How to Reduce Cancellations and No-Shows in a Dental Practice

"Then we're screwed."

That's what an office manager told me when I asked what would happen if everyone showed up for their appointments. I was visiting a two-doctor practice, and both doctors were triple-booked throughout the day.

I understood why. They had so many cancellations and no-shows that the team had started scheduling extra patients to make sure the doctors had enough work to do. It probably seemed like a pretty good solution at first. After all, when you're losing that much production to broken appointments, you have to do something, right?

But I wanted to know just how bad the problem was, so I opened Dentrix and started looking at the appointment histories.

Of the approximately 60 patients scheduled that day, those same patients had accumulated 126 cancellations and no-shows. One patient had missed 24 appointments!

Twenty-four!

At what point do we stop asking why patients keep canceling and start asking why we keep allowing them to?

What struck me was that the office wasn't really solving its cancellation problem. It had simply learned to operate around it. The doctors were triple-booked because nobody knew who would actually show up. And when everyone did show up, the entire schedule fell apart.

Unfortunately, I've seen versions of this problem in dental practices all over the country.

Some offices double-book. Others charge cancellation fees. Some send more reminders or threaten to dismiss patients. And every few months, somebody looks at the accounts receivable report and realizes those $50 cancellation fees are never going to be collected.

How's that working for you?

I think we're often looking at the wrong problem. Cancellations and no-shows aren't necessarily the problem. They're frequently symptoms of a scheduling system that has taught patients that keeping their appointments is optional.

And sometimes we're the ones teaching them.

What Are You Teaching Your Patients?

I have visited dental practices all over the nation for almost 20 years and I can't tell you how many times I've heard someone at the front desk say this. Have you heard it too? "Oh, we have cancellations all the time. If something opens up, we'll give you a call"?

THUD! That's the sound of me falling over and dying in the background.

Why would we tell patients that?

We've just told them that appointments are abandoned so frequently that they can practically count on someone canceling. In fact, if they cancel, it's okay. We have a backup plan. In our offices, we never tell patients we have cancellations because we don't want to make that behavior normal for them.

There's also a difference between telling patients your cancellation policy and getting them to commit to it.

Try asking, "Ms. Jones, will you please call me at least 24 hours ahead of time if you can't make this appointment?"

Then wait for her response.

It's a small change, but now she has personally agreed to something rather than simply listened to another office rule.

The real test, however, comes when she calls an hour before her appointment to cancel.

Most front desk teams respond by asking when she'd like to reschedule. I want you to try something different.

"Ms. Jones, I'm sorry to hear you're having trouble today. What can I do to help you keep this appointment?"

Then be quiet.

You might discover that she can come a little late. Maybe she can arrive earlier. Perhaps she doesn't have time for everything planned, but you could still complete one quadrant of treatment instead of two.

The objective isn't to make someone feel guilty for having a legitimate emergency. It's to see whether there's a reasonable way to preserve the appointment before giving it away.

But what if she still can't make it?

This is where I think many dental practices make their biggest mistake.

Stop Rewarding the Behavior You're Trying to Eliminate

Imagine Ms. Jones cancels an hour before her appointment. Your team responds, "No problem! We have another opening tomorrow morning."

What have we taught her?

That she can cancel at the last minute and still get one of our best appointment times whenever she wants it.

I would handle that differently.

"Ms. Jones, I'm sorry you can't make your reserved appointment today. The next appointment time I can offer you is three weeks from now. I know the doctor would hate for you to wait that long. Are you sure there's nothing we can do to help you keep today's appointment?"

And yes, I would use a three-week scheduling boundary for routine treatment, even if you have openings available tomorrow.

Why? Because you cannot cancel last minute on my schedule and expect me to give you premium appointment times whenever you want them.

Think about your patients who rearrange their work schedules, find childcare, and make every effort to show up on time. Shouldn't we protect the availability of desirable appointments for those patients rather than continually handing those times to someone who repeatedly cancels? Let's be honest. What is the likelihood they will come tomorrow?

I'm not suggesting you postpone urgent treatment or penalize someone dealing with a genuine emergency. Use your judgment. You're a smart person.

But there is nothing unreasonable about communicating that our time has value and that the appointments we reserve are commitments.

And for patients who repeatedly disregard those commitments, I would go a step further and require appropriate prepayment before reserving additional routine treatment time. Not another $50 fee that nobody will collect. A meaningful commitment made before the appointment is scheduled. I've found that patients who pay ahead of time are far more likely to show up to their appointments and to give proper notice.

Of course, establish these policies clearly, apply them consistently, and make sure they comply with your payer agreements and other requirements.

What Happened to That Triple-Booked Practice?

We changed the way the office communicated with patients and responded to broken appointments. Rather than continuing to compensate for cancellations by adding more people to the schedule, we worked on getting the patients already scheduled to keep their commitments.

Eventually, the practice stopped triple-booking. Patients were seen on time, the team experienced less stress, and the doctors became far more productive.Within 3 months the cancellation and no-show rate dropped below 10%.

I love results like that, especially when the answer doesn't require another expensive piece of software or another employee.

Here's what I'd encourage you to do tomorrow. Pull up your schedule for the day and look at how many broken appointments each patient has. Ask the team, "What is our plan if any of these patients call to cancel?" Then simply evaluate. Are you creating expectations and establishing boundaries, or are you making it easy for them to do the same thing again? If it is the latter, then maybe it's time to give them some new tools for their tool belt to gain a better result.

That two-doctor practice thought it had a cancellation problem. What it really had was a system that had learned to accommodate cancellations rather than prevent them.

Sometimes the biggest improvement you can make in your practice isn't finding another way to deal with a problem. It's recognizing what you've been doing to keep that problem alive.

If you're reading this and thinking, "That sounds exactly like my office," I'd love to hear from you. Tell me what your practice is experiencing. I'll help you identify where I'd start looking for the problem.

And if you think your team could benefit from this conversation, share the article with them. Better yet, bring it up at your next team meeting and see what they think.

Jon Rutty has spent more than 15 years consulting with over 150 dental practices on scheduling, case acceptance, team performance, and profitability. Learn more at ThatDentistGuy.com.