Recent changes in physician payments in Ontario have impacted the medical practice a great deal. From a fee-for-service arrangement, the practice now runs on capitation under the provincial health insurance plan. This means that physicians get paid a flat fee, per patient, per year, adjusted to consider the age, gender and medical complexity of the patient. This set up naturally brings to question ‘no show fees’ employed by physicians.

A doctor paid in capitation doesn’t really lose money when a patient fails to show up for an appointment. No shows generally affect physicians who still work under fee-for-service because a sudden cancellation means an unfilled spot that otherwise could have been replaced had there been a notice. Be that as it may, protecting a physician’s income is not the only reason why a ‘no show fee’ must be implemented.

Prithi Yelaja, a spokesperson for the College of Physicians and Surgeons of Ontario (CPSO) infers that the fee will serve as “a deterrent to the patient who doesn’t show up or cancels at the last minute because that becomes a burden on another patient who could have taken that time slot.” The CPSO actually allows doctors to impose this fee as long as the patients are informed beforehand, in writing, the possible penalties for not showing up. Signs posted on office doors are as good as a written letter.

This practice in Ontario can be easily adopted anywhere. If you think about it, the consequences of willful no-show can be used to reinforce patient consideration for the physician and other patients. I am not saying however, that this is the only and best way to encourage a more responsible patient behavior. But it’s only fair. At the least, patients can avoid the fees by sending a cancellation notice to enable the physician’s office to accommodate other patients who wish to make an appointment.

But what do physicians do ever there are patients who refuse to pay the fee? Do they withhold permission to book another appointment? Can they refuse services? I don’t think they can, or will. Most doctors are just using the fees as the deterrent and will not really go so far as to refuse care unless the patient is repeatedly cancelling. I can’t even imagine the hassle of trying to hunt down a patient who did not show up to get the service you’re providing, only to ask him to pay for something he did not get.

It’s not that difficult to pick up a phone and cancel. When someone fails to notify the physician’s office, that person is depriving other patients of a probably much needed service.

An empty schedule means empty collection for fee-for-service practitioners, not so much for those under capitation. Private practice needs a lot of hustling for patients and a cancelled appointment creates a rather deep dent in our economic pillars. So should ‘no show fees’ be implemented? I say yes, but must still be applied with a rational process and conscientious considerations.