I know many successful optometrists who use preappointing as the recall system of choice. Also, many respected practice management consultants strongly recommend it as the most effective recall strategy.

I agree that it can provide a high recall return rate, but I don't believe that it's the best program for my practice.

The way we do it

Don't get me wrong -- I'm in the business of making appointments. They drive everything in my high-volume, five-O.D. practice. I study how to maximize patient volume, and my staff is extremely well-trained in efficiently scheduling appointments.

It's certainly possible to build a highly successful practice without preappointing -- in fact, I believe preappointing can actually be an obstacle to practice growth.

We preappoint follow-up visits and ongoing medical eyecare visits, and we even preappoint patients who simply want to schedule far in advance, but that's different than automatically scheduling all patients for appointments a year or more in advance for routine eye care.

Except for a short period of time 10 years ago, when I tried preappointing because it was "in vogue," my practice has always used personalized letters and postcards for our patient recall system.

We send more than 1,500 recall notices every month. They're easy to process with our office management software, laser printer, window envelopes and postage meter.

Identify and satisfy

We ask patients if they'd rather we remind them to make an appointment by mail or if they'd like to schedule their next visit at the present time. We then do whatever they prefer. The vast majority prefer mail reminders for long-term, routine care.

I built my practice by doing as many things as possible the way patients want them done. It's simple marketing -- identify and satisfy customers' wants and needs. This is the only business strategy that truly works.

Limitations of preappointing

I want the patient in my chair to want to be there. Our doctor-patient relationship is more relaxed when we examine patients who want or need to be seen.

Animosity can easily manifest when patients return for eye exams primarily because of an aggressive preappointment system.

A recall system that boasts a "high effectiveness rate" is, by design, actively working to schedule appointments for people who wouldn't normally schedule at that particular time.

Some preappointing systems work by being a little "pushy." Patients may schedule appointments to avoid embarrassment or to simply go along with the office system -- but this can cause some resentment, and even buyer's remorse later.

Through patients' eyes

I don't like the image preappointing gives my practice. Your patients can easily spot a "business strategy" aimed at selling more goods and services. Even if that's not the intent of a patient recall system, perception is everything. An aggressive system where appointments are automatically scheduled for the following year and reconfirmed through a series of efforts can easily give the wrong impression.

And let's be brutally honest -- patient recall systems in optometric practices are at least as much about marketing as they are about public health policy. I want patients to perceive my practice as caring more about their eye health than about repeat business.

Visits vs. revenues

From a business standpoint, I care about productivity and gross revenues per patient visit.

Aggressive recall systems cause patients to return with "no complaints," which often leads to "no prescription changes" in contact lenses and eyeglasses. Increasing the percentage of "exam only" visits in my schedule greatly reduces my revenues.

Increased no-shows

Preappointing systems lead to more no-shows and rescheduling. It depends on the ability to confirm by phone, which actually doesn't eliminate the increased no-show rate common with preappointing.

It stands to reason: People who have appointments that they didn't voluntarily schedule for services they possibly can't afford at the time are more likely to have something "unexpected" come up at the last minute. They may or may not call and cancel, but in any event, it's too late to fill the slot.

A good recall system is important to your practice -- choose one that patients like and that's good for your image, and the appointment book will fill up.

Dr. Gailmard served as benedict professor of Practice Management at the University of Houston College of Optometry for 1999-2000. He may be reached at neil@gailmard.com.