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The false security of a full schedule


It is not uncommon to hear people talk about the health of their practices by confidently stating how far they are “booked out.” How long it takes for a patient to get an appointment is often a statement of practice wellness.

It is not uncommon to hear people talk about the health of their practices by confidently stating how far they are “booked out.” How long it takes for a patient to get an appointment is often a statement of practice wellness.

A filled appointment book is comforting; it gives assurances that the practice will have similar success in the future as it has enjoyed in the past. We have become convinced that filling our appointment books should be our primary goal, and everything else will take care of itself-and it has worked.

Because filling the appointment book has been so effective, we put intense energy into filling appointment slots. We partnered with vision insurance companies. We even took the lead from our dentist mentors by stressing “recall” and “pre-appointing”-which also worked.

Many practices that have been established and haven’t shown significant growth find themselves “booked out”-and that’s a problem.

Previously from Dr. Rothschild: How to prevent no-shows in your practice

Full appointment book offers false security

A filled appointment book requires that your patients are willing to wait until you are available to see them. This requires your patients to be both patient and loyal-or they have no other reasonable choice. If you are in a community where options are limited, either by location or insurance participation, a full book may serve you well.

Today’s consumers are less willing to wait for what they want and are less loyal to your practice than ever before. A 2014 Consumer Health Study found that 61 percent of all American consumers would change their healthcare provider for a more convenient appointment, compared to 47 percent who would change for a better price.1

Related: How to simplify in the optometry practice

These are existing patients willing to switch providers. New patients don’t have that much loyalty and may schedule an appointment with you but then have an exam at a competitor later that afternoon.


The cost of no-shows

A recent study from the National Institute of Health estimates that no-shows cost an average healthcare practice over $1,000 each and every day.2 And logic dictates that the further into the future an appointment is made, the more likely it is to not be kept.

While simply not showing up for an appointment is rude, changing the appointment also costs our practices money. Staff time taken to communicate with patients about needs to change an appointment can add up to significant expenses. People tend to cancel appointments with little notice. The longer patients have to wait to re-schedule, the more likely they are to cancel.

Related: 5 tips for planning a successful event at your practice

Pre-appointing vs. recall

Almost everyone in eye care agrees that annual comprehensive eye exams are the standard of care maintain visual wellness. We have implemented a recall or pre-appointing strategy to help our patients adhere to this annual exam standard. These systems have many names and employ a variety of techniques. For the sake of this discussion, we will break the systems into two well-accepted categories: recall and pre-appointing.

Recall is any action to remind patients that it is time for them to take action to schedule their yearly exams. Postcards, phone calls, email, and text messages are some examples of tactics used to make contact. Sometimes the messages conveyed are automated to maximize efficiency; others use real people to add the personal touch. Recalled patients do not have an existing appointment scheduled when being “recalled.”

Pre-appointing is the close cousin of recall with one difference: Patients already have an appointment scheduled. A pre-appointment is different from a standard appointment because it is scheduled in the future-typically a year in advance.

Related: Recovering from a fire in the optometry practice

As time for the appointment approaches, many techniques are used to remind the patient of their appointments, and instructions are given to confirm or adjust the appointment time. If confirmed, the pre-appointment is converted to an appointment. 

I have found in my practice that pre-appointed patients are more likely to schedule their next annual exams, and some ODs believe they are more likely to come to that exam. I have also found that pre-appointed patients are also more likely to cancel or no-show for their appointments than recalled patients.


The answer is the system

Proper scheduling techniques depend heavily on the practice’s situation. The most important factor is that having an established system in place and adjusting it frequently based on your ever-changing circumstances. New practices with plenty of openings may be a perfect place for pre-appointments, but a “booked-out” practice trying to attract new patients should consider discontinuing their pre-appointments practice.

Define the primary scheduling objective of your practice by deciding which is more important:

• Availability for new patients within the next few days

• Comfort of a full appointment book for the next few weeks

Related: Getting your staff off to a great start

Consider this strategy

Commit to keeping your schedule 80 percent, instead of 100 percent, full. Full capacity is measured at 100 percent and anything over that causes stress and strain. Think about what happens to a balloon when it exceeds capacity. If you are booked at 100 percent and add an emergency appointment, it is difficult to perform at your best.

Reserve the final 20 percent of your appointments for emergencies, urgencies, and new patients. This allows you to add patients who call and want to come in today or tomorrow without over-stressing the practice. The challenge comes when a loyal, long-time patient wants one of those final spots. The team needs to be reminded of the practice’s policy because loyal patients are more willing to wait.

The strategy listed is not perfect for every practice, but it is a strategy with clear definitions, goals, targets, and room for flexibility. Every scheduling plan needs clear direction.


1. Collier M, Bashman LM. Patient loyalty: It’s up for grabs. Accenture 2014 Consumer Health Study. 2016. Available at: https://www.accenture.com/t20160322T034105__w__/us-en/_acnmedia/Accenture/Conversion-Assets/DotCom/Documents/Global/PDF/Strategy_7/Accenture-Strategy-Patient-Engagement-Consumer-Loyalty.pdf. Accessed 3/15/17.

2. Berg B, Murr M, Chermak D, Woodall J, Pignone M, Sandler RS, Denton B. Estimating the cost of no-shows and evaluating the effects of mitigation strategies. Med Decis Making. 2013 Nov;33(8):976-985.

Read more from Dr. Rothschild here

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