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We work with practice owners, ODs and MD’s every single day, and we see the same pattern play out again and again: a provider gives notice, a retirement comes sooner than expected, or the schedule is simply so full that patients are waiting weeks to be seen. Whatever the reason, a vacant OD or ophthalmologist position costs your practice more than most owners realize, and the clock starts the moment the need exists, not the moment you start searching.

Here is what we have learned from running these searches firsthand: what that cost actually looks like, what the warning signs are, and how to move forward with confidence.

Quick answer: A vacant OD position can cost a practice tens of thousands of dollars in lost production during a typical 3 to 5 month search, plus patient attrition, staff strain, and owner burnout that often cost more than the lost revenue itself. Ophthalmology vacancies cost more and take longer to fill, often 12 to 18 months. The practices that come out ahead are the ones that start the search before the pressure hits.

How Much Does a Vacant Position Actually Cost?

Here is what that looks like broken down by the day. For example, if an OD sees 15 patients a day at an average of $150 to $300 in revenue per visit, that is $2,250 to $4,500 in lost production for every single day the chair sits empty. Over a typical 3 to 5 month search to hire an associate OD, that adds up to well over $100,000 in lost production alone, before you count the hidden costs below.

Do the math with your own numbers. Every practice is different. To get a real number for your practice, use this simple formula:

(Average patients seen per day) × (average revenue per patient) = daily cost of the vacancy

Multiply that daily number by how many days you expect the role to stay open, and you have a realistic picture of what the vacancy will actually cost your practice, not just an industry average. Most owners are surprised by how quickly that number climbs once they run their own numbers instead of relying on a national benchmark.

For ophthalmology practices, a vacant surgical role carries even more weight. A single cataract procedure currently reimburses between roughly $460 and $715 depending on complexity, and most surgeons perform many procedures per week. Run the same formula using your average daily surgical volume and per-procedure reimbursement, and the number gets large fast. A subspecialist absence does not just slow down a schedule. It can shut off an entire revenue stream and referral pipeline that took years to build.

The Hidden Costs Nobody Talks About

Lost production gets the attention, but it is rarely the whole story.

Patient attrition. When patients cannot get timely appointments, they find someone who can. Losing even 10 to 15 percent of your patient base during a vacancy can take years to rebuild.

Owner burnout. Our recruiting team hears this constantly: the owner is working 60 to 70 hours a week trying to keep up, and it is not sustainable. Burnout in your lead provider is far more expensive than the cost of hiring.

Staff strain. Your team fields the calls, manages the backlog, and apologizes to patients. That takes a toll. Replacing a front desk or tech employee costs an estimated 50 to 75 percent of their annual salary once you account for recruiting, training, and lost productivity.

Overhead that does not stop. Rent, equipment leases, payroll, and insurance keep running whether or not your chair is filled.

Missed growth. Every month without a provider is a month you cannot accept new patients, expand your schedule, or build referral relationships.

Why the Search Takes Longer Than You Expect

You are competing against health systems, retail chains, and private equity groups for a shrinking candidate pool. Starting early is not a luxury. It is a real competitive advantage.

Typical timelines to know:

• Associate OD search: 3 to 5 months from launch to signed offer
• Ophthalmologist search: 12 to 18 months, especially for subspecialists

If you want to be positioned for those candidates, your search needs to be active well before those windows open.

Location changes everything about a search. Where your practice sits has a major effect on how long a search takes and how many qualified candidates you will see. Practices in major metro areas typically draw a larger and faster-moving candidate pool. Rural and underserved areas face a much steeper climb. If your practice is outside a major metro, plan for a longer search and lean harder into what makes your specific location and community a genuine draw, whether that is cost of living, quality of life, clinical autonomy, being closer to family, or being needed in a community that does not have many options.

5 Signs Your Practice Is Ready to Add an OD

Not every hire starts with a crisis. The practices that get the best outcomes are usually the ones that recognize the growth signals early. After running searches with hundreds of practices, here is the pattern we see most often, and how to honestly assess where you stand.

1. Your wait times are growing. New patient appointments 3 or more weeks out means you are losing patients before they ever walk in.

2. Your OD is at or near capacity.  If your provider is regularly working through lunch or staying late, you are at the wall.

3. Revenue has plateaued despite demand. If you are turning patients away because you do not have the chair time, your revenue ceiling is artificial. A second provider lifts it immediately.

4. You have the patient volume to keep a new hire busy. Before adding an OD, ask honestly: would they have a full schedule within 90 days? A provider who cannot build that quickly is a retention risk.

