How many calls does a medical practice actually miss?

Every vendor in my category opens with a missed call statistic. I have quoted one myself. They are all different, they are almost all sourced to another blog post, and the chain usually runs cold before it reaches anything you could check.

So this post does two things. It says what the published numbers actually are and why they disagree, and then it tells you how to stop caring about them, because the only number that matters is yours.

The two figures everyone recycles

The low one is around 23 percent of inbound calls missed. The high one is 42 percent during business hours, from a review of roughly 7,000 calls across 22 practices in 18 states.

Both get repeated as though they measure the same thing. They do not, and the gap between them is not really disagreement. It is definition.

• What counts as missed. A ring out is obviously missed. Is a caller who waited ninety seconds on hold and hung up? Is a busy signal? Different studies draw that line in different places and the answer moves by ten points or more
• Which hours. Business hours only, or the whole week? A practice that looks respectable from nine to five looks very different once you count 7pm on a Tuesday
• Which practices. Twenty two practices is a real sample and it is not a national average. Specialty, size, whether there is a phone tree, and whether the front desk also does check in all move the number
• Who paid for it. Most of the figures in circulation come from companies selling something to fix the problem. That does not make them wrong. It does mean the higher figure is the one that gets published

The number that is more useful than either

Two other published figures do more work than the miss rate itself, and they are the ones I would actually plan around.

The first is that around 62 percent of callers who reach voicemail hang up without leaving one. The second is that a large majority of those never call back. Take those two together and the miss rate stops being an operational annoyance and turns into a revenue question, because the missed call is not deferred. For most of those callers it is gone.

That is also why "we call everyone back within the hour" is a weaker answer than it sounds. It only helps the minority who left a message.

How to get your own number this afternoon

This is genuinely a one afternoon job and it beats every statistic in this post, including the ones I just quoted.

1. Pull the call detail record from your phone system for a full month. Every provider has this, though on some of them it is called a call log or a usage report and lives two menus deeper than it should
2. Count total inbound calls. That is your denominator
3. Count calls that ended without connecting to a person. Ring outs, abandoned in queue, busy. Your system will label these differently, so read the legend rather than guessing
4. Split the result by hour of day and by day of week. This is the step people skip and it is the one that tells you something. Most practices find their miss rate is fine at 2pm and terrible at 8:05am and at lunch
5. Now count the calls that arrived when you were closed. Those are not in your miss rate at all, because your phone system does not consider them missed. They are missed

You will end up with two numbers: the share of open hours calls you did not answer, and the raw count of after hours calls you never saw. In my experience the second one surprises people more than the first.

What that looks like in production

At Synergy Medical, a family medicine practice in Michigan running on athenahealth, the after hours volume was roughly 40 to 50 calls a week before we turned anything on. None of those were in a miss rate report anywhere, because nobody was there to miss them.

Over two months MedPhone answered about 2,848 calls and resolved a little over half without a human touching them. The number I care about there is not the total. It is that the front desk got ten to fifteen hours a week back, which went into billing and collections.

I am not going to extrapolate from one practice to a national figure. That is exactly the move that produced the statistics at the top of this post.

Turning the number into money

Once you have your own miss rate, the arithmetic is short. Take your monthly inbound volume, multiply by the share you miss, multiply by the share of callers who are new patients, and multiply by what a new patient is worth over their time with you. That last figure is the one to be conservative with.

We built a calculator that does this with the assumptions visible and editable, because the assumptions are the entire argument. If a vendor shows you a revenue at risk figure and will not show you what is underneath it, the number is marketing.

Run it on your own numbers

Questions people ask

Is 42 percent really plausible?

For a busy practice at peak hour, yes, easily. As an all day average across a whole year it is high. This is why the hour by hour split matters more than the headline: a practice can have an excellent daily average and still lose most of its 8am callers.

Our phone system says we answer 95 percent of calls. Is that wrong?

Probably not wrong, probably measuring something narrower. Many systems count a call as answered the moment it hits the auto attendant, so a caller who navigated a menu, waited, and gave up still shows as answered. Check what your provider counts before you trust the percentage.

Do missed calls matter as much for an established practice?

The revenue at risk is lower because a smaller share of your callers are new patients, but it does not go to zero, and the operational cost is the same. An existing patient who cannot get through to reschedule becomes a no show, which has its own price.

What miss rate should we be aiming at during open hours?

Under 5 percent is a reasonable target and most practices can get there without hiring, by fixing the two or three specific hours where the number is bad. Chasing zero during open hours is usually less valuable than covering the hours when the office is shut.