A recent Medical Group Management Association (MGMA) Stat Poll revealed that practice leaders say no shows account for the biggest appointment challenge in their medical practice (Harrop). It is estimated that no shows cost the health care industry $150 billion each year. McKee states that some estimates show missed appointments cost single physicians as much as $150,000 annually. For multi-physician offices, the numbers are even more staggering. One clinic he researched documented 14,000 no shows in a single year with an estimated loss of over a million dollars. No shows mean lost revenue. According to the Medical Group Management Association 2016 Practice Operation Report, most specialties have a median of 5 percent patient no shows, with neurology and general surgery being higher, at 8 percent. This paper defines a no show as a patient that failed to inform the practice that they were not showing up for their appointment. The purpose of this paper is to provide research why no shows happen, how they impact the physician practice as well the patient’s treatment efficacy and ways to prevent no shows.