What do we lose if we do not value residencies?

Recent trends suggest that residency programs face significant challenges. Image credit: AdobeStock/HISTOCK

Editor’s note: This article was written with the assistance of artificial intelligence.

Optometric residencies are at a crossroads. As the profession continues to evolve with new advancements, expanded scopes of practice, and an increasing number of optometry schools, the role of residencies in shaping the future of optometric practice cannot be overstated. However, recent trends suggest that residency programs face significant challenges, including shifting application trends and increasing concerns about financial viability of the additional year of training for graduates. If residencies are undervalued or overlooked, the optometric profession may suffer in ways that extend beyond individual career choices.

Defining an optometric residency

Before discussing the challenges facing optometric residencies, we must define what a residency entails. According to the Accreditation Council on Optometric Education, optometric residencies are “post-doctoral, educational programs centered on clinical training that result in the resident’s attainment of advanced competencies in eye, vision, and health care.”¹

Residency programs provide:

1. Independent management of complex clinical cases, leading to advanced competencies in a focused area of optometry
2. Multidisciplinary care and interprofessional skills
3. Research and analysis of scientific information, along with didactic and scholarly activities
4. Supervision and mentorship by experienced optometrists¹

There are 5 broad categories of residencies with 16 areas of emphasis, allowing graduates to specialize in specific fields, from ocular disease to pediatric optometry.²

The current state of affairs

Application trends

A review of Optometry Residency Match data from 2015 to 2024 reveals an interesting trend: Although the number of applicants has fluctuated (ranging from 449 to 602 applicants per cycle), the number of residency positions has steadily increased from 411 in 2015 to 526 in 2023.³ Historically, there were more applicants than available residency slots, but in 2022, the trend shifted, and now the number of positions and applicants is nearly equal (Figure).³

Figure. Residency Applicants and Positions From 2015-2024³

^aApplication cycle year refers to academic year (eg, 2015 is academic year 2014-2015).

(Figure adapted from statistics provided by Optometry Residency Match)

Considering the growth of optometry schools and the number of new graduates, one would expect the applicant pool to expand. However, this has not been the case, raising questions about why more students are not pursuing residency training.

Residency category trends

There are notable trends in residency preferences. Ocular disease residencies remain the most available, yet cornea and contact lens residencies are most frequently ranked by applicants.³ This discrepancy suggests that students are gravitating toward specific specialties, perhaps due to job market demand, perceived career benefits, or personal interest.

Why are more graduates not choosing residencies?

According to results from surveys conducted among third-year students by the Association of Schools and Colleges of Optometry in the 2022-2023 and 2023-2024 academic years, students who opt out of residency training cite several reasons:

• Immediate employment: Many students receive job offers or prefer to enter the workforce immediately upon graduation, commonly citing financial reasons for this choice.
• Financial concerns: The relatively low pay of a residency year, combined with student loan debt, is a significant deterrent.
• Lack of interest in specialization: Some students prefer general optometry and do not see residency training as necessary for their career goals.
• Education fatigue: After years of rigorous training, some students are experiencing burnout and do not wish to continue formal education.
• Geographical limitations: Some students are restricted by location and cannot find a residency in their location of interest, although this was less commonly cited.^4,5

Conversely, those who choose to pursue a residency program often do so for reasons such as:

1. Specialized training: Many students express a strong interest in further specialization and advanced training, believing that a residency will provide essential skills and knowledge that are not obtainable through other modes of practice.
2. Career advancement and enhanced competitiveness: Many students believe that completing a residency can lead to better career opportunities, indicating that residency is viewed as a stepping stone to advanced career paths in competitive job markets.
3. Building mentorship and networking relationships: Students express interest in working alongside mentors and supervisors, who provide valuable learning experiences, as well as networking opportunities, which may enhance their professional connections and future job prospects.
4. Preparing for careers in academia or specialized practice: Some students are motivated by long-term goals that include academic careers, where a residency might be viewed as essential for teaching positions or specialized clinical roles.^4,5

The impact of lower NBEO pass rates

Another trend that may correlate with residency decisions declining is National Board of Examiners in Optometry (NBEO) pass rates. Recent years have seen lower pass rates, particularly in Part I Applied Basic Science.⁶ Although there is no direct evidence linking board examination performance with residency participation, one could speculate that struggling students may be hesitant to pursue additional training. This could be a contributing factor to student burnout and a lack of interest in continued educational opportunities or a choice to focus on board examinations to achieve licensure rather than advanced training.

