— By Laura Maguire
Cancellations suck. They just do.
And they happen everywhere. GPs, dentists, psychologists, physios. Every clinical practice deals with them, so having cancellations doesn't mean you're doing something wrong.
I was surprised at the number of cancellations when we first launched Path Allied Health, but since we tightened our cancellation policy we're seeing far fewer.
Some cancellations are completely fair enough. People get sick and life happens, and I'd never want clients to feel like they can't cancel when they need to. But sometimes they fall into the "I forgot" or "something came up" bucket, and those are the ones you can actually do something about. We are never going to get cancellations down to zero, so it's best to aim for less than 6-7%. That's our goal at Path.
Cancellations and no-shows are a hidden revenue leak. One here and there doesn't feel like much, but add them up over a year and it's real money. Two missed appointments a week at $183 is $17,568 a year (based on 48 working weeks). If you're a sole trader, that's a serious chunk of your income.
And it's not just the business that loses out. The client loses progress, and they might end up paying a cancellation fee. The business has a hole in the diary to fill, and someone has to chase the client to get them booked back in so they can stay on track for their goals.
The money matters, obviously. Businesses need to be profitable to be viable. But fewer missed appointments also means more people actually getting the care they came for. To me, that's the bigger win.
Let's talk cancellation fees
Clients don't love them, and I get it. Plenty of people get frustrated when they're charged one, and no one enjoys that conversation.
But whether you're a sole trader or have a team, you probably need one. If you're a sole trader, an empty hour is your income gone. Rent, admin, software and everything else costs money. Most allied health providers land on 48 hours' notice, which lines up with the NDIS rule of two business days for therapy, and it gives you a real chance to fill the spot.
I don't think the fee itself is the problem. It's how it lands. If it comes out of nowhere it can feel like punishment, but if it's explained properly, most people are pretty reasonable once they realise someone else could have had their appointment.
Put it in your service agreement, but don't rely just on that. People don't read every line of their paperwork, so tell them when they first book too. The fee should be the last resort though.
What actually helps
I tend to think about it in three buckets: make it hard to forget, make it easy to reschedule, and understand why people aren't attending.
Making it hard to forget
Book the next appointment before they leave. If someone walks out without their next appointment booked, the chances of them coming back drop. Rebooking should just be how a session ends, not something someone (often you) is chasing two days later.
Give them a reason to come back, too. If a client doesn't really understand the plan, cancelling can feel like no big deal. So at the end of each session, the clinician should be able to explain what's happening next and why it matters to their goal. Something like, "Next week we'll start adding some weight to those squats so you can play netball again next season." Or, "We'll walk all the way round the park so you can walk your child to school." That's a lot more powerful than "see you next week," because people cancel things that feel optional.
Putting the treatment plan in writing helps as well. Give clients a treatment plan with reassessments at set points, so you can look at progress together and decide whether to keep going or wrap things up because they've hit their goal. People like knowing where they're at, and it gives them a bit of control. It's also harder to drift off when the plan is sitting there in front of you.
Then there are reminders. One isn't enough. Send one 72 hours before the appointment and another 24 hours before, and ask clients to reply to confirm in the 72 hour sms. Make them personal too, with their name, the time and who they're seeing. "Hi Sarah, just a reminder you're booked in with Tom at 4:30 Thursday" feels like someone's actually expecting you. A generic automated text doesn't.
Making it easy to reschedule and harder to cancel
Don't put a cancel option in your 72 hour reminder text. If you give people an easy out, some of them will take it. Let them text back or call instead.
Rescheduling, though, should be as easy as possible. Something like "Need to move it? Just reply and we'll find you another time" nudges people towards a new booking if needed. And remember to offer the option to reschedule before the late cancellation fee deadline. Clients really appreciate it.
If you can, offer some after-hours or weekend appointments. A lot of cancellations are really just clashes with work, school pickup or life in general. If you only offer 10am on a Tuesday, you're making it harder for some people to attend. A few early, late or Saturday appointments can help, but only if it works for you and your team.
It's also worth thinking about access and the best time of day for each client. Some clients struggle in the mornings or afternoons with their mood or energy levels, and if you do home visits, they might find people coming into their home at those times intrusive. Others have mobility or access issues that make getting to you hard. They might need someone to drive them, or parking might cause them anxiety. Flag these clients early and work out what day and time actually works for them. It's good care, and you'll probably get fewer last-minute "I can't make it today" messages.
And have a waitlist, and actually use it. If you can fill a cancellation, it's not really a loss.
Understanding why people aren't attending
Start tracking your cancellation and no-show rate, and treat it as a proper business number, like revenue. Most of us think it's fine until we actually look. Your practice software can probably pull the numbers, and if it can't, track them manually for a while.
Be clear about what you're counting, though. At Path, a cancellation is one of two things: someone who cancelled and didn't rebook, or someone who rescheduled within the 48-hour window.
Then look for patterns. Is it worse on Mondays, with one particular clinician (or one particular day, if it's just you), or with new clients? At Path we noticed we had to adjust the time of day for a few clients to reduce cancellations, and thankfully that was an easy fix.
The numbers tell you what's happening, but they don't tell you why. For that, ask your clients. A short client satisfaction survey can help fill in the gaps: how easy it is to book and reschedule, whether the appointment times work, and whether they feel like they're getting somewhere. People will put things in a survey that they'd never say to you directly, and that's the stuff you want to know.
Where I'd start
Before you spend more time or money trying to find new clients, look at what you're already losing to cancellations and no-shows. Shifting that number by even a few percentage points can make a real difference to revenue and capacity. And it's a lot cheaper than spending on marketing to get more clients. I say that as a marketer.
Don't try to fix everything at once. Pick one thing. If it were me, I'd start with tracking, because once you can see the numbers you'll have a much better idea of what needs fixing.
If you'd like a second set of eyes, cancellations are one of the things we look at in a Practice Health Check. Or book a free discovery call and we'll have a chat: calendly.com/laura-maguire-path/discovery-call
And if something has worked really well in your practice, I'd love to hear about it. Come share it in Path Connect.
READ NEXT
