Impressions Are a Surrogate Endpoint. Booked Patients Are the Outcome.
A biomarker moves in the right direction, the paper stops there, and nobody changes how they practice on the strength of it.
Surrogate endpoints are where you start looking, and you don’t stop there.
The intervention still has to reach the outcome that actually matters before you act on it, and every physician learns to read evidence that way.
Then a marketing vendor sends a monthly report and the discipline evaporates.
Impressions up 340 percent. Ranking on page one for a dozen keywords. Ten thousand website visitors. Every one of those is a surrogate endpoint, and the report doesn’t say how many patients booked.
Practices that would never accept this reporting standard in a journal accept it in an invoice, month after month, mostly because nobody ever told them they could ask.
You’re allowed to ask for the hard outcome.
The endpoint hierarchy, applied to your marketing
Ranked from most surrogate to most real:
Impressions count how many times your listing appeared on someone’s screen. A patient scrolled past you. That’s the marketing equivalent of receptor affinity in vitro.
It counts for something. It also sits a long causal chain away from anything you care about. Vendors quote it most because it’s always the largest number on the page.
Rankings measure where you appear for specific searches. Closer to useful.
But rankings for searches nobody runs are worthless, and the vendor picks which rankings you get to see.
Page one “for a dozen keywords” tells you nothing until you know whether a patient in your area would ever type those phrases.
Traffic means people actually reached your website. Now there’s a pulse.
A thousand visitors who leave in eight seconds are worth less than fifty who read your service page and tap the phone number.
Contacts are the first hard event: a call, a form submission, an online booking request.
You can count them and attribute them, and honest reporting starts here.
Booked patients are the outcome.
Everything above this line exists only to produce this line.
Each link in that chain can fail on its own, which is why the chain matters at all.
Plenty of practices rank well and convert nothing, because the website catching the click gives the visitor no reason to book and no obvious way to do it.
Watch only the surrogate and you’ll never catch it. The report looks better every month while the schedule sits exactly where it was.
The instrumentation is the unglamorous part, and it’s the whole game
Connecting the chain is plumbing work: a tracking number so calls from Google get counted, form and booking events that register when someone acts, and a front desk habit of asking new patients how they found you, which is crude and still catches what the software misses.
None of it is exotic. Many practices simply never had it installed, so their marketing decisions run on anecdote.
Things feel busier. The vendor’s chart points up. Who can say.
Once the plumbing’s in, the real questions become answerable.
What does a new patient from Google actually cost, compared to one from a directory or a referral? Which service pages produce calls, and which produce only visits? Did last quarter’s spend buy patients or impressions?
You already make clinical decisions with instrumented data, and the same thing becomes possible here the moment the instruments exist.
Find the contact count first
- Find the contact count: calls, forms, booking requests. If it isn’t in the report, that’s the first line of your reply.
- For every surrogate the report celebrates, ask what it connected to. These impressions, these rankings, this traffic, and how many contacts?
- Ask what one new patient from this channel costs. A competent vendor can answer within a session or two of setting up tracking. Notice whether yours can.
- Cross-check against your own schedule, which is the one source that never lies. New patient volume, and what people say when the front desk asks how they found you.
- If the answer to a hard-outcome question comes back as a bigger surrogate number, you’ve learned something important about the vendor, and you learned it a lot cheaper than you’d have learned it next year.
You don’t have to become a marketer. You just have to apply the standard you already hold everywhere else.
An intervention earns its place at the outcome, or it doesn’t get continued.
Questions practices ask about this
How do I know if my practice has this problem?
Pull your last marketing report and look for a count of calls, form submissions, and booking requests. If every number on the page is impressions, rankings, or visitors, the hard outcome isn't being measured. Another tell is a front desk that can't say how new patients found you. Plenty of practices run for years on charts that never connect to the schedule.
Can my office handle this in house, or does it need a specialist?
Your office can handle a good share of it. Asking every new patient how they found you, and logging that answer somewhere consistent, takes staff training and a few hours a month, no vendor required. Wiring up a tracking number and form or booking events usually needs whoever maintains the site. Ask that person to show you the events firing before you call it done.
How long after tracking goes in before the numbers mean anything?
Data starts landing within days, but give it two or three months before you judge a channel. One month in a small practice swings on a holiday week or a slow referrer, so a single soft month rarely means much. Watch contact counts month over month, then line them up against new patients on your own schedule for the same weeks. Seasonality in your specialty gets clearer after a year of data.
Is it fair to expect my marketing vendor to report booked patients?
Contacts are the fair bar for a vendor, since calls and form submissions are the last event they can see. Booked patients live in your schedule, which a vendor usually can't see and probably shouldn't. Ask for contact counts with dates and, for calls, recordings or durations so you can strip out spam and existing patients. Then reconcile those against new patients on your own schedule.
Photograph: Felicity Tai / Pexels