How Will You Ensure Your Site Ranks on Google in 2020?



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About the Author

About the Author

Maria Todd is frequently hired as a consulting expert and trusted authority on healthcare marketing, branding advertising, publicity and public relations strategies and tactics. She helps medical groups, individual physicians, hospitals and ambulatory surgery facilities and other healthcare providers get results when they invest in brand creation and promotion.

Maria believes that the combination of strategy, tactics, and knowledge of how to use all the options within the marketing stack contribute to better rankings on Google... and that most healthcare marketers are clueless on how to market online. As a result, she argues that their expectations for results are unreasonable and based on fantasy and the notion that if they are a great surgeon or accredited hospital, they should be listed on the top of page one whenever one searches for what they offer. Utterly ridiculous.

Make 2020 the year to learn how to do things right and win results and growth like never before!

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If your competition has more of the 17+ features listed above, it is likely they will rank higher than you.

That’s it, plain and simple. But how do you do these things and have time to run the business and see or help patients?

Google has released hundreds of updates to its algorithms for search engine ranking since 1993. By now, you may have learned some of them, but are you really up to date?  Is your marketing consultant up to date? Is your webmaster up to date? … and is your competitor up to date?

My name is Dr Maria Todd and I have expertise with full stack marketing for healthcare business. I am a “unicorn”. You don’t find many like me who have clinical training and experience, healthcare administration experience, training in advertising and marketing consumer protection compliance and certification in digital marketing from Google. I help clients meet their marketing and business development objectives. I work with healthcare business development projects every day of the week, for my employer and for my private consulting clients. I achieve results or they wouldn’t continue to work with me. That’s the litmus test. Results and the interpretation of the results.

A part of my responsibilities is to make sure that every related action of marketing and advertising connects on a “super-pathway” and works in tandem to produce returns on investment. That means, for one thing, remaining informed about Google’s updates as they are released. No matter if they do this three times in a week. 

But I am also responsible for print and mailing and publication deadlines, demographic targeting, psychographics, mailing list filters, outcomes, and refinements.  I oversee several millions of dollars in advertising campaign development, graphics and content creation, video production, audio production, publicity, advertising placement, for my employer and my clients – every day. Google is but one of these outlets for which I am responsible. And I cannot risk my clients’ or my employer’s reputation and good name by allowing or being the source of scandal, errors, compliance infractions, unsubstantiated marketing and advertising promises, or miscommunications. 

I am paid a fee by the hour for my time spent to read blogs, research, test, and review and interpret and report results and changes or modifications to strategy. A part of that fee covers the incremental costs of the subscriptions to high-value news sources and services to help me winnow down search engine optimization (SEO) research on keywords and key phrases and learn what consumers and others search for and the syntaxes they use when search. SEO research is part tactical and part empathy of your targeted seeker. So if your target is from the USA, they will use different words than a Turk or a Brit or a Mexican or a Spaniard or a Panamanian or a Filipino person entering words in a search engine.  If your target is from West Africa, they may use different words than an East African or a person searching from India or the Middle East. 

To know, empathize or search using the syntax of these languages and cultures, you must know or study the languages and cultures and how they will translate their question from their language to English if your posts are in English. Along the same lines, you must work backwards with SEO to think like your targeted visitor and use words and phrases your targeted visitor might use – and their frames of reference to enable Google to classify your content as relevant to the seekers’ requests. This is one reason why I don’t hire SEO services that pitch me from India and other countries if my targeted reader or viewer is not from there. It isn’t better or worse, it’s just culturally and linguistically different. And the ones pitching are often lead sources hired blindly who don’t know better, so don’t get upset with them. They were hired to do a job and directed to accomplish a task that – at least with me – won’t happen.

Wrong keywords work – they just don’t deliver the results you want

One thing I’ve witnessed time and time again is that website owners and their consulting firms often position and compete for the wrong keywords. If you rank highly for the wrong keywords and phrases, you spend time and money on AdWords only to discover that the keywords you targeted don’t receive “the right” traffic. Oops!

One client spent USD $575 a month on AdWord spend chasing the wrong keywords out of ignorance. They hired an agency who also didn’t know better. This went on for 3 years at a cost of over $20,000 – $20,700 for the Adword spend and more for the agency tech who set things up. What’s that old saying, “even a broken clock is right twice a day”? Yes, you may get lucky and someone may click, but what’s the drop off rate? What is time on page. Google is watching all of that from a powerful vantage point. You may get two points for the click, (because Google makes money when the click occurs) but you then also get penalized and go to the bottom of the page or lower on the page because of the lack of relevance (the one thing Google stakes its reputation) on arrival such that the visitor leaves as quickly as they arrived. 

