Fees a deterrent to no-shows

Dr. Adam Stewart says he doesn’t need to charge fees very often to patients who fail to show up for scheduled medical appointments. And he thinks the no-show fee policy that’s been in place for the past decade at his clinic in the Central Ontario town of Madoc is one reason why. “I don’t have too many missed appointments—maybe once per week?” said Dr. Stewart, who is part of the Central Hastings Family Health Team, which provides access to primary care and programs that it designs and maintains for a mostly rural population halfway between Toronto and Ottawa. Read: How can I increase capacity at my practice? Dr. Stewart noted that he never has missed telephone appointments because he doesn’t “typically schedule those. I try to fit (them) in during the day.” He credits at least some of his low no-show rate for appointments to the fact he’s always done a lot of same-day access scheduling. “Patients rarely miss appointments they book the same day—though it has happened,” he said. But he also believes in the dissuasive nature of his no-show fees, which range from $35 to $65. “I believe the fee is a deterrent,” said Dr. Stewart. “It keeps people accountable. Otherwise, there’s an insidious erosion in the value of our time as physicians. “If a patient misses an appointment without a valid reason it shows a lack of respect for our value and time. Not to mention, if a physician doesn’t charge a fee, then the physician doesn’t appreciate the value of her/his own time.” From a business perspective, Dr. Stewart added, a wasted appointment slot is also a lost opportunity and lost revenue. “I say this from the perspective of a physician who nearly always runs on time,” he said. “I schedule well-spaced appointments; I don’t double-book appointment slots. “I do this because I respect my patients’ time too,” added Dr. Stewart. “I don’t expect patients to wait 40 minutes because I’m always running late. That’s the trade-off.” For family doctors across Canada, the issue of no-show fees for missed appointments remains a lively topic of discussion. If anything, the growing use of video and telephone consultations‚ and the failure of some people to be on the phone or online for such appointments—has only energized the issue. A recent online poll done by the Medical Post that asked the question “Do you charge no-show fees?” found nearly half (46%) of 248 physician respondents agreed with the statement, “I have a policy in place but I cut people slack at my discretion.” Another 19% of respondents simply answered “Yes” as to whether or not they charge fees, while 34% said “No.” A follow-up poll queried doctors as to whether they implemented fees “in an effort to mitigate no-shows for virtual (e.g. phone, video) appointments.” Thirty-nine percent of 236 respondents agreed with the statement, “No, I don’t think it will do anything.” More than a quarter (27%) said, “No, but I’m thinking about it;” 17% said, “Yes, it has helped somewhat;” 10% said, “Yes, it has helped a lot;” and 8% said “Yes, but it hasn’t really helped.” Several family doctors also waded in with lengthy comments on the issue. “I have a policy of charging for no-show, but this is after a reminder phone call or email to which the patient has to reply and confirm that they are coming or their appointment will be given away,” wrote one. “If there is a genuine reason why they couldn't make it, the fee is waived. I usually forgive the first time, and charge if this pattern is repeated. “It has helped to keep my no-show rate very low,” the doctor continued. “I have a cancelation list and can usually fill the spot at short notice.” Another family doctor who charges no-show fees has a similarly flexible and customized approach to the issue. “I have a policy of charging after a reminder phone call or email to which the patient has to reply and confirm that they are coming or their appointment will be given away,” the doctor wrote. “If there is a genuine reason why they couldn’t make it, the fee is waived. I usually forgive the first time, and charge if this pattern is repeated. “It has helped to keep my no-show rate very low,” the doctor added. “I have a cancelation list and can usually fill the spot at short notice.” “Our group of 60 physicians has been charging no-show fees for over 20 years,” added another physician. “They are universal and, prior to the pandemic, patients who have not paid the fees are only permitted to come for walk-in (and wait hours), as they have lost the privilege of appointment-making. “This is tightly tied to our practice management system,” added the doctor. “It has helped to keep our no-show rate at 0.9% (of which half of the patients pay their no-show fee). Since we have stopped charging for no-show fees for telemedicine, our rate has gradually crept up to 1.3%.” For his part, Edmonton dermatologist Dr. Gordon Searles said he was “curious to see” if and how no-show fee policies vary between primary care doctors and specialists. “Our office contacts patients the day prior to their appointment, to confirm their appointment and to pre-screen for COVID symptoms,” said Dr. Searles. “There appears to be a generational gap, whereby younger patients don’t use voicemail (many have not set it up on their phones). As a result, our no-show rate is low, but not very low.” Dr. Searles added that some specialist colleagues who charge no-show fees report say charged patients never return nor rebook. “They prefer instead to go back to their FP and request referral to an alternate specialist,” said Dr. Searles. “There is no fidelity.”

Fees a deterrent to no-shows

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