Block Booking Vs. Open Access: Which Wins Holiday Season

Every hour a doctor chair sits empty in a $1.2 million practice costs roughly $465 in fixed burn, and the schedule doesn't care that you were saving that hour for a crown. An empty operatory doesn't know it was being held for something better.

That's the whole argument about holiday scheduling in two sentences, and it cuts against how most practices run December. Our view: for the third of practices that say they aren't busy enough, holiday-season block booking isn't a production system, it's a superstition, and December is the month to suspend it. Plenty of owners will disagree, and a specific minority of them are right. But the default has flipped, and most practices are still running a template built for a market that ended three years ago.

The Fourth Quarter You Built That Template For Ended in 2022

Block booking made sense when you were booked six weeks out and the constraint was doctor time, not patient demand. That's not the market. In the ADA Health Policy Institute's Q4 2025 State of the U.S. Dental Economy update, one-third of dentists reported they were "not busy enough" and could have treated more patients. Only 12% said they were too busy to treat everyone requesting care. Average new-patient wait time was 13.4 business days.

Look at the direction of travel. Two quarters earlier, the HPI's Q2 2025 economic outlook put "not busy enough" at 26.7%, with 93.9% of practices accepting new patients and an average initial-appointment wait of 13.3 business days. So the share of practices with open capacity climbed by more than six points across two quarters while wait times stayed flat. That combination is diagnostic. When demand tightens, waits stretch. When waits hold steady and idle capacity grows, you're looking at a supply-heavy market where the patient has options.

Here's the part that should bother you. If your first available new-patient slot is 13 business days out on December 3, you're offering a patient an appointment right in the teeth of holiday travel, school breaks and year-end deadlines. Meanwhile 93.9% of the practices in your ZIP code are accepting new patients too. The block you're protecting is the reason that caller got quoted December 22 instead of December 5, and December 22 is a coin flip at best.

What Most Owners Get Wrong: Treating the Block as a Floor

The specific mistake: owners treat a block as a production floor when it functions as a production ceiling.

The logic goes like this. "If I protect three hours a day for crown and quadrant dentistry, I guarantee myself $1,350 a day in major restorative." That's floor thinking. What actually happens in a soft quarter is that the block is a ceiling on everything else. Nothing goes in it unless it qualifies. The hygienist has an emergency exam that needs doctor time, and the software says no. A crown-seat patient calls with a broken temporary, and the block says no. A new patient who found you on a Tuesday wants to come in Wednesday, and the block says December 22.

The owners who make this mistake most reliably are the ones who installed their block template between 2021 and 2023, when practices genuinely were capacity-constrained, and never retuned it. Second-most common: practices running a coaching program's "perfect day" template as delivered, without adjusting the block-to-open ratio for their own demand. A perfect day template is a forecast. Forecasts expire.

The tell is easy to find. Pull your last two Decembers. Count how many blocked doctor hours went unfilled past their release time, if you even have a release time. If more than a quarter of them died empty, your blocks are not producing anything. They're reserving.

The No-Show Research Points One Direction

Block booking's real competition in December isn't open access. It's the no-show.

A 2024 systematic review published in Health Science Reports looked at 16 outpatient-clinic studies of open-access scheduling. Ten of them, 62.5%, found a statistically significant decrease in no-show rates. Four found no significant reduction. Two found no change. Not one direction of harm in the set.

The mechanism is unglamorous and it's the entire reason open access works in a holiday month. Lead time predicts attendance. A patient who books on Monday for Thursday has three days to forget, travel, get sick, or decide the tooth feels fine now. A patient who books 17 days out in the middle of December has 17 days of holiday chaos to lose the appointment to. Shorten the gap and you don't need a better reminder system. You need fewer days.

Block booking structurally lengthens lead time for everything that doesn't fit the block. That's not a side effect. That's the design.

December Costs This Practice $13,798

Take a four-operatory solo practice: two doctor chairs, two hygiene, $1.2 million in annual collections, 62% overhead. Sixteen clinical days in December after holidays and the year-end short week.

Start with the burn rate. Overhead of 62% on $1.2 million is $744,000 a year. Spread across 200 clinical days, that's $3,720 a day. Over an eight-hour day, the practice burns $465 an hour whether chairs are running or not.

