Most practices that run their own Google Ads set one bid and hope. One number, applied to every keyword, from "dermatologist near me" to "psoriasis treatment," adjusted up when the phone is quiet and down when the bill looks big.
In dermatology, that approach overpays for some searches and underpays for others at the same time, because the searches don't cost the same and the patients aren't worth the same. A skin check patient and a psoriasis patient arrive through different searches, at different prices, with different value over a year. The bid should know the difference.
This chapter covers how to set bids by condition in the Isolation campaign, how to tell whether each condition is actually being seen, and how to hand the bidding over to Google once the account has learned enough. It builds directly on the patient values from Chapter 3 and the launch list from Chapter 6.
Nationwide, a Psoriasis Click Can Cost Nearly Three Times a "Dermatologist Near Me" Click
Start with what Google's Keyword Planner says advertisers have been paying for the top of the page, across the whole United States. These ranges run from roughly the 20th to the 80th percentile of what advertisers paid over the last month:
- "dermatologist near me": about $2.15 to $7.79
- "skin cancer screening": about $1.97 to $7.46
- "eczema treatment": about $4.11 to $13.40
- "hair loss treatment": about $4.03 to $22.19
- "psoriasis treatment": about $7.00 to $21.00
At the top of those ranges, an eczema click runs nearly twice a "dermatologist near me" click, and a psoriasis click nearly three times. Your own market will sit somewhere around these figures, higher in some cities and lower in others.
We won't pretend to know every advertiser behind every one of those prices. It doesn't matter much for the practice. What matters is whether the patient behind each search is worth what the click costs, and that answer is different for every condition.
Work Out Each Ad Group's Ceiling From What That Condition's Patient Is Worth
Chapter 3 gave each funnel a ceiling: the most you're willing to pay to win one new patient. To turn that into a bid, walk it back through the two rates between a click and a patient in the chair.
The formula is short: the most you'd pay per new patient, times the share of clicks that book, times the share of bookings that show up. The result is the most a single click is worth to you.
Here is how it looks with made-up numbers. Replace every one of them with your own.
A skin check ad group: suppose a new skin check patient is worth a ceiling of $100 to you, 1 in 10 clicks book, and 8 in 10 bookings show. The click is worth up to $100 x 0.10 x 0.8, or $8. That sits comfortably inside the national range for these searches.
A psoriasis ad group: suppose a new psoriasis patient, who may be managed for years, is worth a ceiling of $300. Condition searches often book at a lower rate than "near me" searches, so say 6 in 100 clicks book, and 8 in 10 show. The click is worth up to $300 x 0.06 x 0.8, or about $14. The psoriasis click is more expensive, and it can still be the better buy.
Those two numbers become the starting maximum bids for their ad groups. Everything after launch is about replacing the made-up rates with real ones. After a month or two, your tracking from Chapter 1 will show each group's actual booking rate, and your front desk will know the show-up rate. Rerun the formula with those, and the bids stop being guesses and become prices you can defend.
Cosmetic Clicks Run on Different Math
The cosmetic side of a practice needs its own version of this calculation, because almost everything in it is different. The patient pays out of pocket, so the first visit brings in real money rather than an insurance-allowed amount. The treatment often repeats, as Chapter 3 showed with Botox, which lasts about three to four months. And the competition includes businesses with very different cost structures, such as med spas and laser chains.
Put those together and a cosmetic click can justify a higher bid than a medical one, but only when the numbers say so. A practice that knows a new injectables patient returns three or four times in the first year can bid with confidence. A practice whose cosmetic patients mostly come once, compare prices and leave should bid far more carefully, and fix the reasons they don't come back before it spends more to find new ones.
Keep the cosmetic ad groups in their own campaign with their own budget, so a run of expensive cosmetic clicks can't quietly drain the money meant for skin checks and eczema visits.
Set Bids Ad Group by Ad Group, Not One Number for the Whole Account
Isolation's bids are yours to set by hand, one per condition group. That's the payoff for the tight condition groups built in Chapter 5: each one can carry a price that fits its patient. Each group gets its own maximum from the math above.
