Reducing No-Shows for High-Value Dentistry

Gary Takacs: This is The Thriving Dentist Show with Gary Takacs, where we help you develop your ideal dental practice—one that provides personal, professional, and financial satisfaction.

Gary Takacs: Welcome to another episode of The Thriving Dentist Show. I’m Gary Takacs, the Thriving Dentist Show founder and co-host. We have a great episode for you today. This episode is titled Reducing No Shows for High Value Dentistry. If you ever struggle with no shows, you’re gonna be very interested in this Thriving Dentist Show episode.

Hey, before we get into the episode, two quick announcements to make. Those of you that are regular listeners know that we often schedule events for our Thriving Dentist community. Those events can be webinars, they can be panel discussions, they can be simply conversations with people we consider to be leaders in our dental profession.

And if you’d like to attend any of those, go to thrivingdentist.com/events. And when you go to that landing page, you’ll always see our next event.

Some of them will provide CE credits. It depends on the nature of the event, but if we’re allowed to provide CE credits, you’ll get CE credits for attending those. And please know that any of the events that you attend, you’ll be attending as our guest. There’s no tuition. It’s a great way to allow us to go into more depth on some of the topics that we don’t have time to cover on the podcast. So come join us for a Thriving Dentist event.

Again, go to thrivingdentist.com/events. You’ll always see the next one. You might want to check in there periodically and take advantage of some complimentary CE—but more importantly, learn some information that you can apply in your practice the next day.

The second announcement that I have is we have a returning guest, my podcast co-host, Naren Arulrajah, with our Thriving Dentist Marketing Tip. And this particular marketing tip is Google E-E-A-T. It’s an acronym. What is it? And why is it important for dental practices? Well, Naren’s gonna unpack this for you in this Thriving Dentist Marketing Tip.

No further ado, here’s Naren Arulrajah.

Naren Arulrajah: In today’s marketing tip, I’ll be talking about Google E-E-A-T, which is E-E-A-T. What is it, and why is it important for healthcare businesses? This is Naren, the co-host of the Thriving Dentist Podcast.

So let me define: E for experience, the second E for expertise, third letter A for authority, and the last T for trustworthiness.

So, what does experience mean? The creator has firsthand practical experience with the topic. This can be shown through life experience, such as patient reviews of a treatment. So let’s say you’re talking about implants—adding that review where the patient talks about their experience with your implants really shows Google that you have relevant experience. They want to show real experience.

Second is expertise. You have the necessary knowledge or skill in the subject matter. Especially for doctors, it means your DDS, your training, the university you went to—if you have any extra qualifications, what are those? That makes you an expert in implants or in dentistry.

Naren Arulrajah: So including the bios and making sure your qualifications are written properly the way Google likes it will get you points on expertise.

And the third one is authority. The creator or website is seen as a leader—an authority on the topic. This is often shown through the creator’s reputation and how often they’re cited or referenced. For example, if you’re giving a talk on implants, include that. And then hopefully, if that talk is linked by other people, that’s even better.

Trustworthiness: the content is accurate, honest, and safe. This is supported by clear information, secure websites like HTTPS, and transparent policies.

So as we move into the AI world, we know Google is the company to beat. They’re used 30 billion times—12 billion times a day on search, and 5 billion times a day on Google Maps. So 17 billion times a day.

Naren Arulrajah: And now Google has incorporated AI into their regular search. So you don’t need to go to ChatGPT to use AI—you can just use it as part of Google. So this is becoming really important because one of the biggest complaints about AI is hallucination. AI makes up words, and a lot of times it’s making up nonsense.

So Google wants to know that anything it says in the form of a paragraph answer for a person is linked to relevant pages, relevant websites. Now, how does Google determine if that page is a good page? By looking at E-E-A-T. And especially in healthcare, that second E—expertise—is important. So including your bio, including your qualifications, makes you really stand out.

The last thing Google will do is rank a page that is not linked to a doctor, if it’s healthcare-related or dentistry-related. So make sure you are leveraging E-E-A-T, not only because that’s the way the world is moving and AI is the way to be.

Naren Arulrajah: And people are sick and tired of AI hallucinating and making up nonsense. I’m sure we all have heard of a case recently where ChatGPT, you know, helped somebody commit suicide in Texas—a young man who was just finishing up his undergraduate degree. And, you know, so people don’t want AI hallucinating and making up nonsense. It wants it to be linked to authoritative, experienced, expert content from real doctors.

