Is Google PPC On Its Way Out?

Most of our clients have come to understand that spending on Google is a “necessary evil” to get vital clicks from new patients, especially as competition in the aesthetic space continues to ramp up on several fronts. But with Google hell bent on pushing AI content and other tools to keep users on its platforms (rather than linking out to the advertisers that pay the bills), how will Google PPC remain relevant in the year ahead?

Let’s take a look at 4 ways a changing online landscape is likely to impact the importance and value of Google PPC advertising for medical practices.

Changing User Behavior

Searchers aren’t using Google like they used to. Long gone are the days of someone typing in “plastic surgeon Seattle” on their PC. But even someone searching Google for “plastic surgeon near me” on their iPhone is nowhere near as common as it was even a year ago. So how are new patients finding our clients these days?

• Artificial Intelligence – Practically anything you interact with online now has an AI component, and increasingly, those AI tools can tackle everything a Google search once provided, and much more. Google certainly has a big stake in AI, but the question remains whether users will prefer their tools compared to ChatGPT, social media widgets, or the next breakthrough we haven’t even heard about yet. If you can use an AI search that isn’t cluttered with advertising and gets you the same or better information, why wouldn’t you?
• Social Platforms – Speaking of social, platforms like Instagram and TikTok are now the leading way many people in younger generations access information online. They would never dream of opening a browser, going to Google, and typing in a search query. You might think this would mean social media advertising is becoming more valuable, but in practice, we still see very low quality lead generation here. However, targeted social advertising can be effective to build brand awareness or enforce brand loyalty.
• Video Search – YouTube has long been a major search engine in its own right. And yes, Google owns YouTube. But in our experience, extending a PPC ad campaign into YouTube does not result in a worthwhile return on investment. That said, to capitalize on the continued popularity of video and video search, we advise clients to produce fun (and also educational) video content that has a good chance of being found and appreciated organically on YouTube.

Google Search Results “Innovations”

Google has changed the layout of their search results pages many times over the years, adding in things like map listings, “people also ask,” and most recently, AI Overviews. This latest upgrade has both further muddied the waters and junked up the search results page while also drastically cutting down on the number of users clicking away from Google to view information on other websites. Many people have also commented that the quality of search results has declined, further incentivizing users to rely on AI Overviews.

The big question for PPC is why users will still click on ads. Prior to AI Overviews, Google’s jumbled mess of a search results page craftily prioritized paid clicks in all kinds of ways, primarily by placing them front and center in results and on map listings. But with AI Overviews now dominating the top spots, why will users want to click through to a paid listing? And just as important for advertisers, what is the quality of the leads that come in from these clicks?

Eroding PPC Value

Google’s fourth quarter 2024 earnings indicated slowing revenue growth across all advertising revenue types. But slowing revenue growth does not mean revenue was down. That’s a bit of a surprise when you think about how much “zero click” AI search answers are being pushed, and you see across-the-board declines in Google organic search traffic (indicating fewer people are clicking on unpaid Google search results). If fewer clicks are happening, how can pay-per-click revenue still be growing? The obvious answer would be that the ads are costing more per click, and that’s exactly what we saw throughout the second half of 2024.

In the year ahead, if fewer clicks continue to be generated from Google search, Google only has a few options to maintain its revenue growth. One is to continue to raise cost per click, eroding the value of their main source of revenue. The other is to change in a more fundamental way how advertisers are charged to get their message seen by users (for instance, by charging based on impressions instead of clicks). Regardless, we see few if any outcomes where Google PPC advertising maintains or improves its current value proposition.

A Challenging Economic Landscape

It doesn’t take a business wizard to tell you that, shall we say, “stressful” political and economic times in the United States are unlikely to be good for business at least in the short term. We’ve already seen less search happening for elective procedures in 2024 and while demand has so far held up better than many may have forecast, no one would be surprised if a recession finally landed in 2025.

What this means for PPC is that the same number of aesthetic providers will be competing to reach a smaller pool of potential patients. Given the Google Ads auction-based bidding system, that’s a recipe for higher cost. We continue to monitor other ad platforms and while avenues like LinkedIn, TikTok, Amazon ads, and Microsoft Advertising currently just cannot offer the return on investment that we’ve seen with Google Ads, it seems like one or more of these platforms will get aggressive to steal market share if Google Ads costs continue to escalate.

Where to Invest Your Ad Dollars

For now, Google Ads continue to provide solid, if no longer outstanding, value for the money spent. But with so much pressure on their business model, we don’t expect that to last forever. AI is likely to further fracture an already challenging online landscape where attention is at an ultrapremium. So will user behavior that is less tolerant of advertising messages.

We continue to advise clients that a PPC spend budget is just one component of a 360 marketing plan effort. Just as you diversify your investment portfolio, you need to diversify your marketing so that as the landscape shifts, you are not caught flat-footed. A practice that puts all its eggs in the PPC basket will very likely have a tough time growing in the coming year. Your best bet, as always, is to find your audience where they are and tell a compelling story.