The Real Reasons Ophthalmologists Decline Job Offers
Every year, outstanding ophthalmology practices lose exceptional candidates.
Sometimes it’s a comprehensive ophthalmologist. Sometimes it’s a hard to find retina surgeon, glaucoma specialist, cornea fellow, or perhaps a pediatric ophthalmologist. The practice has an excellent reputation, modern technology, competitive compensation, talented physicians, and genuinely good people.
Yet the candidate politely declines the offer.
After recruiting ophthalmologists nationwide since 2009, we’ve learned something that often surprises practice owners.
Great candidates rarely turn down great opportunities because of one major issue. More often, several small concerns quietly add up until another opportunity simply feels like the better fit.
The good news? Many of these situations are preventable.
Before we dive in, it’s worth saying something important.
Most Practices Don’t Lose Candidates Because They’re Doing Something Wrong
One of the biggest misconceptions in physician recruiting is that when a candidate declines an offer, something must have gone wrong.
In our experience, that’s usually not true.
Many of the practices we’ve worked with over the past 17 years are outstanding organizations with solid reputations, caring physicians, dedicated staff, and good opportunities.
Sometimes another role is simply a slightly better fit. Perhaps a candidate’s spouse falls in love with another community or receives an outstanding career opportunity elsewhere. Sometimes timing works against everyone.
The purpose of this article is to share what we’ve learned after thousands of conversations with ophthalmologists and hundreds of successful placements. Our hope is that recognizing these small details will help your practice recruit ophthalmologists more effectively and avoid losing outstanding candidates for reasons that are often preventable.
1. It’s Usually Not Just About the Money
Compensation matters.
That’s simply human nature. We all want to feel that we’re being compensated fairly for the value, skills, and experience we bring. That’s why it’s important for practices to understand today’s market—including competitive salaries, relocation assistance, sign-on bonuses, productivity incentives, PTO, and other benefits that candidates expect.
While it’s true that for a small percentage of ophthalmologists, income is the primary reason they’re considering a career move, but for the majority of physicians we speak with, compensation is only one piece of a much larger decision.
Every physician deserves a competitive, market-based compensation package that reflects years of education, training, and the responsibility of caring for patients.
Beyond that, candidates are asking themselves questions like:
- Will I enjoy working with these partners?
- Will I receive mentorship if I need it?
- Is there room to grow professionally?
- Is the partnership opportunity genuine?
- Will I have the autonomy I’m looking for?
- Can I see myself and my family building a life here?
- They have a strong need today, but what does the future look like here?
A practice offering the highest salary doesn’t always win.
Many ophthalmologists are searching for something much bigger and more meaningful than next year’s paycheck.
They’re searching for belonging. They want to make a meaningful contribution and become part of an organization they genuinely believe in.
2. Slow Hiring Creates Doubt
One of the most common reasons practices lose excellent candidates has nothing to do with compensation.
It’s time.
In today’s highly competitive ophthalmology recruiting market, practices need to be organized, communicate consistently, and move efficiently when they find an outstanding candidate.
The strongest candidates are often interviewing with several practices at once. While one practice is coordinating schedules, waiting for a monthly board meeting, or trying to get everyone together, another practice may already be preparing a Letter of Intent.
I was recently working with an ophthalmology practice in the Midwest. The candidate and his wife were excited about the opportunity because they wanted to settle in that region long term. The practice liked the candidate but was slow to move forward. They planned to schedule a virtual meeting with all of the partners. One week became two. Two weeks became a month etc.. Communication halted.
Eventually the candidate told me, “I don’t think they really need me.”
He withdrew from consideration and is now interviewing with competing practices in the same area.
The practice didn’t lose him because of compensation.
They lost him because momentum—and confidence—quickly evaporated.
Candidates often tell us things like:
“I thought the visit went really well, but it’s been three weeks and I still haven’t heard anything. Maybe they’re just not that excited about me- Maybe they don’t really need my skillset.”
Whether that’s true or not almost doesn’t matter.
That’s the perception.
Of course, no practice should rush such an important hiring decision. But having a thoughtful recruiting process, preparing contracts in advance, communicating timelines, and following up promptly by multiple doctors in the group, sends an entirely different message.
It says:
“We’ve prepared for this day.”
“We’re excited about you.”
“We’re ready to move forward.”
Timing is incredibly important.
When you find a great candidate, move thoughtfully—but move decisively. Consistent communication builds confidence throughout the process.
3. Candidates Are Interviewing Your Practice, Too
Every interview is a two-way evaluation.
While candidates certainly want to make a positive impression, they’re quietly evaluating every aspect of your organization.
They notice:
- How physicians speak to one another.
- Whether technicians appear happy.
- If staff members seem engaged.
- How patients are treated.
- Whether the clinic feels organized.
- Whether leadership communicates clearly.
Culture isn’t something candidates read on your website. They experience it.
Candidates also notice the little things.
They notice whether physicians genuinely enjoy working together. Whether staff members smile. Whether technicians seem rushed or engaged. Whether patients appear relaxed and well cared for.
None of these observations, by themselves, determine a candidate’s decision.
Together, however, they create an impression of what everyday life inside your practice might actually feel like.
Many physicians tell us they knew during their site visit whether they could picture themselves becoming part of the practice.
First impressions matter.
Authentic culture matters even more.
4. Recruiting Is an Abbreviated Courtship
One phrase I often come back to is this: Recruiting is an abbreviated courtship.
Both sides are trying to answer the same question:
“Can I see myself spending the next twenty years with these people?”
The practice is evaluating clinical skills, personality, work ethic, and long-term fit.