So leverage that. If you want to know if you are leveraging E-E-A-T in 2025 or not, book a marketing strategy meeting. The link is ekwa.com/td. We spend $900—it’s a $900 value. We spend six hours studying you, your competition. We’ll tell you how they’re doing, how you are doing, and give you a roadmap.

If E-E-A-T is your weakness—by the way, it’s one of the six things Google cares about the most—we’ll tell you how to fix it. Have a nice day.

Naren Arulrajah: Welcome back to The Thriving Dentist Show. Hope you enjoyed that tip. If you have more questions about marketing or SEO or how to attract new patients, book that marketing strategy meeting. It’s ekwa.com/td a thriving dentist. We would love to help.

We would spend six hours studying you and your competition, giving you a report card and, obviously, a plan. So that’s our gift to you—take advantage of it.

Today’s topic is reducing no-shows for high value patients. When we define high value patients, we are really talking about sedation, implants, Invisalign. A no-show for perhaps a filling may not be as impactful as a no-show for an Invisalign patient or a full mouth reconstruction patient.

So I’m really excited to dive into this. I know there’s a lot going on, Gary. I recently did an event where the key thesis was fixing your leaks and imagine getting the wrong patients, right?

If you get the wrong patients who are asking the question, “Is it covered by insurance?” it’s hard to get them to do anything other than what’s covered by insurance. So I think the challenge a lot of practice owners have, being PPO practices, is you want to grow the high value dentistry just like every other dentist who’s not on a PPO.

You take those courses, you get passionate about certain things, but you have a problem where, A, they don’t accept treatment, and when they do, they don’t show up. In other words, they’re not really serious.

So I think this is a really good conversation. What’s your read, Gary, in 2026 as to how you see this? What has changed? What has remained the same in terms of this dilemma—especially in the high value bucket? What are you seeing?

Gary Takacs: High value dentistry is something that can bring a lot of joy and satisfaction to dentists. One of the reasons I love our profession—and pardon my enthusiasm for dentistry—but I truly do love our profession because we have the ability to change people’s lives every day, right?

It could be something we do clinically, or it could be something we do behaviorally. Behaviorally, it could be a patient that just needs a lift. They’ve experienced some challenges and they need to interact with some people that are lifting them up.

Maybe someone that needs some empathy in their life. Maybe we have a patient that is taking care of a failing elderly parent, and we’re providing the emotional support that allows them to show up as they need to show up for taking care of their parent.

Gary Takacs: You know, dentistry can be very, very rewarding. If I look at the progression of education for dentists—from dental school onward—many dentists are drawn to doing those kinds of procedures or mastering the kinds of procedures that we call high value dentistry.

But I want to expand the definition a little bit, Naren, because high value dentistry—I generally think of things like placing and restoring implants, adult orthodontics, cosmetic dentistry, complex restorative dentistry, diagnosing and treating obstructive sleep apnea with appliance therapy, for example.

But there are other forms that would qualify under high value dentistry. For example, quadrant dentistry. That can be high value—doing everyday general dentistry, but doing it a quadrant at a time can be high value dentistry if we’re defining production per hour as part of that. So it doesn’t have to be something exotic. It could be that we’re doing everyday general dentistry, but we’re doing a lot of it.

Oral conscious sedation can lead you to high value dentistry because the typical patient that could benefit from oral conscious sedation is a patient that’s been away from the dentist for 15 to 20 years. As a result of being away from the dentist for 15 to 20 years—and what was the reason, Naren? Why are they away from the dentist typically for 15 to 20 years?

Naren Arulrajah: I think a lot of times it’s the fear of going to a dentist.

Gary Takacs: Yeah, it’s fear. There could be other reasons, but the predominant reason would be fear. When they learn that they could be taken care of in an environment that’s completely comfortable, eliminating the fear from them, they don’t want to have a tooth a year for the next two years done under their insurance plan.

They’ll say, “Doctor, now that I know I can do it this way, I want to get all this dentistry done in as few visits as necessary.” That could be one or two visits, I think.

So I’m broadening the definition of high value dentistry beyond just the nameplate high value services that we think of. My view is that pursuing the pathway where you can deliver that is a pathway for joy for dentists. It’s a pathway to remain challenged. It’s a pathway to continue to advance your skills.

