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Reduction and Management of No-Shows by Family Medicine Residency Practice Exemplars

¹ Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
² Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
³ Garfield County Family Practice Residency Program, Enid, Okla

CORRESPONDING AUTHOR: James W. Mold, MD, MPH Department of Family and Preventive Medicine University of Oklahoma Health Sciences Center 900 NE 10th St Oklahoma City, OK 73104 james-mold{at}ouhsc.edu

Annals Journal Club selection—see inside back cover or http://www.annfammed.org/AJC/.

PURPOSE We wanted to describe the methods used by family medicine residency practices with low no-show rates (rate exemplars) and those able to keep visit rates high despite no-shows (management exemplars).

METHODS Program directors of US family medicine residency programs were asked to respond to a survey questionnaire. Telephone interviews were conducted with the administrators of rate exemplars (no-show rates of 10% or less) and management exemplars (average of 8 to 10 patient visits per half-day plus high administrator satisfaction with no-show management strategies).

RESULTS Directors of 14 rate and 8 management exemplars, identified from among the 141 practices (31.5%) that returned the initial survey instrument, were interviewed and subsequently resurveyed. All of the rate exemplars used multiple strategies, including patient education, patient reminders, patient sanctions, and some degree of open-access scheduling. Practices that managed no-shows well encouraged walk-ins and work-ins and overbooked resident schedules either equally or based upon individual no-show rates. Practice exemplars of both types were highly committed to addressing the no-shows problem and were diligent about following their policies and procedures regarding no-shows.

CONCLUSION Some family medicine residency practices are able to achieve low no-show rates or keep them from affecting practice volume. Those that do use combinations of well-established methods.

Key Words: Appointments and schedules • workload • office management • no-show • primary health care • internship and residency • best practice analysis

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