All-Star Dental Academy Founder and CEO Alex Nottingham JD MBA speaks with All-Star’s Head Instructor and Lead Consultant Larry Guzzardo about how to stop cancellations by patients.
In this episode of Dental All Stars, we welcome Larry Guzzardo, a renowned speaker on practice management. With the nickname “Scheduling Doctor,” Larry is the go-to expert on how to get patients to show up on time and avoid cancellations.
We’ll explore the impact of cancellations on your dental practice, why they happen, and, most importantly, how to fix them. Larry will also share some valuable tips on verbiage to use when speaking to patients to decrease cancellations.
HIGHLIGHTS – Cancellations
- [02:14] Effects of cancellations on a dental practice
- [05:32] Why do cancellations and broken appointments happen?
- [07:23] How to fix broken appointments and cancellations
- [09:26] How to fix broken appointments
- [13:48] Avoiding cancellations right from the first call
- [18:38] Why you should attend the All-Star Practice Growth Summit
QUOTES – Cancellations
- [02:26] You can’t make your goals at all if people don’t show up for their appointments.
- [05:21] On those three broken appointments a week, that’s $3,000 a week times 52. That’s another $150,000 in lost opportunity.
- [06:19] It (cancellations) happens because we don’t, we don’t have a system in place that teaches people to keep their appointments.
- [09:33] we have to develop a mindset that we can teach people how to treat us.
- [12:21] We have to realize that people are always gonna give us a polite excuse why they can’t keep their appointment. And what we have to learn is that we can’t just accept their excuses. We have to enforce the policy.
- [15:33] If we put in a policy, a process, and the doctor is overruling, it’s going to fail.
- [23:36] If you replicate the system over and over, it doesn’t matter what area you’re in. It will work.
About Larry Guzzardo
Larry is the head instructor and lead consultant at All-Star Dental Academy and is a highly sought-after dental practice consultant and international speaker. His skill and talent offer practical, common-sense solutions to improve dental practice productivity. He is also a faculty member at the Dawson Academy. Larry has delivered countless presentations including, “Winning Patient Acceptance of Fine Dentistry,” “Working with You is Tearing Us Apart,” and “The Leadership Challenge.”
About Alex Nottingham JD MBA
Alex is the CEO and Founder of All-Star Dental Academy®. He has authored the dental practice game-changer book “Dental Practice Excellence” and co-wrote a bestselling book with Brian Tracy. Alex has shared the stage with Michael Gerber (the author of “The E–Myth Revisited”), and lectures nationally and internationally to prestigious dental organizations. He is a former Tony Robbins top coach and consultant, having worked with companies upwards of $100 million. His passion is to help others create personal wealth and make a positive impact on the people around them. Alex received his Juris Doctor (JD) and Masters of Business Administration (MBA) from Florida International University.
Episode Transcript – Cancel Dental Cancellations
Transcript performed by A.I. Please excuse the typos.
0:02:17 ALEX NOTTINGHAM: What is the effect on a practice from cancellations?
0:02:21 LARRY GUZZARDO: Well, I think one of the biggest effects is the revenue of the practice is affected. You can’t make your goals at all if people don’t show up for their appointments. And on top of that, just the morale of the office. I mean, I don’t know anybody who likes getting that phone call at 330 or 04:00 in the afternoon. I just was getting ready to call you, and then a little piece of you dies because you know what’s coming. You know what’s coming.
They’re going to let you know that they’re not going to be there tomorrow morning. And now you’ve got to spend the rest of the evening trying to fill that hole. So I think revenue, definitely a big loss of revenue, a big drain on the revenue and the morale of the staff because it makes everybody’s job harder, so much harder.
0:03:09 ALEX NOTTINGHAM: And give me a little bit of the numbers when it comes to broken appointments, because I get what you’re saying. They hurt morale. They’re hit to revenue. But what is it costing an office by this open time, these cancellations?
0:03:25 LARRY GUZZARDO: Well, if you figure a hygienist can probably earn at least or generate about $100 an hour, and I think that would be conservative. A dentist can generate $500 an hour, and I think that’s kind of conservative. But literally, and we talk about this in our seminars, in our live presentations as well. But if a hygienist just had two broken appointments a week, just two, that results in about $10,000 in lost revenue just from that hygienist, and just from those two broken appointments a week, a doctor who produces $500 an hour, that would cancel out about $26,000 in revenue. So combined for the year. For the year. But that’s $36,000.
