What Is the Average No-Show Rate and Cost?

Peer-reviewed research puts the average outpatient no-show rate at roughly 23% worldwide, based on a systematic review of 105 studies. MGMA benchmarks put the median for US medical practices far lower, between 5% and 7%, with single-specialty groups at 6.81% in 2023. Both numbers are right: they measure different care settings using different definitions of a no-show. The most-cited peer-reviewed estimate of the cost is $196 per missed appointment.

No-show rate benchmarks, fully sourced

Most patient no-show statistics online are copied between blog posts until nobody remembers where they started. The figures below each carry their study, year, sample, and setting, so you can judge which benchmark actually applies to your practice.

• 23% worldwide outpatient average: a systematic review of 105 studies concluded "the average no-show rate is of the order of 23%," with regional averages ranging from 13.2% in Oceania to 43.0% in Africa (Dantas et al., Health Policy, 2018).
• 18.8% mean across VA clinics: ten outpatient clinics at a large VA medical center averaged an 18.8% no-show rate across fiscal years 1997 to 2008 (Kheirkhah et al., BMC Health Services Research, 2016).
• 5% to 7% US practice median: the median no-show rate for US medical practices was 5% in 2018 and 7% in 2019 (MGMA, 2022).
• 6.81% single-specialty median in 2023: MGMA DataDive Practice Operations data put the single-specialty aggregate no-show rate at 6.81% in 2023, approaching the pre-pandemic benchmark of 7% recorded in 2019 (MGMA, 2025).

If you run a private specialty practice, the MGMA range is your benchmark. The 23% global average describes a mix of settings weighted toward academic medical centers, hospital outpatient departments, and public health systems, and it should not be used to grade a private practice.

Why published no-show numbers contradict each other

Search for a no-show benchmark and you will find 5%, 7%, 18.8%, and 23% all presented as "the average," usually with no explanation. The numbers disagree because four things vary between studies, not because anyone measured wrong.

• Setting: academic centers, hospital clinics, and public health systems report the highest rates, while established private practices report the lowest. MGMA's benchmark reflects mostly established private practices, which is why its median sits at a fraction of the academic figures.
• Definition: some studies count only patients who miss with no notice. Others fold late cancellations into the no-show count, which can add several points overnight. Two practices with identical patient behavior can report very different rates.
• Patient mix and lead time: referral-heavy academic clinics see more new patients booked weeks out, while private practices see more established patients with shorter waits. The Dantas review found that high lead time and a prior no-show history are the strongest predictors of a missed appointment.
• Cost to the patient: price is not the main driver. VA care is low or no cost to the patient, and those ten clinics still averaged 18.8%.

How to calculate your no-show rate

Divide no-shows by total scheduled appointments for the same period, then multiply by 100. If your practice scheduled 1,400 appointments last month and 98 patients missed without notice, your no-show rate is 98 divided by 1,400, or 7%.

The trap is late cancellations. A patient who cancels two hours before the visit leaves the same empty slot as a no-show, but if you count them together your rate is no longer comparable to MGMA's benchmark. Track them as two lines: a strict no-show rate for benchmarking, and a combined no-show plus late-cancellation rate for measuring wasted capacity.

Run the calculation monthly, and break it out by provider and appointment type. An aggregate 6% can hide a much higher rate on new-patient consults, which is exactly where the revenue lives.

What each missed appointment costs

The most rigorous per-appointment figure comes from the same VA study: the average cost of each no-show was $196 per patient, and the marginal cost of no-shows across the ten clinics studied was $14.58 million in fiscal year 2008 (Kheirkhah et al., 2016). Those are 2008 dollars, so the equivalent figure today is meaningfully higher.

The most-quoted industry figure is that each open, unused 60-minute slot costs a physician $200 on average. That number comes from a scheduling vendor's 2017 op-ed (Healthcare Innovation, 2017), not from research, so treat it as an estimate. It lands close enough to the peer-reviewed figure to work as a rule of thumb.

