Reducing No-Shows

November 1, 2007

I have a problem common with many physicians. It takes about four weeks for me to fit in a “new-patient” appointment. Because I’m a psychiatrist, I’ve been reluctant to place reminder calls to the prospective patient. Four weeks is a long time to wait and, not unexpectedly, there are a significant number of no-shows. I’ve considered not scheduling patients out longer than three weeks and leave slots available for the following week and have patients call at the beginning of the week to secure a slot. Sort of a first-call, first-serve process. There are obvious drawbacks to this idea, such as the patients who call and are frustrated because they must then call the next Monday morning to try to secure a slot for the next week. What do you suggest?

Question: I have a problem common with many physicians. It takes about four weeks for me to fit in a “new-patient” appointment. Because I’m a psychiatrist, I’ve been reluctant to place reminder calls to the prospective patient. Four weeks is a long time to wait and, not unexpectedly, there are a significant number of no-shows.

I’ve considered not scheduling patients out longer than three weeks and leave slots available for the following week and have patients call at the beginning of the week to secure a slot. Sort of a first-call, first-serve process. There are obvious drawbacks to this idea, such as the patients who call and are frustrated because they must then call the next Monday morning to try to secure a slot for the next week. What do you suggest?

Answer: I just finished reading a case study about an orthopedic practice in San Francisco with a no-show problem. The practice initially assumed, as you are, that appointment lead time contributed to the problem. When staff analyzed the data, though, they discovered an inverse relationship between lead time and no-shows. Most no-shows were among patients whose appointments were within zero to seven days of their call to the practice. Perhaps they had problems they wanted treated right away, and they simply found a more accessible practice.

So, first, I’d make sure your assumption is correct. Analyze what percentage of no-shows is from new patients and what the percentage is among all patients (new and existing) by appointment lead time (zero to seven days, eight to 14, 15 to 21, 22 to 28, and so on). You can also survey no-showers to see if they forgot, found another physician, just decided “shrinks” are stupid, or whatever.

If it turns out the problem really is the lead time, I would steer away from the “call-in” plan. A new patient is someone who has taken a step to get help, and the last thing he is going to do is play roulette with scheduling. He’ll just make an appointment someplace else.

Instead, you need to consider why you have a four-week wait time. Can you fit more new patients into your existing scheduling template, perhaps stretching out existing patient appointments (of course, within clinical reason)? If lead time isn’t the issue, tackle the other issues. Ask schedulers to stress to patients the importance of keeping their appointment, for their own health and so others don’t miss the chance to get help.

Track no-shows, and double-book or even release from your practice patients with more than four no-shows in a six- or 12-month period. Set up an easy cancellation line. Patients don’t even have to talk to anybody. They can just leave a message when they can’t make it. You can personally discuss no-shows with patients, too. Just some thoughts. But the key is analyzing first so you aren’t solving a problem that doesn’t exist.