Where dentists get very, very frustrated—and I’ve experienced this certainly in my coaching work—is where they have done all the work to master those skills, but they don’t have the patient base that is interested in those skills. Kind of something you alluded to in the opening.

“I only want to have done what’s covered by my insurance.”

That leads to a very poignant life of quiet desperation for so many dentists. They have the skill to do this. They’ve invested a massive amount of time and energy in developing these skills, and yet they have a patient base that largely isn’t interested.

Now, I’m going to pivot right now—literally do a 180 pivot. That can all change in your practice. That can change. It doesn’t have to be that way. That may be the reality of what you’re experiencing now, but it doesn’t have to be your future.

Just like being a PPO provider may be your reality today, you’re not locked into that. You could change that over time.

To hit our topic today—reducing no-shows for high value dentistry—what are some of the reasons that lead to patients canceling appointments?

Naren Arulrajah: Gary, just one comment I want to ask your feedback on and share. You said something really impactful, and I think it’s very, very true. You gave the example of sedation.

If you had talked to me about this 10 years ago, I would have given you a totally different answer. One thing is, as we age, we change. You know what I mean? I hated going to the gym, but now I’m enjoying going to CrossFit.

In other words, human beings are not going to be the same person forever and ever. The same way—maybe I didn’t really care about taking care of my health, and one day I wake up and I want to get all these health or dental issues that I have been ignoring for 10 years done. I want to have that beautiful smile.

And of course, especially those with grown children—you are one and I’m one—or when they become teenagers, we start thinking about ourselves. A lot of things that we completely ignored up until that point suddenly get into the rearview mirror.

So I think the opportunity is real. The challenge, like you also pointed out, is these practices that are PPO practices have kind of given up. They’re just like, “Okay, it’s not going to work because every question is going to be, ‘Is it covered?’”

So what’s the point of even trying?

Then you also have a team that’s comfortable. I know, Gary—you are a coach and we have mutual clients. You talk to the doctor and he’s like, “I want more new patients.” Then you listen to the phone call and the team doesn’t want new patients. They don’t want new patients the way they say they do.

Gary Takacs: They’re actually in direct opposition to one another in terms of their goals.

Naren Arulrajah: Yeah.

Gary Takacs: That can all change.

Naren Arulrajah: Yeah, and I know with your coaching you have changed so many practices upside down. I’ve seen practices that used to convert 30% converting 70% of new patient calls. I’ve seen practices that had given up and checked out become engaged with bonus plans and growing 10–20%.

So I agree. I think this topic of the reasons why patients cancel appointments—by getting to the root cause, we can really analyze it. But go for it.

Gary Takacs: I was going to comment that I don’t think there’s ever been a time in human history where people have been more interested in health.

Naren Arulrajah: I agree.

Gary Takacs: It’ll be more so tomorrow. People are interested. They want to live longer, and they want to live well longer. They want the kind of life where they live well longer.

Let’s bring this to dentistry. They want to have a beautiful, healthy smile. They want to eat whatever they’d like to eat, and that involves good dental health. They want to live without pain. They want to look good.

That plays very nicely into how we can help patients with what we’re calling high value dentistry.

So what are some of the reasons why patients will no-show for high value treatment appointments?

I’m going to talk about some conceptual reasons why that happens, but I also want to get to some very specific examples of how that happens.

On a conceptual level, the reason why they no-show is they don’t yet value it. They don’t value it. People show up for what they value.

If you feel like you’re pushing treatment on them, I think we’re headed down the wrong direction. I really don’t believe that we sell people dentistry—at least in the high value services.

We don’t sell them.

What we do is help them understand what dentistry can do for them. Once the pivot happens in their mind, they then want something that you have.

If they don’t want something that you are recommending for them—if they don’t really want it—then your incidence of cancellation or no-show is much greater because they don’t value it.

So it’s getting them to value what we do for them. I think that is a whole range of things that we could do.

Gary Takacs: Starting with images—people are highly visual. How is your office decorated? I’m going to suggest that in the back office, in the clinical area of your office, the only artwork you have up are beautiful after photos of patients you’ve helped have the smile of their dreams through high value services. Just beautiful after photos—actual patients.

Of course, we have to get their permission. The patient has to sign a release allowing you to use their image for educational and marketing reasons.

But imagine that. Now imagine people are seeing in your office images of people like themselves that look happy and are representing a really high valued event. That leads to a desire—I’d like to be like that.

