Should You Do an Optometry Residency? Pros, Cons, and My Experience

Residency is one of the most debated steps in optometry after graduation. Do you really need it? Is it worth the financial sacrifice? What are the true pros and cons and how do you decide what’s right for you?

I’ve lived it. In this post, I’ll walk you through why you should or shouldn’t consider residency, unpack the controversial sides of the debate, and share what I learned from my own experience completing an optometric residency in ocular disease and primary care.

Why Consider an Optometry Residency?

Here’s the first thing to understand: a residency isn’t required to practice optometry. You can go straight into patient care after graduation. But a residency gives you something invaluable depth, confidence, and perspective.

Think of it as a one-year immersion that condenses five years of experience into twelve months. It gives you the chance to:

• Specialize in a niche like ocular disease, cornea and contact lenses, pediatrics, or binocular vision.

• Build confidence in high-acuity, high-volume clinical settings.

• Gain exposure to diverse environments, from VA hospitals to ophthalmology clinics.

• Teach or precept students in academia and explore that world firsthand.

• Open doors to future opportunities in speaking, consulting, and leadership.

If you want to enter practice with next-level clinical judgment, stronger case management skills, and more professional options, a residency can be an incredible investment.

The Drawbacks: Time, Money, and Opportunity Cost

Let’s be real: the number one con is delayed earning potential.

The pay gap between a resident and a new-grad optometrist can easily reach six figures and that’s before you factor in lost compound interest on student-loan payments or investments.

Other potential drawbacks include:

• Postponing real-world experience. You’re adding another year before stepping fully into private practice or ownership.

• Limited practice-management exposure. Most residencies don’t emphasize billing, coding, or the business side of eye care though I wish they did.

• Not essential for all paths. If you’re 100% sure you want to focus purely on general patient care and refer out advanced cases, residency may not add much value.

In short: residency costs time and money. You’ll make less, you’ll work hard, and you’ll need to justify that sacrifice through the experience, skill, and confidence you gain.

My Residency Journey: From Hesitation to Growth

During my fourth year at The Ohio State University College of Optometry, I wasn’t sure about doing a residency. My plan was to go straight into private practice.

Then one of my mentors, Dr. Joan Sears at the Salisbury VA Medical Center, told me something that stuck:

“If you skip residency, you might close off half of your professional opportunities.”

She was right. I realized I wanted to keep every door open, whether in clinical leadership, teaching, or consulting, and residency was the key to that.

After exploring programs, I interviewed at Bascom Palmer, SUNY College of Optometry, and the Illinois College of Optometry (ICO). I ultimately matched with ICO’s Primary Care and Ocular Disease Residency, a program with ten residents and incredible clinical variety.

Lessons from a Year at ICO

That year in Chicago was one of the most formative of my career.

I treated complex ocular disease on the South Side, served an underserved population, and learned from world-class faculty who challenged me daily. The program emphasized:

• Intensive clinical training with high-acuity disease management.

• On-call emergencies that sharpened my decision-making under pressure.

• Case presentations and posters that strengthened my clinical reasoning.

• Teaching experience with second-, third-, and fourth-year students — something I hadn’t expected to love, but did.

It wasn’t easy. Moving to a new city, starting fresh, and living on a resident’s salary came with growing pains. But the professional growth was exponential.

When I left ICO, I was confident diagnosing and managing complex ocular disease, comfortable teaching, and ready to serve patients at a higher level. That experience also helped me pass the North Carolina state boards and step into private practice with real momentum.

Is Residency Right for You?

There’s no one-size-fits-all answer. But here’s how I’d frame it:

Residency is worth it if you want to:

• Build next-level clinical confidence

• Keep doors open for academia, consulting, or specialty practice

• Learn from mentors in a high-volume, high-complexity setting

It may not be necessary if you:

• Want to focus solely on primary care and patient relationships

• Need to start earning quickly due to debt or family commitments

• Already feel confident and clear on your career direction

If you’re on the fence, make a pros and cons list, talk with mentors, and give yourself time to reflect or pray on it. You’ll know what feels right.

Final Thoughts

For me, residency was transformative. I came out feeling like I’d been shot out of a cannon, with five years of clinical experience packed into one. It shaped how I approach patient care, leadership, and mentorship today.

Whether you choose to do one or not, make the decision intentionally. Few who complete a residency regret it, and few who skip it do either. It’s all about alignment with your goals, values, and the life you want to build.

Residency is a chapter, not the whole book. But if you choose to write that chapter, make it count.