The No-show Session Cancellation Frustration as a Pediatric Therapist

Therapists are helpers by nature. None of us thought we would get rich by becoming a therapist. Whether you are an occupational therapist, physical therapist, speech therapist, or child psychologist.

Therapists are helpers by nature. You are driven by a deep desire to assist individuals and families in overcoming the challenges they face. None of us thought we would become rich by becoming a therapist. Whether you are an occupational therapist, physical therapist, speech therapist, or psychologist, you entered this field to help families and children in need.

Unfortunately, in today's job market, many jobs for pediatric OTs are contract or hourly. This means that therapists may not have the job security or stability that they hoped for when they embarked on this career path. It can be challenging to plan for the future when you are unsure about the length or stability of your employment.

As a therapist, you may have been offered a position that seemed promising at first. You may have calculated the hourly rates to see if it was enough to pay your bills and student loans. You may have even asked about holidays and cancellation pay. You were likely excited to start your dream job and begin helping those in need.

However, the reality of the job may have turned out differently than you expected. Cancellations can be a significant source of frustration for therapists, as they may not receive compensation for the time that they have set aside for a session that has been canceled. This can make it difficult to manage your finances and plan for the future.

Despite these challenges, it is important to remember why you became a therapist in the first place. You have the opportunity to make a difference in the lives of the individuals and families that you work with. By prioritizing effective communication, clear policies, and self-care strategies, you can work to manage the frustrations of cancellations and maintain your passion for helping others.

But what you didn’t count on was the high cancellation rates, snow days, and family vacations. 

When I was working in early intervention there is nothing more frustrating than “no-shows”.  I wasn’t paid for them, and even worse I wouldn’t even get my “travel pay” and sometimes I would drive up to an hour to a family home!
 
Even now working online as an OT mentor I have no-shows for free mentoring sessions.  It is hard for me to imagine wanting help, making an appointment, and just not showing up.  Especially from OTs who understand the no-show frustration.

Therapists may become frustrated by cancellations for several reasons:

1. Loss of income: When a client cancels a session, the therapist loses out on potential income for that hour. This can be especially frustrating for therapists who rely on a steady stream of clients to make a living.
2. Disruption to schedule: Therapists typically schedule their days around their clients, so a cancellation can throw off their entire schedule. This can make it difficult for them to plan other activities or appointments.
3. Missed opportunity for progress: Therapists work with clients to help them make progress toward their goals, and cancellations can disrupt that progress. If a client cancels frequently, it can slow down their progress or even prevent them from reaching their goals altogether.
4. Emotional investment: Therapists invest a lot of time and emotional energy into their clients, and cancellations can feel like a rejection of that investment. This can be especially frustrating if the therapist has been working with a client for a long time and feels invested in their progress.
5. Professional responsibility: Therapists have a professional responsibility to provide care to their clients, and cancellations can make it difficult for them to fulfill that responsibility. If a client cancels frequently or without adequate notice, it can put the therapist in a difficult position and make it challenging for them to provide quality care.

It's essential to note that while therapists may feel frustrated by cancellations, they also understand that things come up, and cancellations are sometimes necessary. Most therapists have cancellation policies in place that allow for some flexibility while still ensuring that they can provide the best possible care to their clients.

So, what can we do to reduce no-shows? 

1 – Make sure you are sending reminders.  

Does your EMR or calendar have a built-in system for reminders?  Make sure it is turned on and working.  The day before and the day of reminders work best.
 
Text reminders are better than emails.  If you have access to automated text message reminders, use them.   And if you don’t and have a recurring late cancellation or no-show issue with a specific family, I would text them yourself if you are allowed. 

You can reduce the likelihood of cancellations by setting clear expectations with clients from the outset. This may include discussing the importance of attending sessions consistently and outlining any specific policies or expectations around cancellations.

2 – Be understanding, to a point.

Have a family that constantly cancels or no-shows? We as therapists and “helpers” are always looking out for others and can definitely be too nice.  Don’t be a pushover.  
 
Know your employers’ policies and stick to them.  This is one advantage of working for someone else.  Make them the bad guy. 

3 – Look out for yourself.  

If it is necessary to take a child off your caseload due to repeated issues, it is ok.  You have to also make a living.  We cannot help everyone, even if we would love to. 

In order to manage the frustration that can come with cancellations, it is important for therapists to prioritize their own self-care. Seeking support from colleagues, practicing self-compassion, and engaging in stress-reducing activities can all help to reduce the impact of cancellations on mental health and well-being.

Have other ideas that have worked to reduce no-shows?  I’d love to hear!