In this op-ed, the authors share their perspective that because VA audiologists manage high patient volumes, diverse clinical needs and limited appointment time, hearing aid platforms must support efficient care without compromising individualized outcomes.
By Sheena Burks, AuD, chief clinical officer, WSA and Eric Branda, AuD, PhD, head of audiology & research, WSA
There is a certain rhythm to VA audiology that is difficult to appreciate from the outside.
The schedule is full. The waiting room is rarely empty. One veteran may be managing long-term noise-induced hearing loss after decades of service. Another may be dealing with tinnitus, sound sensitivity or the effects of blast exposure. Another may still be working, traveling, using multiple connected devices—and looking for a hearing aid that does not make them feel older than they are.
The work is deeply personal, but it happens inside a system built around volume, documentation, productivity metrics, and access.
That tension defines much of modern VA audiology. Audiologists are expected to deliver individualized care to a patient population with wide-ranging needs, while moving through a clinical day that leaves very little margin for inefficiency.
Research shows that administrative burden and time constraints are the top stressors and burnout factors for audiologists.1,2 This holds across practice settings but is especially acute in the VA environment.
The ramifications of a delayed order, a device that needs to be swapped, or a fitting that requires more fine-tuning than expected extend far beyond a single appointment. They affect the schedule behind it.
In a private practice, that kind of disruption may be frustrating. In a VA clinic, it can become a capacity problem with real consequences. A veteran who traveled a significant distance for an appointment may now wait weeks or months to be rescheduled—delaying treatment, adding administrative burden to the audiologist’s workload, and consuming time and resources across the system.
Technology Has to Fit the Clinic, Not the Other Way Around
Conversations about hearing technology in the VA setting should not start and end with features. Features matter, of course. But the more important question is how well a technology fits into the realities of care delivery.
Does it support a strong first fit? Does it reduce unnecessary follow-ups? Does it allow the audiologist to treat different patient profiles without constantly switching systems or fitting approaches? Does it perform where veterans actually struggle to hear?
Every added step in the process matters when schedules are full. VA audiologists are highly skilled at working across technologies and patient needs. But a familiar fitting environment, consistent feature set, and broad range of form factors can help make the clinical day more efficient without narrowing clinical options.
That is where platform consistency becomes important. Not because VA audiologists need fewer choices, but because the best platform is one that gives them both: the performance needed to support better hearing in real-world environments, and the form factor options needed to make that technology practical for each patient’s life.
When audiologists can stay within a familiar fitting environment while still accessing a broad range of form factors and treatment options—from tinnitus support and CROS to SCIF-compatible devices, instant-fit styles from RICs to earbuds, and custom options—the decision can stay focused on the patient rather than the process.
Form factor is a good example. It is sometimes treated as a matter of preference, but in practice, it can be clinical, functional, and emotional all at once. A patient may prefer the discretion of a custom device, but dexterity challenges, arthritis, or reduced sensation in the fingers may make a traditional custom device difficult to manage. In that case, an instant-fit or earbud-style solution may better balance usability, comfort ,and performance.
This also matters for common clinical needs across the veteran population. Tinnitus, single-sided deafness, speech-in-noise difficulty, cosmetic concerns, connectivity needs, and security requirements do not appear in neat, predictable combinations. The clinical requirements rarely fit a single category—which is exactly what the platform underneath it has to account for.
The Cost of an Unnecessary Follow-Up Is Higher in High-Volume Care
Follow-up care is essential when it is clinically necessary. But avoidable follow-ups are different.
In the VA, where schedules are often booked far in advance, a follow-up created by a preventable fitting issue has an outsized impact. It consumes time that could otherwise be used to support a new evaluation or a first fitting, and it can extend the patient’s path to a solution—especially if the issue requires rescheduling, reordering, or refitting a device.
This is why the first fitting carries so much weight.
A hearing aid that fits well, requires limited fine-tuning, and gives the patient appropriate tools to manage routine listening preferences can help reduce friction after the appointment. Patient-facing apps and support tools do not replace the audiologist’s role. They help patients handle simple adjustments on their own, so the clinic’s time can be preserved for care that requires clinical expertise.
Instant-fit devices are often great solutions for these reasons. Custom hearing aids can be an excellent option, but the process can introduce time: impressions, ordering, manufacturing, fitting, and, occasionally, remakes. If a shell does not fit properly or a patient has to be rescheduled, the impact is not isolated. It takes another appointment slot in a system where appointment slots are limited.
This is where clinically practical design matters. For example, Signia’s Silk IX is an instant-fit solution that has been commercially available through multiple generations, with 9 out of 10 patients fit with the device finding it comfortable. This gives audiologists another way to address discretion, comfort ,and speed within the fitting process. That kind of flexibility is especially relevant in a setting where avoiding unnecessary delays can help preserve access for the next patient on the schedule.
Real-World Performance Still Has to Be the Standard
Efficiency only matters if outcomes hold up outside the clinic. For many veterans, the hardest listening situations are not quiet, one-on-one conversations. They are noisy, layered, and unpredictable: a family dinner, a group conversation, or a crowded community event.
Speech understanding in noise remains one of the most persistent challenges in hearing care, and it is often the reason patients seek help in the first place. A hearing aid that performs well in a controlled environment but falls short in a group conversation has not solved the patient’s real problem.
Platforms like Signia Integrated Xperience were developed with precisely this in mind—bringing real-world conversation performance together with a portfolio broad enough to meet different patient needs within a single, familiar clinical workflow. That includes solutions designed to support speech understanding in multi-talker situations, as well as directional designs that help address noise challenges across different form factors, including smaller in-the-ear styles.
The value is not in any one device. It is in giving audiologists a consistent, well-validated platform that does not force a tradeoff between the right form factor and the right technology. For VA audiologists, that means they can consider the design that makes sense for a patient’s life while still relying on performance designed for the listening environments where veterans often need the most support.
The Standard Should Match the Setting
Veterans are not a uniform patient population, and VA audiology is not a standard clinical environment. The bar for hearing technology in this setting should be set by its realities: the patient volumes, the diversity of clinical need, the compressed schedules, and the real-world listening environments where hearing difficulty actually shows up.
The audiologists working in this system already know what the job demands. The question is whether the technology they’re working with is built to match it.
About the Authors
Sheena Burks, AuD, is chief clinical officer at WSA. Eric Branda, AuD, PhD, is head of audiology & Research at WSA.
References
1. Emanuel DC. Occupational Stress in U.S. Audiologists. Am J Audiol. 2021;30(4):1010-1022. doi:10.1044/2021_AJA-20-00211
2. Zimmer M, Emanuel DC, Reed NS. Burnout in U.S. Audiologists. J Am Acad Audiol. 2022;33(1):36-44. doi:10.1055/s-0041-1735253
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