What a schedule that falls apart actually costs

Two calculations using your figures: what you lose to no-shows, and what goes into answering the same messages over and over. No sign-up, and every formula on screen.

How to read this. You supply your clinic's figures, because only you know them. The one thing that has to be assumed is marked in amber, with a slider and the most conservative value preselected: if it looks optimistic to you, drag it down and watch what happens. The result changes in front of you.

📉 1 · What no-shows cost you

A patient who doesn't turn up leaves a slot that is already paid for: the room, the equipment and the practitioner are still there. What you lose is that appointment's margin.

Appointments booked per month

Average ticket (€ per appointment)

Current no-show rate · 15%

0%50%

Variable cost as % of ticket · 35%

product and consumables90%

Slots you already refill today · 25%

noneall

No-shows avoidable with a reminder · 40%

0%typical range 40–60%

No-shows per month
Of those, avoidable
Less the ones you already refill
Revenue recovered
Contribution margin recovered

⏱️ 2 · What answering messages costs

No revenue estimate here: this is arithmetic on the real cost of an hour of work, employer contributions included.

Incoming messages per day

Operating days per month

Minutes per message (read, reply, book)

Gross annual salary of front desk (€)

Employer payroll overhead · 32%

0%Spain ≈ 32% · varies by country

Resolved without a human · 60%

0%95%

Messages per month
Hours per month spent on them
Hours a person would stop doing
Real cost of one hour of work
Value of the capacity freed

Careful with this number: freeing hours is not automatically saving money. If nobody stops working, what you gain is capacity — those hours go somewhere else — and it is worth whatever that something else generates. It only turns into cash when it avoids a hire, cuts contracted hours, or removes overtime.

🧮 3 · Result on your plan

Adding the two is legitimate because they measure different things: one is revenue you were losing, the other is cost you were spending. No double counting.

Plan

Value recovered

—

margin + capacity, per month

Net result

—

after paying the fee

Break-even

—

appointments saved per month to cover the fee

Implementation

—

to recover the one-off fee

📊 4 · If the assumption falls short

The only arguable figure is how many no-shows a reminder prevents. Here is what happens if it turns out worse than expected.

No-shows avoided	New appointments	Margin	Net after fee

Where each number comes from

Why contribution margin and not revenue

A recovered €200 appointment is not €200 of profit: it consumes product, consumables and, where applicable, the practitioner's commission. Only the margin is incremental profit. Presenting gross revenue as "savings" is the most common mistake in calculators like this, and the first thing an analyst spots.

In favour of the calculation: fixed costs — the room, the equipment, the practitioner already on site — are already paid in that slot. That is precisely why contribution margin, not net margin, is the right measure.

Why slots you already refill are subtracted

Almost no clinic loses 100% of its no-shows: some get rebooked by phone or from a waiting list. If you already refill 25%, only 75% of what is avoided is new revenue. Without this term the result is overstated by 20–40%.

How the hourly cost is calculated

Not gross salary divided by contracted hours. It is the fully loaded cost: salary × (1 + payroll overhead) ÷ effective hours.

Employer payroll overhead (~32%): the default is Spain's general regime — common contingencies 23.60% · unemployment 5.50% · wage guarantee fund 0.20% · vocational training 0.60% · MEI ~0.75% · occupational accident rate by activity. This figure varies a lot by country (roughly 8% in the UK, 13% in Ireland, 20% in Italy), which is why the field is editable — set yours.
Effective hours: 1,700 per year. Not contracted hours (1,780–1,826 under Spanish collective agreements, holidays already deducted): real absence has to be subtracted. Using contracted hours understates the hourly cost — and since a high hourly cost favours the argument here, the conservative value is used.

The 40–60% range

This is the effect attributed to reminders with confirmation: the patient either confirms or cancels in time, and the slot can be reassigned. The default applies 40%, the low end. It is an assumption, not a promise — which is why it sits on a slider instead of being buried in the code.

What this calculator does NOT count

All of this adds up, but cannot be backed by arithmetic, so it stays out:

The lifetime value of a patient who never comes back after a no-show.
The opportunity cost of an idle room beyond the ticket.
The reputational effect of a schedule that works.
Out-of-hours enquiries currently answered the next morning.

Leaving value out is what makes the value left in believable.

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