Site: 
St. Louis VA Healthcare System

Location:
John Cochran campus & Jefferson Barracks campus, possibly St. Charles CBOC

Description: 
We have 7 audiologists on staff. Audiology services are provided at two main campuses in St. Louis: John Cochran division and Jeferson Barracks division. Incumbent will rotate between the facilities for a variety of experiences. Students must be a U.S. Citizen to apply.

Number of externship positions:
1

Funding is assigned by the Office of Academic Affairs and may not have been determined by the application deadline. OAA funding is announced nationally at the same time which should allow sites to know funding at approximately the same time. Historically, our site: Provides 1 paid externship

Clinical opportunities provided during the externship:

• Audiological evaluations
• Hearing Aid Selection and Fitting
• Real Ear Measures
• Electrophysiology Exams to include ABR and OAE
• Osseointegrated auditory devices
• Cochlear Implant Evaluations, Management/Mapping
• Vestibular testing
• Remote Fine Tuning for Hearing Aids
• Telehealth hearing aid management
• Tinnitus evaluation
• Cerumen Management
• Assistive Listening Devices
• Ototoxic monitoring
• Occupational hearing conservation evaluation and management

Clinical opportunities not listed above:
N/A

Externship site expects the extern to have mastered these skills before they begin their clinical externship:
Pure tone audiometry (air and bone) including masking
SRT and word recognition testing
Audiogram interpretation
Basic counseling skills
Hearing aid verification measurements
Basic hearing aid repairs
Otoscopy
Clinical report writing
Good interpersonal skills, professionalism, and willingness to accept feedback

Externship site expects the extern to learn/demonstrate these skills during their clinical externship:
Students are expected to develop into independent clinicians, specifically in the domains of audiometric testing, hearing aid selection and fitting, and follow up care. Students are also expected to be able to be proficient in cochlear implant evaluation/ programming, vestibular evaluation/interpretation, and electrophysiologic testing.

Number of audiologists at site:
7 full-time audiologists

Number of staff at site:
Varies per location

Audiologists holding CCC-A certification:
4

Audiologists holding ABA certification:
0

What level of supervision is provided:
100% in the beginning, progressively reducing to 10% as student progresses throughout the externship year

How many students per year both interns and externs:
1-2

Continuing Education opportunities:
Biannual hearing aid training on site. Promote and encourage the extern to attend JDVAC.

Travel to satellites required?:
Possibly to one CBOC for exposure to different clinic site

Are there interdisciplinary opportunities? If so what:
Speech and ENT

Are there research opportunities? If so what?:
No

Do you have a consortium or collaborative arrangements with other sites that provides additional experience?: 
No

What communication or other support do you expect or require from university during externship?
Periodic check-in from the university providing expectations and dates for university evaluations

Site’s application requirements:

• Cover letter explaining why you’re interested in training at the Veterans Administration Healthcare system
• Resume
• One (1) Transcript (unofficial)
• Two (2) letters of recommendations from previous clinical preceptors

Steps for the student/university to follow the application process:
Submit application packet via email to: julie.miles@va.gov

Site’s application deadline:
Friday, September 13, 2024

Site’s externship contact:
Julie Miles, AuD, CCC-A, julie.miles@va.gov

Anticipated decision date:
Interviews Begin: Monday, September 23, 2024

Dear AVAA Members,

The Association of VA Audiologists strongly supports the continuation of Compensation and Pension Examinations being completed within the VA.  A recent policy change to the Compensation and Pension Examination process will now have all examinations completed by outside contractors.  The Compensation and Examination Advisory Committee has provided a notice of a virtual meeting that is open to the public and will address several topics; specifically the discussion of “the most appropriate means of responding to the needs of Veterans relating to disability compensation”.  This will provide an opportunity for audiologists and other disciplines across VA to voice our support for the continuation of in-house Compensation and Pension examination.  We have included information regarding the meeting as well the AVAA position statement regarding Compensation and Pension examinations below.

The virtual meeting is scheduled to be held over two days on Tuesday December 1, 2020 and Wednesday December 2, 2020 from 9 a.m. – 12 p.m. EST.  The virtual meeting call-in number is 1-800-767-1750 and the access code is 75937#.  Comments may be shared with the committee via submission of a one to two page document no later than November 19, 2020.  Members who are interested in submitting their comments regarding this topic or any other areas addressed in the attached meeting notice pdf, should submit their comments to Sian Roussel at Sian.Roussel@va.gov while including your name, professional affiliation, email address, and phone number.