So when there’s a desire, then the actual mechanics of keeping appointments are a lot easier. If the desire isn’t there, we can go through the mechanics and the hoops they have to jump through to make the appointment. But if they don’t really want it, then that’s something they might schedule a no-show for because the value isn’t there.

Naren Arulrajah: I want to piggyback on that. One way to think about it is—recently I was working with a founder. He has started three businesses and sold one for half a billion. This time he’s doing a modular home business and having some money issues in terms of raising capital, so he wanted my help in doing a slide deck.

I told him two words: fear and greed. That’s what drives people.

Fear—as in, “I’m getting older and I keep hearing about dementia and oral health. I don’t want to get dementia like my father or my brother.” Talk about it, right? It immediately resonates.

Or greed—like you said, that beautiful picture. “I want to look like that amazing, beautiful person with this wonderful smile.”

So those two things are what drive people. Instead of telling them they need something, let them figure it out for themselves. When I see that picture on the wall and I notice that person, I use the word greed to say I want to be like that person.

Gary Takacs: I would change that. I would change the actual label.

Naren Arulrajah: Yeah.

Gary Takacs: Desire.

Naren Arulrajah: Desire—exactly. Maybe that’s a better word. Investors—greed makes sense. But here it’s desire.

Gary Takacs: Desire. They desire something that you can provide them.

Naren Arulrajah: You can provide them.

Gary Takacs: They want something. If everybody just wanted basic stuff—

Naren Arulrajah: Right.

Gary Takacs: The only vehicle we would have would be Hyundais.

Naren Arulrajah: Hyundais. Exactly.

Gary Takacs: But no. In fact, you look at the vehicles that are driven—

Naren Arulrajah: It’s probably like 5% of the people buying Hyundais. Everybody else buys the more expensive stuff.

Gary Takacs: They want something. So we have to help them want what we have.

I’m going to give something for every one of our listeners to do—to take away.

There’s a wonderful quote that I would like you to have. Go online and find a company that can print this as a decal—a peel and stick decal.

The quote comes from Bradley Bale, MD. Bradley Bale, MD is a physician who is perhaps most credited with the oral systemic connection from the medical side. He wrote the book Beat the Heart Attack Gene.

This is a quote in his book.

Are you ready for it, Naren?

Naren Arulrajah: Yeah, I’m ready.

Gary Takacs: All good health begins with the mouth. — Bradley Bale, MD.

Have that made as a decal and put it on a wall in your office, near the top of the wall.

We have a client that sent me a picture of where he put this. There’s a patient restroom inside the office, and he put it on the wall as you exit the restroom. When you exit the restroom, there’s that quote: “All good health begins with the mouth.”

He said there have been many patients that have asked questions. “What does that mean?” Now it opens up a conversation about the oral-systemic connection—the way the mouth is connected to your health.

Now you’re getting people to want. One of the biggest reasons people no-show is they don’t really want what you would be providing during that appointment. They haven’t made that commitment.

So that’s the big idea—help them want it.

Have photos of after cases. Have an entire before-and-after photo album done on an iPad. Those will be closeups—middle nose, middle chin, middle of cheeks—showing people what you can do.

Cultivate reviews. When the patient says to you, after you’ve done whatever it is that you’ve done that might be a high value service, “I am so happy I did this. The only regret I have is I didn’t do it sooner,” cultivate a review like that.

“Mary, I know a lot of people in the world are feeling that way. Would you be kind enough to write us a Google review and maybe say something similar to what you just told us?”

Gary Takacs: Now you’ve got reviews of patients saying how dentistry has been transformational for them and what a difference it’s made. That’s not appropriate for all patients. Some people want to be quiet about some of the things they’ve done, especially in cosmetic dentistry. Some people don’t necessarily want to broadcast that, but others wear it like a badge. So cultivate that.

Build desire for what you can provide. First of all, let them know what you can provide them. How many of your patients still think of dentistry the way we thought of dentistry historically—in the 1960s and 1970s? How do they know what we can do today? Let them know.

So part of where we start is building desire for what it is that we can provide that can be completely transformational.

Naren Arulrajah: So what I’m hearing you say is if somebody’s canceling or no-showing, that means they haven’t really wanted it. That’s the root cause, right? Making them want something—have desire.

Gary Takacs: Yeah. At the time of recording this, the Super Bowl happened relatively recently. Did anyone no-show to the Super Bowl that had tickets?

