Dental Practice Heroes
Where dentists learn how to cut clinical days while increasing profits - without sacrificing patient care, cutting corners, or cranking volume. We teach you how to grow a scalable practice through communication, leadership, and effective management.
Hosted by Dr. Paul Etchison, author of two books on dental practice management, dental coach, and owner of a $6M collections group practice in the south suburbs of Chicago, we provide actionable advice for practice owners who want to intentionally create more time to enjoy their families, wealth, and deep personal fulfillment.
If you want to build a scalable practice framework that no longer stresses, drains, or relies on you for every little thing, we will teach you how and share stories of other dentists who have done it!
Dental Practice Heroes
Cancellation Policies That Patients (& Your Team) Actually Follow
We all have those patients that call and say they’re “sick” at the last minute. When it keeps happening, you’ve got to ask: is your cancellation policy working, or just being ignored?
In this episode, the DPH coaches share how they reduce no-shows and last-minute cancellations, hold patients accountable, and get their team to follow through. From how much to charge (if anything) to getting patients to value your time, you’ll learn how to lower your cancellation rate without losing patients.
Topics discussed in this episode:
- What your average cancellation rate should be
- Henry’s $50 deposit policy
- Why patients no-show or cancel last minute
- Language that reduces cancellations
- Training your team to enforce policies
- How to balance being understanding and staying firm
This episode was produced by Podcast Boutique https://www.podcastboutique.com
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https://www.dentalpracticeheroes.com/playbook
Take Control of Your Practice and Your Life
We help dentists take more time off while making more money through systematization, team empowerment, and creating leadership teams.
Ready to build a practice that works for you? Visit www.DentalPracticeHeroes.com to learn more.
Are you tired of empty chairs and last minute cancellations? They're not just annoying, they cost us money and waste everybody's time. Today, we're not just debating whether we should charge patients or not or how much, but we're also talking about how you can keep no-shows from happening in the first place. You're going to hear the policies that work in our practice, how we get our team to follow them and how we get our patients to respect them. If your cancellation rate is high, this is an episode you will not want to miss. Let's do it.
Speaker 1:You are listening to the Dental Practice Heroes podcast, where we teach dentists how to step back from the chair, empower their team and build a practice that gives them their life back. I'm your host, dr Paul Etcheson, dental coach, author of two books on dental practice management and owner of a large four-doctor practice that runs with ease while I work just one clinical day a week. If you're ready for a practice that supports your life instead of consuming it, you're in the right place. My team of legendary dental coaches and I are here to guide you on your path from overwhelmed owner to dental practice hero. Let's get started. Welcome back to the Dental Practice Heroes podcast, the most popular and most listened to dental podcast in all of the universe. You are here sharing it with us and we're so thankful that you're here.
Speaker 1:We are here with a DPH coach, dr Henry Ernst, owner of an 18-op practice in Carolina, just practicing two days a week, and Dr Steve Markowitz he's got six practices on the East Coast practicing still one day a week and myself also a one-day-a-week dentist. We're here to help you figure out how to run a team-driven practice so you can chill more, take more time off and make more money. So today we're talking about a big part of inefficiency at the dental office and, my God, I have worked with a lot of clients and it gets horrible. It is your cancellation and no show rate and, man, I have seen ones as high as 30%, which is bonkers. And if I had to say what is average man, I'd say probably about 18, 20%. But you know we'll get into it and we'll figure out what we think is going on. So I'm going to pass it to you, henry, what has your experience been with cancellation policy and is this something that you even focus on?
Speaker 2:Very important. I think the most important thing is having a policy and sticking to it, not being wishy-washy. That's probably the main thing I see with clients and dental practices. They put a policy in place. I mean, I'll tell you ours. Ours is $50 deposit. We're open on Saturday, so every single patient that comes hygiene or doctor $50 deposit. That deposit will go towards your treatment or will get refunded to you on the day that you make your appointment, that you actually show up Doctor appointments every single day. Anything over $1,500, $50 deposit, it's not much, it's not about the money at all, but we have to hold them accountable. If you no-show cancel for any reason, within 48 hours you forfeit it.