5. You have been thinking about it for a while. When “we need another provider” comes up in your team meetings regularly, your instincts are ahead of your spreadsheet. Trust them.

If You Are an Ophthalmology Practice, the Stakes Are Even Higher

Everything above applies to ophthalmology practices too, but the timelines are longer, the candidate pool is smaller, and the cost of getting it wrong is steeper. Here is what our team sees specifically in ophthalmology searches.

The recruiting timeline is 12 to 18 months, not 3 to 5. Ophthalmologists, especially subspecialists, are in extremely short supply, and most are not actively looking when the right opportunity comes along. If you need an ophthalmologist in a year, you need to start looking now.

Credentialing adds months after the contract is signed. Once an MD signs an employment agreement, licensing and credentialing typically take 3 to 6 months before they can see a single patient. That is time you cannot rush. It has to be built into your planning.

The hiring cycle has a window. Ophthalmology residents and fellows generally begin their search in the fall and start new positions around September. If you want access to that year’s candidates, your search needs to be active well before that window opens.

Integrated ODs are the engine that feeds your surgical pipeline. An estimated 70 to 75 percent of ophthalmology practices now have integrated optometrists. When that OD role goes vacant, it is not just routine care that suffers. It is the referral and co-management pipeline that drives surgical volume. An empty OD chair in an ophthalmology practice is a strategic problem, not just a scheduling one.

Recruiter Insight: A well-timed placement can save a subspecialty. One of our account executives recently placed an ophthalmologist who stepped in during an unexpected medical leave. The new provider kept the practice running and preserved a subspecialty that would have been lost entirely. That outcome was only possible because the search was already done. If they had started recruiting when the leave began, the damage would have been done long before a candidate walked through the door.

How to Run a Smooth Search

Most of what determines how quickly a search comes together, and how good the outcome is, comes down to timing and preparation.

Starting early gives you access to passive candidates. The best OD and ophthalmologist candidates are often not actively job hunting. They are happy where they are, but open to the right opportunity if it crosses their path at the right time. A practice searching under pressure is limited to whoever happens to be actively looking that month. A practice that starts early reaches the much larger pool of people who were not looking, but would have said yes.

Starting early does not mean hiring early. It just means having options when the right person appears. A search can run in the background while you evaluate timing, candidates, and fit on your own schedule. You stay in control the entire way. The goal is simply to be ready to move when the right person comes along, instead of starting from zero.

Responsive communication matters more than almost anything else. Top candidates are typically considering a few opportunities at once, and the practices that move with confidence tend to get their first choice. A good rule of thumb is to respond to any promising candidate profile within 48 hours and schedule an in-person visit within a week of that first conversation.

Know your numbers. None of this needs to be finalized, but having a sense of each one speeds up the process and helps the search land in a better place:

• Your current patient volume and how far out you are booked
• Your production numbers and what compensation structure they can support
• Whether you have the exam lane space and support staff to bring someone new on board
• The clinical skills and experience level the role requires (general OD, specialty contact lenses, ocular disease management, surgical co-management, subspecialty)
• Full-time or part-time, and what the day-to-day schedule would look like
• A general compensation range, benefits structure, and contract outline
• What makes your practice culture genuinely worth joining, not just the paycheck
• The ideal cultural fit for your team, and any non-negotiables versus flexible points

For ophthalmology searches specifically, factor in extra runway. Notice periods, credentialing, and licensing all add time after a contract is signed, so having these pieces ready matters even more when the total timeline stretches to 12 to 18 months.

What the Right Hire Actually Changes

The impact of adding the right OD or ophthalmologist goes well beyond having more appointment slots available.

A well-matched provider allows a practice to expand hours, keep more specialty and surgical care in-house, and consistently absorb new patient demand. That increased production creates room to invest in staff, equipment, and the overall patient experience. Growth builds on itself.

For the practice owner personally, the shift is often just as significant. Many owners describe feeling caught between the practice they have built and the life they want outside of it. A trusted provider changes that equation.

Ready to Find Your Ideal OD or Ophthalmologist?

You have built something worth protecting. The right provider does not just fill a chair. They protect your revenue, care for your patients, and open up whatever comes next, whether that means more flexibility now or a smoother transition down the road.

ETS Vision can run the entire search for you or work alongside your own efforts. It’s free to get started and no fee unless you hire someone we present. Reach out to talk through what your local market looks like and what a search could realistically produce for your practice.

The best searches start a little earlier than they need to. The second best time is right now.