The physician is evaluating culture, leadership, opportunity, trust, and whether this feels like a place they can confidently call home.
Unlike a traditional interview, physician recruiting is about much more than filling an opening.
You’re inviting someone into your practice, your culture, your patients’ lives, and perhaps one day your ownership group.
Likewise, the physician isn’t simply accepting employment.
They’re deciding where they’ll invest years—perhaps decades—of their professional life.
When practices remember that, recruiting becomes less about selling and more about building relationships.
5. The Spouse and Family Matter More Than Many Practices Realize
Rarely is an ophthalmologist making this decision alone.
A spouse may be considering career opportunities.
Children may be changing schools.
Families may be leaving grandparents, lifelong friends, and established support systems.
Sometimes the practice itself is exactly what the physician wants. The challenge is everything outside the office.
Practices that genuinely help candidates explore the community, schools, neighborhoods, recreation, churches, and career opportunities for spouses leave a positive lasting impression.
Helping a family feel at home isn’t a distraction from recruiting, it’s part of recruiting.
6. Partnership Has to Feel Real
Many practices advertise a partnership opportunity.
Candidates appreciate that.
But they also ask thoughtful questions.
- How is partnership determined?
- What’s the timeline?
- How is the buy-in calculated?
- Are the owners considering private equity?
- What ownership opportunities exist?
- How have previous associates progressed?
Practices don’t need every answer finalized but transparency builds confidence.
Candidates don’t expect perfection.
They do expect honesty.
What makes candidates nervous isn’t hearing, “We’re still working through that.” It’s hearing five different answers from five different partners.
7. Unanswered Questions Create Anxiety
Most physicians understand that every detail won’t be finalized immediately.
But uncertainty has a way of growing.
If compensation is still being discussed…
If clinic schedules continue changing…
If call responsibilities remain unclear…
If future expectations keep shifting…
Candidates naturally begin wondering what other surprises might be waiting.
Clear communication doesn’t eliminate every concern.
It simply allows physicians to make informed decisions with confidence.
8. Physicians Want to Feel Wanted
One of the most overlooked parts of physician recruiting has nothing to do with contracts and compensation.
It’s relationships.
Over the years, I’ve heard candidates say the same thing countless times.
“Several weeks have gone by since my site visit and I haven’t heard much– Do you think they really want me.”
Candidates remember practices that:
- Follow up promptly.
- Thank them for visiting.
- Communicate frequently.
- Introduce them personally to physicians and staff.
- Answer questions honestly.
- Show genuine enthusiasm.
Recruiting isn’t about pressure.
It’s about helping someone picture themselves becoming part of your team.
Feeling genuinely welcomed often leaves a bigger impression than the nicest dinner or the most luxurious hotel.
I remember one ophthalmologist who was considering two excellent opportunities. Both practices offered competitive compensation, strong reputations, and promising long-term potential.
One practice stayed actively engaged after the visit. Its physicians included the candidate’s spouse in conversations and continued helping the family picture what life in the community could look like. Each of the partners in the group were in touch with the candidate; texting photos of favorite restaurants, local shopping areas, hiking trails, schools, the nearby minor league baseball stadium, and places to kayak along the river.
These were small gestures, but they felt personal and genuine. The practice wasn’t simply describing a job. Its physicians were helping the candidate and spouse imagine a life there.
The other practice took nearly three weeks to reconnect because one of the partners was traveling. By the time they followed up, the physician had already accepted the first opportunity.
Sometimes a candidate chooses a practice not because it offered more, but because its people made the candidate and family feel genuinely wanted.
9. Small Moments Build or Break Trust
Trust isn’t built in one conversation.
It’s built throughout the entire recruiting process.
One delayed response. One inconsistent answer. One forgotten promise. One missed phone call.
None of these seem significant by themselves.
Together, however, they shape how candidates perceive your practice.
Likewise, every thoughtful interaction reinforces confidence.
Professionalism.
Responsiveness.
Consistency.
Honesty.
Those qualities begin building trust long before an employment agreement is signed.
Final Thoughts: Recruiting Is Personal
After recruiting ophthalmologists since 2009, one thing has become abundantly clear.
Physicians aren’t simply choosing a job.
They aren’t making one of the biggest decisions of their professional lives based on a marketing brochure or a job description.
They’re choosing future partners or a future team.
Future mentors.
A community.
A place to raise children.
A place to build a career—and a life.
Likewise, practices aren’t simply filling an opening.
They’re inviting someone into the future of their organization.
That’s why great recruiting should never feel transactional.
At the end of the day, recruiting isn’t about convincing someone to take a job. It’s about helping the right ophthalmologist confidently say, “These are my people.”
The practices that consistently attract outstanding ophthalmologists aren’t always the biggest, newest, or highest-paying. More often, they’re the practices that communicate clearly, move thoughtfully, build trust, and genuinely care about helping candidates determine whether it’s the right long-term fit.
At OjO, that’s always been our philosophy.
We’re not trying to convince physicians to accept jobs.
We’re trying to help great ophthalmologists find practices where they’ll thrive—and help great ophthalmology practices find physicians who will become trusted colleagues, partners, and friends for years to come.
Have Questions?
Every practice opportunity, every physician, and every role is unique. If something in this article resonates with you—or if you’d simply like to talk through a recruiting challenge—we’re always happy to listen and help.
Whether you’re looking to hire an ophthalmologist, recruit a medical optometrist, or just want an experienced perspective on today’s recruiting market, don’t hesitate to reach out.
You can contact us anytime at info@ojorecruiting.com. We’d be glad to hear from you.