Speaker 1:What if someone's sick, you forfeit it? I just want to play devil's advocate because, like this is what you're going to get from your team. Is you're going to say people are going to say, well, it's so hard to tell somebody. If they call me and they say I am so sick, do you really want me to come in? Cause I'll come in, but I got, I'm throwing up and you know, you know people lie, but I mean still $50.
Speaker 2:So we stuck with it place for about seven years now and we've just stuck with it. People are going to come up with excuses, people are going to say this or that and the line it's not what we like to say. It's not epitome of customer service. But the office policy is 48 hours notice. Right, be more proactive with your notice. As soon as you don't give us time, you know we can't do anything. We can't take back time. I, we can't do anything, we can't take back time. I'll also say this on the front end when your team members are scheduling people. This is the typical dental office. Hey, paul, let's get you on the schedule to do that root canal. Okay, sounds great. Number one you're putting the appointment, associating it with a root canal procedure, which already may give somebody a chance not to show up. Yeah, I don't think I'm coming.
Speaker 2:The alternate version is hey, paul, let's set aside some time with the doctor so he can fix that tooth that he was talking about right Now. It's not associating root canal with the visit and it's also putting the emphasis on securing the time with the doctor. Patients don't care about our time, they don't appreciate our time, they don't know how much it costs to run a practice per hour. We have to make sure that the emphasis is there on we're reserving this time for you and I think don't be wishy-washy with it. Just really, it kind of hit me when we first put this in place years ago and we had a patient right in the beginning when we started it wishy-washy right Patient. When we started it, wishy-washy right Patients called up the office and said oh, I'm supposed to come in for a couple of crowns at six o'clock. I don't know if I'm going to make it. What's going to happen if I don't show up? And team member comes back to ask me that and I said well, they're going to forfeit the deposit. And what happened?
Speaker 2:The guy showed up and when that happened I jumped up and down. I said see, this stuff works. He's a nice guy. I actually asked him. I said if it wasn't for the $50, would you have not shown up? He's like yeah, I wasn't feeling like coming. And I'll tell you what happens a lot, especially with our Saturday patients. Patient shows up on Saturday, gets their hygiene visit done and they set aside their next one. Hey, just leave my deposit on. So most people, especially our Saturday frequent flyers, we call them they just have the $50 deposit, it's in their chart and they just leave it in their impotuity.
Speaker 1:Everybody. What about new patients? No, we don't do new patients? Yeah, Okay cool.
Speaker 2:But I think the main point I'm just trying to make is come up with a policy that your team can be on board with, because they have to stand behind it. They're the ones who have to defend it and say the, and behind it, they're the ones who have to, you know, defend it and say the, and then you, as the owner, don't wiggle, stay consistent the moment you wiggle on one.
Speaker 1:they're going to ask you again and again and again how about you, steve? How's this looking in your office Like? What's your experience been?
Speaker 3:Yeah, I love all what Henry just said. There is nothing if I could highlight on a podcast highlight. There is nothing more expensive than empty chair time nothing. So it costs the office, the practice, more than anything you are doing. So people spend so much time looking at their supplies and their marketing and all this line items they should spend just as much time on, or, if not more, they should spend more time on, making sure, when the office is open, the chairs are full.
Speaker 3:So there are two things of why people don't show up to appointments. One is they don't value the service that you're providing enough more so than whatever else they want to do, and that could be because of fear. Number two, they don't have a relationship strong enough with either you or the person they're seeing and they don't respect their time. So what we do, we spend a lot of time on both of those two things, meaning I want our hygienists and our assistants and our doctors to know their patients and be able to look at the schedule and be like there's a chance that person doesn't show up. What I would hate more than anything when I first started doing this is I would look at this schedule and I would be able to pick out who wouldn't show up and then they wouldn't show up. Whose fault is that? So the policy needs to align with rewarding the people who are great patients and you know are going to show up and getting rid or punishing the patients who aren't going to be part of this anyways.
