It’s business as usual. Your caseload is a healthy mix of new clients, and some who’ve been with you for a while. You book 34 clients a week, expecting 30 will show. Your volume is manageable, even comfortable, and at 30 sessions a week you can make a living.

Then, out of nowhere there’s a strange, spontaneous, unexpected occurrence that drops your weekly caseload in half!

What’s worse, it seems that every time you turn around there’s another drop. Every month your caseload falls short of what you expect.

You review your calendar and notice that in the past year there’s been an unexpected event about every 8 weeks that has resulted in multiple days of cancelled appointments. You write them down:

  • New Year’s Day (January)
  • Memorial Day (May)
  • Independence Day (July)
  • Labor Day (September)
  • Thanksgiving (November)
  • Christmas / Hanukkah (December)

To your horror, you find nine additional “anomalies” that resulted in multiple cancellations for at least one day.

  • MLK Jr Day (January)
  • Valentine’s Day (February)
  • President’s Day (February)
  • St Patty’s Day (March)
  • Patriot’s Day / Emancipation Day (April)
  • Mother’s Day (May)
  • Father’s Day (June)
  • Columbus Day (October)
  • Halloween (October)

Upon further investigation, you see a spattering of cancellations for “summer vacations,” not including your own vacation, and you recall that several winter storms shut you down for a couple days each.

Not an Exception to the Rule

What all this means is that your practice can scarcely make it through a month without an “exception to the rule” that leads to rescheduled appointments (and in our field a rescheduled appointment, if pushed to the following week, might as well be a cancelled appointment). So, to sustain an average of 30 clients a week one needs to adjust his/her bookings to accommodate not just a usual cancellation rate but also regular “anomalies”—about one half week of cancellations out of every five.

Hence, if you book 34 clients a week you might find that your actual weekly session count is 30, 30, 30, 30, 15. With this, you’re still 10% short of your target of 30 sessions a week!

The solution: Book 38 clients a week, which is likely to result in the following: 34, 34, 34, 34, 15. Mean average = 30. Hence it’s four heavy weeks (sprint), and a one week with less than half your usual sessions (rest).

Calculations May Vary

While the principle will hold true for almost all outpatient practices, the exact math might not fit with your clinical specialty or client demographic. For example, your cancellation rate in any given week could be higher or lower than the 4-session adjustment above. Also, your clients might have fewer or more holidays (e.g., is your caseload predominately college students? They’re often on break so you’ll need intense sprints!). Look closely at your weekly volumes, and do your own practice-specific calculations to decide how many sessions you’ll need to book to ensure that at the end of the month (and year) you’ve hit your practice goals.

Does your caseload resemble a steady jog, or a sprint? Let me know @thriveworks or @anthonycentore.