Monday, November 19, 2007

Empty Office

I have yet to establish a firm "no-show" policy for my private practice, but I very much need to do so. My last two new-client appointments-- one on Friday, one today-- have both failed to materialize. Both were referred by colleagues, made the appointments very recently, indicated a sense of urgency, and expressed gratitude that I could see them so quickly. Then, they just didn't come. So I'm sitting around the office, not making any income. It's crap.

What's the right policy for this? One local shrink makes prospective clients sign an agreement, before making the first appointment, stating that if they do not show up they will be charged the full fee for the session, but never allowed to reschedule. This seems draconian. What is fair?

I was reading a book yesterday which contained a chapter on how to out-source your routine business needs to India. It is tempting to hire someone in Bangalore to make reminder phone calls each night to all the patients I have scheduled for the next day...


Blogger jcat said...

Ok, so my pdoc does have 3.5 support staff just for him..... But the way he works is that you get a confirmation call the day before. If you cancel then, no problem - his waiting list is so long that it will be filled within a couple of calls. If you confirm though, you are billable for the full amount regardless of whether you show or not. And he doesn't do the medical aid claims, so you personally need to pay (and yes, about 1 of the 3.5 is devoted to account issues!!). A new patient who doesn't show? Not sure, but unless you had a really good reason, you wouldn't get another new patient appt - he only sees two new patients a week, and the waiting list for those slots is around 4 months.

What can I say....he's the best. He works really hard and I figure that anyone who stuffs him around without cause should pay!

BTW, SA call centres/support staff are ranked up there with India...and for your side of the US, we're probably in a better time zone too

11/19/07, 4:35 PM  
Blogger NeoNurseChic said...

Just don't do what I just did. I drove an hour for a dentist appointment that I truly believed was at 4:30. They called me at about 4:10 and asked where I was - apparently they had me down for 4pm. They asked if I wanted to reschedule (yes, I drove an hour in the rain and rush hour traffic to reschedule), but I couldnt' do it while driving in horrendous conditions. I may have been a bit short with the it's probably ultimately my fault somehow, but GAH!

My personal feeling is that if I get charged for that nonsense, I will not be happy.

However, I believe that if someone doesn't have a good reason for not showing (not, they were trying to get there for the last hour but truly believed the appt was at some other time than you have written down), then they should be charged a fee. When my psychiatrist was a resident, his office had a policy that if you cancelled with less than 24 hours to go to the appt time, then you paid for it. He did give me one freebie, but then even the times I cancelled because I was legitimately ill, I still got charged. Was it fair? Not particularly, but I suppose it worked. It worked to make me rather upset, but that's because nearly every penny I make goes towards bills and fees and loan repayment. Maybe for someone else who was inclined to just randomly cancel in order to get their nails done, it worked wonders. I never cancelled unless I couldn't get out of bed, so therefore I thought it was a little harsh.

A no show is different than cancelling at the last minute, IMHO. Someone who doesn't even have the curtesy to show up - I'm not sure they should be allowed to reschedule. Someone in solo private practice can't afford to lose a whole hour to an unreliable person who could do this frequently. I almost became a private piano teacher, so I understand the reality of sitting in your car twiddling your thumbs because your student never showed up at his own house for his lesson! If they call with some legitimate reason, even after the fact - that they did not show because they were in a car accident or some other majorly good reason, then I'd give them another chance.

So I'm not suggesting a completely strict policy, but one that is rather case-based. It would be easier to have a set policy, but I would tell patients that if they did not show prior to that first appointment and didn't have some major emergency as the reason why, then they would be forced to pay for the time slot. You may even go so far as to say that they won't have the ability to reschedule. Sure it may sound draconian, but it's your life and income, too... If a person cancels at the last minute with good reason, then I'd be more flexible, but still annoyed perhaps. I dunno...

I'm the person where if I'm running even 30 seconds late for my appointment, I call ahead to say that I'll be there but am running behind. I hate being late, even though I sometimes am as I drive rather far for many of my doctor's appts (even though I live in suburban Philadelphia where doctors are plenty!), and traffic can be a problem. OK I'll stop rambling now! Best of luck with it! I can't imagine the misfortune of having 2 no-show new patients within days of one another!

Take care,
Carrie :)

11/19/07, 5:00 PM  
Blogger Rach said...

I'm with Carrie. I have a tendency to call if I'm running late - I don't have far to travel but often traffic is so horrendous that I have no choice but to call and say that traffic is hairy.

Re: cancelling. If I have to cancel or change my appointment, I don't get charged if someone can take my slot - and like jcat, there is usually someone looking for an appointment. Similarly, I keep myself on a cancellation list, so that if someone else cancels, I can use that appointment.

I guess there comes a point when you start spending more time on administration than on patient care (especially if you don't have a secretary).

11/19/07, 6:41 PM  
Blogger Ladyk73 said...

First appintments are iffy. Do you even have enough info to bill the people?

You don't want to piss off the Dr who is referring you these patients.

I dunno... The only time I did not go to an appointment, I was hospitalized. Of course my Dr figured that out....


11/19/07, 9:32 PM  
Blogger C Neal said...

Outsourcing is definitely the solution, and I wouldn't be surprised if this is exactly what happened to your patients. Life's hectic, you've got appointments everywhere, and the regular docs aren't helping any with the anxiety, so one day, whilst negotiating a cell phone contract, you opt for the Personality Export feature along with the free texting.

Next thing, your dumpy old body becomes a hollow shell while your carefree consciousness rides the ether on global satellite networks. While you're enjoying the disembodied playboy lifestyle, a family of seven from Bangalore assumes your citizenship and carries on the mundane day-to-day existence you once had. Of course, for them, it's a fantastic opportunity, so it's win-win all around.

Although the family from Bangalore won't have any use for your old psych appointments for a decade at least, and this leaves your old doctor in the lurch. So it goes.

11/20/07, 9:33 AM  

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