Speaker 3:So what we do is we highlight patients who we know are high risk. They either have to call to make an appointment or, if they are on there and they're high risk, they need to call back and we need to physically talk to them and say they're going to show up and if they don't call us back, we fill that appointment and then we do not ever, ever, ever allow someone to reschedule their appointment to tomorrow or within the next week, like there has to be some kind of consequence for not respecting our time. So if someone's going to call us and they're going to move, even if there's open share time, we are going to either move it out or say call us when it's a convenient time and we'll see if we can get you in that day.
Speaker 3:I don't believe fully in charging people for missed appointments. I don't want to fight make those. I don't want to have those fights. I'm not in the business of collecting 50 or $75 for missed appointment times. It's not worth my time. It's written in our policies but we write that off. Whether that's wrong or right, I'm happy to fight that out.
Speaker 1:Well, I think that's critical to point out, because we had this conversation with my team. I'm always big about as the leader. We've got to create a way that there has to be a why. You have to really identify what is the goal of the policy or the procedure. When I say what is the goal of the $50 charge, some people would say, well, to cover the hygienist time. And I'm like, no, the goal is we just want them to show up for their damn appointment. I could care less about $50. I mean $50 for the chance of getting a negative review for charging 50.
Speaker 1:So when we had a really high cancellations, we got up to like 15, 16% at one point. What we started doing is we started telling people we had to make sure they talked about it. That was the part that was missing. Nobody was talking about it. It was like you want to cancel today? Okay, sure, let's reschedule. You know, nothing happened, but so.
Speaker 1:But what we found is that if we talk about it, we make a big deal about it and then we say, hey, I'm supposed to charge you $75. I'm going to waive it this time, but in the future I need you to know that I can only do it once and what would happen is it would start to kind of weed out the bad people, because then those people we would require a deposit and then they would either not pay it and go somewhere else or they would start showing up for their appointments. But the effectiveness in that policy was in the discussion and the consistency of the discussion. It wasn't so much in the actual charge. But then when you're talking about how to read these deposits for everybody, there's part of me thinking that my policy it didn't work until we warned the patient and they got away with it once, Whereas in your policy it is a focal part of the discussion for almost every single appointment. So it's almost like a preemptive, more proactive approach and that's what I think I like about it.
Speaker 2:Yeah, well, I think in the semantics here is important too. It's not a charge, it's a deposit. Right, when I think charge, I'm thinking my money's gone, I'm not getting it back. A deposit is just hey, we're asking to leave this, you know, as collateral for our time. And this is the other thing that comes up in dentistry Okay, I need to come to your office and I'm going to get two crowns done $3,000, let's say, to schedule. Am I required to leave all the money before I make that appointment or am I required to do a deposit?
Speaker 2:Right, we kind of went back and forth with that discussion and what worked for our office was the deposit. Right, try to get the money. Hey, listen, this is what you're due next time. Would you like to pay it now as a convenience? Okay, well, at minimum I need the deposit for the doctor's time and blah, blah, blah, they give the policy there While it's on my mind. One other thing that really just aggravates the crap out of me, and I hear medical practitioners when they call you know to hey, you've got an appointment with our office on Friday. If you need to cancel before the first thing they say if you need to cancel, like, don't even tell me that, Don't even give me that option. It's not an option. Don't say it, don't even offer it, because the moment you say that and it's nice outside in the Carolinas there's a decent chance they're going outside.
Speaker 1:I think it should be. If you need to cancel, don't.
Speaker 3:That's like one of the seven naughty words. We don't use that word. So, like what we train our team to do is, when they're calling patients to say, like we don't even say we have a cancellation list. We were able to move some things around and now have an opening for this time. Does this time work for you? I don't want that word coming out of anyone's mouth.
