. Professional associations cannot limit the choice of the consumer within our internal codes of professional behavior. Within the new code, professional conduct is still held as a value and providers are encouraged to “1.12. work collaboratively with peers using open direct communication to resolve differences of opinion or to recognize others’ perceptions”, “1.13. respect the professional services offered by colleagues in music therapy and other disciplines and endeavor to communicate openly when a change in provider occurs or is pending”, and “3.3. work in a manner that aligns with truthful and fair business practices that benefit clients, society, and the profession” (AMTA, 2019a). These values support music therapists in promoting communication and professional relationships, while in no way limiting the consumer’s choice for service delivery. These same values can be referenced to support a wide variety of issues in practice management. Examining a Business Decision with the New Code of Ethics: Ethical Considerations of Subcontracting While the changes in the Code of Ethics (2019a) have addressed some specific concerns, it has also articulated a variety of ways in which music therapists may evaluate ethical dilemmas. Although there are many consequential choices a music therapy entrepreneur or manager must address as they scale and grow a business, the decision to hire an employee or subcontract work to another music therapist has significant legal and professional ramifications. Music therapists leading a business entity or program should consult with an attorney and an accountant to consider legal and financial implications of hiring and subcontracting, in accordance with Code 3.1, “a music therapist must consult with relevant laws and regulations” (AMTA, 2019a). The federal legal requirements for classifying employees and subcontractors as defined by the Internal Revenue Service (IRS) should always be the first step in deciding how to move forward. If a music therapist believes they meet the requirements of the IRS for utilizing subcontractors, there are additional ethical considerations which can be guided by the new AMTA Code of Ethics (2019a). The following discussion is provided as a way to think through potential ethical dilemmas when considering subcontracting music therapy services. The model and questions below are from the Santa Clara University Markkula Center for Applied Ethics (2009). The appendix of the new AMTA Code of Ethics (2019a) provides them as a guide to inform the decision-making process. Additional questions have been added by the author. “Recognize an Ethical Issue” “Could this decision or situation be damaging to someone or to some group” (Markkula Center for Applied Ethics, 2009)? “Is this issue about more than what is legal or what is most efficient? If so, how” (Markkula Center for Applied Ethics, 2009)? Subcontracting work to other music therapists raises ethical issues of communication, supervision, remuneration, and business practices. As already mentioned, classifying employees is a legal question, but it is also an ethical question in that it defines the type of relationship one has with the individuals providing services on your behalf as subcontractors, and thereby changes the relationship one has with clients and stakeholders seeking services. 2. “Get the Facts” “What are the relevant facts of the case” (Markkula Center for Applied Ethics, 2009)? Relevant facts include IRS rules for classifying workers, the contract specifics of the relationship, and the permanency of the role (IRS, 2017a, b). Other important facts would be whether there are other employees or subcontractors involved, as generally employees and subcontractors are not permitted to perform the same role. Considerations of financial and behavioral control as defined by the IRS are also relevant in this situation (IRS, 2017a, b). If a music therapist believes that a subcontractor is performing services independently so as to meet legal requirements of subcontracting then the contracting music therapist does not have “the right to direct and control the work performed by the worker” (IRS, 2017b) nor can they provide the equipment or facility space for the subcontractor to perform their duties. b. “What individuals and groups have an important stake in the outcome” (Markkula Center for Applied Ethics, 2009)? When determining who the relevant stakeholders are, one may consider the business owner, the subcontractor, the clients themselves, and their care providers, guardians, or agency representatives. It is also helpful to “assess the obligations and to whom” as in Dileo’s (2000) Ethical Decision Making model. As one follows this thinking, relevant questions to gather information might include: c. What accountability does the business owner have to client(s), parents, or administrators of a community partner contracting services? d. How does a business owner communicate financial interests in a subcontracted position to clients? e. How does a business owner or manager provide accurate information about the provision of services by a subcontractor, while still abiding by IRS rules to provide complete independence to the subcontrator and how they fulfill the work? f. Given that another individual with “an important stake in the outcome” (Markkula Center for Applied Ethics, 2009) is the subcontractor and considering our professional ethics for “Respecting the Dignity and Right of All” and “Act with Compassion” (AMTA, 2019a), does the individual accepting the subcontracted work fully understand the financial and legal implications of subcontracting? g. Has the subcontractor set a rate that they believe is “fair and reasonable” for the services they are providing (AMTA, 2019a)? h. Is the subcontractor freely engaged in developing additional services to market in the community? i. “What are the options for acting” (Markkula Center for Applied Ethics, 2009)? In evaluating the options for acting, the music therapy business owner may consider choices: (1) to maintain the size of their practice and refer additional work out to other music therapists, (2) subcontract the work to other therapists with consideration for all of the legal and ethical concerns, or (3) hire the worker as an employee with the ability to provide additional benefits, oversight and supervision, scheduling, providing instruments, documentation tools, and feedback. j. The Markkula Center for Applied Ethics further asks, “Have all the relevant persons and groups been consulted” (2009)? k. Are all contracted agencies, administrators, parents, and clients aware of the relationship established with subcontractors? l. Are they comfortable with your role and billing practices? m. Is the subcontractor fully informed about their responsibilities? n. Have issues regarding documentation been addressed, as subcontractors are not required to report on or “measure the details of how the work is done” (IRS, 2017b)? 