Naren Arulrajah: I don’t think so.

Gary Takacs: I do not think so. Maybe if something terrible happened.

Naren Arulrajah: Something terrible—hospital, maybe.

Gary Takacs: Otherwise, did they no-show for that?

Naren Arulrajah: No.

Gary Takacs: In fact, they could have filled probably 50 stadiums with people who wanted to go.

Naren Arulrajah: Exactly.

Gary Takacs: Why? It was viewed as valuable. That’s where you want to go. If you enjoy football, that’s where you want to go. It has value.

I wonder if there’s any data on this—if a Super Bowl has ever failed to sell out. I don’t think so.

Naren Arulrajah: I don’t think so. Maybe the very first Super Bowl—maybe they had one seat left.

Gary Takacs: What about an NBA All-Star Game or a World Series game? Those are things people want. So make dentistry what people want—not just the technical part of what we’re doing.

Make looking good with a beautiful, healthy smile something people want. That’s not a hard thing to promote because people want that.

Put that decal up on your wall: “All health begins with the mouth.”

By the way, buy a couple dozen of Bradley Bale’s books and put them in your reception room. Hand them out. It’s a New York Times bestseller. We have no commercial ties to Dr. Bale’s book, but put that book in your reception room.

Naren Arulrajah: By the way, I had a friend of mine—very good friend—he almost died. He said, “I wish I had read this book. I wouldn’t have had this near death experience.” He was so mad at his healthcare providers that they didn’t talk about that.

Gary Takacs: I think it begins with building value. Help people want.

I’m going to go out on a limb here and maybe challenge some people. How is the dental health of the doctor, and how is the health of your team members? How does it look?

Do you have a smile that represents what you can do with cosmetic dentistry?

Naren Arulrajah: Great question.

Gary Takacs: If you don’t, and that’s something you want to develop, that might be something you want to represent yourself. We can certainly represent it through photo albums, through photos, through the language that we use, and through talking to our patients about these things.

But I want to get a little more tactical too. There are some tactical things we can do.

I want to answer a question. People pay for things they value.

Did anyone walk up to the ticket office for the Super Bowl and buy their ticket right there?

Naren Arulrajah: I don’t think so. I think they’d buy it like 7, 8, 9, even 12 months in advance.

Gary Takacs: They bought it ahead of time. They bought and paid for it ahead of time.

Naren Arulrajah: Even before they know who’s going to be in the Super Bowl.

Gary Takacs: Exactly. They bought it ahead of time. So does it make sense to require a deposit for high value dentistry? Absolutely.

Naren Arulrajah: Absolutely.

Gary Takacs: For example, if we have a patient doing everyday general dentistry—a single tooth, two-surface filling—if that patient doesn’t show up, it’s not a crisis. In fact, you might look at it and say, “Great, I needed a break anyway.”

But if you’ve blocked four hours for a smile design prep and temporization, and it’s dedicated doctor time—four hours of dedicated doctor time—and that patient doesn’t show up, can we agree we have a problem?

Naren Arulrajah: Absolutely.

Gary Takacs: We absolutely have a problem.

So what I would suggest—and this is going to be controversial for some—is that for dentistry like that, I would require it to be paid in full before the first appointment. Not just a deposit, but paid in full.

Recently, my wife and I went to a newer independent restaurant here in Scottsdale. My wife and I enjoy restaurants, and we enjoy supporting independent restaurants. It’s a tough business, and I like supporting those entrepreneurs.

When I made the reservation, they required a $100 deposit to make the reservation. That’s not common, but I really liked what they did. What are they doing? They’re building value.

Just for fun, I decided to call instead of using OpenTable. I actually know the owner, so I wanted to hear how the staff was handling this and give some feedback.

She was very kind. She asked what time I’d like a reservation, and if there was anything special. I said, “No, it’s just date night with my wife.” She said, “You’re going to have such a wonderful time here.”

Then she said, “Just so you know, Gary, we do require a $100 deposit to hold that reservation for you.”

So I decided to playfully push back a little because that’s not common. I wanted to hear how she handled it.

I said, “I can’t remember ever paying a deposit for a restaurant reservation.”

She said, “I completely understand. The reason we require a deposit is that, believe it or not, we have had people make reservations and not show up. If we had just a little bit of notice, we could fill those reservations. So we now require a $100 deposit. Of course, it will be applied to your meal.”

