Ask a practice where new patients come from and you will usually hear a channel: Google, the sign, the insurance directory, a doctor down the road.
Ask the patients and you get a person. Somebody they trust told them to come.
That difference is the whole subject of this post, because the thing most practices are sold is a way to reach strangers, and the thing most practices actually run on is what happened in an exam room three months ago.
A visit makes two things
Both of them after the patient has gone home.
A recommendation. Somebody at church, at the school gate, in a group chat. Unmeasurable, unbuyable, and by a distance the most persuasive thing in this market.
A review. Public, permanent, and read by people who will never meet the patient who wrote it.
Neither is a marketing channel. Both are consequences of an appointment that already happened, which is why they are the only part of this that compounds. Ad spend stops the day you stop paying. A patient who sends you two people over a decade does not.
What patients say they actually weigh
There is less good data on this than you would hope, and a great deal of bad data. What follows is the honest version.
In a 2022 survey of 200 new patients at a single orthopaedic sports medicine clinic, published in Arthroscopy, Sports Medicine, and Rehabilitation, patients were asked what they used to choose their physician. Background education and training came first at 51.5%. Online reviews were next at 42%. A recommendation from friends or family followed at 39%. Insurance coverage was 31%, location 21%, social media 15.5%.
One clinic, one specialty, one state, two hundred people. That is a direction, not a national statistic, and anybody who quotes it to you as one is being careless.
But two things in it are worth sitting with. The first is that reviews and personal recommendation sit almost level, which means they are not competing explanations of how patients choose. They are the same behaviour with two surfaces. The second is that the single most-cited factor was the doctor's own training, and that is usually the hardest fact to find on a practice website. It tends to live on a text-only page called About, three clicks in, with nothing in the page's code telling a search engine or an AI assistant that the practice has a board-certified doctor at all.
Your reputation is perishable
This is the finding that should change something.
Researchers writing in JAMA Internal Medicine in 2022 examined 8.69 million online ratings covering 587,562 physicians. The average rating was 5.30 years old. Fewer than a quarter came from the previous three years. And among doctors with fifty or more reviews, 41.54% were being read at a rating at least half a star away from what their recent patients had actually given them. Twenty percent lower, twenty-one percent higher.
Read that last part again, because it cuts both ways and one of those ways is expensive. Roughly one in five well-reviewed doctors is being judged today on a score below what the people they treat this year would give them.
A reputation is not a trophy you win and keep on a shelf. It decays quietly while you work, and the only thing that tops it back up is asking, consistently, forever.
A practice that stopped collecting reviews three years ago is being read today on the opinions of patients it saw before that.
And then the website drops the referral
Here is the part almost nobody plans for.
A recommendation does not go to your phone. It goes to a search bar. The neighbour says the name, and then the patient looks you up, because that is what everyone does now before calling anybody. Your website is the second half of every piece of word of mouth you have ever earned.
We spent several weeks opening practice websites in one metro area, twenty-six of them, reading each one the way a patient reads it and then the way a machine reads it. Every one had something wrong with it. Some of it was ordinary. Some of it was not.
One homepage said "simply request an appointment below" with no form below. One had a Request Appointment page whose entire content was the sentence "This is just a placeholder," listed in the site's own map as a real page. On another the main homepage button, the one saying Request an Appointment, went to a page that no longer existed. One printed its phone number twice as a heading and never once made it tappable. One published no office hours anywhere at all. One published three sets of hours, two of them on the same page, disagreeing by half an hour.
Five of the fifteen sites in the most recent batch showed no patient review, quote or rating anywhere, while their public reputations ran into the hundreds of reviews. One declared a star rating and a review count in its code that had not moved since around 2021. One had a page called Testimonials that contained no testimonials, only a poster asking you to leave one.
Every one of those is a referral being dropped. Not a stranger who never heard of you. Somebody your patient personally vouched for, who arrived at your door and found it stuck.
What this actually costs
The cheapest patient you will ever get is the one another patient sent. They arrive already trusting you. No advertising reached them. No competitor can outbid you for them, because the thing that persuaded them is not for sale.
They will still look you up. And what they find is either the practice their friend described, or a page that has not been touched since a vendor built it.
Four checks, this week, without hiring anybody
None of this needs us.
- Search your own practice name on your phone and read what comes back, including the star rating. Compare it to what your patients have actually been saying lately.
- Find where your training and board certification appear on your own website. Time how long it takes. If it is on one text-only page, it is invisible to more than patients.
- Ask yourself what happens when a patient tells you they loved it. If the honest answer is nothing, that is the largest cheap opportunity in your practice.
- Open your own site on a phone and try to book an appointment at nine on a Sunday night. Every referral you earn will do exactly this, at exactly that hour.
The last one is the one that stings, and it is also the one you can fix by Friday.