Why Your Google Ads Agency Is Costing You More Than You Think
Most agencies hide their true cost behind retainers, management fees, and inflated ad spend. Here's how to audit your agency relationship. And know exactly when it's time to switch.
Reality check: The average healthcare practice pays 3–5x more per booked consultation than they should. Most never find out because their agency doesn't report on that metric.
The Hidden Cost Structure Most Practices Never See
Your agency charges $2,500/month retainer. Seems clear. But that's rarely the full picture.
The real cost includes: (1) Management fee markup on top of ad spend. Some agencies add 10–20% on top of your media budget without disclosing it. (2) Setup fees that were supposed to be one-time but quietly recur. (3) The opportunity cost of months of underperformance while you're locked into a contract. (4) Staff time managing the relationship. Calls, reports, follow-ups.
One of the fastest ways to see the real cost: ask your agency for read-only access to your Google Ads account. If they hesitate or make excuses, that's a red flag. The account is yours. You should be able to see every dollar of spend at any time.
The Retainer Model's Built-In Conflict of Interest
When an agency charges a flat retainer regardless of results, their incentive is retention. Not performance. A satisfied client who stays is worth more than an outstanding result that leads to a short contract.
This creates perverse incentives: agencies are rewarded for managing expectations, not for hitting targets. Monthly reports become performance theater. Lots of impressions data, click-through rates, and "brand awareness" metrics that obscure the actual question: how many booked consultations did we get this month?
The performance model eliminates this conflict entirely. When the agency only earns money when you earn money, every optimization decision aligns with your interests. There's no reason to preserve a failing campaign or protect a comfortable status quo.
5 Signs Your Agency Is Underperforming
Sign 1: They can't tell you your cost per booked consultation. Cost per click and cost per lead are vanity metrics if they don't map to actual booked appointments.
Sign 2: Your campaigns haven't changed in months. Google Ads requires constant iteration. Keyword expansions, ad copy testing, bid adjustments, negative keyword additions. Static campaigns decay.
Sign 3: They're running broad match keywords without tight negative keyword lists. Broad match captures enormous volumes of irrelevant traffic. Without aggressive negatives, you're paying for clicks that will never convert.
Sign 4: Your landing pages haven't been updated since launch. The landing page is 50% of the conversion equation. An agency that only manages the ads and ignores the landing page is leaving half the optimization table untouched.
Sign 5: Monthly reports arrive but nothing changes. Reports should drive decisions, not just document history. If you read the report and then wait for next month's report, the agency isn't doing the work.
How to Audit Your Current Setup in 30 Minutes
Step 1: Request Google Ads read-only access. Log in and go to the Search Terms report under Keywords. Sort by cost descending. Review the top 20 terms your budget is being spent on. Are they relevant? Are they procedure-specific or generic?
Step 2: Check your conversion tracking. Go to Tools & Settings → Conversions. Are conversions being tracked? Is phone call tracking set up? Are the conversion values correct?
Step 3: Review your landing pages. Click on your own ads and experience the landing page as a patient would. Is the CTA clear? Does the page load fast on mobile? Is there social proof above the fold?
Step 4: Calculate your true cost per consultation. Total monthly spend ÷ total booked consultations from ads = your real cost per result. If you don't know this number, that's the first problem to solve.
Step 5: Ask for a monthly breakdown of search term-level performance, not just campaign-level. If the agency can't provide this, they're not managing the account at the level your investment deserves.
When to Switch Agencies. And What to Look For.
Switch when: you've been running for 90+ days and don't have a clear cost-per-consultation number, your monthly retainer is higher than your monthly results can justify, the agency has shown no urgency to improve underperforming campaigns, or you can't access your own account.
What to look for in a replacement: transparency over your account (you own it, always), reporting that includes cost per booked consultation (not just clicks), a model that ties their compensation to your results, and a track record in your specific specialty.
The performance model exists for exactly this reason. When an agency is deeply invested in your success, the entire incentive structure changes. No generic playbooks. No junior account managers. Just the work of actually driving booked consultations.
Retainer vs Performance: At a Glance
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