Two dermatology practices bid on "eczema treatment near me." One bids $15 a click and sends the searcher to its homepage. The other bids $11 and sends the searcher to a page about eczema: what it is, how the practice treats it, who treats it, and a button to book. The second practice can win the better spot and pay less for it.
That isn't a trick. It's how Google's ad auction is built. Google doesn't simply sell the top of the page to the highest bidder. It weighs the bid against how useful the ad and the page will be to the person searching. For a dermatology practice, that makes the website part of the ad budget, and the single most common website problem in this field is easy to name: one broad page trying to answer every skin question at once.
Chapter 3 worked out what a new patient is worth. This chapter is about paying less to reach them.
Google Ranks the Ad and the Page, Not Just the Bid
Every time an ad could show, Google runs an auction and gives each ad an Ad Rank, which decides whether it shows and where. Google lists six things that go into it:
- Your bid: the ceiling you set on what a click is worth to you.
- How good the ad and the page are: whether an eczema searcher who clicks will find eczema.
- Ad Rank thresholds: a quality floor. An ad below it doesn't show, whatever the bid.
- The competition in that auction: the other practices, chains and med spas bidding at that moment.
- The searcher's situation: the exact words, where they are, what device they're on and when.
- What your extras are expected to add: call buttons, sitelinks and other assets attached to the ad.
Only the first is money. The second is the one a practice controls most directly, because it lives on the practice's own website. Google's own help page on Ad Rank adds that better ads often end up paying less per click than weaker ones.
Quality Score Is the Check Engine Light, Not the Engine
Inside the account, Google shows each keyword a Quality Score from 1 to 10. It's tempting to treat that number as the thing to improve. Google says otherwise: the score isn't fed into the auction at all. It's there to help you diagnose problems.
Think of it as a check engine light. It doesn't make the car go. It tells you where to look. The score comes from three readings, each graded against other advertisers as above average, average or below average:
- Expected clickthrough rate: Google's forecast of whether people will click this ad for this keyword.
- Ad relevance: whether the ad talks about the skin problem in the search, or about the practice in general.
- Landing page experience: whether the page a patient lands on answers the search they typed, and works well on their phone.
When a dermatology keyword shows a low score, the component that's marked below average tells you which job to do: rewrite the ad, split the ad group, or fix the page. Start with whichever one is marked below average; the page is the one you can fix without touching the ad account at all.
An Eczema Search Deserves an Eczema Page
Here is the pattern that costs dermatology practices money. Someone searches "eczema treatment." The ad says something about eczema. The click lands on a page called Medical Dermatology that lists 30 conditions, with eczema somewhere in the middle. The patient has to hunt for the thing they searched for, and Google can see that the page isn't really about the search.
Most practices in our example-market sample, the Atlanta sites this guide uses throughout, have already done half the work, and practices in other cities tend to look similar. Of the 10 dermatology sites that offer both medical and cosmetic care, 8 split them into separate menus. The next step is splitting the medical side by condition, so each condition that you advertise has a page of its own.
Dermatology Associates of Atlanta is a good model of the idea. The practice organizes itself into named centers, including The Eczema Center and The Psoriasis Treatment Center, so a searcher looking for either one lands in a place that's clearly about their problem. You don't need to rebrand anything to get the benefit. You need a page per condition you pay to advertise, and an ad group per condition that points at it.
The structure is simple: one ad group for eczema searches, its ads written about eczema, landing on the eczema page. The same for acne, psoriasis, hair loss and rosacea. Each piece of the chain matches the one before it, which is exactly what ad relevance and landing page experience measure.
Skin Checks, Moles and Mohs Need Three Different Pages
The skin cancer side of a practice gets lumped together more than any other, and it covers three very different visits.
A skin check page is for someone who wants a screening. It should say what happens in the exam, how long it takes, how often to come in, and how to book.
A mole removal page is for someone who already has a spot they want looked at or taken off. It should explain the options, what a biopsy involves, and what happens after.
