Know Your Worth: How Externs Enhance the Field of Audiology

As fourth year externs, we have overheard countless discussions on the “value of externs” and their place in our profession. Interestingly, we are at a transition period – one foot in the door to our professional careers and the other as a student. In this blog post, we list five benefits that externs can bring to any clinical domain (in no particular order). We hope these benefits highlight the value of externs to audiologists and provide another forum for discussion between current and future externs and preceptors. 

1. Keeping up with current best practices/research:

   As current externs, we enjoy having conversations with fellow students, professors, and preceptors on their clinic methodology and decision-making when diagnosing and treating patients. It is important to learn from as many perspectives as possible so we can implement our didactic studies into practice. Research is at the heart of clinical decision-making, and, as externs and students, we must stay on top of recent literature. It is likely that an extern might have other evidence-based research to present, making them a valuable partner in the clinical decision-making process while ensuring that current best practices are being followed.

2. Streamlining novel clinic protocol modifications:

   The first few times (or months) an extern might not be as efficient at completing certain tasks or may need some extra time (after all, this is a learning experience for us). However, with time, practice, and prompt supervisor feedback, we can become efficient and valuable additions to any clinical team. With strong communication and trusting relationships, both the extern and the preceptor have opportunities to learn from each other.

   Additionally, a benefit from working with a wide range of preceptors is that each clinician may work differently when accomplishing the same task. The extern has a unique opportunity to view many clinical techniques and apply the ones they think work best and most efficiently. Furthermore, the extern might be coming from a different region or academic program and therefore may introduce more novel techniques and procedures that are standard at their previous institutions but may not be standard at their current clinical rotation. Externs can also respectfully recommend alternative methods of performing certain tasks our preceptors may find useful. By doing so, we increase our independence while giving everyone an opportunity to learn from each other.

3. Productivity, efficiency, and supervisor stress:

   An additional value of training externs is that they can be an extra set of trained hands assisting in an appointment without having to pay the full salary of a second audiologist or hire/train an audiology assistant. For example, if a challenging patient with attention deficits comes into the clinic to have their hearing aid programmed, externs can assist in conditioning the patient and/or programming the device as needed. Moreover, the supervisor can focus on ensuring the family members understand pertinent information, rather than on modifying the child’s behavior. This can lead to a less stressful appointment for both the family and supervisor while improving the efficiency of the appointment. As externs, we can save time, reduce effort, and hopefully relieve some stress from the preceptor.

4. Keeping it in the black:

   The part that everyone is wondering about is the profitability of taking an extern. While there is no current research regarding a cost/benefit analysis of having an extern, there are some examples of how an extern provides clinical and monetary value to a practice. Depending on state laws, an extern may be able to perform non-billable or low reimbursement services such as seeing walk-in patients and reprogramming repaired aids. This will open up the preceptor’s schedule for more profitable services. A similar example would be for the extern to complete the hands-on portion of the vestibular assessment while the preceptor completes the reporting and charting of the appointment, thereby reducing the additional hours needed for administrative tasks.

   There are several AuD programs, such as the University of Kansas Medical Center, that mandate the reporting of extern productivity. This is done by having the student submit the procedure codes performed each month, along with each code’s Medicare reimbursement rate. While these reported reimbursement numbers do not take into account overhead expenses of the practice, publishing the results of extern productivity reports would create a more transparent environment and allow preceptors to more accurately ascertain the financial impact of hiring and compensating externs. While this does not directly affect the clinical externship site, it could potentially lead to an overall increase to the average yearly salary of an audiologist.

5. The prudent preceptor, pruners of the profession:

   Preceptors constantly shape the future of our profession by molding the next generation of audiologists. When a strong working relationship is established between the preceptor and student, more opportunities are available to forge lasting connections and collaborate on future projects. In this profession, we must make positive strides when serving our patients, advocate for our profession, and advance our scope of practice collectively. When preceptors and externs support each other effectively, they have a unique opportunity to increase the value of the profession and shape more valuable clinicians.

Of course, there are a variety of other benefits that externs bring; these are just a few of them. 

Kevin Kock is a fourth-year AuD student at the University of Iowa. Currently, he is in his externship year at Oregon Health and Science University in the LEND program. Kevin serves as the SAA Externship Subcommittee Chair and as NSSLHA’s VP for Finance. Clinically, Kevin is interested in collaborative care for pediatric and disabled populations, hearing conservation, community outreach, and legislative advocacy.  

Ethan Platt is an AuD student at the University of Kansas Medical Center currently in his fourth-year externship. He is externing at American Hearing + Audiology, a large private practice group in the Kansas City metro area. Ethan is an active member of the Kansas Speech and Hearing Association along with a member of the SAA Externship Subcommittee within the SAA Education Committee. Ethan’s primary interests include legislative advocacy, early intervention for pediatric populations, working on multidisciplinary teams, and translational research.