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Professional Courtesy: The Appointment is Broken and You Can’t Fix It by Thomas Giacobbi, DDS, FAGD

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by Thomas Giacobbi, DDS, FAGD, Editorial Director, Dentaltown Magazine

No-shows and broken appointments are common management topics on the Dentaltown message boards. When patients reserve your time and cancel on short notice or don't even bother to cancel at all, this is lost revenue to the practice, plain and simple. Your frustration is compounded when you know there are other patients who are pushed out a week or two due to a full schedule. Let's face it, this problem will never be solved, regardless of the fact that many approaches have been developed over the years in an attempt to mitigate this problem. Here are some of those approaches and their inherent flaws.

Charge a deposit over the phone for the appointment. I know that people who do this claim it works because everyone who pays the deposit will show up for his or her appointment. Winning? Yes, until someone can get an accurate count of how many paying patients have left the practice in search of another provider. This doesn't just alienate the deadbeats or people without money, by the way. I can afford every appointment that I make, but I would not be inclined to do business with someone who operated on the assumption that I could not be trusted to appear as promised.

Confirming appointments by phone, email or text. This technique has been proven to be effective, but not 100-percent effective. People who say, "Yes, I will be there at 10 a.m. tomorrow" are not immune from finding something better to do, or having a meeting at work, or a sick puppy … you get the idea. I think the multitudes of appointment- reminder services that have been developed over the last five years are some of the greatest innovations for practice-management since scheduling software. These services significantly reduce the number of hours that the front-office staff spends hunting people down. Many patients tell me that they love getting the email reminders for their appointments. No matter which method you employ, people will still say they didn't see or hear the reminder.

Charge a penalty for the no-show after the broken appointment or short-notice cancellation. I have utilized this policy in my practice and I will add that we are very lenient on enforcement. This policy gives the patient coordinators in our practice an "arrow in their quiver" to deal with patients who abuse their good nature. We charge $1 a minute, so the penalty is directly related to the amount of time lost. I am not under the delusion that this policy will "fix" people. There are two primary outcomes: people who believe they are entitled to miss appointments may leave the practice, and people who are flaky by nature will pay their penance and be guilt-free the next time they call for an appointment.

Should new patients schedule with the doctor or hygienist first? Every discussion of no-shows includes new patients. In this case, the no-show has more to do with the conversation on the phone than the patient's personal problems with keeping appointments. In other words, if patients don't like your policy of seeing the doctor before the cleaning, they may take the appointment, then find an office that will clean their teeth at the first visit, and not bother to call you back and cancel. If the patient doesn't like the demeanor of your patient coordinator over the phone, he or she will take the path of least resistance (accept the appointment) and then never call again. Some people are kind enough to call back and say, "Something suddenly came up," but not everyone has that courtesy.

Listening to recordings of your new-patient phone calls is a powerful education, whether you see one or 100 new patients a month. In my office, new adult patients are scheduled with the doctor first for a couple of reasons. First, you never know how long the first visit will take—what X-rays will be needed, whether the patient has a large treatment plan, whether there will be many questions to answer, if something needs immediate attention, what kind of cleaning will be required, etc. Second, I schedule new patients in my side column so a no-show is not as devastating to production as a whole, or to our busy hygiene schedule.

When the no-show numbers of your established patients are high, I think it has something to do with how your office operates. Do you make it easy for them to reschedule when they miss an appointment? Do you keep them waiting or move their appointments on short notice? If the no-show numbers of your new patients are high, take a hard look at the phone conversations that lead to those appointments in the first place. Remember, these are people who called you for an appointment (unless they like to make crank calls), and the new-patient appointment is the one appointment they wouldn't miss. Even deadbeats like to make a good first impression.

Sometimes it just feels like you have a problem with broken appointments and no-shows. Just like anything else in your practice that needs examination, this is a problem that must be measured. I use a fairly basic yardstick that I find easy to track. It provides a good point of reference for our team each month. For every appointment on the schedule at the start of the day that becomes a no-show or same-day cancellation, we record a -1. For every productive appointment (not bite adjustments, etc.) that is added to the schedule that day, we record a +1. The front-office staff keeps a running tally of the sum and reports it at our monthly meeting. If the number is positive, we have done a great job at recovering lost production, and if the number is negative, we need to look at our call list.

When it comes to people, dentistry is more art than science. These imperfect people with their imperfect teeth will sometimes disappoint you with their absence. Track the trends and focus your efforts on accommodating the people who need you, because eventually everybody needs to see the dentist. Please share your comments in the digital version of this article at Dentaltown.com. You can follow me on Twitter @ddsTom..


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September 2025
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