In private practice, few things can be as frustrating and costly as patient cancellations. 

For physiotherapy practices, where continuity of care is paramount, cancellations can disrupt treatment plans, decrease revenue and even strain patient– provider relationships.

However, by implementing a few simple strategies, you can significantly reduce cancellations while simultaneously enhancing patient satisfaction.

Patients may cancel appointments with their physiotherapist for various reasons. Common factors include sudden changes in their health status such as acute illness or injury, making it impractical or unsafe to attend the session. 

Personal emergencies like family issues or unexpected work commitments can also necessitate cancellation.

Financial constraints or issues with insurance coverage might make it difficult for some patients to afford ongoing physiotherapy.

Logistical challenges such as transportation problems, conflicts with other scheduled activities or even forgetting the appointment can also play a role.

Finally, some patients might feel they are not making sufficient progress or may lack motivation to continue treatment, leading them to cancel their appointments.

This last is an issue that Queensland physiotherapist Nick Schuster APAM, the founder of Scarborough Physio and Health, says can be handled effectively by providing a treatment plan, also known as a plan of care. 

Creating a treatment plan with the patient is the first major component in reducing appointment cancellations, Nick says of his three-step approach.

Nick, who has been a clinic owner for 20 years and is an allied health educator and the author of Becoming the ultimate physio, says many of his physiotherapist clients report being adversely affected by patient cancellations, especially in the past few years, largely due to the coronavirus pandemic. 

In some instances, Nick says, practitioners noted a pattern of patients repeatedly cancelling appointments both during and after the pandemic lockdowns in 2020 and 2021.

‘Prior to COVID-19, appointment cancellations in the physiotherapy industry tended to sit at around one in 11 appointments and this was very manageable,’ Nick says.

‘In the early stages of the pandemic, in 2020 and 2021, it rose to one in six appointments. 

'In 2022 it rose again, to one in four appointments. 

'There were many allied health clinics in Australia that became unprofitable during this time because the cancellations reduced their already thin profit margins. 

'In our clinic in 2023, the statistics returned to about one in six appointments cancelled and right now it’s sitting at about one in seven.’

Nick set a goal for practitioners at his clinic to keep their cancellation rate under 15 per cent. 

With the support of Specialist Musculoskeletal Physiotherapist (as awarded by the Australian College of Physiotherapists in 2016) Dr Kieran Richardson FACP, physiotherapist Paul Wright, APA Musculoskeletal Physiotherapist James Schomburgk MACP and mentors, he created a three-step plan to reduce the likelihood of patient appointment cancellations.

‘The first step is the treatment plan or plan of care. 

'The second is the booking stage and the third is the recall or follow-up. 

'If a therapist does these three things well, they have a higher rate of success in minimising appointment cancellations,’ Nick says.

Step one

There are three questions every new patient wants answered when they attend your clinic for the first time: What’s wrong with me? Can you help me? How long will it take to treat the problem?

Nick says that by answering all three questions, clinicians can directly improve the rate of patient return appointments.

Referencing the treatment plan template used in his own clinic, Nick says that the physiotherapist needs to include the person’s name, their provisional diagnosis (giving the patient an explanation of what’s wrong without going into too much pathoanatomical detail) and an approximate order of magnitude of healing. 

The physiotherapist also confirms that the patient is in the right place and that they can help them, and provides some advice as to how the patient can help themselves with their condition or injury.

‘Let me give you an example. The patient comes in with back pain. 

'The physiotherapist says “Okay, John, you’ve got a flexion-related low back pain that could be a disc. The approximate resolution time for this condition, based on my experience, is three months so it’s likely that you’re going to need intensive physiotherapy for a month. Intensive means twice a week and then you’ll need weekly physio for a month. 

'After that, you’ll need booster sessions every two weeks until you’re better. You’re in the right place. I’m the therapist who can help you with this and I’m going to give you these exercises and advice but I’m not going to flood you.”’

