BOW VALLEY – A Canmore clinic hopes shedding light on the impact of patients not showing up for appointments will help uplift a health care system already under strain.
Dr. Brendan Flowers, owner and physician at Mountain Maternity and Family Medicine, called the number of no-shows, or missed appointments, at the clinic over the last few months “scary” in a community where many are without a regular healthcare provider or waiting months to see a doctor.
“We are trying to bring to the forefront the idea that with the physician shortages that we have, every appointment counts,” said Flowers. “We started looking at the no-shows from our clinic the past few months and realized there’s actually an increasing number of them. We’re serving more patients, but at the same time, there’s more patients who are not showing up for their appointments.”
In June, the clinic had 43 no-shows, totalling 14.75 missed hours of appointments. For July, there were 39 missed appointments, which amounts to 12.5 hours, and in August, there were 50 no-shows, or nearly 20 hours of missed appointments without cancellation notice.
Missed appointments are common, but Flowers said it's been an increasing trend over the past year. In 15 to 30-minute appointment intervals over a physician’s eight-plus hour work day, missed appointments at the Canmore clinic average about 43 missed patients per month, or 20 days of missed patient opportunities over a year.
While there are valid reasons for some missed appointments, Flowers said he believes the frequency in which they’re occurring exceeds what is advantageous to the community.
“That’s the difficulty is that patients are waiting weeks to months to get in for regular appointments, and some of these are actually meet-and-greet appointments,” he explained. “We’ve been working hard at recruiting and everyone’s looking for a GP (general practitioner). So, they book a meet-and-greet, but then, unfortunately, they don’t show up for the appointment, which means that one more person doesn’t have a GP when they need it.”
The clinic is taking an education-first approach with signage posted and regularly updated in its office to inform patients of the number of hours of missed appointments each month, with the intent of decreasing no-shows.
The response has so far been positive, Flowers said, though, it’s too early to tell if it will affect change.
If it doesn’t, the clinic may need to start charging patients for not showing up to appointments as it has a trickle-down effect on the clinic’s finances when it can’t bill for service, along with its ability to hire and retain staff.
“It’s an interesting dynamic when it’s a publicly funded healthcare system that’s actually not publicly funded from a clinic perspective – it’s privately administered,” said Flowers.
Patients are not charged for medically necessary services at privately owned walk-in clinics because these services are publicly funded by the government. In the case of a no-show, however, the physician’s office loses money because it cannot charge for services a doctor would have otherwise rendered during that appointment.
“There is a financial component to this in addition to the desire to serve patients from a health perspective,” said Flowers.
Alberta doctors are increasingly charging no-show patients to meet the rising costs of running a medical office in the province.
Dr. Graham Campbell, chair of the Alberta Medical Association’s (AMA) Specialty Care Alliance, said charging for missed appointments is a common practice, but each clinic may have its own strategies to recoup costs, including educating patients and sending appointment reminders.
“To my knowledge, the AMA doesn’t particularly advocate for one solution or another. I think the solutions are best left up to the individual physicians running their practices who know their patients and what works for their patients,” he said. “What works for a practice in the west of Calgary may not work in downtown Calgary or downtown Edmonton or Canmore or Banff, or wherever else it happens to be.”
Campbell, a Calgary-based radiologist, said he hasn’t noticed any recent trends one way or the other in the number of no-shows in his practice. The AMA also does not track those statistics, which are typically recorded by each individual clinic.
“Obviously it does have an effect on practices, though. If your number of patient no-shows goes up, then you have all these expense running your practice and you have no revenue for those patients who didn’t show up for those times, and that makes it harder for physicians to stay in business,” he said
“And then as a result, missed appointments harm patients – both those who missed their appointment, but also those who aren’t seen because of the spot that’s been taken and having to wait longer to be seen.”
Dr. Kendra Barrick, president and co-chair of the Bow Valley Primary Care Network (BVPCN), said the number of people without physician care in the Bow Valley is difficult to track with much of the population being transient and living in the area short-term, but “it’s in the 1,000s.”
“I can say that with confidence,” she said.
Barrick noted that in recent years, the Bow Valley has seen about 14 doctors move on from the area, close their practices, retire or pass away, which compounds the issue.
There has been some success in recruiting new physicians but the high cost and low supply of housing in the Bow Valley has played a role impacting the number of physicians able to live in the area, according to the primary care network.
“I’d have to check those numbers, but we haven’t made up 14 new doctors. So, I would say we are still at a significant decrease,” Barrick said.
Overall, she noted there hasn’t been a noticeable change in the number of no-shows recorded by local clinics and reported to the BVPCN, but there is always room for more education on the subject.
“I think there’s always a lot of education around missed appointments and what that means. We’ve had initiatives through the Primary Care Network as to what to do if you can’t attend an appointment,” she said, adding there are a number of reasons a patient might be unable to attend, like road construction and traffic delays, not having the means to travel, or family emergencies.
“It’s letting patients know if they can call [to cancel], the more notice the better, and communicating if you’re unable to attend and talking to your physician about barriers, such as transportation, so that they can help support patients.”
The Local Journalism Initiative is funded by the Government of Canada. The position covers Îyârhe (Stoney) Nakoda First Nation and Kananaskis Country.