Capturing Intent without Money
Expanding Google Ad Inventory by focussing on alternative levers to budget
Let’s begin with Marketing 101.
In the last decade, private practice orthodontists relied on three sources of referrals for their new patients.
GP Referrals: About 65% of patients came from general dentists who identified orthodontic issues and were referred to a preferred specialist
Patient Referrals: About 20% of patients were referred by current and former parents and patients in the community or local school districts. These patients might enter observation pools if they aren’t ready to start treatment right away.
Other: This rather infamous category contributes about 15% of new patients, from paid and unpaid promotions through digital media, hosting community events, and in-network referrals from insurance firms.
While each of these large segments deserves its own article, I’ll talk about one that is often poorly executed.
Surprise, surprise - Google Ads!
Whoa … but why? Aren’t Google Ads supposed to be straightforward for small businesses? How could an orthodontist lose out on Google Ads?
Let’s quickly recap the basics. You pick a specific keyword that you want to rank for, like “orthodontist in New Haven,” and outbid the competition to capture the top spot on Google Search. Every time your ad gets displayed when a person searches for a keyword, you are offered an impression. Every time a user clicks on your ad impression, you pay for the click.
Google is in that advertising business. Infact, 79% of its revenue in Q1’23 came from ads. Because ads are so valuable, all ad impressions aren’t made equal.
Where are the biggest leaks?
Imagine the keyword “Orthodontist in New Haven” gets searched 10,000 times a month. That means Google has the opportunity to showcase your ad 10,000 times. But it won’t!
Your ad only gets a subset of impressions from the total available inventory, let’s say 1,000. Google uses three large parameters to choose which 1,000 people get to see your ad versus a competitor -
Budget: The higher you bid, the more likely you are to earn a higher share of impressions. Plain old - auction style
Ad Quality: Specific signals in your advertisements that tell Google it is more likely to be clicked. Google wants your click-worthy ads, and they charge you only for clicks, not impressions
Context of the Search Terms: A parent searching for an “orthodontist in New Haven” has a different intent than a minor outside Connecticut. Google collects other data about you to frame the context of your search
Among the three, the biggest leaks happen in the “Ad Quality” Bucket.
In all the practices I visited, orthodontists were losing up to 82% of potential ad inventory because of low ad-quality
It makes sense why this would happen. Generally, agencies charge a % of ad-spend or a fixed fee per month for marketing. When performance is poorer than usual, they can simply turn the blame back on the orthodontist, asking them to “spend more, cuz the competition is heating up.” No one is really in control of influencing what a patient is searching for or the context within which they are searching. Small private practices don’t have Invisalign-size budgets to advertise and influence what gets searched.
Optimizing ad quality is hard, and orthodontists don’t know about it. So, it gets hidden under the rug.
I helped a practice improve its landing-page experience, which improved its ad quality by 26% percentage points in 3.5 months. Suddenly, they increased their share of accessible ad inventory by 40%. That means their Google Ads reached 40% more people looking for an “orthodontist in New Haven.”
Even better, their cost to acquire patient leads became 28% cheaper.
Improving your ad-quality score can’t make your Google Ads reach more people and at a cost lower than what you are currently spending. The easiest way to improve your ad quality score is by improving the experience of your website (aka landing page). Make sure the content on your website is relevant and attractive to your target user when they search for a specific keyword.
If a mom of teenage sons looks up “orthodontist in New Haven,” she should land on a website that speaks to her needs and wants.
Google Ads aren’t that complicated. Just learning what questions you need to ask your agency can save you money and expand your marketing. There is demand waiting to find you, and they will if your ad quality reflects your quality!