POSTED ON: Nov 02, 2026
Healthcare costs keep rising, reimbursement isn't keeping pace, and practice managers often cut marketing budgets first. The challenge is deciding what to remove without weakening the flow of new patients.
According to the American Medical Association's analysis, Medicare physician payments declined 33% from 2001 to 2026, adjusted for inflation in practice costs. With margins under pressure, cutting expenses makes sense. Cutting by instinct does not.
A large invoice doesn't necessarily mean a channel is wasteful, just as a low cost doesn't guarantee value. We asked healthcare operators and marketers which activities and practices should stop paying for, which deserve protection, and what data should guide those decisions.
Methodology: RepuGen asked healthcare operators and marketers on Featured.com which practices to keep, reduce, or eliminate when cutting marketing budgets. We received 82 responses from 81 contributors and selected 9 experts based on relevant roles and firsthand experience. Read our previous expert study for more on the approach.
Cut marketing expenses you can't tie to patients who actually attended appointments, starting with paid directory upgrades and broad advertising campaigns that can't prove results. Protect SEO, accurate listings, genuine patient reviews, and referral relationships when they contribute to patient acquisition. Compare channels using cost per new patient who attended, not clicks or leads alone. Before cutting anything, check whether the marketing is failing or whether you are not following up on inquiries. The right decision depends on evidence, not invoice size.
Sort every marketing expense by whether it can be connected to a patient who booked and attended, and whether its value continues after spending stops. Paid channels rent attention, which usually disappears when the budget ends. Website content, organic visibility, and trusted referral relationships can continue producing value after the initial investment.
Michael DeMasi, President of Rubicon Recovery Center, puts the distinction plainly:
"Cut what you rent and protect what you own. Paid ads and directory listings are rented attention, and they stop working the day you stop paying... A channel that looks cheap at the top of the funnel can turn out to be your most expensive once you see who really walks through the door."
That is a useful starting point, not a universal rule. Each channel should earn its place through evidence.
What our experts recommend
| Channel | What Our Experts Recommend | Why |
|---|---|---|
| Paid directory subscriptions | Cut first unless they show booked patients | Visibility and leads do not necessarily translate into appointments |
| Paid advertising | Reduce to the highest intent services | Results generally stop when spending stops |
| SEO and website content | Protect | Useful content can continue attracting relevant searches |
| Reviews and reputation | Protect if active | Reviews can influence decisions across multiple acquisition channels |
| Referral relationships | Protect | Trusted recommendations can bring patients with established confidence in the practice |
Compare every channel using cost per new patient who actually attended an appointment, attributed to the source that brought them in. Clicks, impressions, profile views, and leads measure different activities, so they cannot fairly establish which channel delivers the best patient acquisition results.
Bram Vermolen, SEO Strategist at Space’M Online, explains:
"Website traffic and clicks are nice to have, but ultimately what’s important is what’s the cost of acquiring a new patient that shows up for an appointment (not just books one), and what their booking rate is."
Start by asking every new patient how they heard about your practice and recording the answer in their chart. Use separate call tracking numbers for advertising and directories where appropriate so that you can compare reported sources with actual attendance.
Before your next budget meeting, pull 6 months of new patient records by source from your scheduling system. If you cannot reliably identify where patients came from, improve attribution before making large cuts.
Keep your free profiles accurate, but pause paid directory upgrades for a test. If total new patient bookings stay steady when you switch off an upgrade, the subscription may have been taking credit for patients who would have found you anyway.
Directories themselves should not be dismissed. In RepuGen's patient survey, insurance directories and search engines were the 2 leading discovery tools across age groups. That makes an accurate free listing valuable, even when a paid upgrade cannot demonstrate incremental bookings.
Khalid Hossen, Dental Search Marketing Specialist, recommends testing the weakest paid channel before committing to a cancellation:
"Next, test the weakest paid channel by pausing it, such as a directory subscription or a broad ad campaign. Turn it off for three to four weeks and watch your total new-patient bookings, not that channel’s own report. If bookings hold steady, the channel was taking credit rather than bringing in patients."
Google also states that businesses cannot request or pay for better local rankings. Local results depend on relevance, distance, and prominence. A fully optimized Google Business Profile can support local visibility without requiring a paid ranking upgrade.
Start here: List every directory you pay for, its annual cost, and the booked patients it generated last year. If you can't prove its contribution, test the subscription before renewing.
Keep the campaigns that produce attended appointments at a sustainable cost, usually high-intent searches for specific services. Reduce broad awareness campaigns and pause campaigns that lack reliable call or form tracking. Paid advertising is relatively easy to scale down and restart, but the decision should be based on results rather than budget pressure alone.
Dr. Mark Karolak, Facial Plastic Surgeon at Karolak Facial Plastic Surgery, describes how he prioritizes marketing when spending tightens:
"When budget tightens, I protect anything that helps a patient trust me before they ever call. I would usually retain reputation management, local SEO, and referral programs; reduce paid ads to the highest-intent procedures; and eliminate directory subscriptions that cannot show real booked consults."
Measure kept consultations and the conversion from consultation to procedure by source, not lead volume alone. A campaign that generates many inquiries but few attended consultations may need refinement or a pause, while a smaller campaign producing appropriate patients may deserve continued investment.
Start here: Turn off ads on your own practice name for 2 weeks and compare total bookings with the previous period. Check for other factors that could explain any change before deciding whether the campaign is necessary.
