How to hire a fill-in optometrist: what to look for, where to find candidates and what to offer

Fill-in bookings are coverage, not growth hires: your own vacation or continuing-education days, a medical or parental leave, the gap between an associate leaving and a replacement starting, or a run of exam days your current schedule cannot absorb. The need has edges — defined dates and a known end — and that is what separates fill-in work from a permanent seat.

A second use is testing a relationship before a longer commitment. If you want to see an OD work before booking a multi-week stretch, pay for the trial day. Under the FLSA regulations, work that is not requested but 'suffered or permitted' is work time (29 CFR 785.11) — for an employer covered by the FLSA, the rule that makes an unpaid trial day risky.

Know when the answer is not a fill-in. If demand is steady every week and the schedule stays full after the coverage ends, a per-diem patch never closes, and the honest move is a permanent hire — our hub covers hiring for your optometry practice more broadly, from associates to staff.

The labels travel together. Per diem, locum and fill-in all describe short-term clinical coverage; CMS's own manual once called its substitute-physician provision the 'locum tenens' rules, and practices and ODs use the terms for one another's arrangements. What matters is the schedule and terms you negotiate, not the word in the posting.

If you have not hired one before, the career-side guide to what a fill-in optometrist does describes the work and how ODs structure fill-in arrangements.

Start close to home. Neighboring practice owners who trade coverage, recent retirees who still hold an active license, and associates at corporate or OD-MD practices who want extra days are natural first calls for a defined block of dates. Your state association's classifieds and local OD study clubs reach the same circle.

Then post the dates. A per-diem listing with the dates, hours, exam mix and pay reaches ODs actively looking for fill-in work, and the fill-in optometrist job listings are where such a posting runs. Our guide to where to post the job compares the boards.

One posting rule to check before the ad goes live: pay disclosure. Washington requires employers with 15 or more employees to disclose the wage scale or salary range and a general description of benefits in each job posting (RCW 49.58.110, effective January 1, 2023). Washington's is the only pay-disclosure law our research verified, so check whether the state or city where you post has its own rule.

Staffing firms and booking platforms place locum ODs and may handle part of the paperwork for a fee. Our research did not verify typical agency fees, so ask any firm to quote its fee in writing and to state exactly what it covers — the OD's malpractice coverage, travel and billing support can each sit on either side of the invoice.

Whatever the channel, check the same three things before you book. First, the license. There is no national optometry license: each of the 51 U.S. jurisdictions sets its own requirements. Verify the OD's license in your own state board's lookup rather than taking a resume's word for it.

Second, federal exclusion status. No Medicare or other federal program payment is made for items or services furnished, ordered or prescribed by an excluded individual, and the prohibition extends to anyone who employs or contracts with them. OIG says no statute or regulation requires checking its LEIE list, but strongly recommends a check before hiring or contracting and periodically afterwards; because the list updates monthly, OIG says monthly screening best minimizes risk.

Third, malpractice history. The NPDB lets a private group practice query directly only if it qualifies as a health care entity — one that provides health care services and follows a formal peer review process; an OD can always run a self-query and share the report with you. Ask for a current one alongside the license and exclusion checks.

Start with the honest part: our research found no verified benchmark for fill-in OD daily rates. Treat any figure you hear as one arrangement's quote rather than a market constant, and set your number by negotiation and market survey.

Define what the day includes before you compare quotes. Four details move the number:

• Length of the booking. A single day prices differently than a multi-week block.
• Shape of the day. Hours, expected exam volume, and the mix of routine and medical work.
• Travel. Who covers distance, lodging and time on the road.
• Extras. Which side carries malpractice coverage, a technician, and billing support for the day's claims.

Pick a structure and say it plainly: a flat day rate, an hourly rate, or a half-day minimum for short blocks. The structure interacts with how the OD is classified — contractor or employee — which this page covers below, so agree on both in writing along with the cancellation terms.

To land in a defensible range, ask the market directly: neighboring owners what they pay for coverage, the ODs you approach what they charge, and two or three staffing firms for all-in quotes. Our career-side guide to fill-in optometrist pay covers how per diem rates are set from the OD's side — the other half of the same negotiation.

Whether the fill-in's exams run through your enrollments or the OD's own decides who bills, who is paid, and which credentials the day requires. Settle it before the date: billing and credentialing choices are hard to reconstruct after the patients leave.

Medicare recognizes a fee-for-time structure, formerly called locum tenens. Under the Medicare Claims Processing Manual (chapter 1, section 30.2.11), a regular physician who is unavailable may bill for a substitute paid per diem or similar, for no more than a continuous 60 days (except military call-up), using HCPCS modifier Q6 for the substitute's services.

CMS's definitions treat optometrists as physicians for covered services (42 CFR 410.20(b)(4)), so the provision applies to fill-in ODs by inference. The manual is nonetheless written around physicians, so confirm the arrangement with your Medicare administrative contractor before the first claim goes out.