Then she said, “If you’re not ready to provide the deposit now, just call back when you are.”

It wasn’t impolite. It was very matter-of-fact.

I give her an A+. She explained why: “Believe it or not, people make reservations and don’t show up. If we had advance notice, we could fill that reservation.”

Then she said, “If you’re not ready to provide the deposit now, just call back when you are.”

I said, “No, no, no—here’s my card.”

Naren Arulrajah: There it is.

Gary Takacs: I reported back to the owner that she did an A+ job. She built value.

“Just call back when you are ready.”

It’s the same thing in dentistry. If you’re not ready to commit to the four-hour appointment, just let us know when you are.

That also subtly taps into something interesting—people often want what they can’t have.

Naren Arulrajah: Exactly. Gary, the minute you take it away from them, they’re like, “Oh, please, please, please—no, no, no.”

Gary Takacs: No, no, no, no, no—I’m ready. Then you get the card.

I recognize this is not common practice at all, but what is common practice is people no-showing. How about we avoid that? How about we do something different?

Naren Arulrajah: Gary, let me ask you something. What systems can be used to reduce no-shows? I know you have 24 systems—you’re famous for that. What systems specifically?

Gary Takacs: If I get very mechanical here, we need a confirmation system that requires a response. For high value dentistry, the patient has to respond back—not just let it float.

For high value dentistry, I’ve recommended my clients require what I call a hard confirmation. Hard confirmation means the patient responds back: “Yes, I’m coming. I’m looking forward to the appointment.” Whatever they say—but they confirm.

If they haven’t hard confirmed, then we follow up.

For everyday dentistry, everyday general dentistry, we might confirm two days in advance because if they’re not coming, that gives us time to fill it. But for high value dentistry, I might go three or four days in advance because we might need more time to fill that larger appointment.

But we’re going to need them to hard confirm.

The other thing is when you’re presenting the dentistry to the patient, make sure everything is buttoned down in the appointment process—how many appointments are involved and the fact that because it’s high value dentistry, it does require prepayment.

Button it down.

If it’s paid for, the likelihood they show up goes up geometrically. Of course, if there’s an emergency, they may reschedule.

Naren Arulrajah: Of course.

Gary Takacs: But it really allows them to make a commitment.

Another thing—when you’re presenting dentistry and you’re not quite sure the patient is committed—what did the receptionist at the restaurant do for me? She took it away.

“If you’re not ready, Mr. Takacs, just call back when you are.”

If you’re not ready to make the reservation and provide a deposit, just call back when you are.

You can have that same conversation.

“George, as we’re talking about this, it seems like you’d like to have this done, but I’m not sure if you’re committed to the treatment. Talk to me about that. What are you thinking?”

Take the time to talk with them, answer any questions, and determine whether they’re committed.

“I’d love to help you with this, but it does require dedicated appointments that will be one-on-one time with you. Because of that, we need a patient’s commitment to the appointment time. If you’re not ready, that’s fine—we’ll be ready when you are.”

Take it away.

What’s the human dynamic when you take something away?

Naren Arulrajah: They want it.

Gary Takacs: They want it. “Oh no, no, no—I’m ready.”

So one of those systems would be a confirmation system that requires them to respond back.

But remember, if they’ve prepaid, you’re already reducing a lot of that risk. They’ll be confirming—“Yes, I’m coming. Yes, I’m coming.”—because they’ve already made a financial commitment.

Another part of the system is heavy training with your team, because the team has to present this confidently.

At the restaurant I mentioned, we actually met the woman who made our appointment when we went in. She was a young woman in her early twenties, and she was very skilled. That tells me the restaurant had done good training.

She wasn’t a deeply experienced restaurant employee—she had simply been trained well, and she handled it beautifully.

So as part of your systems, make sure your team is trained very, very well. Practice it, and make sure the i’s are dotted and the t’s are crossed so the message is delivered consistently.

Naren Arulrajah: One of the things that I hear from doctors is, especially with high value services, patients cancel. Of course, they have an excuse—or they no-show and they have an excuse. How do you remove that kind of situation? After a while, the doctors accept it. They’re like, “Okay.” How do you get rid of that problem?

Gary Takacs: It goes back to a core concept that Dr. Phil, the TV psychologist personality, shares. We train people how to treat us.

Naren Arulrajah: Right.

