A Saskatoon medical clinic has introduced a ‘three strikes and you’re out’ policy for people who fail to show up for doctors’ appointments.
Under the new policy that started Jan. 1, Lakeside Medical Clinic gives no-show patients a warning the first time, then levies a $50 fee for the second offence, according to the clinic’s website.
Those who skip a third appointment face a bill for $100 and can be dropped by their doctor and banned from the clinic.
Dr. Jason Hosain, who has studied no-shows in Saskatchewan and the response to them, said he understands the increased value placed on appointments with family doctors, even though he does not believe no-shows represent a growing problem.
“Appointments are precious,” Hosain said in an interview this month. “You want to make sure it’s a commodity you’re not wasting.”
But Hosain cautioned against applying sanctions to patients without considering their circumstances. Patients who miss appointments could be suffering from issues like mental health struggles and insecure housing, he said.
“There’s an underlying factor that drives these no-shows,” Hosain said. “These are not just people who are not showing up because they don’t want to. So I think we have to be very judicious about these policies.”
Saskatoon’s Erindale Health Centre introduced no-show fees four years ago after about 1,000 patients failed to show for appointments in the previous year, according to information on the clinic’s website.
Even with the policy, 20 to 30 patients fail to show up each week, the clinic’s office manager, Sharadyn Andre, said in an interview. The clinic charges $20 or $40 for missed appointments, which are generally scheduled for either 15 minutes or 30 minutes.
Some Saskatoon residents say no-show fees make sense due to doctor shortage
Like Lakeside, Erindale introduced a three-strikes policy that warned patients they could lose their doctor after three straight missed appointments.
But the new policy failed to halt a rising tide of no-shows and the clinic revised the rules in the fall of 2023 to require patients to pay outstanding no-show fees before they can see a physician. Patients also face being discharged from a doctor’s care after three missed appointments in a year.
“Obviously, if people are coming in and they have like a medical emergency, we don’t say, like, ‘No, you can’t come in, like, you haven’t paid for your no-show fee,'” Andre said.
The clinic’s no-show charges conform to the fee guide for uninsured services set out for doctors by the Saskatchewan Medical Association, which suggests patients can be charged half of the cost of an appointment if they fail to show up, Andre said.
Doctors at the Erindale clinic decide when no-show fees are charged, and they take into account factors like severe weather, genuine emergencies and ability to pay, Andre said.
“I would say that our doctors are usually fairly lenient about who they are and who they aren’t charging for,” Andre said. “I know some places charge more — quite a bit more. I know specialists definitely charge quite a bit more.”
The no-show policy was introduced after the clinic started using an online notification system called Medeo. When patients were reminded of appointments a day before and they confirmed and still missed the appointment, the clinic decided to impose penalties.
Jamie Donlevy of Saskatoon missed a doctor’s appointment and paid a fee after she switched phones and her calendars failed to sync.
“I mean, I didn’t love paying it, but I did,” Donlevy said. “So that was just the way it is. And with how hard it is to get a doctor these days, I think you’ve just got to keep them happy.”
Determining how large a problem no-show patients has become and how much it costs the system is difficult, since no health-care body in Saskatchewan appears to be tracking the data.
CBC contacted the Saskatchewan Medical Association, the Saskatchewan Health Authority and the Saskatchewan College of Physicians and Surgeons. All said they do not track missed appointments. The college said in an email that it has not taken a position on no-show fees.
The Lakeside clinic did not respond to a message left by CBC.
Hosain said all of the information is documented on computers and could be compiled easily.
He ran the data for the main clinic where he works in Saskatoon, the West Winds Primary Health Centre clinic, and found the overall no-show rate was 4.5 per cent for the 30 days preceding March 10.
The lowest rate for a doctor at West Winds was two per cent and the highest was 12 per cent.
Hosain’s rate was six per cent, the same as the overall rate for the other clinic where he works.
He said it’s worthwhile to examine the patients driving high and low no-show rates. The doctor at two per cent sees a mainly stable group of patients, including many seniors, while the doctor with the 12 per cent rate deals with more vulnerable people.
Hosain said his research suggests the problem of missing appointments is not getting worse, but he acknowledges appointments with doctors may be viewed differently when so many are struggling to attain primary care.
Estimates suggest as many as 300,000 people in the province — almost equivalent to the population of Saskatoon — lack a family doctor.
Hosain said a change in billing practices since the COVID-19 pandemic hit in 2020 can provide the answer for some doctors or clinics beset by no-shows. Prior to the pandemic, doctors could only charge for in-person visits.
Now, however, doctors can also charge for virtual visits. Hosain suggests doctors and clinics use virtual appointments with patients in an electronic waiting room, either on a phone or online, to fill vacancies created by no-shows.
He also said he understands why clinics have introduced measures to ensure patients show up.
“It’s frustrating because there are a lot of resources that go into booking an appointment.”
