Which Google Ads Bidding Strategy a Clinic Should Actually Use

Google gives you a short list. Maximise Clicks, Maximise Conversions, Target CPA, Target ROAS, Manual CPC. For a healthcare clinic running search ads, two of those matter, one is a graduation, and the rest you can ignore.

Maximise Clicks does exactly what the name says. It buys the most clicks your budget can afford and it does not care whether a single one of them ever books. It optimises for volume, not quality. It is a traffic strategy, not a patient strategy, and I have rebuilt more clinic accounts off Maximise Clicks than any other setting.

Maximise Conversions is the right default for a clinic the day your tracking is real. It tries to spend your budget getting the most conversions it can, and it sets a bid for every individual auction using signals like device, location, time of day and the actual search query. Target CPA is the same engine with a steering wheel, where you tell it the cost per booking you are willing to pay.

Manual CPC gives you full control over every bid. It also demands constant hands on adjustment that a busy clinic owner will never do, and it cannot see the auction time signals the automated strategies use. For almost every clinic I work with, manual bidding is a way to do more work for a worse result.

Here is the part nobody tells clinic owners. Every Smart Bidding strategy optimises toward whatever you have marked as a conversion. Not what you meant. What you literally told it. The algorithm is obedient and it is fast, and it will find the cheapest possible way to make your chosen action happen.

So if your primary conversion is a Book Online button click, Smart Bidding learns to find people who click buttons. If your primary conversion is a page view, it learns to find cheap page viewers. Neither of those people are patients. They are noise that the system has been told to chase, and it will chase them brilliantly.

This matters because of how conversions train the model. Only primary conversion actions train the bidding. Secondary actions are recorded for your reports and then ignored by the bidding strategy. So the single primary action you choose is the entire instruction set the algorithm receives. Choose a button click and you have built a machine that buys button clicks.

That clinic owner with the 62 percent conversion rate had three button clicks and a page view all set as primary conversions. The account was not broken at the bid level. It had been told that clicking around the site was the goal, so it went and bought the cheapest people who would click around the site. Garbage in, garbage out.

For a clinic, the single primary conversion is a completed booking or a genuine new patient phone call. A booking confirmed in Cliniko, Nookal or Halaxy. A call long enough to be a real enquiry, not a wrong number. That is the action you want more of, so that is the only action the algorithm should be trained on.

Everything else gets marked as secondary. Button clicks, directions taps, page views, time on site. They are fine to keep for reporting, because they tell you a story, but they must not train the bidding. Secondary means the system records them and ignores them when it decides what to buy.

The trap is that secondary actions look like progress. A clinic owner sees four hundred conversions and feels successful. But if 90 percent of those are button presses, the account is hiding the truth that maybe forty real bookings came through. Big numbers are not the goal. Bookings are the goal.

Get this right and the rest of the article is the easy part. Get it wrong and you can read every word, pick the perfect strategy, and still build an account that looks tidy and produces almost nothing. The strategy ladder only works on top of a true conversion.

Once your tracking counts real bookings, start on Maximise Conversions. Not Maximise Clicks. This is the default I use for every new clinic campaign, because it points the whole engine at the outcome you care about from day one and it accelerates how fast you gather real conversion data.

A common industry rule of thumb is to have around 15 conversions in the last 30 days before this strategy has enough to work with, and I find that a sensible floor in practice. Maximise Conversions will try to spend your full daily budget chasing bookings, so your budget setting matters. Keep it funded enough to give the system room to find auctions.

There is a live debate worth knowing about. Google product managers now say you can start a brand new campaign directly on the Smart Bidding strategy you ultimately want, because the system learns from account level signals from the first day. That contradicts a decade of agency advice that said warm up on Maximise Clicks first. I treat the warm up ritual as mostly unnecessary. Start on Maximise Conversions and let it learn.

The only time I will touch Maximise Clicks is the very earliest no data days on a brand new account with no history at all, purely to seed some traffic, and I exit it fast. If you find yourself still on Maximise Clicks a month in because the cheap clicks look healthy, you have confused a busy looking account with a working one.

