You are probably here because a plan exists and nothing moved.
That is the situation this page is written for. Below are the eight things that have to be true for this to work, stated plainly enough that you can rule us out without spending a call on it. Four of them rule people out more often than the budget does.
Independent practices only. No health systems, no private-equity platforms. A scale-first media brief is a different job, and pretending otherwise costs both sides a year.
The short answer
We work with independent, physician-owned practices in one of 32 specialties, in one of 99 metros, that can expand or replace their site, clear a $2,000 per month floor, and measure results over quarters rather than weeks. Behavioral health is the deepest competence. Health systems and private-equity platforms are not a fit.
Eight things that have to be true, and none of them is the budget.
The money question is the easiest of the eight and the one everyone leads with. These are in the order they actually decide the outcome.
- Independent ownershipThe practice is owned by the physicians or clinicians who work in it. We do not take health systems or private-equity platforms, because a scale-first media brief is a different job with different constraints.Physician-owned
- One of the 32 specialtiesThe register is enumerated, not illustrative. If your field is not one of the 32, we have not done the research that makes us useful to you, and we would be guessing.On the register
- A site that can be expandedOr a willingness to replace it. Depth is the mechanism here, and a platform that caps you at twenty pages caps the entire programme with it.Or replaceable
- A budget that clears the floorEngagements start at $2,000 per month. Below that the work cannot be done to the standard on this site, so we say no rather than do a thin version of it.$2,000/month floor
- Patience measured in quartersOrganic positions move in three to four months, local in two to four, inquiry volume at six to twelve. An owner who needs a different quarter’s numbers needs paid media from someone else, and we will say so.Three quarters, not three weeks
- Someone who can approve contentOne named person at the practice with the authority to approve clinical copy. Seven posts a week does not survive a committee, and it is the single most common reason a content programme stalls after month two.One approver
- Willingness to be measuredA baseline gets recorded before anything starts, and the monthly report carries the miss beside the win. If a documented starting position is uncomfortable, this will be an uncomfortable engagement.Baseline on the record
- Self-referred volume worth havingSome practices are almost entirely physician-referral driven and are content that way. That is a legitimate model, and it is one where most of what we build has nowhere to land.Not referral-only
If you are unsure which side of one of these you are on, say so on the call. Being told no at the enquiry stage is a service, and it is the one part of this we can deliver in twenty minutes.
The second list is as load-bearing as the first one.
Writing down who we are not for is what keeps the first list honest. It is also the faster read: most owners find themselves in the right-hand column in under a minute.
Practices this is built for
- A solo or small-group practice competing against a hospital system’s marketing department for the same radius
- A cash-pay or partially cash-pay practice that has no insurance referral pipeline to fall back on
- A psychiatry, psychology or addiction-treatment practice in a market with no credible authority site in the lane
- A practice that grew on word of mouth, plateaued, and has never had a page written for how patients actually search
- A multi-location group whose location pages are the same page with the city name swapped
- An owner who has been sold to before and wants the uncomfortable part of the diagnosis first
Practices this is not for
- Health systems and private-equity platforms buying scale-first media
- A practice that needs different numbers this quarter, which is a paid-media brief rather than this one
- A practice on a platform that caps page count, with no appetite to move off it
- A practice below the $2,000 per month floor, where the honest answer is to wait rather than to buy a thin version
- A practice whose volume is entirely physician referral and that wants it to stay that way
- Anyone who needs a guarantee attached to a ranking, which nobody can give and we will not imply
Three real options, and what separates them.
Not a scorecard in our favour. Two of these three are the right answer for a lot of practices, and the middle column is where most of the category sits.
| What you get | A healthcare-only firm, founder-led | A generalist agency with a healthcare page | A freelancer or a small local shop |
|---|---|---|---|
| Who holds strategy | Steven Lockhart, on every engagement, and the principal you reach | An account manager, with strategy escalated upward | The same person who also does the work |
| Specialty research | A written register for each of 32 specialties, before your build starts | Usually assembled during your engagement, at your cost | Depends entirely on prior client history |
| Regulatory constraint | Treated as a design input: HIPAA, FTC 16 CFR 255 and 465, AMA Opinion 9.6.1, state advertising rules | Often handled reactively, after a takedown or a complaint | Rarely in scope, and rarely priced |
| What you own at the end | The site, the content, the profiles, the analytics and the data | Varies. Ask specifically about the analytics property and the GBP | Usually yours, but often undocumented |
| Capacity risk | Deliberately small, which means intake closes when it is full | Large, which means your account can be reassigned | One person, which means one point of failure |
| Published floor | $2,000 per month, stated before the first call | Typically disclosed after two or three meetings | Usually lower, with scope to match |
The regulatory row is not rhetorical. A patient testimonial used in marketing requires a written HIPAA authorisation under 45 CFR 164.508. The FTC’s rule on consumer reviews and testimonials, 16 CFR 465, has been enforceable since 21 October 2024. Endorsement disclosure sits under 16 CFR 255, and physician advertising conduct under AMA Opinion 9.6.1. Ask any firm you are considering to tell you which of those four applies to a patient story on a website.
