Reminders aren't enough: How practices can get to the root of patient no-shows

It's easy to blame no-shows on patients, but appointment attendance is a problem that physicians and practice leaders can study, understand and reduce.

There are reasons why patients don't arrive at the doctor's office — and ways to make sure they get there, said A.G. Ghanim, M.B.B.Ch., healthcare senior manager at the University of Michigan, where he oversees complex clinical operations across multiple sites. He also is founder of ZLinQ Consulting, with a six-step process to define, diagnose, prioritize, design, implement and optimize solutions for patient no-shows.

Trained as a physician, he moved into health care administration and has worked in private, public and academic systems. He was a presenter of "No-Shows Are Not Inevitable: Operational Playbooks Medical Practices Are Using to Protect Access" at the Medical Group Management Association (MGMA) 2026 Annual Conference.

In a video interview with Medical Economics, Ghanim used the example of managing a pain clinic where an entire surgical team could be left waiting at 7 a.m. for a patient who didn't arrive. He has become convinced that no-shows deserved more rigorous study.

"The more you study no-shows, the more you understand how to deal with it and how systems can actually benefit from it," he said.

He described the hidden costs of a missed visit, from lost revenue to hours of rework by scheduling and prior authorization staff. He also discussed the toll on patients: When a patient misses a hard-to-get specialty appointment, the next opening may be months away, and another patient who could have filled the slot also loses out.

Ghanim explained why practices that have tried reminders and other quick fixes often see little change, and why he urges leaders to define and diagnose the problem before acting. He also explained why blaming a clinic's low-income location misses the real causes, and how some clinics he has worked with cut no-show rates from 19% to as low as 5%. Comparing how small independent practices and large health systems can tackle no-shows, larger systems more likely have ready data to identify trends, while independent physicians have an advantage to put a plan in place quickly.

"In a small independent practice, basically, you own everything. If you have a plan, the plan can be executed tomorrow because you are the big boss," he said.

Medical Economics was in San Antonio at the MGMA Annual Conference, Sept 27-30, celebrating 100 years of MGMA, attending sessions and speaking with industry leaders. Follow our coverage on our MGMA conference page.