Every empty slot on the schedule represents more than lost revenue. It can mean a missed diagnosis, a lapsed prescription, or a patient who drifts away from care. To understand where appointment follow-through breaks down and why, Tebra surveyed 1,000 Americans about their scheduling habits and analyzed state-level Google search volume across 14 appointment-related queries. The results revealed a national map of appointment friction, along with the practical fixes patients say would keep them coming back.

Where a patient lives shapes how much they wrestle with getting to the doctor, and search behavior offers an early window into which states feel that strain most.

Delaware recorded the highest per-capita search interest across the 14 appointment-friction queries, at 744 searches per 100,000 residents.

The states most preoccupied with appointment friction were Delaware, Hawaii, Rhode Island, Connecticut, and Vermont, a cluster concentrated heavily in the Northeast.

At the other end of the spectrum, Utah residents searched these terms least at 425 per 100,000 residents, followed by Iowa, Michigan, Idaho, and Missouri.

Not every state struggles with the same obstacle. Breaking the data into categories shows which specific hurdle weighs most on each region.

Search interest in appointment anxiety was highest across several Northeast and Mid-Atlantic states. Massachusetts residents searched anxiety-related terms more than any other state at 531 per 100,000 residents, followed by Maryland (524), Virginia (522), Connecticut (519), and Hawaii (512). Delaware residents, meanwhile, searched "scared to go to the doctor" more than anyone, at 20 per 100,000 residents.

Cancellation searches told a different geographic story, peaking in less populous states. Vermont led at 129 per 100,000 residents, ahead of Alaska (108), Wyoming (102), Delaware (98), and North Dakota (96).

Rescheduling interest clustered in the Northeast once again. Rhode Island topped the list at 70 per 100,000 residents, with Delaware (70), Vermont (67), Hawaii (64), and North Dakota (63) close behind.

Searches tied directly to missed appointments and no-shows were highest in Rhode Island at 126 per 100,000 residents, followed by Alaska (117), Vermont (99), Delaware (94), and Hawaii (85).

Search trends point to the where, but the survey reveals the why. Patients were candid about how often they miss care and what pushes them to do it.

Missing care turned out to be nearly universal, with 71% of patients having missed, canceled, or rescheduled an appointment in the past year.

The habit skewed young, with skipping care most common among younger generations:

Gen Z patients were also the most likely to miss an appointment outright at 22%, nearly 4 times the Baby Boomer rate of 6%, with Millennials at 18% and Gen X at 13%.

A work conflict was the most common culprit, cited by 35% of those who skipped care, followed by cost or insurance concerns at 16%. Doctor anxiety played a meaningful role too, with a third of Americans (33%) having missed or canceled an appointment because of nervousness about going. Perhaps most telling for practices, nearly two-thirds of patients (64%) admitted they would not tell their practice the real reason they missed.

Some types of visits caused more anxiety than others. The visits patients dreaded most were the following:

A missed appointment rarely ends with the missed appointment. For many patients, the consequences ripple outward, and so does the case for easier scheduling.

Consequences were common. Among patients who skipped care, 59% faced real fallout, including:

Delays stretched on for some, as 17% waited 3 or more months to be seen again, or never rebooked at all.

Digital friction proved to be its own barrier. More than a quarter of patients (28%) had put off canceling or rescheduling because the office required a phone call instead of a text, link, app, or portal.

The fixes patients want are digital. When asked what would make them more likely to show up, patients pointed to text message reminders (58%), an online scheduling portal (43%), a one-click cancel or reschedule link (37%), and email reminders (30%). Younger patients leaned hardest into these tools, with an online scheduling portal appealing to 48% of Gen Z.

Appointment friction reflects the small obstacles, anxiety, work conflicts, and clunky cancellation processes that stand between intent and follow-through. The patients in this research were clear about what would help: simple, digital, low-pressure ways to stay connected to their care. Practices that listen to those signals can turn a missed slot into a kept one, and a hesitant patient into a loyal one.

Tebra surveyed 1,000 Americans to explore how often they miss, cancel, or reschedule healthcare appointments and why. Of respondents, 48.6% were Millennials (born 1981–1996), 25.3% were Generation X (born 1965–1980), 15.5% were Generation Z (born 1997 or later), and 10.6% were Baby Boomers (born 1946–1964).

To identify where patients experience the most appointment friction, we analyzed state-level search volume per 100,000 residents for 14 queries related to scheduling difficulty from 2022 to the present. The queries were grouped into four categories:

For the category-driver map, each state was classified by the category on which it over-indexed most, defined as the category where its per-capita search volume sat furthest above the national average for that category. 

Search volume reflects relative interest, not confirmed behavior or clinical outcomes, and tools estimate volume with rounding at low counts, so small-volume states should be read as directional. 

Tebra, headquartered in Southern California, empowers private healthcare practices with AI and automation to drive growth, streamline care, and boost efficiency. Our all-in-one EHR and billing platform delivers everything you need to attract and engage your patients, including online scheduling, reputation management, and digital communications.

The data and findings in this article are available for noncommercial use only. If you share or reference them, please include proper attribution along with a link back to Tebra.