Originally published in June 2026 by The Medical Post
Author: Kylie Taggart
A look at efforts and initiatives that demonstrate benefit
It's a problem encountered in every physician's office and clinic in Canada: patients who miss appointments, leaving the physician with a hole in their schedule that could have been filled by another patient who needs care. Here in Canada, we call them "no-shows."
If every clinic experiences it, there must be evidence-based guidance and best practices that physicians and office managers can use to reduce their number. While there is such guidance available, there's no one-size-fits-all solution. That's because there's substantial variability both in medical practices and how they're run and between and among patient populations. Yet leveraging a combination of proven tactics could help your practice and your patients. While many physicians have looked into this problem before, revisiting it and looking at new approaches may be worthwhile.
First the Problem
The Alberta Medical Association (AMA) suggests that physicians take a look at their EMR to see how many missed appointments are happening in the clinic. If the rate and impact are low, it might not be something worth the effort to correct, the AMA suggests.
Part of understanding the problem is to examine reasons behind why patients miss appointments. To conquer no-shows, you want to get to the bottom of why a person is missing an appointment, explained Dr. Jason Hosain, a family physician in Saskatoon and an assistant professor of family medicine at University of Saskatchewan. When he examined his EMR data, he found that of 100 patients who had missed an appointment, 75% missed one, 21% missed two or more, and 4% missed three or more. He's not concerned about the ones who've missed one ("Who hasn't missed one appointment?"), but those who have missed more than one.
"They're not a bad person. They're missing because something is going on in their life," Dr. Hosain said.
The National Health Service (NHS) in the U.K. published guidance in 2023 on how to lower the number of "did not attend" occurrences in outpatient services. Their advice is to go to the patients to learn what they think would work when it comes to reducing missed appointments. The NHS suggests conducting a phone or online survey.
Another option is a patient advisory board. It's something Stephen Beckwith said has helped his family health team. Beckwith is the CEO of South East Toronto Family Health Team, which serves more than 40,000 patients from their three sites. The team asks their advisory board, "How would be the best way to receive the information? What would make you show up?"
Engage with Patients and Provide Patient Education
Patients may not even understand the consequences of not showing up for an appointment. Or, they may not fully understand how the system works, Beckwith said. His family health team does outreach to teach patients about team-based care. The team includes allied healthcare professionals and patients may not understand the purpose of those appointments, wanting just to see a physician.
It may be worth the effort to revisit a patient agreement, verbally or in writing, so patients know what is expected of them and what they can expect from the team, Beckwith said. Respect has to go both ways, and physicians who may be late due to hospital duties or other reasons should communicate that possibility with patients.
No-shows sometimes increase when a locum physician is covering. Here it helps to message patients to assure them they will continue to get a similar quality of care, Beckwith said.
Another way to engage is through social media. The Collège des Médecins du Québec launched a social media campaign in 2024 to try and get the public to tell physicians if they can't make an appointment. Beckwith's family health team also found resident physicians were keen to engage patients over social media.
Technology 1: Consider Automated Reminders
Phone, email or text reminders are one of the first ways to conquer high no-show rates. The Canadian Drug Agency conducted a survey on no-show rates in medical imaging appointments across Canada, releasing a report on the findings in March 2025. Phone reminders were the most common method used by the 85 centres surveyed. Many sites used methods where the patients had to input something (e.g., confirm the appointment in some way) when they got a message. The survey results suggest most of the centres found no impact of the reminders on missed appointments, but literature reviewed by the Canadian Drug Agency suggests other centres around the world were able to reduce no-shows based on the tactic.
The NHS guidance has suggested wording for appointment reminders, to ensure that the tone is appropriate and patients have all the necessary information. The AMA and other groups also provide a sample script.
Any new system needs to be examined from the patient's lens and the practice lens. Automated reminders don't work for everyone, Beckwith said, and physicians should flag their office administrators if someone needs a regular phone call or a bit more VIP treatment to navigate the system.
Technology 2: Consider Online Appointment Booking
Giving patients more agency around the timing of their appointments is another approach to reduce no-shows. A pilot study in the U.K. involved five teaching hospitals who used an appointment management solution software to reduce their no-shows ("did not attends") in the radiology department. It allowed patients to cancel and reschedule their own appointments. The program also involved automated text message reminders. The pilot study included more than 3,500 messages to patients. There was an average reduction in no-shows by 81%, which translated into a 21-times return on investment into the software program. Another pilot study at the Royal Orthopedic Hospital in Birmingham using similar software reduced no-shows from 10.9% to 7.1 % in nine weeks.
OntarioMD, a government-funded organization that offers free services to help Ontario physicians with technological solutions, has resources that indicate online appointment booking not only reduces no-shows but also saves administrator time. Beckwith, a long-time peer leader with OntarioMD, suggested that Ontario physicians take advantage of OntarioMD's peer-to-peer program to find out what would work best for their practice.
Technology 3: Consider Online Cancellation
Some hint that online appointment booking may contribute to the number of no-shows, especially if there is no easy option to cancel an appointment. Quebec has a front-line access desk, and Dr. Mylaine Breton, a professor of medicine and health sciences at the University of Sherbrooke, told Profession Santé, the Medical Post's sister brand in Quebec, that it may have increased the province's rate. The most recent no-show rates were announced by Christian Dubé, the health minister at the time, in 2023. He said there were 30,000 missed FP appointments each month in Quebec. That translated into more than 400,000 a year, out of 18 million family medicine appointments. While it comes to a rate of 2.2%, which is generally considered low, Dubé elaborated that for specialists the no-show rate is 10%.
In February 2025, the then-president of the Collège des Médecins du Québec, Dr. Mauril Gaudreault called on the provincial government to add a service to allow patients to cancel, or register, for medical appointments. He said the service needed to be easy to use and the same province wide.
It's now standard for a clinic to charge a fee for a missed appointment.In a conversation with the Globe and Mail, Dr. Adam Thompson, president of Doctors B.C., said he charges a small fee for no shows because of the impact on other patients' access (and is waived for patients who missed based on their medical condition). A no-show fee places a sense of value to the appointment, he said.
No-show fees "can get iffy because you're adding a financial component to it. It's a conversation that neither providers or staff want to have," Beckwith said. There are so many reasons why a patient may miss an appointment, from transportation or employment issues to sheer forgetfulness. A fee may be an added burden to patients who are struggling in various ways.
Dr. Hosain urges physicians to think of a missed appointment as an opportunity. "This is a red flag. You need to think of what is going on in this person's life." He phones the patient if they missed an appointment and can sometimes change it into a virtual appointment on the spot.
Whether a clinic charges a no-show fee or not, the clinic's policy must be solid and articulated clearly to all patients and all staff. Office administrators must know the details on how to enforce the policy.
Mitigate the Risks of Change
The NHS guidance also lists the risks to trying to tackle no-show numbers. All can be mitigated with a bit of advanced planning. There's a risk of putting a new administration system in place without the right supports and appropriate human resources. Another risk is limiting the ways patients can communicate with the clinic if they're not digitally literate. There's also a concern that patients can become more anxious about the appointment if there's a number of strategies around attendance.
Lowering the no-show rate in a clinic could lead to better patient care and better access to care. While guidance based on evidence exists, the best advice may come from patients and from peers with similar practices and patient populations.