Third Year Site Concerns

[LeeAud]

I'm a third year, and I'm currently completing one of my third year externships at an ENT practice. There are four audiologists on staff, and the clinic stays very busy. That being said, we're typically so busy that I have been thrown into seeing patients by myself from day one. Now, I consider myself to have good clinical skills and patient interaction, and for the most part, I've felt competent enough to see patients on my own. However, there have been many instances where I did not feel comfortable seeing a particular patient by myself (difficult to test child, persistent malingerer, etc.). My supervisors always say, "We're always here to help" and "Don't hesitate to ask us for anything", but nine times out of ten, they're all busy in other rooms seeing other patients. And if they're not busy, they really are always happy to jump in and help out, although I do often get the feeling they think I should be able to do these things on my own by now. (I've actually been reprimanded by one of the physicians before for making a mistake on something, and while I know that the mistake was 100% my fault, there was no supervisor available to help at the time.) My question is, having looked over ASHA and AAA statements regarding supervision, is this appropriate? I like having the opportunity to work independently sometimes, but I still feel that I should be supervised much more than I actually am. Any thoughts? I'd love to know how other third years are supervised... Thanks in advance for any replies!

---

Members don't see this ad.

 

[TheEarDoc]

OK this is not right. IF by 3rd year you mean you are at an ENT office between the 2nd and 3rd year of your program, then no they should not be throwing you off on your own like this. If you mean you are on your 4th year externship then, I can see a lot of autonomy, but until I deemed a student's skill set to be on the level I desired, that student would not be flying solo.

They took you on to educate you, not use you as slave labor. The physician should know this. The audiologists should know this and you should be getting some hand holding in the beginning even if you have amazing above board clinical skills. If you are seeing medicare patients, then technically by ASHA standards your supervisor is supposed to be in the room with 100% supervision or they aren't supposed to be billing for the services you are providing (I know this does not happen in the real world, but that is the expectation!).

I would take this as a chance to be your own advocate. I would first try talking to your supervisors and explaining to them that you feel like you've been thrown in over your head and need a little bit of hand holding until you get your feet wet (every office runs differently, and for many students the 3rd year placement is often times vastly different than their university clinic placement and they take some time to adjust to the flow of the office). If they don't change then I would discuss this issue with your supervisor at your university (often times your clinic coordinator works as the go between between the university and your site) and just let them know this is going on.

Remember their agreement was to educate you, not use you as slave labor! I know some supervisors like the sink or swim method, but that's not always helpful to all students. We all learn differently.

Good luck!

 

[BellAuD]

Going off that question, as a 4th year extern is it legal to leave me at the practice to see patients if all audiologists are out for the afternoon? My guess is no but I do not know where to look to find the evidence to support this.

 

[TheEarDoc]

According to ASHA, no a supervisor must be on site. According to AAA I do not believe there is a hard and fast rule, but it's not a good idea to ever leave a student alone. You are not licensed.

Now if you're seeing medicare patients (which if you're at an ENT practice most likely you are) then if there is no supervisor on site giving at least 50% supervision then they are not supposed to be billing for the services you perform. IF they are billing for services you are performing without someone on site, then I believe it is fraud.

It's OK I've seen many ENT placements do this where they will pick up a 4th year and think they can just pay them a cheap wage and work them like an audiologist. I've even seen ENT's try and force AuD students in their 4th year to get their hearing aid dealer's license to try and bill for services that are unsupervised (even though a hearing aid dispenser cannot charge for a hearing evaluation so again the ENT would be engaging in fraudulent billing).

Now this is a sticky wicket for you as a student. You are a student and need to work with this office, but at the same time you aren't a licensed employee. They agreed when they took you that they would supervise you and teach you. Sounds like they are not holding up their end of the bargain.

Best way I would say to handle this would be talk to your program's clinical coordinator. Explain what is going on. They will know the ASHA and AAA and Medicare rules and then they can broach the subject for you (after all that's why you're still paying your tuition in your 4th year). They can step in and be an intermediary. You don't want to put yourself in a position where is ASHA ever checks your hours and no supervisor was present that they would revoke those clinical clock hours or if Medicare would step in and see you are having services billed that you are providing without the correct supervision.