Google Ads ROI for Medical Practices: What to Expect in Your First 90 Days

The 30-60-90 Framework

Google Ads follows a predictable ROI timeline for medical practices if you have the infrastructure right:

Days 1–30: Data Collection Phase
Your first month is about gathering data, not proving ROI. You should be running 20–40 clicks/day minimum (or your account lacks power). Google's machine learning algorithms need at least 15–20 conversions to start optimizing. Most medical practices see zero to minimal ROI in month 1 because the account is still "cold." This is normal. Agencies that promise immediate results are lying.

You should expect: 50–150 total clicks, 3–15 leads (assuming 5–10% conversion rate), 0–2 consultations at this stage. Budget: $1,500–$3,000. Do not judge ROI yet.

Days 31–60: Optimization Phase
By day 31, you have enough data to start meaningful optimization. Smart bidding starts working (if set up correctly). Landing pages are being tested. Negative keywords are being refined. The account moves from cold to warm.

You should see a 30–50% improvement in metrics from month 1 to month 2 if optimization is happening. CPL drops from $250 to $150. Conversion rate climbs from 4% to 7%. CTR improves because the algorithm is showing your ads to better-intent searchers.

Budget: $2,000–$4,000. You should see 4–8 leads generating 1–2 consultations. At this point, you might break even or see slight positive ROI — but don't scale yet.

Days 61–90: Scale & Prove Phase
By day 90, a properly optimized account is running efficiently. Conversion rates are stable. Cost per lead is predictable. You're getting 30–50% more leads than month 1 on the same budget. This is when real ROI appears.

Expected: 6–12 leads, 2–4 consultations, clear positive ROI. This is when you should consider scaling budget (if the account is performing) or fixing the setup (if ROI is still negative).

Realistic ROI Benchmarks by Vertical

ROI varies dramatically by practice type. Here's what "success" looks like by day 90:

Aesthetic/Med Spa (Highest ROI):
CPL: $50–120
Conversion rate (click to lead): 8–15%
Lead-to-consultation: 25–40%
Cost per consultation: $300–600
By day 90: You've spent $5,000 and booked 8–15 consultations. Average service value is $2,000+, so immediate positive ROI is realistic.

Cosmetic Surgery (High-Value, Slower):
CPL: $80–200
Conversion rate: 5–10%
Lead-to-consultation: 30–50%
Cost per consultation: $800–2,500
By day 90: You've spent $8,000 and booked 3–6 consultations. Immediate ROI depends on your close rate, but consultations alone represent $40,000–$150,000 potential revenue.

Dentistry/Orthodontics (High Volume, Lower Value):
CPL: $30–80
Conversion rate: 10–18%
Lead-to-consultation: 50–70%
Cost per consultation: $150–400
By day 90: You've spent $4,000 and booked 12–25 consultations. Lower margins per patient but faster ROI proof.

Specialty Medicine (Complex Sales):
CPL: $100–300
Conversion rate: 3–8%
Lead-to-consultation: 20–35%
Cost per consultation: $800–4,000
By day 90: You've spent $6,000 and booked 1–3 consultations. ROI timeline is longer because sales cycles are longer. Don't expect immediate proof, expect data.

Why Most Practices Miss ROI in 90 Days

Most medical practices that fail at Google Ads fail within the first 90 days. The reasons are predictable:

Setup #1: No Conversion Tracking
You're running ads but can't measure what's converting. You're flying blind. Result: budget gets wasted on low-intent traffic because you don't know what to optimize for. Without conversion data, smart bidding is useless. Without conversion data, ROI is invisible.

Setup #2: Homepage Landing Pages
Sending Google Ads traffic to your homepage instead of dedicated landing pages drops conversion rates in half. Searchers land on a cluttered page with distracting navigation. They bounce. Your CTR looks good but conversion rate is 1–2%. This inflates CPL and kills ROI calculation.

Setup #3: Broad Match Without Negative Keywords
Running broad match on "botox" pulls in 50% irrelevant traffic: "botox training," "botox side effects," "botox overdose." Your CPL becomes artificially high because half your traffic is never going to convert. By day 90, your CPL looks like $250 when it should be $80 with tight keyword matching.

Setup #4: Insufficient Budget
Running a $1,500/month budget in a competitive market doesn't generate enough conversions for Google's algorithm to learn. You need 20+ conversions/month to get smart bidding working. At $3–5 CPL for dentistry, that's $60–100/month in conversion cost — meaning you need $1,500+ just to get enough data. Too little budget = too little data = no optimization.

Setup #5: Unrealistic Expectations
Many practices expect to see positive ROI by day 30 on a brand new account. That's not how Google Ads works. If you're expecting month 1 ROI, you'll kill the account before it has time to optimize.

The Math: What 90 Days Actually Costs

A realistic 90-day test for a medical practice:

Ad spend: $10,000 ($3,300/month average)
Agency fee (if performance-based): $2,500–$4,000
Total investment: $12,500–$14,000
Expected leads: 40–60 (at 5–8% conversion rate)
Expected consultations: 6–12 (at 20–30% lead-to-consultation)

If average consultation value is $5,000–$8,000, and your close rate is 15–25%, that's 1–3 surgeries/services booked. Revenue from those clients: $8,000–$24,000+.

For aesthetic practices and dentistry: positive ROI by day 90 is realistic if the account is set up right. For surgery and specialty practices: proof of concept by day 90, full ROI by month 6.

If you're not seeing this math work by day 90, the problem isn't Google Ads — it's the account setup, landing pages, or targeting.

How to Track ROI Correctly

Don't just look at CPL. Track the full funnel:

Month 1: Track clicks, impressions, CTR, CPC. Note baseline metrics. No conversion tracking is reliable yet (only 3–10 conversions).
Month 2: Compare CPL month-over-month. Calculate conversion rate trends. Note if CPL is dropping (good sign) or staying flat (optimization isn't working).
Month 3: Calculate true cost per consultation booked. Compare to your average profit per client. Decide: scale (if profitable) or fix (if not).

The ROI verdict should come down to: cost per consultation vs. lifetime value of a client. If you're paying $400 for a consultation and the lifetime value of a new client is $3,000+, that's a 7:1 ROI on Google Ads spend. Scale it. If you're paying $800 for a consultation on a $2,000 lifetime value, that's barely break-even and you need to optimize or walk.