The alternative is for the fill-in to bill under their own Medicare enrollment. Under 42 CFR 424.520(d) and 424.521, a newly enrolling physician's — including an optometrist's — billing privileges start on the later of the date an approved enrollment application was filed or the date they first furnish services at a new location. Retroactive billing of up to 30 days is available where circumstances prevented earlier enrollment. If the OD is not enrolled at all, that lead time alone can decide which structure works for your dates.

Vision plans are credential-by-credential, and their requirements are the OD's to meet. VSP, for example, requires optometrists on its network to be TPA (therapeutic) certified, with exceptions applicable to Texas and Puerto Rico, and requires all network doctors to register with CAQH. VSP also requires each doctor to have an NPI, to be a Medicare provider or in the process of enrolling, and to individually carry professional liability insurance of at least $1,000,000 per occurrence and $3,000,000 aggregate — limits may vary by state.

What those requirements do not tell you is timing. Our research did not verify credentialing turnaround times for VSP, EyeMed or commercial payers, so ask each plan how long adding a doctor takes and build the answer into your booking lead time. Your provider agreement and each plan's rules decide whether a per-diem doctor can see your plan patients and how; confirm both with the plan before the day. The mechanics are covered in our optometry insurance credentialing guide.

Settle malpractice in writing before the day: whose policy responds if a patient is harmed during the fill-in's work. Plans set minimums — VSP requires each network doctor to individually carry professional liability coverage of at least $1,000,000 per occurrence and $3,000,000 aggregate, with limits that may vary by state. A plan minimum does not, though, allocate responsibility between your policy and the OD's.

Ask your carrier or agent how your policy treats a per-diem OD, as an employee or as a contractor, and ask the OD for a certificate of insurance showing the coverage they carry. Our research found no verifiable benchmark for optometry malpractice premiums, so price any gap you find from quotes, not published averages.

Put the arrangement in a written agreement even for a single day. The clauses that earn their keep: dates and hours; the rate and what it includes; cancellation and notice terms; who bills which payers and under whose NPI; chart access and documentation expectations; who owns the records; confidentiality; and how a patient complaint is handled.

How you pay the fill-in matters as much as how much. For federal tax purposes the IRS classifies workers with the common-law control test, grouping the evidence into behavioral control, financial control and the type of relationship. Classification is fact-specific rather than something a job title settles, so confirm the structure with a healthcare attorney or tax adviser before you pay a fill-in on a 1099.

The wage-hour side is in motion. On May 1, 2025, the DOL Wage and Hour Division said it will no longer apply its 2024 independent-contractor rule in FLSA investigations. It will instead use Fact Sheet #13 (July 2008) and Opinion Letter FLSA2019-6, while the 2024 rule still applies in private lawsuits until further action. On February 26, 2026, the DOL proposed rescinding the 2024 rule and replacing it with an economic-reality test built on two core factors: control over the work, and opportunity for profit or loss. As of the DOL page read October 12, 2026, that replacement was still a proposal, so check for a final rule before relying on either analysis.

Restrictive covenants can surface too, especially with an OD who practices nearby. Work from current law: the FTC published a Federal Register notice removing its Non-Compete Rule in February 2026, so whether a non-compete or non-solicitation clause can be enforced is a state-law question, and the answer differs by state. Have counsel review any clause you expect to rely on — and if the OD carries obligations to another practice, that is theirs to resolve with their own counsel before the dates are booked.

A fill-in day succeeds or fails on the prep you do the week before. Collect the paperwork first: the signed agreement, the license you verified in the board lookup, the OD's NPI, a W-9 if they are paid as a contractor, a certificate of insurance, and signed confidentiality acknowledgments for your practice's policies.

Set up the systems side. Give the fill-in their own EHR login with the access level the day needs, load the exam templates and order sets for the visit types on their schedule, and walk them through your documentation standard once so claims leave the building complete.

Brief the team. Tell your technicians which pre-testing tasks the fill-in expects, how clinical questions route when the OD wants a second opinion, and who makes gatekeeping calls while you are out. A five-minute huddle the morning of the first day keeps the whole schedule from drifting.

Front-desk work does not pause for a fill-in. Run eligibility and plan verification on the day's schedule as usual, hand over the recall list and any special instructions — dilated patients, contact lens trainings, interpreter needs — and make sure the optical knows who authorizes orders while the usual doctor is away.

Close the day with a written handover: what was seen, what needs follow-up, which patients to rebook, and anything left unresolved. If the arrangement worked, say so and book the next block before the OD's calendar fills — rebooking an OD who already knows your flow is the easiest coverage you will arrange.

This page is employer information, not medical, clinical, licensing, billing, coding or legal advice. Scope of practice and licensure are set state by state; confirm requirements with your state's optometry board, Medicare questions with CMS or your Medicare administrative contractor, plan questions with each payer, and contract, classification and non-compete questions with a healthcare attorney.