You may have a new orthopedic robot system you want to advertise and attract visitors to teach them more about how it can help them have a better knee replacement with better consistency and precision. But if you use the wrong keywords and the visitor has no idea that such robots exist or how they work, the visitor using Google isn’t going to connect with your content. 

Many people define medical tourism improperly – syndicating the myth that it requires travel to another country. It does not. Likewise, people mistakenly define a keyword as any phrase you would like your site to rank for in Google’s search results. You don’t really care about ranking as much as you care about connecting relevantly to the searchers’ intentions, right? If you try to rank for a single term or single word such as medical tourism, or Canadian medical tourism, you may rank someplace. But would a Canadian search for “Canadian medical tourism”? Of course not! So you won’t attract Canadians with that tactic. What would a Canadian search for instead?

Different categories of Keywords

  • Head-term keywords – i.e., “Classic cars”
  • Long-tail keywords – three or more words or phrases, i.e., robotic assisted knee replacement
  • Navigational keywords – to locate a brand or particular website i.e., AskMariaTodd or
  • Informational keywords: words to discover a particular answer – i.e., “how to …” , “what are the options for…”
  • Transactional keywords: i.e., “low-cost MRI near me”
When my client set about purchasing keywords, the consultant, knowing little about the client’s business and making misassumptions, targeted head-terms and navigational keywords. Assuming plastic and cosmetic surgery was the money-maker, they targeted “boob job” and geotargeted Las Vegas. Month after month after month, without results. Yes, there were clicks, just like the broken clock analogy. And then came the drop offs. The targeted AdWords didn’t convert to revenue, even though clicks happened. When I asked the consultant what strategy they used – they said “A PPC strategy. We never applied any SEO strategy.” I wanted to throw something in a fit of rage!  Such incompetence!  But the client didn’t know any better and blindly trusted and faithfully kept paying the bill until I explained why they should stop and find another consultant or a different tactical approach. 


Despite high traffic numbers, most head terms and navigational keywords will fail to lead to any revenues. Long tail, information and transactional keywords match customer intention and search term entry. They are the money shot! 

Relevance to what the searching human has entered is they key to success with Google SEO and SERP. Another mistake is targeting search words for webcrawlers. Simply stated, webcrawlers don’t buy healthcare services. why target them?

Emulate your competitors – but only if they are successful doing what you want to achieve

I read a blog post by an SEO blogger that recommended readers steal competitors’ keywords. So I ran the competitor’s keywords into the recommended online tools. What I learned is that they didn’t know how to use keywords and couldn’t possibly be attracting patients. Copying their SEO keywords would not produce the desired results. Was this blogger make a scientific recommendation or an anecdotal one to create traffic to their own website?

Another recommendation from another blogger sent readers to a different tool to learn which keywords sent visitors to competitor’s websites. When copied that may lead to clicks, which if one is depending on AdWords can cost an advertiser using a PPC strategy a lot of money for each click.  But if they don’t produce revenue, why do it?  You cannot blindly follow advice of bloggers. You must read and apply critical thinking and have some knowledge to know which advice to follow and which advice to ignore…or hire someone that can do this for you and defend a chosen strategy.

A better approach is to define your ideal client or visitor. Then think like them. Empathize. Leverage data you own about past customers or patients. Leverage profitability data. Target their needs that intersect with your best and most profitable service lines or products – not your whole service catalog or portfolio. 

Focus like a laser beam. Do you want to rank for procedures that sell for $1900 with a 15% margin, or procedures that sell for $15,000 with a 42% margin? After all, it’s your business and your choice. Conversions count, yes. But they aren’t equal.

Marketing for general products and services and SEO tactics that work are very different from SEO tactics for healthcare services procurement

People may search for pizza delivery near them. Will they search and decide to buy using the same terms to find a surgeon? And do people search for surgeons or specialists? Or hospitals? Hospitals being inanimate, brick and mortar edifices where surgeons and specialists work aren’t the object of American patient searches. In the USA, the building known as the hospital is “incidental to” the services of the surgeon who will cut their body or the specialist who will interpret their test results and make a diagnosis. Hospitals don’t make diagnoses. But in Dubai or Mexico, or India where doctors are employees of hospitals – people think of hospital and practitioner as a joined, welded unit. So the search will be different. A provider using this reverse logic in Mexico because it works with Mexican patients, now trying to attract US patients overlooks this cultural difference and then wonders why they can’t attract US patients with the same tactics and strategy that drives Mexicans to their doorstep. 

