Fam Pract Manag. 2007 Jul-Aug;14(7):50.

Reducing no-shows


We've noticed that three-month, four-month and six-month follow-up visits tend to have the highest percentage of no-shows. Is there a good way to reduce our no-show rate, or should we just give up on the idea of scheduling follow-up visits in advance?


There is a correlation between long waits for any type of appointment (e.g., new problem or follow-up) and higher no-show rates.

To reduce or eliminate no-shows, many practices are tempted to avoid making any return appointments and instead opt to have patients call to schedule their appointment at a later time. This is a serious mistake. These practices could lose patients to needed follow-up as well as lose control over their internally generated demand (i.e., return visits) and the opportunity to shape that demand.

Each practice must decide how far into the future it will schedule return visits. I have found that in many cases three to four months is a “sweet spot.” If return visits are scheduled to occur after that time, then no-show rates rise quickly. Practices should also avoid being too restrictive about return-visit scheduling. Preventing patients from scheduling return visits more than a month or two into the future creates additional work for office staff. For example, if a practice insists that return visits cannot be scheduled more than one month in advance, patients who want a return visit in three months would be instructed to call back in two months to schedule it. This often leads to duplicative phone calls and frustrated patients who may decide to forego needed follow-up care, and it requires the office staff to explain the policy over and over again.

I recommend scheduling return visits up to four months into the future and creating an electronic reminder file to keep track of patients who need to be seen for follow-up visits after that time. You can use this file to keep track of which patients should be calling you to schedule an appointment and which patients you need to call to remind them of their visit, if a follow-up visit has already been scheduled. In addition to using reminder calls or letters, these strategies can reduce no-shows:

  1. Measure no-shows. Measure no-shows by provider, day of the week, time of day, visit type and other factors such as co-pay requirement. Use the measures to confirm anecdotes and to craft a strategy to reduce the problem.

  2. “Sell” the return visit. Patients frequently do not show up for return visits because they do not see their value. Providers must convince patients of the need for the return visit. Staff members should reinforce this to patients as well.

  3. Get patient participation. Ensure that patients actively participate in deciding the date and time of their return visit.

Prevent medication diversion

When we see new patients in our office who complain of ongoing problems with back and neck pain or headaches, we automatically request their prior medical records. We also call nearby pharmacies to ensure that no other doctors are prescribing narcotics for them. It would be great if more offices followed this process to stop the diversion of pain medications.

Highlight immunizations in charts

When I administer an immunization and document the expiration date, lot number, area and type of immunization in the patient's chart, I use a yellow highlighter pen to draw attention to the note. I've found that this enables us to quickly see whether patients' immunizations are up-to-date without lots of flipping through the chart. This is especially helpful when I perform school physicals or when I haven't seen a patient in a while.


Practice Pearls presents readers' advice on practice operations and patient care, along with tips drawn from the literature. Send us your best pearl (250 words of less), and you'll earn $50 if we publish it. We also welcome questions for our Q&A section. Send pearls, questions, and comments to, or add your comments below.


Copyright © 2007 by the American Academy of Family Physicians.
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