The tap that doesn't quite turn off

Every agency pitch I've ever heard, and I've heard plenty, contains some version of the same line. Google Ads is like turning on a tap. When you want more new clients, we just turn this tap on. The tricky bit is going to be telling us when to turn it off, because you'll have too many bookings.

I've been on the receiving end of that pitch as a clinic owner. It works. You sit there nodding, picturing your diary full, and you're already thinking through which clinician you'll need to hire to handle the overflow. You sign. The first month is fine. The second month is okay. By the third month, the tap doesn't seem to be working the way it was supposed to.

That's where the explanations start. It's the season. It's the economy. It's the local competition. It's the front desk. It's the website. It's anything except the campaign. Meanwhile you're still paying the bill.

It's not that the agencies are dishonest. Most of them genuinely want the campaign to work. The structural issue is that promising results upfront is what closes the deal, and once the deal is closed, there's a long quiet stretch where you can't really tell whether the campaign is working or not. By the time you do, you've already paid for three or four months of it.

The clinic owners I see getting taken for a ride aren't naive. They're busy. They don't know the right questions to ask, and the agency isn't volunteering them. The conversation that should happen at month one, where the agency walks you through what a good report looks like and what numbers actually matter, almost never happens.

Most monthly reports I see from agencies are 30 to 60 pages long. Impressions, demographics, day-of-week breakdowns, hour-of-day breakdowns, audience overlaps. The lead is buried so deep you'd need a metal detector to find it.

A clinic owner doesn't need 60 pages. They need four things. What you spent. What you got. Where it went. What's next. If your monthly report doesn't make those four things plain inside the first page, the agency is hiding something, even if they don't realise that's what they're doing.

And on 'what you got': the only number that counts is real new patients booked. Not impressions. Not clicks. Not form submissions on a landing page. Not phone-app taps. Real humans who walked through the door. If your agency is reporting conversions and the number doesn't match the new patients in your practice management software, the definitions don't line up. That's the first conversation to have.

The single most common mistake I see is a misalignment on what 'conversion' means. The agency thinks a conversion is someone who completed a form on a landing page. You think a conversion is a paying patient in your diary. Both of you are sitting in the same meeting using the same word for two completely different things.

And the worst version of this trap is when the agency is bidding on your own brand name. The campaign report shows beautiful conversions at $5 a pop. They're all return clients searching for your phone number to rebook. The campaign earned none of them. If you're doing Google Ads, your clinic name needs to be a negative keyword. Don't let anyone tell you otherwise. Anyone searching for you specifically is going to find you, organically, in the regular Google results. You don't need to pay to win clicks you'd already win for free.

If you're already working with an agency and any of this is sitting uncomfortably, you don't need to fire them. You need to start a different conversation. Here are the four I'd open with.

If those four questions get clean, specific answers, your agency is doing the work. Stay with them. If they get vague answers or excuses, the agency is hoping you don't ask them again. That's the moment to either change the conversation or change the agency.

The clinics that win the long game on paid acquisition aren't the ones with the biggest budgets. They're the ones whose owners learned the right questions to ask, and built a relationship with someone who answered them honestly.