American Association for Physician Leadership


Unhappy Patients Are Costly

Judy Capko | Cheryl Bisera

March 3, 2021


Unhappy patients: every practice has them. Maybe you believe you have very few, or perhaps you’re reading this because you know you have too many.

Unhappy patients: every practice has them. Maybe you believe you have very few, or perhaps you’re reading this because you know you have too many.

Unhappy patients are sometimes sneaky; quietly disappearing so that you never knew they were, well, unhappy. More than 90%1 will not say anything; they will simply go away and vow never to do business with you again. They may not tell you why they left, but they will tell people in their sphere of influence, and that should be of grave concern to you.

It’s the sneaky (quiet) patients that cost you the most and give you the least opportunity to improve. Are unhappy patients an unavoidable nuisance that you and your staff usher through the system and breathe a sigh of relief once they leave, or are they something far more indicative of why your practice isn’t meeting its potential? Any sigh of relief when they walk out the door is misguided because that’s when an unhappy patient begins to drain your practice of potential revenue. Physicians go to school for umpteen years, scratch away at their education debt, work long hours trying to fix other people’s often complex problems, and now they have to worry about how those patients might hurt the practice’s bottom line if the physicians look at them the wrong way? It may sound absurd and over-reactive at first, but the truth is that patients are a barometer for the quality of care and service they receive. It’s not just potential patients who are paying attention to “unhappy patients,” payers are too.

Facing the demands of today’s changing marketplace is your path to success. Charles Darwin said, “It’s not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change”—so it is in your medical practice. Pay for Performance, nearly one billion dollars in payments to hospitals will be based partially on patient satisfaction, this being determined by a Centers for Medicare & Medicaid Services’ survey administered to patients. Hospitals that score high with patients receive bonus payments, those with low scores will lose money. This program is part of a much broader pay-for-performance system built into the healthcare overhaul that will affect future payments to physicians. Times are changing, and payers are looking for new ways to measure care and patient experiences. The result is an increased focus on the patient’s overall experience and financial accountability of providers, be it reward or penalty. It may seem unreasonable, being asked to focus on these nonclinical issues. But studies show a strong correlation between patient satisfaction and patient compliance, ultimately resulting in improved outcomes. You can succeed on the customer service front while maintaining your clinical integrity and thriving financially.

The Real Cost of Attrition

When patients quietly change physicians and you simply don’t see them again, you’ve lost money. You’ve not only lost the revenue from their visits, but the potential visits of their extended family. You’ve also lost potential revenue from the business of their friends, neighbors, and coworkers who would have given considerable weight to the answer to this question, “Who do you see for ___?” when they ask your former patients next week, next month, or next year. How will you attract patients to make up for attrition and at what cost?Times are changing, and payers are looking for new ways to measure care and patient experiences. Some physicians maintain that the demand for their services is so great that an unhappy patient leaving the practice has no significant impact. In reality, even if this patient never participated in a survey conducted by one of your insurance payers, there is a high internal cost to attrition. To begin with, there is the cost of time and resources required to create and maintain visibility for your practice. This includes contracting to be on an insurance plan’s provider list and marketing—which when done right will cost you time, money, and effort. Next is the cost of resources to query and schedule a new patient, and gather and record data in preparation for the patient’s visit. Then, of course, the expense of time and resources to integrate a new patient into the practice and gather historical clinical data, and time spent face-to-face.________

For these reasons, new patient visits are generally less profitable than subsequent follow-up or existing patient visits. Studies have shown that it costs approximately five times more to obtain a new customer than to retain an existing one. It takes subsequent visits to begin to recoup the costs of obtaining and setting up a new patient in your system. If a new patient is discontented, there may not be a subsequent visit. Unhappy patients lead to attrition, attrition is costly, and therefore unhappy patients are costly.