To the Advisory Committee on Disability Compensation:

The Association of VA Audiologists represents every audiologist employed by the Department of Veterans affairs.  We are writing to your committee to voice our support for continuing VA Compensation and Pension Examinations at VA facilities rather than having 100% of the examinations be outsourced to the private sector.

Tinnitus and Hearing Loss are the two most common service connected disabilities among Veterans.  These two disabilities represent 12.8% of all service connected disabilities.  In FY19, Tinnitus and Hearing Loss were the first and third most prevalent service connected disabilities, respectively.  VA audiologists are well trained at providing high-level, fully accurate Compensation and Pension examinations to our nation’s Veterans.

Our main concern is always providing the best care to our Veterans.  In 2018, the Government Accountability Office reported that they do not track whether these private contractors are meeting quality and timeliness standards that our Veterans deserve.  In the Government Accountability Office’s 2018 report, recommendations were made to address these issues, yet two years later these recommendations have not been implemented to ensure proper oversight.

Prior to this policy change, in 2016 nearly 60% of Compensation and Pension examinations were completed by outside contractors at a cost of over 6 billion dollars.  Fully outsourcing all Compensation and Pension Examinations will further inflate this already unnecessarily large number while also placing the Veteran at risk of receiving an improper evaluation since quality of care evaluations are not in place.  Additionally, contractors may not provide full attention to the Compensation and Pension Examinations which could lead to improper and inconsistent ratings being provided which may come as a detriment to the patient or to U.S. tax payers.

Lastly, many Veterans also seek audiologic services at the same time as their Compensation and Pension Examination.  This allows Veterans with hearing loss to receive necessary services such as hearing aid evaluations, hearing aid checks, and hearing aid adjustments to be completed on the same day as their Compensation and Pension appointment.  This is convenient for the Veteran, helps reduce wait times within the VA, and ensures continuity of care.<

While we do agree that there are times when a need exists for private contractors to supplement the Compensation and Pension Examination process to reduce wait times and improve ease of access when necessary, we do not believe that outsourcing all Compensation and Pension Examinations to private contractors is in the best interest of the Veteran, VA, or American tax payers.  We hope that you will reconsider your position and continue to allow the VA to provide in-house Compensation and Pension Examinations to ensure we maintain the best care possible for all of our nation’s Veterans.

The Association of VA Audiologists

VA C&P Advisory Committee Comments Request

To our fellow members of AVAA,

Legislation has been proposed in the U.S. House of Representatives (H.R. 6612) and in the U.S. Senate (S. 785) which would require Hearing Instrument Specialists to be hired at all VA Medical Centers.  This legislation would also require the Secretary of Veterans Affairs to “prescribe the technical qualifications” of Hearing Instrument Specialists in the VA.  These bills have the potential to completely change the way hearing healthcare is provided to our nation’s heroes as well as to possibly change the scope of practice for Hearing Instrument Specialists at the federal level.  All of the national audiology organizations are aware of this legislation.  AVAA stands strongly opposed to this legislation as it will negatively impact Veteran’s hearing healthcare.  In addition, this legislation will lead to increased financial costs for the VA, not reduce patient wait times, and will lead to increase space burdens for all VA Medical Centers.

The American Academy of Audiology has provided information on these bills in their Legislative Action Center.  The AAA Legislative Action Center provides a tool for you to directly contact your representatives to state your opposition to this legislation.  AAA also provides a template that you can use in your communication with your representative or you can use the AVAA opposition letter attached in this statement which provides additional information as to why we are against both bills.

 https://www.audiology.org/get-involved/advocacy/legislative-action-center

This legislation could lead to Hearing Instrument Specialists being able to redefine their own scope of practice at the federal level.  The language of the bill states that O*NET would be used to define the core tasks a Hearing Instrument Specialist complete.  O*NET definitions of tasks and work activities are created based on surveys of members within a profession. This potential expansion of allowable services through these bills could then lead to the same changes occurring at the state level which would ultimately be a direct threat the field of audiology and all patient hearing healthcare. We stand committed to fighting for the hearing healthcare of our Veterans, for VA audiologists, and for the profession of audiology.

The Association of VA Audiologists

Click here for the AVAA Opposition Template » 

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