0:04:16 ALEX NOTTINGHAM: And not to mention, you typically have to pay the hygienist, the wage. So add that on top of it.
0:04:22 LARRY GUZZARDO: Well, you have to add that on top of that. But what else I would look at is not only just that lost time and revenue, but the staff has to remember it’s taking money from them as well. Oh, yeah, true.
0:04:34 ALEX NOTTINGHAM: You’re also paying well, it’s taken away from them in terms of the bonus situation, what you talk about, but also you’re paying your entire team to be there’s no production. So now that $40,000 a year. You’re adding that it’s probably closer to 60 or 70,000. And probably it just occurred to me that’s a missed opportunity for more treatment planning, more case presentation, that’s not going to happen.
0:05:02 LARRY GUZZARDO: Right, exactly. Because you’re not doing those periodic checks, so you’re not going to find those other things. So it adds up enormously because that’s probably about maybe $1,000 each appointment that gets missed. You’re losing an opportunity for overall productivity. Add that to it, you know what I mean? On those three broken appointments a week, that’s $3,000 a week times 52. That’s another $150,000 in lost opportunities.
0:05:33 ALEX NOTTINGHAM: And why do they happen? Why do cancellations and broken appointments happen?
0:05:38 LARRY GUZZARDO: Well, see, this is where everybody is going to think I’m some kind of a jerk or an ogre. But the truth is, it’s because I think it’s easy to break an appointment in a dental office. We’re so focused on the fact that, oh, you can’t come in, I’ll just go ahead and get this rescheduled. And so it makes it really difficult for us. But what it does is it teaches the patient, oh, that was pretty good because the airlines just shut the door on my face if I show up late or my hairdresser cancels my appointment, or my massage therapist goes apeshit, pardon my French, but we know how they get.
But in a dental office, I think it happens because we don’t have a system in place that teaches people to keep their appointment. And that’s what we need. We don’t want a system that punishes people, because if they feel like they’re being punished, then they’re going to retaliate and they’re going to become resistant, and they’re going to create more problems for us. So why they happen is we don’t have a system in place.
That’s why they happen.
0:06:45 ALEX NOTTINGHAM: And your famous line that I choose to borrow at times, which is what is it? Is not having a broken appointment policy or cancellation policy is like taking a SWAT. What is it, a fly swatter?
0:07:00 LARRY GUZZARDO: When I look at some of the policies that we put in place, how many times we’ll let people change their appointment, or how many times we’ll let them break their appointment, or maybe we’ll charge them. I don’t like that either. It’s kind of like taking a fly swatter to our rhinoceros. And I think we need something a lot stronger than that, more like rambo coming in there and taking charge.
0:07:23 ALEX NOTTINGHAM: And what’s so interesting is you see two spectrums of how to fix broken appointments and cancellations is one is they just happen, and we just let it go. Because for whatever reason, we don’t have the policy in place. We are afraid of losing them. And the other way is we punish them and we penalize them. And I know you don’t believe in this.
0:07:48 LARRY GUZZARDO: No, I don’t, because I want people to learn on their own, because people who learn their own lessons, they remember them, and they become very, very compliant. So we don’t want people to feel like they’re being punished at all. And so a lot of it has to do with the fact that we just don’t have a system in place for dealing with broken and canceled appointments. We don’t have any kind of policy other than maybe we’ll try to charge you, which I would recommend something different, where maybe we don’t put ourselves in that position.
The reason why I don’t like charging for broken appointments is because we know that we’re dealing with somebody on the other end of the line that we don’t want to schedule. We know that, oh, no, it’s Larry again. I don’t want to schedule him, but Larry insists. Oh, please, I’ll be good. I’m such a nice guy. I know, I know. I’ll do it. And so we think, okay, Larry, I’m going to give you this appointment. But Larry, if you don’t show up, I’m going to charge you.
And Larry’s going to say, okay, that’s all right, I’ll pay it, and maybe Larry will. But that’s not our issue. The issue is, when we do something like this, when do we find out that Larry’s not showing up? We don’t find out until he doesn’t show up. And now we feel like we’ve shot ourselves in the foot because we have no time to react. I would propose a different kind of system that teaches people to keep their appointments, or better yet, puts us in a position where if you do have to make a change, we’ve got adequate time to find another patient to take their place.