Why residencies matter more than ever

The importance of residency training is increasing due to several factors:

1. Scope of practice expansion: Many states are pushing for broader treatment capabilities for optometrists. Residency training enhances clinical competence through exposure to complex clinical cases and advanced procedures, preparing practitioners for these expanded roles.
2. Faculty recruitment: With 25 optometry schools in the US and 3 more schools on the way, the need for qualified faculty is greater than ever. Many academic institutions prefer or require residency-trained faculty members due to their advanced clinical competency, as well as experience with didactic and scholarly activities.
3. Career development in specialized settings: Certain career paths, such as working in US Department of Veterans Affairs hospitals, academic medical centers, or academia, often require residency training as a prerequisite.

In each of the prior examples, residencies are uniquely poised to prepare optometrists to be leaders for the profession, particularly as it pertains to advanced clinical competencies.

The call to action: Valuing residency training

The optometric community must recognize and actively promote the value of residency training while also respecting individual career choices. Here are key actions that can help maintain and strengthen residency programs:

1. Promote the long-term benefits: Although a residency year may seem like a short-term sacrifice, the long-term career benefits often outweigh the initial financial and time investment. Development of advanced clinical competency allows for enhanced patient care as well as access to unique employment opportunities.⁷
2. Correct misinformation: Residency training is not equivalent to simply working under a seasoned mentor in private practice. The structured, rigorous nature of a residency offers unparalleled clinical exposure and academic growth. Additionally, the scholarly work of a residency is specific and unique to these programs, offering an enhanced experience to this extra year of training.
3. Respect individual decisions: Optometrists who choose not to pursue residency have legitimate reasons, including but not limited to financial constraints and personal career goals. Encouraging residency training should not come at the expense of shaming those who opt for direct employment.

As optometry continues to grow and evolve, the role of residencies in shaping the future of the profession remains critical. By fostering an environment that both values and supports residency training while acknowledging the challenges graduates face, the profession can ensure that residency programs remain a vital asset for generations to come.

References

1. Accreditation resources and directories of programs. American Optometric Association. Accessed April 3, 2025. https://www.aoa.org/education/accreditation-council-on-optometric-education/accreditation-resources-and-directories-of-programs

2. ASCO residency titles and descriptions. Association of Schools and Colleges of Optometry. Accessed April 3, 2025. https://optometriceducation.org/current-students/residency-programs/asco-residency-titles-and-descriptions/

3. ORMatch statistics. National Matching Services Inc. Accessed April 3, 2025. https://natmatch.com/ormatch/statistics.html

4. Association of Schools and Colleges of Optometry (ASCO). Third-Year Student Residency Survey Report 2022-2023. Association of Schools and Colleges of Optometry, June 2023.

5. Association of Schools and Colleges of Optometry (ASCO). Third-Year Student Residency Survey Report 2023-2024. Association of Schools and Colleges of Optometry, June 2024.

6. National Board of Examiners in Optometry Yearly Performance Report. Association of Schools and Colleges of Optometry. January 6, 2025. Accessed April 3, 2025. https://optometriceducation.org/news/national-board-of-examiners-in-optometry-yearly-performance-report/

7. Quinn N, Keppol S, Bligdon S, Lyons S. Impact of optometric residency training on future career paths: a survey of perceptions of optometry students, residents and alumni. Optom Educ. 2015;40(2):94-103.