The floor is published, and the maths behind it is too.
Engagements start at $2,000 per month. What that figure buys is a function of page volume, and page volume is the mechanism, so the arithmetic is worth seeing before the call rather than after it.
What the floor buys
A workable site is live in two to three weeks, and the entry tier is 500+ pages laddering toward 10,000. Content runs at seven posts a week, which is 365+ indexed pages a year on top of that foundation, plus a press release a month from week five and four to eight new Google reviews a month building toward a 50+ profile.
For scoping a plan we work from roughly 25 pages per city-and-service target per $1,000 per month. That is a planning estimate for sizing the programme, not a deliverable count and not a promise.
Why there is a floor at all
Because below it the build cannot be done to the standard published on this site, and a thin version of it is worse than nothing: it consumes the same year and produces a site that still cannot compete. The floor also prices out the second-best practice in a zip code, which we do not like and will not pretend otherwise.
What a specific practice pays is set on the first call rather than after three meetings. If the answer is that you should wait a quarter and spend the money on something else, that is the answer you will get.
One thing we will not do at any price
Attach a guarantee to a ranking, a patient count or a revenue figure. Nobody controls a search result, and an outcome guarantee in this category is a Section 5 problem under the FTC Act before it is a marketing problem. Every result we publish carries its starting baseline and its timeframe, and results vary by market, specialty, budget and starting position.
The fastest way to find out is to be told no.
Tell us the specialty and the metro. If this is not a fit you will know inside twenty minutes, and you will know why. If it is, you will leave with a plan you could hand to another agency.
How to evaluate us, or anyone else.
These three answers are written to be useful whether or not you call. If they help you hire a different firm well, that is a reasonable outcome.
On checkable things rather than on the pitch. Four that separate firms quickly: ask to see their own site’s publishing cadence and count the missed weeks; ask which specialties they have written research for and to see one; ask what happens to the analytics property, the Google Business Profile and the content if you leave; and ask for a result with its starting baseline and its timeframe attached, because a percentage without a baseline is not a result. Google’s own guidance on experience, expertise, authoritativeness and trust describes what a search engine is assessing on your site. Source: Google Search Central, Creating helpful, reliable, people-first content.
Worth checking: process credentials that constrain how the work is run, whether that is Lean Six Sigma, a documented QA gate, or a published methodology you can read before signing. Worth checking twice: any claim about regulated conduct. A firm marketing for medical practices should be able to tell you, without looking it up, that a patient testimonial requires a HIPAA authorisation under 45 CFR 164.508, that the FTC’s rule on fake reviews and testimonials has been enforceable since 21 October 2024 under 16 CFR 465, and that AMA Opinion 9.6.1 governs how physician advertising is expected to behave. Noise: platform partner badges, award logos with no published criteria, and any client count presented as evidence of quality.
Ask what they would tell you not to buy. A firm that sells everything to everyone has no answer to that, and the answer is where the actual expertise sits. Then ask three concrete things: what is the floor, what moves first and when, and what would make you tell me this is not a fit. You should end the call able to repeat the plan back to a partner in order, and you should be able to tell whether you were sold to or diagnosed.
Sources cited above, in order of appearance: Google Search Central, Creating helpful, reliable, people-first content. 45 CFR 164.508, HIPAA authorisation for uses and disclosures of protected health information. FTC 16 CFR 465, Rule on the Use of Consumer Reviews and Testimonials, effective 21 October 2024. FTC 16 CFR 255, Guides Concerning the Use of Endorsements and Testimonials. AMA Code of Medical Ethics Opinion 9.6.1, Advertising and Publicity. Nothing on this page is legal advice, and a marketing agency is not a substitute for your own counsel.
Two lists decide most of it. Your field, and your metro.
Both are enumerated rather than described, so you can check in a minute whether we have done the research that would make us useful to you.
All 32 specialties
How patients in your field search, who holds those terms today, and which advertising rules bite in that field.
Open the register The workAll 36 services
Four pillars, twelve lines, one dependency order, and the standard we hold ourselves to on each of them.
See the services The rosterAll 99 metros
Ten regions, with each metro’s demand tier and the depth that tier earns. One office, in Newport Beach.
Find your metroThirty minutes. A diagnosis, not a pitch.
Tell us the specialty and the market. We will tell you what is actually in your way, and we will tell you if the answer is that you do not need an agency yet.