Charging them, well, that goes to it.
0:09:27 ALEX NOTTINGHAM: How do we fix broken appointments? What’s your philosophy?
0:09:32 LARRY GUZZARDO: Well, I think that we have to develop a mindset that we can teach people how to treat us. We see this in a lot of different organizations. I joked about the airlines, but they did teach me because they shut the door in my face. And I’m not asking us to be like the airlines, but I say this all the time. I’m not that far off because the airlines have taught us, get here, get here on time, get in your seat, sit down, you know what I mean? And you’ll get the seat that you chose.
So we know that people can learn. So it really starts with a mindset that people can be trained, if you will, that we can teach them how to treat us. And we also have to realize that if we sat down and we looked at all the reasons that people give us for missing their appointments, I’m busy at work. I’m not feeling good. I can’t come, or I’ve got to go to a port and meeting, you know what I mean? My cat died. Again, when we look at all the reasons, if you just kind of wrote them all down, I think what people would discover is that they’re really not reasons.
0:10:49 LARRY GUZZARDO: They’re really not they’re more like excuses. It’s like, you’ve had this appointment for six months, so when a meeting came up, why didn’t you just say, I’ve got another meeting. You know what I mean? But they don’t do that because they feel, well, I’ll change the appointment at the dental office rather than make them change the meeting at the office. That would be easier for them, but somehow the patient thinks, no, it’s easier to make the dental office change.
So my point is that it would be better that we recognized as a group. These aren’t really reasons. These are more like excuses. And I say this because when I talk with staff members privately, they all tell me, I know that patient was lying to me. I knew they were lying to me. But how do you get around that? And that’s kind of what we talk about in our course, and that’s what we talk about in our live sessions. We have a lot of fun with it, but we have to recognize we can’t feel sorry for them.
Because the reality, Alex, is every office knows of the elderly patient who needs a little TLC. Every office knows of the family that’s struggling or the individual that’s going through a tough time. These people aren’t your problem, and we know they’re not our problem. I’m talking about the patient where you come to your morning huddle and you look at the schedule and you say to yourself, oh, he’s not coming in, and that one’s going to be late, and this one never shows up.
This is the person that I am talking about. So there’s a lot of moving parts here. We have to realize that people are always going to give us a polite excuse, I’m sick, my boss won’t let me off of work. Like, that’s real. Or, I got to talk to my spouse, or whatever it is. They’re always going to give us a polite excuse why they can’t keep their appointment. And what we have to learn is that we can’t just accept their excuses. We have to enforce the policy because you know who I’m talking about.
It’s those individuals that do this all the time.
0:12:52 ALEX NOTTINGHAM: And I think that gives a perspective because often we’re thinking, oh, one more patient. We don’t want to lose them. There’s a lot of fear of if I’m not reappointing them, I’m losing my new patients or my current patients by doing that. And I think you’re saying, let’s be real. You know, there are certain people that are repeat offenders, and those if you think out further, it’s not going to be a winning combination. It’s going to continue to be a loss to your practice and time and money.
0:13:22 LARRY GUZZARDO: Right. Because what I think gets you better compliance from patients overall are patients who understand how your system works.
0:13:31 ALEX NOTTINGHAM: Right.
0:13:31 LARRY GUZZARDO: They’re much more compliant. Again, I’ll use the airlines as an example. I don’t like all of their rules, but you know what? I know what they are, and because I know what those rules are, I either comply with them or I work with another airline. But it makes it easier for me, and I feel more comfortable when I’m dealing with them. I think the education starts right at the very first phone call. Like we teach in our own systems, we have to start educating patients right when they calling for that new patient appointment, explaining to them that we reserve specific time for our new patients so that they can be seen quickly and not be here longer than we had planned.
I’ll look to check to see when the first available appointment is open because this is what the doctor would want for you.
0:14:18 ALEX NOTTINGHAM: Well, I think that the first even prerequisite step is setting up. What type of office do you want? Give you an example. I have a chiropractor, a friend of mine, and I’ll change appointments whenever I like. And I’m like, you know that he actually uses our program too. Chiropractor uses our program, and he goes, you know, we don’t teach that. He’s like, I don’t care. Come in, go. I like to give my patients flexibility and okay, look, you can create whatever situation you like.