Likewise, searching for a specialist to cut their body is very different from searching for a product that might cost them $45 or less. There’s less risk, less consideration, and the chance for do-overs in the event of a mistake is upsetting but not critical. Trust, authority and expertise are critical in medical and dental search results. So now, Google Medic one of the most recent search engine updates to Google Algorithms really digs deep. Did you plagiarize Mayo Clinic or WebMD? Take two steps back. Did you copy Wikipedia for content? Take 



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On-page SEO  is the process of gearing content to web crawlers so that Google locates your Keywords and positions you for search engine return placement based on the 200 factors used by Google to rank order what is to be found on your site.

A few tips and pointers 

  1. Use URLS that are easy to remember, user friendly and search engine friendly. 
  2. Culture and language are a part of user friendly URLs. Webcrawlers don’t care one way or another. 
  3. Make menus easy to locate and use. Make the labels for links easy to understand. 
  4. Failure to have main navigation featured in text instead of images makes your links invisible to Google. 
  5. Decide which links are your most important for your intended targets and objectives, so that Google’s search engine spider can easily understand how your site works and which pages are the most important and worthy of placement on its search engine returns.
  6. If you are stuck in the past from 10 years ago when keyword stuffing was a “best practice” you won’t make it under today’s Google rules and algorithms.

Latent Semantic Indexing (LSI)

This is tech speak for “related phrases”. What related keywords can you use? For example, when I write about medical tourism and dental tourism, I also use LSI by referring to health tourism, health travel, medical travel, and let Google have fun with the LSI in my content.  When I write about concierge medicine, I also mention membership practice, direct primary care, and similar terms. I am very strategic about the use of LSI tactics and keywords, and I never just stuff these in indiscriminately. Google rewards good writing style to human readers with good rankings and steerage to my content as a result. 

But there are also programming techniques that couple with LSI to round out the effort. These include:

  • Meta descriptions and meta title tags
  • Navigation anchor text
  • Navigation anchor title tags
  • Use of headings
  • Content text
  • Bolded and Italicized treatments and decorations
  • Internal links in content
  • Image filenames, image alt tags and image title tags, 
  • Video filenames and video titles
Lots of times, I write the content and then go back and fill in these technical aspects or have someone who knows programming better than me do it for me. They can’t write my content because they aren’t the expert in my domain. But they can take what I wrote and finish the technical adornments for me.
If you do not specify what you want done, you’ll end up with freelancer quotes for all kinds of work that a freelance SEO technician might offer. Do you want fries with that? How about a pickle or a cookie? Ketchup? Mustard, Mayo? Oil and vinegar? You aren’t buying a sandwich! You are advertising your business and your expertise and products or services. Specify what you want them to do. Otherwise you’ll have a fully dressed sandwich that you’ll not enjoy, but you’ll still have to pay for it.


Fast Loading vs Slow Loading Sites

This is one of those things that tends to drive me nuts. I can design web content for fast speed and can be done in by hardware, technology and web host problems. If your site always loads slowly, Google will downrank you and penalize you for it.

Each second that your site drags on decreases 7% of your conversion potential. I tested a site I own on my premium webhost WPEngine, with a content delivery network (CDN) and on GoDaddy’s without a CDN, and on NameCheap. There is a difference! 

If I need additional help with loading speeds from tactics like minification, compression, and more, I rely on my technical team. That’s above my pay grade, but I know what it is. 

Site Maps

They are a basic tool, and my Content Management System (WordPress) creates them for me. I don’t pay someone to do this for me.

For most of my clients, doctors, dentists, hospital and ASC administrators, they need to know “about all the things on this page, but they don’t need to “do” these things for themselves. They need to know what to say to direct the work of those who support them. So for that reason, I am going to stop here. Going deeper into the techie stuff is a) not my wheelhouse, b) not my targeted readers’ objectives, and c) not the best use of my time. 

SEO and Social Media

The two are very closely interrelated, but beyond the scope of this article. Know that they don’t live in a vacuum. 

Google corroborates your authority by what is posted in your social profiles. So if you are not on LinkedIn and you are attempting to boost trust, authority and expertise and you aren’t present or active on the leading trust, authority and expertise social site, the crawlers wonder, the people wonder and you suffer ranking consequences as a result. 

Get listed on LinkedIn, active and post or share original content with a smattering of curated works of other like-minded experts. Don’t do like some people I know, proclaim expertise and then only post selfies of yourself speaking at events with nothing but a list of names and hashtags. Google sees through this thin strategy – and so does your audience. Learn how to use each social network to its best advantage. 