Your Reputation Is at Stake

When patients leave your practice, you may not even know that they had a bad experience until it’s too late. The digital age has empowered consumers to voice their opinions and rate their experiences online, reaching hundreds or even thousands of potential new customers. Potential patients can “check you out” by reading posts from your patients on review sites such as,, and

A personal testimony is powerful and has great influence on whether or not a shopping patient will take the next step toward choosing you as his or her physician. Unfortunately, it’s the unhappy customers that are most motivated to post, and they have little at stake for publically slamming you. Reputation damage caused by unhappy patients can quickly destroy the practice you worked so hard to build and cause economic disaster you may never be able to overcome. Warren Buffett once said, “It takes 20 years to build a reputation and five minutes to ruin it. If you think about that, you’ll do things differently.”

Consider these statistics

• For every customer who bothers to complain, there are 26 others that remain silent.

• A dissatisfied customer will tell 9 to 15 people about it, 13% of them will tell 20 people about their experience. It is important to recognize that patient satisfaction, or lack thereof, is going to affect your bottom line—reputation is an irreplaceable commodity.

Noncompliant Patients Hurt the Practice

Not every patient is going to be compliant, that’s a given; but when a patient feels known and valued by his or her physician and the practice, chances are the patient will be compliant. Developing strong relationships and high levels of patient satisfaction can lead to improved communication and compliance, ultimately leading to improved outcomes.

Patients who don’t feel connected, valued, or personally known by their physician are more likely to stop listening to the physician, become noncompliant, and take their medical care into their own hands. If a new patient is discontented, there may not be a subsequent visit.

Noncompliant patients don’t follow your treatment plan, don’t keep their appointments, and/or don’t take their medications as prescribed. They are frustrating for everyone in the practice and difficult to manage—they can be downright annoying, and their expectations can be unrealistic. Sometimes they are unhappy long before they stop following your treatment regimen and stop giving you the respect you and your staff deserve. Everyone in the practice may know them as “high-maintenance patients” that take up far more time than the average patient; calling frequently, demanding to get an appointment immediately, and asking for medications and testing that the physician deems inappropriate. These types of patients, despite their lack of compliance, are more likely to be the ones that threaten to sue you, switch physicians, and disparage your reputation in the community.

There is a high price to pay for noncompliant patients: frustration, an unpleasant work environment, the cost of resources to manage them, and the potential damage to your reputation. Noncompliant patients represent significant cost for your medical practice. This lack of respect and noncompliance are costly in many ways beyond the interaction with your practice. It is not uncommon for noncompliant patients to ignore deteriorating health conditions and further compromise their health. Such patients end up in the emergency department, sometimes resulting in extensive, costly diagnostic studies and hospitalization.

The costs of these noncompliant patients place further burden on our healthcare system and are under scrutiny by the government and private health insurance plans, resulting in the emergence of the Patient-Centered Medical Home. Measuring and improving clinical outcomes is a strategy within healthcare reform aimed at keeping patients healthier, coordinating care among providers, getting sick patients better quicker, educating patients, and encouraging healthy lifestyles with the ultimate goal of reducing the cost of healthcare. Physicians play a vital role in accomplishing these goals by marrying their clinical skills with stronger patient-physician relationships built on trust and respect. The intent of a patient-centered practice is to create a better health partnership between healthcare providers and their patients.

Excerpted from The Patient-Centered Payoff: Driving Practice Growth Through Image, Culture and Patient Experience by Judy Capko and Cheryl Bisera.

Judy Capko

Healthcare consultant and author of Secrets of the Best-Run Practices, 3rd edition (2017, American Association for Physician Leadership®).

Cheryl Bisera

Cheryl Bisera is an author, a speaker, and the founder and leader of Cheryl Bisera Consulting, an image-development and marketing firm focused on the healthcare industry.

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The American Association for Physician Leadership (AAPL) changed its name from the American College of Physician Executives (ACPE) in 2014. We may have changed our name, but we are the same organization that has been serving physician leaders since 1975.


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