3. “Evaluate Alternative Actions” In evaluating your options, this model suggests asking the following questions: “Which option will produce the most good and do the least harm?” “Which option best respects the rights of all who have a stake?” “Which option treats people equally or proportionately?” “Which option serves the community as a whole, not just some members?” “Which option leads me to act as the sort of person I want to be?” (Markkula Center for Applied Ethics, 2009). It is essential for music therapists who are responsible for service delivery to consider how the potential business model options for growth would impact everyone involved, including clients, family members, stakeholders, agency administrators, and funders. It is also relevant to ask what option will support the kind of service delivery and music therapy business I want to create? 4. “Make a Decision and Test It” The model suggests, “Considering all these approaches, which option best addresses the situation” (Markkula Center for Applied Ethics, 2009)? Once a decision is made, the music therapist may consult with peers, supervisors, or other respected people to test the decision. This process allows time for reflection and consideration of possible consequences. 5. “Act and Reflect on the Outcome” The music therapist then implements the decision “with the greatest care and attention to the concerns of all stakeholders” (Markkula Center for Applied Ethics, 2009), working to “act with compassion and genuine interest when dealing with peers” and “provide accurate information to clients” (AMTA, 2019a). Through this process, the music therapy business owner or manager may continue to assess the decision while striving for excellence. Additionally, the personal growth in this decision-making process may inform future experiences. Conclusion Music therapy entrepreneurs are accountable to many different people in a variety of contexts that can make the ethical challenges in business practices quite complex. Business owners and managers must continue to increase their knowledge and competencies regarding legal requirements and regulations, knowing that while an action may be legal and comply with the rule of law, it may not be ethical. While the new AMTA Code of Ethics (2019a) does not provide prescriptive answers to specific questions, it does provide support in “guiding the practice of music therapy in a responsible, fair, and accountable manner.” Music therapists who are self-employed or who manage music therapy practices can look to “Principle #5. Strive for Excellence” (AMTA, 2019a) to guide their ongoing personal growth. Music therapy entrepreneurs need to not only enhance their clinical and therapeutic skills, but also deepen their knowledge and understanding of business models and policies. With reflection on the core values articulated in the AMTA Code of Ethics (2019a) and a continuous process of self-examination, supervision, and consultation with colleagues, ethical business practices can be a cornerstone in music therapy businesses. Acknowledgments Thanks to all of my colleagues who have helped me develop my competencies and to my team at Roman Music Therapy Services for their support in all of our projects. A sincere thank you to all of the Music Therapy Business Owners who have shared their celebrations, successes, fears, and struggles with me over the past 15 years. Your dedication continues to inspire me to learn and share more. References American Music Therapy Association (AMTA) (2014, 2019a ). Code of ethics . Silver Spring, MD: American Music Therapy Association . Retrieved from https://www.musictherapy.org/about/ethics/ American Music Therapy Association . ( 2019b ). Member survey and workforce analysis: A descriptive statistical profile of the 2019 AMTA membership and music therapy community [PDF] . Silver Spring, MD : American Music Therapy Association . Retrieved from https://www.musictherapy.org/assets/ 1/7/2019WorkforceAnalysis.pdf Google Scholar Google Preview OpenURL Placeholder Text WorldCat COPAC American Music Therapy Association . ( 2018 ). Ethics 2014 code with red lines [PDF] . Silver Spring, MD : American Music Therapy Association . Google Scholar Google Preview OpenURL Placeholder Text WorldCat COPAC Dileo , C . ( 2000 ). Ethical thinking in music therapy . Cherry Hill, NJ : Jeffrey Books . Google Scholar Google Preview OpenURL Placeholder Text WorldCat COPAC Federal Trade Commission . ( n.d .). Competition in professional services in the United States. Retrieved from https://www.ftc.gov/system/files/attachments/us-submissions-oecd-2010-present-other-international-competition-fora/iberto-professional-services.pdf Federal Trade Commission . ( 2017 ). The antitrust laws . Retrieved from https://www.ftc.gov/tips-advice/competition-guidance/guide-antitrust-laws/antitrust-laws Internal Revenue Services . ( 2017a ). Employee or independent contractor? Know the rules. Retrieved from https://www.irs.gov/newsroom/employee-or-independent-contractor-know-the-rules Internal Revenue Services . ( 2017b ). Understanding employee vs. contractor designation. Retrieved from https://www.irs.gov/newsroom/understanding-employee-vs-contractor-designation Markkula Center for Applied Ethics . ( 2009 ). Making an ethical decision. Retrieved from https://www.scu.edu/media/ethics-center/resources/making.pdf © the American Music Therapy Association 2020. All rights reserved.For permissions, please e-mail: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
TI - Expanding a Music Therapy Business Using AMTA’s Aspirational Code of Ethics
JF - Music Therapy Perspectives
DO - 10.1093/mtp/miaa001
DA - 2020-03-26
UR - https://www.deepdyve.com/lp/oxford-university-press/expanding-a-music-therapy-business-using-amta-s-aspirational-code-of-r6Q5hHMGEN
DP - DeepDyve
ER -