And my point is you have to be bought in first to see what type of effect it has. Maybe in Cairo it’s different than dentistry. But the point is you got to step in saying, this is what I envision. For example, we’re going to be doing a webinar in a month on insurance freedom. And that that’s a possibility. It’s not for everybody. But you got to say, what type of office do I want? What do I choose to create?
And when it comes to broken appointments, how do I choose to be treated and what am I putting out there? And so it’s got to be a commitment to, I see what I’m looking to do, and I’m going to commit to that. Because if we put in a policy, a process, and doctor is overruling, oh, just get the person in, don’t worry about it, it’s going to fail. So you got to be very clear on what you’re looking to create. And then you can put in a program that Larry is teaching the scheduling doctor, which is a process of teaching like you teach children.
This is how we’re going to do it. It’s an area of respect. I make an appointment for you. I’m going to block time for you. You’re going to come in. It’s a respect thing, and that’s how we go, and people will respect and what’s interesting, and even though I train with this, you taught me this, I break appointments and move it all day long because the doctor is saying to me, I don’t care. And I’m like, okay, that gives me flexibility.
0:16:16 LARRY GUZZARDO: Well, I don’t think it right, but if you have a walk in clinic, maybe that’s not so much of a problem.
0:16:21 ALEX NOTTINGHAM: Maybe that’s a different situation, right?
0:16:23 LARRY GUZZARDO: And so if it’s a dental office that has a walk in clinic and they don’t have to worry about not being able to fill that time, then I could see a policy like that would work out really well. But I know most offices are not walk in clinics, and I know most of them have an enormous amount of preparation time. They’re going to departmental meetings, they’re going to morning huddles. They’re ordering supplies or equipment or materials or whatever. They’re getting things ready.
They’ve talked to their laboratory technician. So it’s not just the time that gets spent when the person comes in and we set up the room. There’s all that prep work that goes into it before the patient even gets here. So patients who just willy nilly just skip their appointments is going to be tough. But you’re right, if the doctor is just going to be like, I’m okay with it, then you’re right, get used to it, because that’s what it’s going to be like.
0:17:15 ALEX NOTTINGHAM: So you have how you like your office to run in, your plan, your vision. You then have the policy, the broken appointment cancellation policy, and the subsequent verbiage. And we actually talk about the verbiage on our webinar, not just in the program, but we have a free webinar. Free webinar that we teach the verbiage for a broken appointment and a canceled appointment. Right. Now, what’s really interesting, I like to switch over for a little bit into it’s really a spectacle to see you live, Larry.
I remember back, that’s how we met. You. Heather and I were building all star. It was over ten years ago, Larry, and we saw you at the Florida Dental Association meeting, this huge meeting in Orlando, and you were the keynote in multiple situations, and Heather was auditing many of your courses, and it was just phenomenal to see you live. The knowledge you have on everything, practice management, and I know just particularly with scheduling, is something that’s really dear to your heart because it’s the lifeblood of the practice.
And granted, podcast people can see, or if you’re watching us on YouTube, you can see your mannerisms, but live, it’s a lot of fun. You were just speaking at the Yankee recently, got great reviews. Tell me, what is it like for a lot of the people that are listening, that are coming to the event or those that are thinking about coming to see All Star live? And you’re one of our main speakers. What is the benefit, you know, the benefit of online training?
What’s the benefit of coming to see your coaches and speakers like yourself live and bringing your team?
0:19:00 LARRY GUZZARDO: I think the biggest benefit for everybody is I’ll use the word role play, but you get to stump the instructor, because in something even like this or even in a course, we’re controlling the dialogue and how it’s presented. What I really like in live sessions is when it’s the audience participation, when you start getting the, yeah, butts, and I’m like, I’m taking you on. You’re going down. You know what I mean? You’re not going to beat me on this one.
But that’s the beauty of that’s, where they get to see the system working, you know what I mean? Because as you get those challenges from people, and you know how they like to stump you, like, no, I’ve got one. That this is it. And what do you do about this, and what do you do about that and all that? And it’s just like, no, come at me. Come at me all you want. I’m ready for you. So it’s the role playing.
