Inside Dentistry
Jul/Aug 2006
Volume 2, Issue 6

What is Really Behind Cancellations and No-Shows?

Gregory A. Winteregg, DDS

In dental offices, it is common for 10% to 20% of the patients during a productive day to cancel or not show. Oftentimes, the dental staff assumes it is

because the patient was not confirmed properly or the patient really did “have to work late.” Perhaps the patients in your area just have a low dental IQ and do not really care about their mouths. The real solution: Have the patient pay for the service before they are scheduled.

In most scenarios, the patient is called and confirmed the week before the appointment. The patient is then called the day before the appointment. My staff has even been known to take the appointment book home on the weekends to confirm appointments for Monday. The worst scenario is when the patient is called at 4:00 PM to confirm an 8:00 AM bridge appointment for the next day only to find an empty chair the next morning. In my office, this problem did not get solved until we began having the patient pay before he or she was scheduled.

The truth of the matter is that most broken appointments were actually never intended to be kept. This is not a condemnation of the population in general. When the patient makes the appointment, he or she “intends” on being there, but it is not the same intention as gathering a paycheck at the end of the week. In reality, the patient was never sold the treatment plan, meaning he or she never actually bought into it, and certainly did not pay for it.


As practicing dentists, we need to get past an aversion for selling. Selling is part of running a business. The services have to be sold or the business does not succeed. There has been a formula broadly promoted in the dental profession that states it is acceptable to have 1 to 2 months of production in receivables. This formula is simply an indication that cases are not being closed. I spoke to one of my clients recently who routinely collects more than $200,000 per month, and his accounts receivable is about $35,000. This client is closing the cases and getting paid.

Very few people make an appointment with no intention of keeping it. Oftentimes, the patient has some doubts that for whatever the reason he or she does not mention during the consultation, including “How much is this procedure going to hurt?” “Does this mean I am going to get a shot?” “Does a root canal really hurt as much as Jay Leno says it does?” “Will the temporaries fall out and embarrass me?”

If these questions are not answered, the patient will not show up. But if the patient is not asking these critical questions, how do you bring up these issues? Ask your patients to pay in advance, and they will tell you their concerns. You will then have a chance to handle their considerations in advance. Sometimes you will find that no matter what you say, there is nothing you can do to convince a patient to agree to the treatment. However, if you can get the patient to share his or her concerns, a communication is established, which can really help the patient, and can in turn sell the procedure.

At some point, we were convinced that it was unprofessional to sell our services and get paid. That also means that it is unprofessional to make sure people get the care they really need. It also means it is unprofessional to want to have a viable business. It is unprofessional to make a profit as you are truly helping people.


The real solution is to have patients pay, at least a portion of the total or a down payment, before they are scheduled. In this way, the service has truly been sold, and you know your patients truly intend on keeping their appointments.

In this circumstance, third-party finance companies, such as Unicorn Financial Services, come into play. If the patient says he or she cannot afford the procedure, pull out an application and see if you can get him or her approved. My clients tell me they can generally get an approval/denial in less than 2 minutes using the online service. The patient cannot complain about the interest rate because Unicorn now offers 12 to 18 months at no interest. (Keep in mind that with these types of plans the treatment usually must be started before you can get paid. But in the patient’s mind, once they sign the loan papers, they are intending on doing the service.) Once the procedure is started, you can get paid. The patient has been sold the procedure and that means that he or she will show up. Now everyone is happy and the patient gets the necessary care.


Once I learned how to handle this properly, my cancellations and no-shows went nearly to zero. The main point is that you care about your patients and you want them to get what they really need. If the finances are fully confronted when you present the case, your patients will tell you their real concerns and give you a chance to handle them. Otherwise, you make an appointment and cross your fingers.

Therefore, the next time you encounter a broken appointment and ask your staff “Did we confirm this appointment?” also ask “Did we have the patient pay in advance?” This is something you can control and take complete responsibility for. Cancellations and no-shows are rarely an administrative issue. They are a sales issue.

Dr. Greg Winteregg provides this general dental practice management advice to provide some bottom line suggestions of actions that have been shown to have potential to help you improve dental practices. Neither MGE nor Dr. Winteregg may be held liable for adverse actions resulting from your implementation of these suggestions, which are provided only as examples of topics covered by the MGE program. Dr. Winteregg may be contacted at 1-800-640-1140 or by e-mail at Greg@mgeonline.com.

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