Nick also suggests giving the patient some written information to take away from their first appointment. 

Research suggests that patients only remember 10 per cent of what was said in the initial appointment, Nick says, so he recommends providing the patient with something written to take home if you want to increase patient compliance.

The second appointment affords the opportunity to check in with the patient, to modify the treatment plan and to refer on, if required. 

The physiotherapist might send the patient for a scan or to see an exercise physiologist, a personal trainer, a remedial massage therapist, a GP or another allied health practitioner.

However, booking that second appointment is the second step that physiotherapists need to manage well in order to minimise the risk of patient cancellation, Nick says.

Step two

Towards the end of the first appointment, it is time to book the patient in for a second appointment. Ideally, Nick says, it should be the treating clinician making that booking while the patient is in the room. 

This reinforces to the patient that the treatment plan is progressing and that they are with the right practitioner to treat their condition or injury.

In situations where the physiotherapist is not able to physically book the patient into the patient management system, they need to walk the patient out to the administration desk and advise admin staff of the next steps to take. 

While booking additional appointments is also recommended where possible, Nick advises physiotherapists not to go beyond the third appointment in this initial phase.

‘This seems quite simple but it’s not always done well. 

'There is anecdotal evidence that a patient is more likely to follow through when the therapist makes the booking themselves in the room compared with admin making the booking,’ Nick says.

‘If the therapist is very busy and can’t do this, then handing over to admin with instructions is the next best.

‘The last thing you want is for the patient to come out of your room and the admin staff to ask, “When does the therapist want to see you again?” and then the patient stares at them blankly. 

'Because that’s when the patient doesn’t make another appointment or they say “I’ll check my diary” and then they don’t book ahead.

‘The reason I don’t advocate booking more than five or six appointments in advance is that we need the flexibility to modify the patient’s plan based on how they are or aren’t recovering,’ Nick says. 

‘The reality is that there are very few patients who need just one session. 

'My sweet spot tends to be booking three appointments ahead.’

Step three

Patients most commonly cancel appointments for reasons to do with themselves, Nick says. 

However, a perceived lack of care on behalf of practitioners can also be a contributor. 

To mitigate this, Nick suggests that clinics or individual practitioners take the time to follow up with their patients.

‘I’ve read research saying that anywhere from 68 to 85 per cent of people don’t come back to a business for one reason and that reason is perceived apathy because they think you don’t care. 

'If you don’t follow up with your patients, that’s what they’re going to assume,’ Nick says.

‘The only patients we don’t follow up with in our clinics are those who have reached their goal and been discharged. 

'However, those patients do end up on an email list where we regularly communicate general information about the clinic to them. 

'My philosophy is that if a patient is not discharged and they’re not better yet, then it benefits you, the patient and the clinic for you to follow them up.’

Because email open rates tend to be low, Nick suggests that the best way to contact patients for a follow-up is by phone, with text message as the next best option.

‘All you’ve got to say is, “Hi, it’s Nick from Scarborough Physio and Health. I’m just checking in to see how you’re going with your back problem/with your course of treatment that I’m delivering. How are you? Do you still have the problem?” 

'That’s the general message of the call.

‘The patient is going to respond in one of two ways. “I’m better; thank you so much for your help” or “Thanks for contacting me. It’s really good to know that you care and I will rebook an appointment with you”. 

'Some physios might get hung up on when making phone calls to patients but a bigger problem is your patients believing you don’t care about them if you don’t follow them up. 

'If they are not discharged—if they haven’t achieved their goal—you need to follow them up, ideally with a call or a text message but make sure you do something.’

If and when appointment cancellations do occur, Nick says it is important that physios ‘get out of their own heads’ and instead focus on making sure that they follow up with that patient. 

Actively taking steps to reduce appointment cancellations as a private practitioner in the allied health industry can empower you to better manage your patient load and can lead to a healthier, thriving practice, Nick says.

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