Private blog networks are a no-no

Thinking of buying several domains and building a network of sites where the only back links are to your other sites? From Google’s bird’s eye view, they see right through this using the 200+ ranking factors in their algorithm. You risk severe punishments.  If on the other hand, you create value on each site, and target segments of users with different interests, you may be fine. 

Link Exchanges

Build relationships with other experts in your industry and exchange backlinks on a collection of topics where you boost one another’s rankings, trust, authority and expertise. You may also earn some  backlinks by testimonials so think twice before you flame someone. Be nice. Be fair. Be civil. Be honest.

WEb analytics

I absolutely love, love, love analytics! I use analytics to discover information on clients’ websites, their clients’ demographics, interests, online behaviors, location and more. I can drill down to what’s working and what isn’t working. I can also locate market insufficiencies and exploit them. As a healthcare business development expert, you could say that I “weaponize” analytics to the benefit of my employer and my customers.  And they will tell you in reference checks that I often exceed their expectations with the way I utilize the data I glean from analytics while staying on budget or even conserving budget that was estimated for marketing and advertising. They’ll tell you that I can squeeze 7 cents out of a nickel.

I don’t set up Google Analytics for clients, I have experts do that and set up event tags from various touchpoints on each clients’ website. They do a better job than me and cost less than my hourly rate. That’s a primary way I conserve budget. I don’t try to do everything myself, but I do maintain oversight and directional responsibility. That’s the difference between a “consultant” and a “contractor.” Consultants apply learned expertise at the strategic and tactical level. They direct lower paid, lesser experienced contractors to get the work done.Then they check the work to make sure it was done properly and that the strategic and tactical plan is working.  The consultant works directly with the client decision maker. The contractor does not. 

The problem is, most clients don’t know the difference, call everyone “my consultant” and often make wrong decisions expecting strategy and tactics out of a lower cost “contractor” while the expectation of the contractor is that the hiring party has already laid out the strategy and tactics. So the contractor does what it does and the client sees things on invoices spin out of control and results that aren’t what they wanted. One has disappointed the other without intention. The other has unrealistic expectations about the deliverable and its effectiveness. Neither has addressed strategy or tactics.  Hire a consultant for a few hours for strategy and tactical plans and guidance. Hire the lower paid contractor for more hours of more busy work, or directly employ them part time. 

The years I’ve invested in learning how to use analytics and what to examine is beyond the scope of this article. I can’t teach anyone all the little tricks in a one or two day seminar. That’s not realistic. At a strategic level, start looking from the bird’s eye view and hire an expert with the experience and know how to go granular and gather hard-to-find data.

The Acquisition section of your analytics indicates from where your traffic arrives to your site. Channels help you dig deeper. Organic search informs you of people searching specifically for you and your site. The Segments analytics narrow down market segmentation such as paid traffic, search engine traffic, device type traffic, where people are from, how much time was spent by them on your site, and what sections of your site isn’t performing up to expected objectives and goals.

With call tracking and dynamic number insertion, you can use different phone numbers to measure different user segments, messages, and more. This tool requires appropriate set up so that you don’t damage your SEO with some mistakes and oversights. It can integrate with AdWords and Google Analytics. With the proper Plugins to your website, your expert can have this up and running in an hour, so don’t get stuck paying for hours and hours of setup. Be a prudent buyer of outside help.  These tools run under $100 a month to use. They are not free.

Heat maps are another tool I love to use, especially if I am planning a mailout and need to cut down to the bone on postage and printing. Heat maps tell me where visitors came from, how they use the site, and how far they scroll down most pages.  The tool  I use to do this currently costs $24 a month. Many consultants and contractors or agencies buy these tools on your behalf and mark them up as much as 10X. Be careful and ask for original invoices and licenses. Put all licenses used to operate your site on a spreadsheet with a renewal date, a summary of what it does, why you decided to buy it, and how much it cost you.

Google Tag Assistant is another valuable tool that helps diagnose issues for tracking analytics for event tags you set up on your site. If the event tags are not functioning, your data capture fishing net will be empty. And if you are a data junkie like me, Google Data Studio is your go-to report generator. It’s free!  It is also GDPR and CCPA compliant. 


Can’t find yourself?