Maximise Conversions and Target CPA are not rivals. They are a sequence. You launch on Maximise Conversions to gather data and prove the campaign produces bookings at a cost you can live with. You graduate to Target CPA once you have enough conversion volume that you can hand the system a specific cost per booking target and trust it to hold the line.

The threshold matters. The figure most commonly cited for Target CPA is around 30 conversions in the last 30 days for it to evaluate and optimise reliably. In my own experience managing clinic accounts, the band is roughly 15 to 30 conversions where it can technically run, and 30 to 50 where it behaves predictably. Below that, the algorithm is guessing, the cost per booking swings wildly, and owners panic and start changing settings.

A clean trigger I look for is roughly one conversion per day at an acceptable cost. When a clinic is producing a booking a day steadily and the cost looks right, it has the velocity to move to Target CPA. If you are a solo physio doing twelve bookings a month, you may never hit that on completed bookings alone, which is exactly why you count qualified new patient calls plus online bookings together as the primary signal.

When you do switch, set your first target 10 to 20 percent above your trailing 30 day actual cost per booking, then ratchet it down in 10 to 20 percent steps after each stable period. Setting your dream cost per booking on day one is the classic mistake. It wipes out most of your auctions, triggers a limited by target warning, and kills your volume instead of improving your efficiency.

Most clinic owners switch to Target CPA too early because they are impatient, or too late because they are nervous. The honest answer is a number. Count your real bookings tracked in the last 30 days and compare it to the data the algorithm wants.

Use the check below. It will not solve the harder question of whether your tracking is honest, because only you can answer that, but it will tell you whether you have the conversion density to graduate. If you are not ready, stay on Maximise Conversions and keep feeding it. There is no prize for switching early.

And one more time, because it is the whole game. If your tracking counts button clicks or page views, this readiness number is meaningless. You might show forty conversions and feel ready when you have four real bookings. Answer the tracking question honestly first.

Every new account has a chicken and egg problem. Smart Bidding wants conversions to learn from, and you have none yet. This is the moment clinic owners reach for Maximise Clicks out of fear, and it is the moment to be disciplined instead.

Start on Maximise Conversions with clean data inputs so the early dataset the system learns from is local and honest. Use phrase and exact match keywords rather than broad. Run on the Search Network only, with Search Partners and Display turned off. Set location targeting to presence, so you are paying for people actually in your catchment, not people merely interested in it. Turn off auto created assets so Google is not adding text you never wrote.

Fund it properly. A sensible floor I work to is a daily budget of at least twice your target cost per booking, and three to five times gives the system real room to learn. A budget set too tight starves Smart Bidding of the auctions it needs, then you conclude the automation is broken when really you never gave it enough oxygen.

Then respect the learning period. After you launch or change the strategy, the system shows a learning status for roughly seven days, sometimes stretching to fourteen. Do not react to daily swings. Do not keep editing. Every material change can reset the learning clock, and a campaign that never stops being edited never stabilises. Set the hypothesis, leave it alone, and read the result at month end.

My rule across every clinic I manage is simple. Let the data make the decisions. I build a hypothesis at launch, I track at month end, I adjust once, then I leave it to learn again. I do not fiddle daily, because daily fiddling resets the learning and tells me nothing.

The path is always the same. Fix the conversion so it counts real bookings. Launch on Maximise Conversions. Gather data while resisting the urge to tinker. Cross the threshold of roughly 15 to 30 real conversions in 30 days. Graduate to Target CPA with a target set above the actual, then ratchet it down. That is the whole ladder, and it works because each rung sits on the one below.

Across allied health, a healthy cost to acquire a new patient sits between $65 and $120. Under $90 is strong. If you are sitting at $200 or more, something is loose, and nine times out of ten it is not the bidding strategy, it is the conversion definition, the budget, or a target set in fantasy land. Look there before you blame the algorithm.

The bidding strategy is genuinely the easy part. I could teach the Maximise Conversions to Target CPA ladder to a clinic owner in ten minutes. What takes the real work, and what decides whether any of it pays for itself, is making sure the thing you are optimising toward is a real patient walking through your door.