I’m the staff member, and they’re the patient. And that’s where they roast of Larry.
0:20:00 ALEX NOTTINGHAM: A roast of Larry.
0:20:01 LARRY GUZZARDO: It’s where they really start to learn, because they’re, like, challenging me, and they’re like, oh, he just used his process, and they challenged me again. They’re like, oh, sure, that was the policy. No, he sounded really nice doing that. So it’s the live interaction, and you can’t get that, unfortunately, in a podcast or in a recorded course, right?
0:20:23 ALEX NOTTINGHAM: And it’s important that as well, that when I teach people about training, that you can’t just go to a seminar once a year and expect that’s going to work. It’s not enough. It is the icing on the cake. It’s almost like with school, you do your coursework, and then you go to the lecture discussions, the panels. That’s where you kind of ingrain it. And I was just thinking, as an aside that with events where a lot of our members come, like this event that they know you, they’ve studied it all, they’re ready to go.
0:20:55 LARRY GUZZARDO: They’re gunning for me. They’re gunning, yeah.
0:20:59 ALEX NOTTINGHAM: And that’s where you can go deeper. You can really work with the professors, the teachers, the coaches on the material. And so that’s I’m a big fan of do the online work, do the coaching. If you’re working with a coach and then come to the live events to then interact and also rub shoulders with some other great personnel. So that makes a lot of sense because I know you do a lot of international, national speaking, and obviously you do very well at it, and we love having you.
0:21:27 LARRY GUZZARDO: It’s the interaction, it’s them getting to see a live demonstration of how the process works.
0:21:34 ALEX NOTTINGHAM: Excellent. And what I plan to do as well is have you on in another podcast. I know you’re also going to be speaking about referrals, generating referrals and verbiage behind that. So it may be useful for us to talk again and share some of that material for the podcast and for our channel on YouTube and the other platforms that we disseminate this great material.
0:21:58 LARRY GUZZARDO: I’ll be back at the scene of the crime in June at the Florida meeting.
0:22:04 ALEX NOTTINGHAM: Oh, you’re going back?
0:22:05 LARRY GUZZARDO: Yeah, I’m coming back. I’m doing a full day. I believe it’s July the first. I think it’s that one.
0:22:10 ALEX NOTTINGHAM: I’ll make sure I’m there. Where’s it going to be?
0:22:12 LARRY GUZZARDO: It’s going to be Orlando at the gaylord resort.
0:22:15 ALEX NOTTINGHAM: Oh, I like that place.
0:22:16 LARRY GUZZARDO: Yeah, it’s a real nice facility. Everybody loves it. And it’s florida. Who can’t be happy there?
0:22:22 ALEX NOTTINGHAM: Well, that’s where I’m at. So, Larry, thank you as always for what is it? Gracious.
0:22:29 LARRY GUZZARDO: Graciously.
0:22:29 ALEX NOTTINGHAM: How do I say that? Yeah, graciously. Gracing us. It’s gracing us on the show. And for those that are again listening or watching, if you’re watching, subscribe to YouTube so you can get notified when we post this immediately. If you’re on Spotify, listening to Spotify, or was it itunes or Apple podcast, subscribe and follow. So you can be the first when you get the material.
0:22:57 LARRY GUZZARDO: Yeah, when you get the whole team on board, everybody realizes, this is so easy. I hear it all the time. I wish you would have started doing this years ago.
0:23:07 ALEX NOTTINGHAM: Well, what I always say is there’s a formula that we’re looking to do that if you follow the formula, you do this, you do this, you do this. You start to see things go. Many dentists are haphazard. I’ll do a seminar, I’ll do this, I’ll do a CD, I’ll do an online training, and it’s all over the place.
0:23:24 LARRY GUZZARDO: Right.
0:23:26 ALEX NOTTINGHAM: The benefit is I didn’t come directly from dentistry, besides my father being a dentist, and that whole story that you can learn about in the webinars, my background is with Tony Robbins and business and systems. And it’s like if you replicate the system over and over. It doesn’t matter what area you’re in, it will work. And so the same idea with dentists. It’s that compound effect, little by little, starts to build on each other rather than starting and stopping.
So I want to thank everybody for being here and listening. And until next time, go out there.
And be an all-star.