One thing that can drive a business owner to the insane asylum is when they own a business and a website and they search for the official business name on their new site and nothing comes up. If you search an exact name match, Google may need a little nudge to link your business with your new site and your brand.  It isn’t difficult to do, but it can take a few weeks to smooth out the kinks. You should also get listed on at least 50 different online business directories and claim your free listings to link back to your website. The more links the better, but shoot for about 50. Setting up Facebook, Twitter and LinkedIn also counts. Do a post a day for a few weeks so that Google finds you and deems your site active, alive and real.

What if your ranking drops off?

It happens. Often. Ranking is dynamic. There’s one top listing and billions of pages being created who want to get listed first for some things. Ranking isn’t a one off event. If you aren’t ready to stay on top of this or hire someone to do it for you, then take what you get and focus on other things you can do to grow your brand and its recognition. It isn’t the end of the world to not be first. 

That being said, you could have hit a roadblock with a Google update or filter, a penalty, or for some other reason, your numbers go down. They also go back up. It’s dynamic and there are no guarantees so don’t pay people to do this for you if the promises are unrealistic. 

Local SEO

  • 97% of U.S. search engine users searched online to find a local doctor. They didn’t do that with the hospital or the ASC as they go where they are told by their doctor. 
  • 76% of consumers who conducted a local search using their phone reached out to the business, same day. 

Local search is great for pizza delivery, retail, and searching names address and phone (NAP) information. Most people in your local community know where the hospital is located, but might use local search to find an urgent care center, a physician office, or diagnostic center. But they also use local search to read REVIEWS! Local listings can lead to many more inquiries and conversions that regular SEO rankings. The thing of it is, you can’t forego one for the other. You must do a combination of both as a strategy and tactical maneuver.  To rank high with local SEO, you need to remind your customers to post reviews and feedbacks, photos, and more. But healthcare customers are often loathe to put their private matters out there. That’s the difference. If you take local SEO business case arguments from a seller of Local SEO and they tell you the same story they tell the pizza place or the local bicycle shop or custom frame shop, RUN for the nearest exit! The rep doesn’t know what they are talking about. Sellers gonna sell!  I tell them “Go sell crazy down the road! Not buying it today. Sorry. Bye.”

Get listed for local SEO using Google My Business if you have a storefront location or an office. If you work from home, rent an address with a street number, not a PMB or PO Box. That’s one of the 200 factors for Google ranking. You can do it yourself, but I find that my clients (doctors, dentists, veterinarians, hospital and clinic and ASC execs) and my readers and followers make more money doing other things. Ask your website manager to do this. It is easy, free and takes very little time to accomplish. 

Build link and review signals, on page signals, citation signals (testimonials count too), and be mindful of click through rates mobile clicks to call. Many sales people selling local SEO will also talk about check ins, but again, healthcare consumers don’t want everyone knowing they’ve gone to certain specialists or hospitals or clinics. 

Citations are created each time your name, address and phone number is mentioned on the web. The more citations you have, the higher you’ll rank over your local competitors. You can also build citations on the following sites:

You don’t need to pay for these. The free listings work just fine for citations. But do list them on a spreadsheet so if something changes or you move, you remember to update them accordingly. This is critical for doctors who may leave a practice and need to be found at their new location. You may not be able to call or email or mail to each established or former patient because of your non-compete clause terms and conditions, but you can blitz the internet with your new location so patients who so desire can contact you directly.  And don’t forget photos and videos! they can go on GMB as well. 

One critical warning or admonition. Keep the access credentials of your GMB in a safe place. Where I work as Director of Business Development, I am locked out of the GMB because nobody knows the credentials to get in and update and maintain it. It was created by a consultant or administrator years ago and since then, all the people have changed, the consultant may go out of business and you are then left with hours of effort to pass re-vetting by Google to get back in. The same goes for your YouTube and Facebook credentials.  I contacted GMB support to regain ownership (that’s what they said had to do) and for weeks I’ve been round and round providing information and still no resolution. First they needed owner info, second they want a storefront picture then they tell me to sign in to GMB to update business info but we can’t because they still haven’t sent me access.  This is a vicious cycle to recover login information. Save yourself with preventive best practices.

Summary and conclusion

I never intended to run this article this long. Oh well, there’s so much to  know about SEO. As you’ve figured out by now, it is complex and multidimensional. It requires commitment to maintain and to master. And it isn’t free. While you can do many things without additional cost on your own, you may be more effective caring for patients and running the business, and hiring someone (not me!) as a contractor to do things for you to build and maintain your SEO strategy on a routine basis. I’ll direct your contractor and build your strategy but you don’t want to pay my hourly rate to work as a contractor and do this for you. And even if you do, I don’t have the time to do this long term for you.



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