A Mohs surgery page is for someone who already has a diagnosis, often referred by another doctor. It should explain the procedure, name the Mohs surgeon, and make it easy for a referring office or a worried patient to call.
Put all three on one "Skin Cancer" page and each visitor reads past two-thirds of it looking for their answer. Forefront Dermatology's Atlanta location shows another useful touch: a skin cancer page built for that office, with its address, hours and map, so a local searcher lands on a local page rather than a national one.
Cosmetic Pages Have to Show the Price or the Path to It
Cosmetic patients shop, and Chapter 2 showed that the searches around Botox and lasers are crowded with med spas. A cosmetic landing page that makes the shopper work to find what they want to know sends them back to the search results.
Price is the clearest example. Only 4 of the 12 example-market sites we looked at publish an actual dollar price anywhere in their page text, and 7 of the 12 name a financing partner. You don't have to post a price list. But a cosmetic page should give the shopper a way to the number: a starting price, a "most patients spend" range, a membership, a financing link, or a clear promise of pricing at the consult.
The rest of a good cosmetic page is the same discipline as a condition page: one treatment per page, the treatment's name in the headline, who performs it, what results to expect, and a booking button that doesn't send the patient into a generic contact form.
A Slow Page Loses the Patient Before the Page Loads
Landing page experience includes how the page works on a phone, which is where many patients will first see your ad. We ran Google's free PageSpeed Insights test on the homepages of the example-market practices in our sample. Run it on your own pages; that's the only result that matters for your account. Of the six that returned results, the mobile performance scores ranged from 12 to 96 out of 100, and the time for the main content to appear ranged from 2.4 seconds to 18.1. Dermatology Consultants' homepage scored 96. Four of the others took more than six seconds to show their main content.
Two cautions if you run the test yourself. Scores move between runs, sometimes by 20 points on the same page, so test two or three times and look at the pattern. And test the landing pages your ads actually use, not just the homepage.
The usual culprits on a practice website are oversized photos, sliders, chat and review widgets, and booking tools that load before anything else. You don't need a perfect score. You need the eczema page to show the patient something useful in the first couple of seconds.
Audit Your Pages Before You Build a Single Ad Group
Before any campaign goes live, make a short list: every condition and treatment you plan to advertise in the first few months. For a typical practice starting at the bottom of the funnel, that might be skin checks, mole removal, eczema, acne, psoriasis and hair loss on the medical side, plus one or two cosmetic services you most want to grow.
Then, for each item on the list, open your own website on your phone and answer three questions. Is there a page about this one thing? Does the headline name it in the words a patient would use? Can the patient book from that page without scrolling or hunting? Any item that gets a no is a page to write or fix before the ad group launches.
Most practices find they already have half of these pages, written years ago for search engines and never looked at again. Those pages usually need a clear booking button, the name of the doctor who treats the condition, and a trim. The missing ones are usually the conditions the practice is best known for, because nobody thought they needed explaining. That audit takes an afternoon and saves money from the first click onward.
Better Pages Buy Cheaper Top Spots
Put it together and the order of work becomes clear. Before you raise a bid, look at the page behind the keyword. If the ad group is about eczema and the page is about everything, fix the page. If the page is right but slow, speed it up. If both are fine, then consider the bid.
That order matters because the fixes compound. A page that matches the search helps the auction, and it also helps the patient book, which is the booking rate from Chapter 3. The same change lowers what you pay for the click and raises how many clicks become patients.
Next: The Keywords Hiding in Your Competitors' Websites
With condition pages in place, the next job is filling each ad group with the right searches. Chapter 5 shows how to find them, starting with a tool most practices never think to use: Google's own Keyword Planner, pointed at a competitor's website.
The Google Ads for Dermatologists guide home lists every chapter. In our Google Ads management work, the landing page review comes before the keyword list, for exactly the reasons above.