Speaker 1:It's just part of our bread. What's something that I think is crucial to go through is what is acceptable and what's unacceptable. You know one discussion I had with my team. We said 24 hours. A lot of people are 48. What are you guys? Just really quick 48. 48. Okay, so we're 24. We did 24 just to make it really easy and we just never changed it.
Speaker 1:And I'm curious like we want to treat everybody the same and we want to say that to our patients. Hey, we don't want to have to make decisions, we want the only way to be fair with everybody is just have it be black and white. But what do you say to someone who says someone was had to get rushed to the hospital, a funeral, someone passed away, Like I mean, is it so cut and dry that there's no exception for bending? Because what I struggle with with my team is that if we allow them to bend a little bit, it's just like they just blow it open. They take it to the next level. That's just like now. It's like damn it, that's not what I wanted. What do you guys think of that?
Speaker 3:So for us, one of our values is it's never the wrong thing to do the right thing. So we can apply this to our cancellation policy and if someone calls and says I need to take my mom to the hospital or I'm not feeling good or whatever, and I could go up to that team member and say why is henry not here today? And they're like, oh they, they had to do. Did you push back? No, it was the right thing to do. He really seemed like he was in a panic. End of discussion, that's it yeah and that's again.
Speaker 3:I understand the black and whiteness and team members love having that black and white policy, but people are not black and white and if we start to treat them like that, then I feel in my world at least, I feel like that we start treating patients more like numbers as opposed to understanding what they're going through and where they're at. So the black and whiteness of what I'm trying to create is I have enough trust in the person on the phone and if they think that's the right thing to do, that's the right thing to do. With that being said, we can't have repeat offenders. So, yes, it's okay if someone calls out sick once every two or three years maybe, but within 18 months if we've had to move their appointment more than two times, we're too busy for that. That's not fair. The policy that we have is yes, we have leniency, but we can't have the expectation that this person's not going to show and we need to track how many times they're either moving their appointment or no showing.
Speaker 1:What if someone sounds really sick man I just I can't come in. Oh, can't make it, Don't come in. Is that a violation? Yes, that's a charge.
Speaker 3:It's not a violation. I'm so sorry you're sick. I do want you to know. We're booking out like 10 months and we probably won't be able to get you in. Do you want me to put you on ASIP list? Are you sure there's any way you can come into this appointment? How do you want me to best help you and then help navigate the conversation? I don't think it's ever helpful for us to be like. This is our cancellation policy. Yes, I understand it, but the patient on the other side doesn't want to hear that. They just want to be helped.
Speaker 1:It's just so hard. Because I struggle with this and I think a lot of practice owners can relate to it is I want my team to use their brains and I want them to do the right thing, and I will never shame them for allowing somebody some leniency and making exceptions. But it drives me crazy when those exceptions become so consistent that it's like you just didn't want to have a difficult conversation.
Speaker 3:But that's the training when we found most, besides having those high-risk patients need to actually call back the office, the little bit of pushback and says just say, if someone calls and says I'm so sick, I'm so sorry, I hope you're okay, you sure there's any way you can make it today. I'm booking out so far. And if they still say like no, no, no, okay, all right, do you want me to give you a call back or do you want to try to schedule that now Because, honestly, we can't see it till February Again, I think some of that that starts with training our team and then us as doctors, backing them up with the decision that they made and not Not poopooing it.
Speaker 2:You know, this is a great conversation, and I think we could have this with 10, 20 doctors, and we're all going to have different perspectives, right? This is the beauty of being a business owner there's nobody who's right, nobody has the right answer and nobody has the wrong answer. It's all about what really works and what do you feel strongly about.
Speaker 2:You know we have our policy, that it's a little bit black and white, I'll be honest with you, and I work two days a week, so if there's ever an exception that needs to be made, they're going to reach out to me. You know they're going to text me and they're going to ask me whatever, and knock on wood, I haven't got any question like that. I can't remember. So it must be working.
Speaker 1:Yeah, right, see, I hate that. I hate when you let me ask the owner and I tell my team do not do that to me, because then you just immediately make me look like an a-hole if I say no.