Gary Takacs: The reason why offices have cancellations and no-shows is they’ve trained their patients that it’s okay.

Naren Arulrajah: Right. In other words, I’m not important—you’re more important—so you can cancel. It’s okay.

Gary Takacs: One of the ways you can change that is during the new patient visit. At the end of the new patient appointment, say something like this.

Let’s say I’m the new patient coordinator and you’re the patient.

“Naren, first of all, it’s been such a pleasure meeting you today. Thank you for choosing our office for your care—we appreciate that. Before you leave today, I want to take a minute and explain four things you can expect from us as an active patient in our practice. May I take a minute to explain those four things?”

You nod your head.

“Number one, Naren, we’re going to work hard to always deliver the highest quality dentistry that we’re capable of.

Number two, that means we’re going to use the latest materials, the latest advances, and the latest technology because that’s how we would like to be treated. We’re going to treat you like a family member. We think of you as part of our patient family.

Number three, we stand behind our work. If something isn’t right, we redo it until it is—until it meets our standard.

Number four, we hand you a business card with the protocol to reach the doctor after hours. If you or any of your family members have an issue that needs attention after hours, here’s the protocol to reach our doctor. If it’s routine, call the office and leave a message. But if it’s something that requires attention, you can reach our doctor.”

Then we say:

“Now that we’ve explained what you can expect from us, may I take a minute and explain what we expect from you?”

Naren Arulrajah: Absolutely.

Gary Takacs: Just one thing.

“We ask that if you make an appointment in our practice, you show up.”

Then immediately backpedal.

“No, no, no—we’re family people. We know life gets crazy sometimes. Stuff happens. I saw a bumper sticker the other day that said ‘stuff happens.’ Well, the first word wasn’t stuff, but it did start with S.”

They laugh.

Then say:

“All we ask is that if you make an appointment and you need to change it, please give us at least two days’ advance notice so we can schedule another deserving patient.”

Now you’re training the patient.

Naren Arulrajah: To give you two days.

Gary Takacs: Exactly. If they need to change it.

Will that work 100% of the time? No. But it will radically reduce no-shows because now they’ll call you in advance. Most people will follow expectations if we clearly lay them out like that.

So that’s one of the ways we start changing that.

Naren Arulrajah: Thank you, Gary. That’s great. I think even when they do no-show, the way you handle it also trains them on what they’re going to do next time.

How would you handle it if somebody does no-show or doesn’t give that 48-hour notice? How would you handle it, Gary?

Gary Takacs: You hear all kinds of excuses. I do believe in forgiveness—everyone gets one get-out-of-jail-free card.

“Naren, I understand. I’m sorry that this happened. I’m sorry that whatever is going on is happening.”

So I’ll give you some wiggle room on that two-day advance notice. But in the future, we are going to require a two-day notice to move any appointments.

Naren Arulrajah: And then you even say that if they don’t, there’s going to be a missed appointment fee?

Gary Takacs: If that happens in the future without the two-day notice, there is a broken appointment fee. I just want you to know that now.

Then stand tall—confident.

Also, you’ve got to respect your patients’ time. Make sure you’re an on-time office. It’s hard to ask them to respect your time if you’re not respecting their time.

This has been a fun discussion.

I really would encourage you to require payment in full for high value dentistry. You’re going to find out right then if they’re committed to it.

You should also have options available. CareCredit can be a great option for interest-free financing. That way, you still get paid up front, which is great.

Gary Takacs: I think it’s time that we started demonstrating that our time is valuable and communicating it in a way that the patient understands how valuable it is. I think you’re going to get a lot less frustration with these cancellations and no-shows.

This doesn’t necessarily apply across the board to everyday general dentistry, but we have to recognize that a four-hour appointment is different than a single tooth, two-surface filling. We’ve got to treat your time accordingly.

Well, this has been a lot of fun. I hope you’ve appreciated this episode.

I’ll bring it back full circle. Go to thrivingdentist.com/events to see when the next event is.

If you haven’t scheduled a marketing strategy meeting with Naren and Ekwa, I would encourage you to do that. And if you would like some guidance and help to develop your ideal practice, set up a coaching strategy meeting with me. Go to thrivingdentist.com/csm.

We are accepting new clients and would love the opportunity to help you develop your ideal practice.

On that note, thank you for the privilege of your time. Naren and I look forward to connecting with you on the next Thriving Dentist Show.