Do You Charge Patients for Missing Appointments? Should You?

Patients not arriving for appointments can make a doctor’s day worse. You’d think it’s better for a doctor because it gives him or her time to relax but that’s not often the case. An empty time slot doesn’t mean a doctor can go home early. The missing patient’s appointment might be in the middle of the day. Even if it’s the last appointment on a schedule a doctor will usually wait a while in case the patient is running late for any reason. Also a missed appointment in the middle of the day doesn’t mean that a doctor will move on through his or her list of patients because the following patient won’t necessarily show up early and with every other patient showing up on time a doctor’s day will more or else end at the same time.

There are ways to minimize patients missing appointments of course through email, text, or even calls. With all the technology and means of communication present today not being able to reach a patient is rarely ever the case. There are some things for a doctor to do during their gap as well. These include catching up on reading, journals, CMEs or they might try something doctors don’t usually do which is to simply relax and take a break.

First of all it’s important to do your best to make sure patients don’t miss appointments. For starters it’s important to explain the importance of these visits to your patients. Explain their condition to them and why follow up is necessary. For instance you need to explain to a diabetic that they need to visit you a few times per year in order to make sure their blood sugar levels aren’t high and that they’re adequately controlled and don’t need their medication to be adjusted. The same goes for hypertensives and any other patient with a chronic condition. Conditions with severe complications need to be followed up in order to catch any of these complications early and manage them before they get worse.

You can instruct your reception and staff at the office to send emails for instance to patients reminding them a day or two before the date of the appointment. Texts are also another viable option. It’s hard to think that anyone these days doesn’t know how to at least read the text messages he or she receives. If a patient is old and doesn’t seem to use technology then a phone call would be suitable. Take care that you don’t nag your patients or come off too strong. Just remind them once a day or two before an appointment and leave it at that.

There are a couple of things to do during the 30 minute or so gap you have when a patient doesn’t show up. Completing continuous medical education (CME) activities is one of these. CME credits are really useful and so are the CMEs themselves. It’s also a requirement in some states that you complete a certain number of CME credits per year in order to keep practicing medicine. CMEs are available online, offline, and through conferences or training modules. Online activities usually have a fixed date and time. They’re like an online class and you can’t just take them whenever you’re free. Obviously you won’t leave and go take a training module in another state during a gap, so your main option is an offline CME. There are videos and articles that you can view usually followed by a very short quiz and once you’re done you get a certificate/credit for completing the activity. That’s a great way to spend half an hour because you’ll be able to complete multiple CMEs which will refresh your memory regarding medical info relating to your specialty and to medicine in general. They’re also a lot of fun to do.

When we speak about updating and refreshing our medical knowledge we have to mention medical journals. Journals such as the New England Journal of Medicine for example always publish the latest studies and will definitely not just refresh, but also add to and update your medical knowledge. You don’t even need to get hardcopies as you can simply view these journals online and access their full content for a subscription fee that usually isn’t that much. You can also subscribe to receive the latest update on your email so you can quickly access new studies that interest you from your email directly without having to open the journal’s website. These sites usually also have interactive modules and training exercises so you’re not just learning passively. They may feature short quizzes and imaging as well. It’s also likely that you’ll find CMEs on their websites. Basically journals are a great way to spend time and gain a lot medically speaking. They’re fun, won’t take up too much time, and will definitely add to your knowledge. If you aren’t interested in learning the latest in other specialties you can simply just access the content related to yours.

Of course there’s also a clever way to help patients and not have any gap time. That is by creating waiting lists. If a patient visits your office without an appointment instead of simply turning them down you can have your staff inform them that they’re arriving without an appointment and so you won’t be able to see them immediately. But, let them know that if a patient doesn’t show up and there’s a gap where the upcoming patient didn’t arrive yet then you’ll be able to see them. Make it clear to them that if no gaps are available that day then you’ll see them at the very end. The choice will be theirs if they want to try their luck and see if someone doesn’t come or else wait till the end or just leave now and not risk it. Remember to only allow one or two patients on the waiting list because you don’t want to crowd your office. Also, if you have five or six patients on the waitlist and everyone on the appointment schedule does show up then you’ll have to see these five patients at the very end which will add over two hours to your work day.

Finally you can simply do the unthinkable: relax. Working for up to 7 hours straight seeing patients can be exhausting and draining. By the time you see your last patient you can barely get your mind to work, but you do it anyway because the stakes are too high and these are important lives. So taking a 30 minute break won’t hurt anyone. In fact it can do you and your following patients a lot of good because you’ll be refreshed and therefore more capable of focusing and staying on top of your game for your next patients. You can use that time to do whatever you like. You can simply rest your eyes on your desk a little bit. You can browse the internet a little taking your mind off medicine. Calling your family or friends can also relieve a lot of stress and make you feel better. There’s no shortage of ways to relax just find something you love doing that can be done inside your office.

So should you charge no shows? One missed appointment every few days won't really affect your practice from a financial aspect. Also, charging patients for missing appointments may make you seem money oriented which won't look good. So it may be better to avoid reacting to patients not arriving to your clinic, unless you know their condition is severe and that the appointment was critical. Maybe then you can call in order to make sure that they're okay.

Doctors like systems usually and an absent patient disrupts that system. Instead of being bothered by it though, use it to your advantage and utilize the time you have. You already had your staff remind the patient so it’s not your fault that they didn’t come to their meeting. Use that time to catch up on medical reading through journals, complete CMEs, or create one or two spots on a waitlist in order to help patients who came without a prior appointment. Alternatively neglect anything “productive” and take a little break doing something you find fun.