Speaker 2:Well, I've empowered them to make good decisions and do the right thing. But the policy is pretty black and white Gosh. Maybe like a year ago there was like somebody who I really knew patient's been in the practice for a long time and I kind of did what you said, steve. I said you know what? Let's give them some grace Gosh, what let's give them some grace Gosh. They've been a practice so long, so there's never going to be a right answer here. But I think what has worked for me was to make the policy that the team agrees with, the team is on board with, and we'll stand behind and stand behind it. Don't wiggle one way or the other, or else you're going to get everybody that takes advantage of it.
Speaker 1:Yeah, I'm just curious for your situation. You're asking for a deposit, which I think a lot of people would love to do for hygiene. Our solution we have rarely have a failure reschedule. On the doctor side, we're trying to collect the whole patient copay. We take half that as our requirement but we try to collect all of it because we know when we collect all of it, when that person comes in that day it's going to be a better experience. They won't ask questions about their insurance coverage, they won't have any financial questions. We get all that out of the way and we'll tell the patient. We like to get the financial stuff out of the way so that we can stay on time the day of the appointment. So all of our we're an on-time office. But I'm curious how your team is presenting this deposit. Like there's got to be some verbal training and there's got to be a way to do it. And I'm just I'm curious what they say.
Speaker 2:So with hygiene it's almost like a joke, right? You make it like a fun thing, right? We only do it for hygiene on Saturday hygiene appointments. So not every day, not every day, just Saturday. Because what we noticed was all of a sudden it's a nice day outside and stuff like that, and all of a sudden your Saturday hygiene, which had three or four columns, all of a sudden like half of it's gone. So we did it just for that purpose and we joke around with the patients like listen, it's kind of like sitting in first class. No other offices are open on Saturday. You're getting to come in and get your teeth cleaned. All that we're asking is a $50 deposit to reserve that time in first class for you, and they're all fine with it. And, like I said, I think it's to the point now where people have their deposits on file and they just leave them for the next one, for the next one.
Speaker 1:Yeah, I think I want to do this at my office and I want to do it for appointments after four o'clock because it's such a high priority time. And I mean we've got people scheduling three, four appointments ahead of time, Like they're scheduling their next two years of appointments, and it's like I don't mind doing that, but at the same time it's like I don't know it's such a give and take of trying to be accommodating and not getting abused at the same time.
Speaker 2:It seems that analogy works well with the patients. You mentioned it, steve too. We're. Hey, we're really popular, we're. Our Saturday appointments are booked out for eight, 10 months, you know. So if you want to reserve that time, I would highly suggest we do it, and all we ask is a $50 deposit, right?
Speaker 1:Yeah, and, like Henry said, there's no right or wrong answer. It's just you've got to have something, you've got to discuss it as a team and you've got to stick to it. Consistency it's so important in everything we do, consistency. I'm going to let you do the final thoughts, steve. What do you?
Speaker 3:think I think for any policy, especially the cancellation policy, because I think we hammered home how important it is the team needs to know exactly what it is. You need to train how you want those situations to be handled and then you need to follow through on what you said you were going to do and the patients who want to be there will be there and don't fight. My recommendation would be don't make fights over $75 or $50. Let those patients go fight with someone else.
Speaker 2:Totally, henry. Final thoughts yeah, love it. Don't want those patients in your office when you've got a growing, successful, happy practice. We don't need those people that are just the vampires of our time. Have the policy in place, stick with it and don't be afraid to revisit it. You know, we revisited before and now we found something that really works and we're consistent with it.
Speaker 1:It's a great point, awesome. Well, if you are listening and you're thinking, this is the year you're going to get your practice to run without you and have it be smooth, flowing, systematized this is the kind of stuff we do at Dental Practice Heroes. Go check out our website, dentalpracticeheroescom and see what coaching packages we have. We want to help you live a better life and be better in every regard because of your practice, so that's what we're here for. Go check us out. Thank you so much for listening. We'll talk to you next time.
