By Dr. Carrie Mauterer, CDA Editor
From the Winter 2023 Journal of the Colorado Dental Association
Dr. Carrie Mauterer
Our dental assistant comrades know this feeling more than any of us; you have just completed the perfect set up in op4 for the incredibly complicated procedure next on your column. The dental floss that is resting on the sterile tray has been meticulously measured and wound into a perfect infinity shape. The instruments are wrapped elegantly with military style squared corners. The essential oils diffuser is mellowing the mood with your new blend of either “Oil up Buttercup,” “The Grumpy Husband” or “Not Today Satan” depending on your current intake of caffeine. You were victorious in finding that one instrument stored in the wrong drawer and laid it out in the back up position in case the procedure took a left turn. The napkin bib holder is looped and resting on a brand-new aqua patient bib. The room is filled with readiness and anticipation. You are ready for Mrs. Jones. You’ve never been prouder of a perfect setup.
5 minutes into her appointment, you are still ready for Mrs. Jones.
15 minutes into her appointment, you call Mrs. Jones and receive the sad news that she can’t make it today because it is her dog’s birthday, and she needs to start the beef bourguignon for his birthday supper. Your next patient is due in 2.5 hours, so your only option is to start putting away your setup and start all over again for a new procedure. Cue violins.
Patient no shows and short cancellations are happening more now than ever in our dental offices. The most recent ADA Health Policy Institute article reported that 81% of dentists said no shows and cancellations under 24 hours were the reason why their schedule wasn’t full by the end of the day. With the rise in labor costs and supply costs, this preventable inefficiency is sucking the fun out of our funfetti. The cumulative effects of diminishing margins with every no show are crushing every colleague I have spoken to.
Most dental offices prefer to give the patient an appointed time and day for their visit so that the focus can be solely on that patient’s care. Very few dental practices have shifted to a first-come, first-served model because the tradition of reserving appointment times runs so strongly in our dental DNA. We place the importance of the patient’s time over ours with this model. This traditional approach to a polished patient experience has been in place for decades. So, if we don’t want to convert our practices to a triage environment like an ER department, how do we encourage our patients to respect our time as much as we respect theirs?
I don’t have all of the answers, but I do know it will require all of us to re-educate our patients of the importance of consideration when moving their appointment times.
If you Google the words, “Cancellation” “Policy” “Dental” you will find that many dental offices have a very strict and punitive policy for no show appointments and short cancellations. Some even place their cancellation policy on their websites and patients have to acknowledge that they read the policy prior to booking an appointment online. The old me used to worry that this would affect patient satisfaction and internal referrals in my office. The new me is comfortable in establishing these boundaries with our patients ahead of time and enforcing the consequences when appropriate. Just like effective parenting strategies, it is possible to have a mutually respectful relationship with our patients without patients getting upset about a short cancellation fee.
Another idea that many offices are investing in is an auto-confirmation service that does the bulk of the work for your front office. Many offices are now requiring patients to either confirm the appointment via text or by phone call in order to keep their appointment on the schedule. Again, I see offices taking a tougher stance on this and actively removing appointments from the schedule that remain unconfirmed.
Keeping an active ASAP list of patients who would like an earlier appointment in order to short fill an appointment is always helpful too. My office has gone through many versions of this short call list ranging from a list inside my office manager’s head to a paper list to an ASAP list within my practice management software.
A newer emerging trend among dental offices is a hybrid model where some of the schedule is for appointments scheduled ahead of time and some of the schedule is reserved for same day triage and treatment. With a less predictable schedule, doctors and their teams need to stay nimble and think quickly on their feet to keep their days running smoothly.
The most innovative idea I have heard yet was from an executive of a DSO who announced that their company spent years and some serious dollars in developing a proprietary software that can accurately predict future no shows in the schedule and prompt a double booking of that appointment time. Last minute schedule openings have certainly caught the attention of the dental nation.
There are many more ideas out there that we can share with each other to keep our practices running at high enough margins to make it work. If you are struggling with patients short cancelling their appointments, I assure you that you are not alone in this frustration. As we all adapt to the new normal of fall out in our daily schedules, we can all do our part to educate and re-train our patients to respect our time. We can also adapt and create innovative solutions to cover loss of production due to short cancellations. One thing that is quickly becoming a truth across the nation’s dental profession is this: We can’t afford to continue to walk the same pathway anymore. A few changes in your practice leadership can make a big difference to your team’s success.