SEO takes time to build and can take time to recover after cuts. Useful website content that answers real patient questions can continue attracting people who are actively considering care long after the initial work is complete. When budgets tighten, our contributors recommend trimming content volume before stopping SEO outright.
Michael Nadhir, Founder and CEO of KindMind Behavioral Health, explains why he protects organic search:
"That kind of organic intent-driven traffic is hard to replace with paid spend, so I protect it first. If someone is Googling “what happens at a psychiatric evaluation” at 11 pm, I want KindMind’s answer waiting for them."
Organic visibility also matters as more patients use AI tools alongside traditional search. RepuGen's AI search study found that about 4 in 10 patients research providers using AI tools, either alone or alongside traditional search. These systems can draw on website content, business listings, and reviews to generate answers, making accessible, accurate information more important than conventional search rankings.
Smaller practices can also compete by making their expertise and services easy to understand. See how smaller practices can win AI search results.
Start here: Identify the 3 website pages that generate the most new patient inquiries. Protect their accuracy and usefulness before reducing the work supporting them.
Usually, yes, if the work is active and useful. Reviews may rarely appear as a directly attributed referral source, but patients can read them before booking regardless of how they discovered the practice. That makes healthcare reputation management relevant across paid advertising, organic search, and referrals. However, a reputation management subscription that nobody uses is just another expense.
RepuGen's 2026 Healthcare Behavioral Study found that about 89% of patients check online reviews when researching a new provider. Separately, BrightLocal's 2026 Local Consumer Review Survey found that 68% of consumers would use only businesses with a rating of 4 or more stars. These findings underscore the importance of reviews, though they don't guarantee a specific return from a paid tool.
Dr. Igor Ivitskiy, PhD, Founder of Doctor Ads, explains why he would protect reputation management:
"Reputation management is the line I would protect even though it looks worst on paper: it brings in almost no directly attributed patients, yet it lifts the conversion rate of paid clicks, organic traffic and referrals, because all of those people read the reviews before they book."
Amin Said, Founder of AI Local Boost, offers an important counterweight:
"Keep reputation management if reviews are recent, responses are consistent, and review themes show fewer booking objections; reduce it if it’s just a fancy dashboard; eliminate it if nobody is replying or learning from patient feedback."
Both perspectives matter. Protect work that supports review collection, appropriate responses, and learning from feedback. Don't keep paying for a tool just because reputation matters in principle.
For additional context, see how practices compete with larger health systems.
Start here: Check when your latest review was posted and whether your last 5 reviews received responses.
Yes. Referral relationships with other physicians and satisfied patients can bring in people who already trust your practice. They also often require less direct spending than paid acquisition channels. The priority is tracking referral sources and maintaining those relationships, rather than paying for referrals.
Garric Vosloo, CEO of Functional Medicine Fast Track, brings 30 years of private practice experience to this point:
"...most practices underinvest here relative to paid ads, yet a referred patient arrives pre-trusting you. That’s structurally more valuable than any cold channel when budgets are tight."
There is an important compliance distinction. The federal Anti-Kickback Statute prohibits paying or rewarding people to induce referrals involving federal healthcare program business. Referral programs should focus on building professional relationships and tracking sources, never paying for referrals. Review the Office of Inspector General's guidance on fraud and abuse laws and consult healthcare counsel on applicable state rules.
Start here: Make sure your intake question, “How did you hear about us?”, captures the referring physician's name rather than recording only “referral.”
Check what happens after a prospective patient contacts your practice. Unanswered calls, unreturned inquiries, and slow follow-up can make effective marketing look like it is failing.
Dillon Loomis, Founder and SEO Consultant at Pinnacle Pursuit SEO, describes a problem he has seen firsthand:
"One other thing I’d look at before cutting anything is whether the leads you’re already paying for are actually being followed up on. I’ve worked with a practice where one person at the front desk handled every inquiry, and when she was out, those leads just sat there. Sometimes it looks like a marketing problem when, in reality, the marketing is working."
Before reducing spend, check inquiry response times, missed calls, and whether each lead has a clear follow-up owner. RepuGen's free Reputation Scorecard can also help you compare your reviews and listings with nearby practices before making budget decisions.
Compare each channel using cost per new patient who attended an appointment, using your scheduling system and an intake question about how patients found you. Clicks, impressions, and leads measure activity, not completed visits, so you can't compare them fairly across channels.
Keep free listings complete and accurate, since patients still use directories to find care. Paid upgrades should demonstrate that they generate booked patients. Pause a subscription for 3 to 4 weeks and monitor total bookings. If bookings remain steady, the upgrade may not be adding new patients.
No. Google states that businesses cannot request or pay for a better local ranking. Local results depend on relevance, distance, and prominence, including review count and ratings. Focus on accurate business information and a complete profile rather than paying for a promised ranking advantage.
Paying or rewarding referrals can violate the federal Anti-Kickback Statute when federal healthcare program business is involved, and state rules may also apply. Build referral relationships and track referral sources. Consult healthcare counsel before establishing any referral incentive or reward program.
The practices that emerge from a marketing budget cut in a stronger position aren't necessarily the ones that spend the least. They protect what continues to produce results and pause what cannot demonstrate its value. Before removing a channel, measure the patients it brings in and check whether follow-up is working. See how RepuGen helps you assess your online reputation and make more informed marketing decisions.
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