While Daisy may not be a bulldog by breed, she represents the importance of having a strong-willed yet personable team member at your front desk, closing the gaps in your schedule. Photos courtesy of Dr. Crystal Brimer.
Put a bulldog at your front desk, and develop a system to eliminate empty appointment slots
By Crystal Brimer, OD, FAAO
April 30, 2026
No-shows and last-minute cancellations disrupt your day and your revenue. That’s especially the case in specialty practices like mine, which is focused on dry eye. Missed care delays treatment and patients are hard to reschedule when you’re booked months out. Overbooking creates staff stress and long waits and compromises care when everyone does show up.
Our team decided that we can have control over every empty chair.
I was empowered to take control after noticing our bottom-line revenue was on the rise after some recent staffing changes. One staff member at the front desk was making a difference by refusing to have an empty exam chair during our day.
COMMUNICATE THE VALUE OF YOUR TIME AND SERVICES
Your front desk staff does more than admin. They protect your schedule. This person has a key impact on revenue production and schedule control. This job goes beyond filling exam slots but also managing patient behavior and expectations. It requires a mindset shift, for staff and patients, that is well worth the time spent to get there.
Hire or train someone professional, friendly and consistent. They should be comfortable creating urgency and communicating value. Teach them to present exam slots as limited, explain long wait times for rebooking and offer the cancellation list as an incentive. That messaging alone often reduces cancellations.
When making appointments, our front desk staff reiterates the value of each appointment and keeping it. When the staff tells patients, “Our next open slot is in four months,” it’s explained that they will be added to our cancellation list as soon as they complete all their forms. It’s an incentive for them to get the paperwork done, and it’s also a gesture from us saying that we really do want to see them sooner.
She tells them, “Add us as a contact and answer our call because whoever answers gets the open appointment.” We are able to give them some confidence that they will get a sooner appointment if they want it.
A high-five from Daisy for eliminating empty appointment slots on the schedule.
KEEP A COMPREHENSIVE CANCELLATION LIST
In order to keep the schedule predictable, we needed an effective system to be in place. Her cancellation list was impressive. It’s not just names, but it also tracked preferred times, distance from the office, reason/urgency (color-coded) and responsiveness. From her original list, we developed a formal program.
When a last-minute opening appears, use that list first. For under-one-hour notices, deploy an all-hands staff approach: calling retired patients, nearby residents or frequent responders. Use targeted texts sparingly—send to those most likely to accept, not mass blasts.
My message to the staff is to focus on today’s openings. If down to the wire, we can move up an appointment from the next day to fill today’s slot. It buys us more time to fill the empty appointments.
CANCELLATION CALLS
Appointment reminders via call and text go out two weeks, one week and one day before their visit. Patients who receive a reminder text message can not cancel via text, but are prompted to call if they need to cancel or reschedule. We use this call as an opportunity to try to keep the patient in their time slot.
The conversation goes like this. “Are you sure you want to cancel? I don’t know when I can get you back in.” It’s not aggressive; it reinforces the appointment’s value and sometimes keeps the visit.
We implement clear cancellation fees to deter last-minute drops. Our practice charges $25 for cancellations made within 24 hours and new patients have to pay their $99 dry eye evaluation fee in advance if they’ve missed an appointment.
ANALYZE YOUR EXAM SCHEDULE EFFICIENCY
Improved efficiency goes beyond just looking at empty spots. Does your schedule format make sense? Our office color codes the purpose of the visit for consistent scheduling. Different team members can step in to help schedule. By knowing the appropriate time slots, we avoid long waits.
We recently added four more appointment slots, by starting 15 minutes earlier in the morning and before lunch, and by starting each session with 2 patients being worked up at once.
It’s always a work in progress. I’m looking again at what we can do to shorten our patients’ three- to four-month wait for an appointment. What tasks can be delegated to free up more of my time?
After extensive training and observation, I recently turned my Tixel i procedures over to my assistant. This became an enormous value add to the patients and practice. For patients, they no longer have to wait an additional 4 months, after finally getting in for their dry eye evaluation, to receive their initial treatment. For the practice, we are providing an extra 10-12 treatments per day.
Think about the minutes vs. money. Focus your schedule on higher-value exams to maximize revenue per minute. The adage is true: whatever you measure you improve. Track metrics and hold yourself to benchmarks:
- No-show rate: less than 5%
- Time to refill appointment: 30 minutes or less
- Percentage of same-day refill appointments: 90% or greater
STICKING TO THE NEW SYSTEM
It’s been more than five years since we made this change to filling our empty appointment spots. We’ll never go back to our old ways.
This system works because the staff understands how we get outcomes. Patients receive timely care, when they are often miserable, and staff understand that impact on the patients and the business.
In specialties, it’s easy to appreciate urgency. For primary care, emphasize the bigger-picture benefits to staff—patient access, revenue stability, and smoother days. Reward the small things and validate the process improvements.
It’s paying attention to the details that can help you grow 10%, even on a flat year.
Read more on general management here.
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Crystal Brimer, OD, FAAO, is the owner of Dry Eye Equation in Wilmington, North Carolina. She is also the founder of the Dry Eye Institute, where she provides dry eye implementation training to eyecare professionals nationwide. |
