The 'five percent' solution

Dec. 1, 2001
For the last 100 years, patients have been "no-showing" for their appointments.

by Roger P. Levin, DDS, MBA

For the last 100 years, patients have been "no-showing" for their appointments. Perhaps in the early days, people were more respectful. By mid-century, however, people were busier. Families began needing two cars and started working more hours. Their kids were busier, too — all those activities! Consequently, keeping appointments — or even taking the time to cancel — had little priority. Currently, people are so busy and overwhelmed that not showing up for dental appointments has become the norm.

So how do dentists deal with this problem? Some things are constant; over the last 100 years, we have always handled it the same way: We do nothing. We act like doormats, afraid to tell patients that their missed appointments cost us a ton of money. In fact, many practices lose $200-$300 or more for every no-show that occurs.

What should really scare dentists is the mathematical analysis of no-shows. Approximately 21 percent of our clients have five percent of their patients that "no-show" regularly; another 20 percent hover around the 4.5 percent mark. A 5 percent no-show rate over 20 years equals a staggering one year of lost production time.

No-shows are eating the heart out of a lot of practices. Since these patients are inconsistent, their impact is often not apparent.

Front-desk personnel often are at a loss about how to get these patients to honor their appointments. Scripts can be an effective means of training them to communicate effectively the message that no-shows are unacceptable. The method is pleasant, direct, and emphasizes to patients that not showing up will cost them money!

At this point you might be saying, "Oh, no. This means confrontation; a patient might get mad at me." True, but the alternative is to have your production time eaten up by people who do not respect your time enough to bother canceling their appointments.

This has to stop! Here are some steps for practitioners:

Don't take it anymore. When a patient cancels at the last minute, use a script explaining that they should rethink their cancellation. People are busy, but they can reprioritize. Let patients know that the time has been reserved for them and that there is a fee for a missed appointment. Ask if they could rearrange their schedule to keep the appointment since you have already denied this time slot to other patients. Be pleasant, firm, and direct. You will often find that patients will reprioritize.

Kick them out. Patients who miss two appointments in one year should be removed from the practice. After all, you are literally wasting dollars on these patients annually. Your chances of ever breaking even or catching up are small. So stop being afraid of the loss of a patient. If you are going to lose six or 12 months every 20 years of your career, you may as well be playing golf (or working on building your practice to new levels).

Don't give offenders appointments. Those who offend routinely should be given the least desirable appointment, or no appointment.

Personally, I prefer no appointment. Tell them you will call them when you have an opening. This way, when the next no-show gives a mere two hours notice, you can call another repeat offender to fill the slot.

This approach works since demand frequently increases desirability. If patients know they can get appointments whenever they want, they are much less likely to show. If you need convincing, ask any woman with a standing Friday hair appointment if she would ever dream of missing that appointment.

For more information on dealing with no-shows, send a self-addressed, stamped envelope to: Levin Group "Management Scripts," 10 New Plant Court, Owings Mills, MD 21117.

Roger P. Levin, DDS, MBA, president and CEO of The Levin Group and the Levin Advanced Learning Institute, provides worldwide leadership in dental management for general dentists and specialists. Contact The Levin Group at (410) 654-1234.

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