Do Google Ads really well, or do not do them at all

Here is the trap, and I walked straight into it with my own clinics before I understood Google Ads. You decide in your head that you should spend some money on Google Ads. You set up a campaign, the money starts leaving the account on schedule, and you get this small warm feeling that you are doing something positive for the practice. The feeling is real. The patients are not.

That is what I mean by a mental budget. It is a number you carry around in your head, detached from any number you could actually defend. You are buying the sensation of having acted, not the outcome of acting. And because the money goes out smoothly every month, nothing forces you to check whether a single new patient ever came from it.

The cruel part is that the worse the account is set up, the better the mental budget feels, because a badly set up account gives you no uncomfortable data to argue with. No conversions means no bad news. You can sit there for a year feeling productive. So before we talk about doing it well, I want to show you exactly what doing it badly looks like when you finally open the account.

When I review a struggling account, I am not looking for clever optimisations. I am looking for the two things that quietly turn a budget into a donation. The first is a Smart Campaign left on Google's default settings. The second is conversion tracking that was never set up properly, or at all.

I am blunt about why this happens. The way it is built at the moment, it is kind of built as if it is how Google sets it up, so you can basically go on and lose money. That is genuinely the best way I can describe a default Smart Campaign. It hides which keywords people actually clicked through on, so you cannot see where your money went. Pair that with broken tracking and you are flying with the windows painted over.

Without tracking the completed booking, you know how many people landed on a page and nothing about how many actually booked. You think you are measuring. You are measuring the wrong thing. And once you cannot trust your own numbers, you cannot make a single sensible decision about budget, because you genuinely do not know whether the spend got you no clients or heaps of clients.

It helps to understand whose side Google is on, because it is not yours and it is not pretending to be. Google's job is to spend your money as fast as possible. Your job is to get as many new clients as fast as possible. Those two goals are quietly different, and the gap between them is where neglected accounts leak.

A Smart Campaign on broad match keywords leans hard toward Google's goal. It will keep widening the net of searches it matches you to, pulling in all kinds of weird and wonderful things related to the keywords you are bidding on. Left alone, that is how a podiatry budget ends up paying for searches about running shoes, or a physio budget pays for someone Googling a stretching video. The platform is doing exactly what it was built to do. It will always try to ask you to spend more, so you do not necessarily want to listen to it.

None of that is a flaw you can wish away with a bigger budget. It is the default behaviour. Which is exactly why the choice is binary, and why the next section is the one that actually saves clinic owners money.

This is the whole article in one line. Either do it really well or just do not do it at all, because you can reinvest that money somewhere else in the business. I draw an actual line in the sand with owners. Option one is to invest in Google Ads properly. Option two is to take that same money and double down on the channels that do not cost you a click, the referral partners, the local businesses, the reactivation of clients you already have.

The one option I rule out is the middle. Spending a little, badly, on autopilot is the only genuinely bad choice on the table, because it is the only one that costs money and returns nothing. You either want to get it done properly or just not spend the money there and save it. There is no half committed version of this channel that quietly works in the background.

So what does properly actually mean. It is not vague. It is four specific things, and if you are not going to do all four, you are better off keeping the money.

Even if you do all four things perfectly, there is a number below which Google Ads cannot return what you put in. From what I see across the accounts I run, you need to be spending around $600 a month in ad spend before a return is even possible. At roughly $350 a month, it is almost never worthwhile, because the fixed work of running it well and the dynamics of the auction simply do not leave room for a profit.

Think of Google Ads as a digital auction, because that is what it is. The closer you are to a Sydney or Melbourne CBD, the crazier and more expensive the bidding gets. A large regional centre with decent search volume and a clinic that is a bit further from the city often has an easier, cheaper auction to win. Geography sets the difficulty before you write a single ad.

So the $600 floor is not a target to celebrate, it is a gate. If your honest budget sits below it, the well run version of this channel still will not pay you back, and the answer is the same as it is for a neglected account. Keep the money. Which brings us to the harder question underneath all of this.

Doing it well is only half the decision. The other half is whether the maths can ever stack up for your clinic, and that comes down to one ceiling. For every new client you get from Google Ads, the total cost, including what you pay someone to run it, has to be less than your initial appointment fee. Ideally a fair bit less.

I work this off the first visit deliberately, not the lifetime value. You absolutely want patients to come back for a full treatment journey, but you should not be counting on that lifetime value when you are deciding whether the ads pay back. The first appointment fee is the honest ceiling. If a clinic charges $147 for an initial consult, then every new patient from Google has to land under $147 all in, or the channel does not make sense yet.

The simple monthly test is this. The money that comes in from those new patients should always be bigger than the money you spent to get them. If it is not, you are borrowing from the future to pay for ads now, and that is not a strategy. Marketing is transactional. Every month, you either see more come in than goes out, or you stop. That is the whole game.

When I run those numbers with an owner and they do not stack up, I do not soften it. I tell them to keep the money. And strangely, that is the moment most owners decide they want to work with me, because it is the first time a Google Ads provider has told them not to spend.

Doing it really well does not mean signing up to manage a complicated thing yourself, and it does not mean being locked in to someone forever either. For most small clinics the smartest path is to hire an expert to build it properly first, so you inherit a campaign that is built well with good conversion tracking, the things you would not be able to set up yourself without a whole lot of effort and hardship. Then, if you want, you take the keys.

For a sole trader especially, ongoing management has a natural expiry. Within the first three to six months either you take it over yourself now that the asset is built, or the clinic has grown enough that having an expert keep optimising it starts to pay for itself. Both are fine endings. The account, the tracking, the ads and the landing page are all yours to keep either way.

That is the version of well run that I am arguing for. Not a forever contract, not a feeling, but a properly built asset that either earns its keep or hands you the keys. Anything less than that, and you already know what I am going to say.