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 By Neil B. Gailmard, OD, MBA, FAAO, Editor June 7, 2006 - Tip #229 
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No Show Fees - A Costly Policy

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A surprising number of practices have a fee that is charged to patients who fail to show up for appointments. There are many variations on the exact policy - such as not really charging it (but only threatening to do so) or giving a discount on the no show fee if a future appointment is kept.

We may have to agree to disagree on this, but I think these policies are damaging to the practices. Further, it might serve as a sign of a customer-tough philosophy in general for any given practice. I assume doctors who have these policies like the impression it gives the public - sort of a "we don't really need you" attitude. My way or the highway. Maybe these practices are so large and successful and booked so far in advance that they truly don't need patients. If that is the case, then I have no problem with the tough-love policy. But I've seen a lot of practices, and I hardly ever see one that could not use more patients. Lots more patients. In fact, I can't envision any practice that has enough patients. If demand is high enough, I'd hire more staff, hire associate doctors and build new offices.

Understandable logic - but flawed

I think I understand why no show fee policies are developed. It seems unfair and inconsiderate when a patient reserves the doctor's time and does not use it. Income is lost. Time is wasted. Expenses, like staff salaries, are still incurred. Another patient could have used that appointment time.

Further, the irritated doctor reasons that he is better off without these people. If they pay the fee, then fine, but if they don't recognize the value of the doctor's time, they can go elsewhere. This is where we differ. If the primary goal is making a profit, I believe we are better off letting the patient win. This is an example of customer service, which yields patient satisfaction and loyalty. That is the single most important aspect of practice building.


When a patient misses an appointment, he invariably believes it is not his fault. And many times it isn't, but in any case, there is always an excuse. It's human nature. Smart businesses don't worry about fairness; they look at everything they do from the patient's point of view. Marketing is defined as identifying and satisfying customers' wants and needs. The patient's perception is all that matters and they never put the practice's needs ahead of their own.

One final drawback to the no show fee is that to be effective, it must be stated in advance to every patient, even though only a small percentage of people are guilty of the offense. This causes every patient to perceive the practice as tough. I think it makes them easy pickings for another practice which projects the high-service image.

Best wishes for continued success,

Read Past Tips Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week

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Send questions and comments to neil@gailmard.com.

Dr. Gailmard offers consulting services to eye care professionals through Prima Eye Group; information is available at www.primaeyegroup.com.

Please Note: The views expressed in Management Tip of the Week do not necessarily reflect those of the sponsor.

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