How to hire an optometrist for an ophthalmology or OD-MD practice

Hiring an optometrist for an ophthalmology or OD-MD practice is a role-design exercise first and a recruiting exercise second. Decide which clinical functions the seat owns — primary eye care, perioperative care around your surgeons, or a medical optometry clinic — because the residency question, the pay plan and the scope checks all follow from that design. This page walks the five decisions in order.

You are recruiting into a minority setting. BLS counted the largest employers of optometrists in 2025 as offices of optometrists (61%), offices of physicians (14%), retail trade (13%), self-employed workers (5%) and outpatient care centers (4%) — the offices-of-physicians row is the one an ophthalmology practice sits in.

Build the seat around named functions rather than a generic associate label:

• Primary eye care. Comprehensive exams, refraction and contact lens care that absorb routine demand and keep your surgeons' lanes open for surgical and procedural schedules.
• Perioperative and co-management care. Where your group runs a co-management model, the OD seat can own the pre- and post-operative visit load around your surgical schedule, with escalation paths your surgeons define.
• Medical optometry. An ocular disease clinic your ODs staff — the glaucoma, dry eye and retina follow-up work that sits between routine care and surgery — inside whatever your state's scope rules allow.

Whichever functions you pick, budget the technician time that supports the seat along with the seat itself. In the BLS OEWS May 2025 industry row for offices of physicians (NAICS 621100, which includes ophthalmology practices), ophthalmic medical technicians (SOC 29-2057) earned a median of $47,200 a year; offices of optometrists is shown as a separate row.

One decision comes before all of it: whether you are hiring at all. An employed OD seat — a doctor on your schedule, in your EHR, building your panel — is a different build from a co-management relationship with independent ODs in your community, where surgical patients return to their own doctor for ongoing care. If what you need is capacity you control, hire; if what you need is referral flow, that is a network project rather than a seat.

What the work looks like from the OD's chair is the career side's question, not this page's — our medical optometrist careers hub covers the role itself. The rest of this page stays on the employer side.

The first fork in medical-side hiring is training depth. A residency is a structured clinical training year after the OD degree — BLS describes the path as a 4-year O.D. with an optional 1-year residency — and residency positions are allocated through the Optometry Residency Match (ORMatch), run for ASCO by National Matching Services. Residency training and state licensure are separate things — the license check later in this page applies to every candidate either way.

The pipeline is small and knowable. In the 2026 ORMatch for positions beginning that year, 283 programs at 271 sites offered 518 positions; 455 applicants participated and 356 matched — 78% of participants — leaving 162 positions (31%) unfilled in the Match. Unfilled positions can be filled in the post-match process, so more residents start each year than the Match alone shows.

For your hiring math, a hard residency requirement narrows the candidate pool to ODs who have completed a residency. Each year's incoming residency class is small: 356 matched through ORMatch for positions beginning in 2026, plus the residents placed after the Match. Write the requirement only when the seat's design genuinely calls for it, and treat it as a preference everywhere else.

What residency adds for an MD practice depends on where the residency ran. Ask each residency-trained candidate which setting their program sat in and how its patient mix compares to the seat you designed, then score that against the functions in your role document. For seats centered on primary eye care and perioperative visits, experienced general ODs are strong candidates; for a medical-clinic-heavy seat, residency depth may justify the narrower pool.

However you draw the line, keep the license verification identical for both groups — confirm the license in your state board's lookup before the offer. The residency question never replaces the license check.

Residency programs are a direct channel for residency-trained candidates. The 2026 Match's 271 participating sites are a working contact list: ask each program's residency coordinator whether they pass employer openings to graduating residents. Don't set the timeline from memory or from another recruiter's calendar — check ORMatch's current cycle dates directly.

Start the pipeline earlier than graduation, too. In ASCO's 2024-25 externship survey, U.S. member schools reported 931 affiliated private-practice externship sites with 2,054 externships completed — the largest setting, ahead of the VA's 422 sites and co-management centers' 293. An ophthalmology practice that hosts students on externship gets an extended audition with externs before you ever post the seat. Each externship runs on an executed agreement between the OD program and the host site — ACOE Standard 2.24 requires one — so contact the clinical education office at the programs near you about affiliations.