For surgical specialties the stakes are higher than either number suggests. A no-showed new-patient consult at an orthopedic practice is not a $200 slot, it is potentially a surgical case that books somewhere else. No-shows are also just the visible portion of patient leakage: the missed appointment shows up on your schedule, while the patient who never booked at all shows up nowhere. You can estimate your own number in a few minutes with our leakage calculator.

Where the $150 billion figure actually comes from

Almost every article about no-shows repeats the claim that missed appointments cost the US healthcare system $150 billion per year. We traced it. The figure comes from an April 2017 op-ed in Health Management Technology, now Healthcare Innovation, written by Jamie Gier, then chief marketing officer of the scheduling vendor SCI Solutions. The same op-ed is the source of the $200-per-slot estimate.

No methodology for the $150 billion was ever published. The figure is also frequently mis-cited as "Health Management Technology, 2006," which makes a vendor estimate look like an older independent research finding. That does not make the number wrong, but it does make it unverifiable.

Our advice: use $150 billion as a directional statement of scale if you need one, label it an industry estimate, and build any financial case on the peer-reviewed $196 per-appointment cost instead.

Are no-shows getting worse?

They rose sharply before the pandemic. MGMA reported that the median no-show rate for medical practices jumped 40% in a single year, from 5% in 2018 to 7% in 2019 (MGMA, 2022). In an August 2022 MGMA Stat poll reported in the same article, 49% of medical groups said no-show rates had increased since 2021.

The pandemic years bent the trend line, with the median near 5% in 2021 and 2022 before climbing to 6.81% in 2023, close to the 2019 benchmark (MGMA, 2025). Practices are responding with penalties: a January 2025 MGMA Stat poll of 622 medical groups found that 42% now charge a no-show fee.

Fees address the symptom. The pattern underneath is friction: patients who cannot reach the practice to cancel, confirm, or rebook on their own schedule tend to stop showing up instead.

What actually reduces no-shows

The best-studied intervention is the appointment reminder. In a study of 9,835 patients, those who received no reminder missed 23.1% of appointments, versus 17.3% with an automated reminder and 13.6% with a live staff phone call (Parikh et al., The American Journal of Medicine, 2010). Channel, timing, and what happens after the reminder all change the effect size, and we walk through the full evidence in do appointment reminders reduce no-shows. Access matters just as much: across Clinekt deployments, 82% of patients try to book outside office hours, and practices that support after-hours booking and rebooking remove one of the main reasons slots stay empty.

Common questions

What is a good no-show rate for a medical practice?

MGMA data puts the median for US medical practices between 5% and 7%, with single-specialty groups at 6.81% in 2023. A rate under 5% is ahead of benchmark for a private practice. Academic centers and hospital clinics run much higher, so always compare against your own setting.

How do you calculate a no-show rate?

Divide the number of no-shows by the total number of scheduled appointments in the same period, then multiply by 100. Count only patients who missed without notice, and track late cancellations separately so your rate stays comparable to published benchmarks.

How much does one no-show cost a medical practice?

The most-cited peer-reviewed figure is $196 per missed appointment, measured in 2008 dollars across ten VA clinics. A common vendor estimate puts each open, unused 60-minute slot at $200. For surgical specialties, a missed new-patient consult can cost far more in downstream revenue.

Is the $150 billion no-show statistic accurate?

It is an industry estimate, not a research finding. The figure originates in a 2017 op-ed written by a scheduling vendor's marketing executive, with no published methodology. It works as a directional statement of scale, but financial decisions should rest on the peer-reviewed $196 per-appointment figure.

Why do some studies say the average no-show rate is 23% while MGMA says 5% to 7%?

The 23% average comes from a global review weighted toward academic, hospital, and public-sector clinics, which see more new patients and longer lead times. MGMA's median reflects established US private practices. Setting and definition explain the gap, not measurement error.

Last updated July 16, 2026. To cite this page: Clinekt Health, "What is the average patient no-show rate, and what does each missed appointment cost?", clinekthealth.com, July 2026.

Benchmarking your no-show rate is step one. Quantifying what it costs you is step two: our leakage calculator estimates the revenue your practice loses to missed and never-booked appointments, and if you would rather see the fix than the math, book a demo.