Failure to keep clinic appointments: implications for residency education and productivity.

BACKGROUND AND OBJECTIVES Missed clinic appointments significantly impact continuity of care, resident education, and clinical productivity. This national survey analyzed the awareness of family practice residency clinics regarding their missed appointment rate and the use of reminder systems. METHODS We mailed a questionnaire to all 468 family practice residency programs in the United States and mailed two follow-up surveys to nonrespondents. RESULTS The overall survey response rate was 60%. More than one third of the clinics reported a no-show rate of > 21%. When asked how the clinic arrived at their no-show rate, 64 (17.7%) respondents stated that the reported rate was an estimate. More than one third of all clinics did not use a patient reminder system for clinic appointments. When comparing clinics with high (> 20%) and low (< 20%) no-show rates, there was no statistically significant difference between the use or nonuse of mailed, telephone, or combined reminder systems. CONCLUSIONS The clinic appointment no-show rate varies greatly among family practice residency programs. Even with the widely reported use of reminder systems, one third of programs continue to have no-show rates above 20%. This study is unusual in that there was no statistically significant difference in no-show rates between programs, based on the use of reminder systems. In an era of cost containment and increased accountability, appointment failures are a factor that will require additional study and intervention by family practice residency programs nationwide.