Conversion Science · established evidence
What 444,995 Physical Therapy Patients Reveal About Missed Calls, No-Shows, and Lost Care
A peer-reviewed analysis of 444,995 patients across more than 6 million physical therapy encounters found 73 percent of patients missed at least one appointment for a given care episode, rising to 85 percent for patients on Medicaid. Separately, one hospital system's own internal call audit found more than half of incoming calls going to voicemail at some clinics before it set a 10 percent improvement target. Appointment-based clinical practices leak revenue at both ends of the same funnel, calls that never get answered on the way in, and appointments that never get kept on the way out, and clinicians are structurally the worst-positioned people to fix either problem themselves, because they are mid-treatment exactly when both happen.
The no-show number, at a scale few marketing claims can match
Most vertical-specific statistics in healthcare marketing trace back to a vendor blog post with an undisclosed sample. This one does not. Bhavsar, Doerfler, Giczewska, Alhanti, Lutz, Thigpen and George published a peer-reviewed analysis in PLOS ONE covering 444,995 patients across over 6 million physical therapy encounters for musculoskeletal conditions, and found 73 percent of patients missed at least one appointment for a given care episode. The rate rose to 85 percent for patients on Medicaid.
The same study identified predictors beyond insurance status: smoking status, higher BMI, more prior cancellations, and longer gaps between scheduling and the visit date, or between visits, all raised no-show risk. That is a scale and a specificity almost no other vertical-marketing statistic in this space can claim, and it means no-shows are not a minor scheduling nuisance in physical therapy. They are close to a structural feature of the care model, unless something actively counters them.
Why a missed appointment costs more than one visit's revenue
A single no-show is a lost appointment slot, real revenue on its own. But the PLOS ONE data also found more prior cancellations predicted future no-shows, meaning attrition compounds: a patient who misses once is measurably more likely to miss again, and a stalled care episode is also a stalled clinical outcome, not just a billing gap. Every missed visit delays the progress a treatment plan is built around, a cost the practice absorbs twice, once in lost revenue and once in a patient whose recovery takes longer or stalls out entirely.
This is the specific, evidence-backed target a booking and reminder system is engineered against: reducing the compounding pattern the underlying research identifies.
The other end of the funnel: calls that never get answered at all
No-shows only happen to patients who already booked. A separate, earlier leak happens before that: the call that never gets answered in the first place. One hospital system's internal review, published through MGMA, found more than 50 percent of incoming calls going to voicemail at some clinics before it intervened, prompting the system to set a 10 percent or better missed-call target as an improvement goal, not a starting baseline.
The reason is structural, not a staffing failure to be ashamed of. A chiropractor mid-adjustment or a physical therapist mid-session cannot step away to answer a ringing phone, and a small practice rarely has a dedicated, always-available front desk. The phone rings exactly when the people who could answer it are unavailable by the nature of the work itself.
What happens after a call goes unanswered
A broader set of vendor-published studies, methodology not independently verified in this pass and treated here as contested and directional rather than an established industry average, put typical medical-practice missed-call rates in the 23 to 42 percent range, note that roughly 60 percent of callers hang up within 60 seconds, and that only about 30 percent of those callers call back. A missed call frequently sends the caller straight to a competitor instead, especially for time-sensitive pain or injury care where the next available practice, not necessarily the best one, gets the appointment.
Read together with the MGMA case data, a consistent picture emerges even where the exact industry-wide percentage is not settled: a meaningful share of the demand a chiropractic or PT practice has already earned, a patient who searched, found the practice, and picked up the phone to call, is lost before a single word is exchanged, for a reason that has nothing to do with the quality of care on offer.
The evidence
Key findings, with their sources
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73 percent of physical therapy patients missed at least one appointment for a given care episode, rising to 85 percent for patients on Medicaid, across 444,995 patients and over 6 million encounters.
established Bhavsar, Doerfler, Giczewska, Alhanti, Lutz, Thigpen & George, "Prevalence and predictors of no-shows to physical therapy for musculoskeletal conditions," PLOS ONE, 2021, PMC8162651.
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Predictors of PT no-shows include smoking status, higher BMI, more prior cancellations, and longer gaps between scheduling and the visit date or between visits.
established Bhavsar et al., PLOS ONE, 2021, PMC8162651.
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More than 50 percent of incoming calls went to voicemail at some clinics in one hospital system's internal audit, before it set a 10 percent or better missed-call target.
established MGMA, "Enhancing patient access by empowering front desk staff through phone system improvements," mgma.com, 2026.
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Vendor-published estimates put typical medical-practice missed-call rates at 23 to 42 percent, with roughly 60 percent of callers hanging up within 60 seconds and only about 30 percent of those calling back.
contested AgentZap, AnswerNet, Aira and related call-answering vendor publications, 2026 (undisclosed sampling, directionally consistent across sources).
Reference
Glossary
- No-show
- A booked appointment the patient does not attend and does not cancel in advance, distinct from a cancellation, which frees the slot for another patient.
- Care episode
- The full course of treatment for a given condition, spanning multiple appointments, the unit the 73 percent no-show figure is measured against, not a single missed visit in isolation.
- Missed-call rate
- The share of incoming calls that go unanswered and route to voicemail or disconnect, rather than reaching a person, the specific operational gap a text-back or answering system is built to close.
Straight answers
Frequently asked questions
Is the 73 percent no-show figure specific to physical therapy, or a general healthcare number?
It is specific to physical therapy. The figure comes from a peer-reviewed analysis of 444,995 patients and over 6 million physical therapy encounters for musculoskeletal conditions, published in PLOS ONE, one of the largest and most methodologically transparent studies located for this vertical.
Does chiropractic have an equivalent, peer-reviewed no-show or attrition study?
Not one located in this research pass. Several chiropractic-practice-management vendor sources describe a similar attrition pattern, patients quietly stopping care once acute pain eases rather than formally cancelling, but those claims rest on marketing-blog sources with undisclosed methodology, not a peer-reviewed study, and are treated as directional rather than established.
Is the missed-call statistic an industry average?
The most credible single figure, more than 50 percent of calls to voicemail at some clinics, comes from one hospital system's own internal audit case, published via MGMA, not an industry-wide average. Broader vendor-published ranges (23 to 42 percent) are directionally consistent but carry undisclosed methodology, so they are presented here as contested supporting context, not a stated industry norm.
What actually fixes the missed-call problem for a solo or small-group practice?
A system that answers or responds the moment a call is missed, typically an automated text-back that reaches the caller within seconds instead of routing to voicemail, so the patient who already found and called the practice does not have to decide whether to wait or call the next name on their list.
Provenance
Sources
- Bhavsar, Doerfler, Giczewska, Alhanti, Lutz, Thigpen & George, "Prevalence and predictors of no-shows to physical therapy for musculoskeletal conditions," PLOS ONE, 2021, PMC8162651 (established, peer-reviewed)journals.plos.org
- MGMA, "Enhancing patient access by empowering front desk staff through phone system improvements," mgma.com, 2026 (established, named professional association, single-organization case data)mgma.com
- AgentZap, AnswerNet, Aira and related call-answering vendor publications, 2026 (contested, undisclosed sampling)
Every figure above is attributed to a real, dated source and tagged with its evidence tier. Where a claim could not be verified to a primary source, it is not stated as fact.