At launch, bid toward the top of each group's range, as Chapter 6 explained, because a new account hasn't earned any Quality Score yet. Then review weekly. A group that's booking patients below its ceiling can afford more exposure. A group that's spending without bookings needs a look at its page and ads before its bid goes any higher.
Keep an eye on the keyword level, too. Chapter 4's Quality Score readings show up there, and a keyword with a below-average landing page experience will keep costing more than its neighbors until the page is fixed.
Top-of-Page Share Tells You Whether a Condition Is Getting Seen
Clicks and conversions tell you what happened. Impression share tells you what you missed.
Google reports two numbers worth adding to your columns. Search top impression share is the share of the top-of-page ad slots you actually got, out of all the ones you were eligible for. Search absolute top impression share is the same idea for the single first position.
You don't need to win every auction. For the searches that matter most, such as "dermatologist near me," your town names and your skin check searches, aim to be among the top ads for roughly 75 to 90 percent of the auctions you're eligible for. Below that, patients are seeing other practices first. Above that, each extra point of share tends to cost more than the last, so check that those final clicks are still booking patients before you pay for them.
Lost to Rank or Lost to Budget: The Two Reasons a Skin Check Ad Goes Missing
When a condition's top impression share is low, Google tells you why in two more columns.
Search lost top impression share due to rank estimates how often your ad missed the top ads because its Ad Rank was too low. The fix is quality or bid: a better page, a better-matched ad, or a higher bid for that ad group.
Search lost top impression share due to budget estimates how often you missed because the campaign ran out of money. The fix is budget, or moving money from a funnel that's performing worse.
Those are different problems with opposite answers. Raising the bid on an ad group that's losing to budget makes the money run out sooner. Raising the budget on one that's losing to rank buys more of the same poor position. Read both columns before touching anything.
Med Spas and Multi-State Groups Show Up in the Auction. Know When to Walk Away.
Inside the account, a report called Auction insights lists the other advertisers who entered your auctions and how often each one outranked you, search by search. It's worth opening once a month for each funnel, because the cast of competitors on a skin check search is rarely the same as the cast on a Botox search. In dermatology, expect a mix: other local practices, regional and national groups, and on cosmetic searches, med spas and laser studios.
Use it to make decisions, not to chase. If one competitor sits above you on a search that fits your ceiling, a modest bid increase or a better page may win it. If a search's price keeps climbing past what its patient is worth, the right move is to lower the bid or leave that auction entirely and put the money into searches that pay back. Walking away from an overpriced search isn't losing. It's refusing to buy patients at a loss. In practice, the searches most likely to cross that line are broad cosmetic terms in crowded markets and a few condition searches where the price has drifted up without the bookings to match. Check them first.
Judge all of this by bookings, not clicks, and check the bookings with the people who take them. Once a month, sit down with the front desk and ask which ad-driven calls and bookings turned into real new patients and which were wrong numbers, existing patients or people looking for something the practice doesn't do. That conversation catches problems no report will.
Give Medical and Cosmetic Their Own Target When Exploration Takes Over
When Exploration launches, Google does the bidding, toward a target cost per acquisition, or target CPA. The target comes from what Isolation has actually been paying per booking.
In dermatology, set that target per funnel, not for the practice as a whole. A cosmetic booking and a skin check booking are worth different amounts, so they deserve different targets, which is one more reason medical and cosmetic run as separate campaigns. Start each target near the real cost per booking its Isolation campaign produced, give it a few weeks to settle, and move it in small steps.
Next: Write the Ad in the Words Patients Use
Bids decide how often the ad shows. The words in the ad decide whether a worried patient picks yours. Chapter 8 covers writing dermatology ads, starting with the most useful source most practices ignore: the words patients use about you in their reviews.
The Google Ads for Dermatologists guide home lists every chapter. Condition-level bidding like this is how every account under our Google Ads management is run.