Work the association and community channels alongside the programs. Ask your own ODs and your surgeons which meetings, study clubs and job boards they actually read. For medical-side optometrists that check-list should include the American Academy of Optometry (AAO) and your state optometric association — then post and show up where the answer points. Confirm each body's current job-board and meeting details directly: our research did not verify pricing, dates or reach for individual boards, so treat every channel as a test.

Then post the seat where candidates already look: see the medical optometrist listings candidates see, and write a posting that names the setting, the surgeon support, the schedule and the pay range — our job posting guide covers the anatomy. If a hard-to-fill seat justifies a search firm, our recruiters and staffing agencies guide covers the working relationship, and our where to post optometry jobs guide compares the boards.

Anchor pay in federal data before you design anything. In the BLS OEWS May 2025 release, the median wage for optometrists (SOC 29-1041) was $145,630 in offices of physicians — the industry row that includes ophthalmology practices — and $129,250 in offices of optometrists; the same release shows outpatient care centers at $207,030. Every one of those figures covers wage-and-salary ODs only: practice owners and sublease ODs are excluded from the series, so the medians are employee benchmarks and not owners' incomes.

Then choose the structure: salary, base plus production, or production-heavy. What the MD setting changes is the mix in the OD's book, where routine refraction sits next to medically billed visits, so define the production metric precisely (which visit types count, on which revenue) before the offer rather than after the first pay dispute. The design questions — metric, rate, guarantees during ramp, floors and ceilings — are covered in our compensation plans guide. Our research found no verified benchmark for production percentages or sign-on bonuses, so treat both as negotiated terms set from your own market.

Recruit with the debt picture in mind. ASCO's Annual Student Data Report 2025-26 puts the average educational indebtedness of 2024-25 OD graduates with debt at $209,280 — graduate and professional debt only — and 78.6% of the 1,340 graduates reported having debt. Employer student-loan help is a live lever: employers can exclude up to $5,250 a year of educational assistance from an employee's income, and P.L. 119-21 permanently extended that exclusion to employer payments of student loans made after 2025 (IRS Pub. 15-B, 2026). Confirm the mechanics with your tax preparer before you promise a figure.

Price the workload along with the wage. A 2025 survey of optometrists found burnout highest in hospital-based (62.5%), integrated care (62.4%) and ophthalmology-department (61.1%) settings, and lowest in private practice — solo 49.6%, large private 48.7% — while commercial settings landed at 54.9%. The survey's subgroups are small, so read it as descriptive rather than definitive — but it argues for designing the seat with realistic templates, technician support and schedule control instead of assuming the paycheck alone retains a medical-side OD.

Verify the license before the offer, not after the start date. Confirm the candidate holds a current license in your state through your state board of optometry's own lookup, and treat every credential claim on the resume — therapeutic certification, glaucoma coverage, procedure experience — as something the board's record confirms rather than the resume. A candidate's scope from a previous state tells you what they were permitted there — it is not permission in your state, so start from your own board's record, not the other state's.

Second, map scope to the seat. What an optometrist may do — the drugs they may prescribe, the procedures they may perform — is set by your state's statute and board rules, differs from state to state, and changes as new scope laws pass, sometimes taking effect years later. Write the seat's clinical functions down, check each one against your own state's current rules, and confirm with your state board of optometry before the posting goes live.

Third, write the supervision map before day one: which doctor answers which clinical questions, what escalates to your surgeons and on what timeline, and what the OD may delegate to your technicians. Delegation is itself a state-law question — our state delegation rules guide collects what we have verified so far — so confirm your state's boundaries with the board rather than importing another practice's chart.

Fourth, paper the relationship. Employee or contractor is a classification question with tax consequences, so decide it deliberately rather than by default. Payer enrollment runs on its own clock for each plan, so start Medicare and vision-plan credentialing early and build the wait into the ramp — our insurance credentialing guide covers the steps. Restrictive covenants are a state-law question now that the FTC removed its Non-Compete Rule in February 2026; our non-compete agreements guide covers the employer side. Have a healthcare attorney review the contract, the covenants and the practice structure before the candidate signs anything.

This page is employer information, not medical, clinical, licensing, billing, coding or legal advice. Scope of practice, delegation and licensure are set state by state — confirm requirements with your state board of optometry, and take contract, classification and practice-structure questions to a healthcare attorney.

For the employer-side guides beyond this role — job descriptions, interview questions, compliance, staffing levels — start from hiring for your optometry practice.