Now the blocks. The practice holds three doctor hours a day for major restorative, which is 48 blocked hours in December. In a soft quarter, the realistic December fill rate on those blocks is 60%, so 40% die empty: 19.2 hours. At a $450 hourly doctor production target, that's $8,640 of production that never existed. Those same 19.2 hours carried $8,928 of overhead burn regardless.

Then the attendance side. Twenty-six patient visits a day across four chairs is 416 December visits. At a 12% combined no-show and same-day-cancel rate, that's 49.9 lost visits. Blended visit value of $310 puts the damage at $15,475. Pull that rate down four points to 8% by shortening lead times, which sits comfortably inside what the review found, and you recover 16.6 visits. That's $5,158.

Add them: $8,640 in dead blocks plus $5,158 in recoverable no-shows equals $13,798 in one month. For reference, the Bureau of Labor Statistics puts the May 2025 median annual wage for dentists at $176,110. One December of rigid blocking in a soft market costs this practice about 7.8% of a median dentist's entire year of pay.

We wouldn't take that deal to protect a template.

When Block Booking Still Deserves the Chair

The honest counter, because there is one.

If you're in the 12% that's genuinely too busy to see everyone who asks, block booking is correct and open access would cost you money. When demand exceeds capacity, the job of the schedule is to allocate scarce chair time to the highest-value work, and that's precisely what a block does. Same for practices with hard physical constraints: one sedation-capable room, one CBCT, a surgical assistant who works Tuesdays and Thursdays, an implant day that requires a rep on site. You can't open-access your way around a single piece of equipment.

Practices with a genuinely deep, pre-scheduled treatment backlog also do fine with blocks, because the block fills itself from existing unscheduled treatment rather than waiting on the phone to ring. If you have 90 days of accepted-but-unscheduled major restorative sitting in the software, block away.

The test isn't philosophical. It's arithmetic. Count your unfilled blocked hours from the last 60 days. If it's under 10%, your blocks are working and you should leave them alone. If it's over 25%, you're running a scarcity system in an abundance market.

Decaying Blocks: The Version We'd Actually Run

We wouldn't tear out block booking in December. We'd put an expiration date on every block and enforce it without a meeting.

The rule is simple. A block holds its restriction until a defined release point, then converts to open. Longer blocks and higher-value procedures get longer protection, because they're harder to refill from the general population:

• Three-hour surgical or full-arch blocks: release at 96 hours out.
• Two-hour crown and quadrant blocks: release at 72 hours out.
• Ninety-minute restorative blocks: release at 48 hours out.
• Any block sitting empty inside 24 hours: it's an emergency slot, a new-patient slot, or a same-day treatment slot, and whoever calls first gets it.

This preserves the only thing blocks actually do well, which is stopping your front desk from filling Tuesday morning with three recall exams before a crown-prep patient can call. It removes the thing they do badly, which is holding empty air hostage until the day it dies.

The second piece matters more than the template. Open access doesn't work through the schedule. It works through the phone. If a caller on December 8 hears "our next opening is the 22nd," you've built nothing, because you've reproduced the 13.4-day wait the HPI data already shows is standard. December's open-access practice answers the phone live, offers something inside 72 hours, and works a short-call list that gets texted the instant a block releases. That list needs to be maintained weekly, not pulled from a report at 4pm on the day of the hole.

And staff the front desk for it. The practices that fail at open access almost always fail on call handling, not on scheduling logic. You cannot compress lead time if nobody picks up.

Do This Before December 1

Pull December 2024 and count how many blocked doctor hours went unfilled past the day before. If that number is over 25% of your blocked hours, put a release rule on every block this week and write it into the software, not into a team huddle where it gets forgotten by the 10th. Build a short-call list of 40 named patients with accepted treatment and a mobile number, and assign one person to text it the moment a block releases. Then track two numbers daily through the month: unfilled blocked hours and average days between booking and appointment.

What would change our position: if the Q1 2026 HPI data shows the "not busy enough" share reversing back toward the mid-20s while wait times stretch past 15 business days, the capacity math flips and blocks start earning their keep again. We're watching that number and nothing else. We're also watching whether practices that hold blocks longest are the ones with real backlogs or just the ones with the oldest templates, because those are very different problems wearing the same costume.

Before you change anything, find out what an idle hour actually costs in your operatory. Your burn rate per open hour is the number that decides whether a protected block is an investment or a donation, and it falls straight out of your overhead ratio and clinical days. Plug in your collections, overhead and day count and run your own numbers, then compare that hourly figure against what your blocks actually produced last December.