The Playbook That Filled Your Schedule in 2019 Is Not Filling It Now
Think back to what was filling your elective schedule five or six years ago. For most practices the list is short and it is roughly the same list. A Google Ads budget that produced leads at a price you could live with. A Facebook page you posted to a few times a month. A website that got refreshed every couple of years. Referrals from optometry, or from primary care, or from whoever sent you patients. A seminar or an open house, if you were the kind of practice that did those.
It worked. That is the part worth sitting with, because it means nobody was doing anything wrong. The playbook was correct for the market it was built in.
What practices are running into now is not a failure of execution. It is that most of the items on that list have quietly changed underneath them, and the ones that changed did not announce it.
What a decline actually looks like from the inside
Almost none of this shows up as a crash. If your cost per lead had doubled in a week, somebody would have called a meeting. Instead it goes up eleven percent, then eight, then six, across enough quarters that every individual increase is explainable. Seasonality. A competitor bidding harder. A bad month.
Same with the referral line. Nobody stops referring. They refer slightly less, or they refer the straightforward cases and keep the interesting ones, and the change is small enough in any given month that it reads as noise.
The organic social page is the clearest version of it. The reach on a practice post is a fraction of what it was in 2019, and the posts did not get worse. The platform changed what it shows people. But because the page still exists and still gets posted to, it stays on the list of things the practice is doing, and it keeps counting as marketing.
Put those together and you get the pattern we see most often. A practice is doing more marketing than it did five years ago, spending more on it, and filling the same number of chairs or slightly fewer. Nothing broke. Several things eroded at once, at different speeds, and the erosion never crossed the threshold where anyone would have stopped to look.
The instinct is to buy more of what you already bought
When results flatten, the natural move is to increase the budget on whatever produced results last. It is the lowest risk decision in the room and it is easy to defend.
It also assumes the channel is still capable of what it used to do. Sometimes that is true and the spend was simply too low. Often it is not, and the practice spends a year of budget proving something it could have tested in a month.
The opposite instinct is not better. Abandoning a channel because it had a soft quarter throws out the one thing that was still working, and rebuilding it costs more than holding it would have.
Both mistakes come from the same place, which is that the practice does not have a reliable way to tell the difference between a channel that is underfunded and a channel that is finished.
The question almost nobody can answer
Here is a fair test, and it is worth running on your own practice before you read the next paragraph.
Take your last twenty elective patients. Not leads, not inquiries. Patients who scheduled and showed up. Can you say, for each one, what actually brought them in?
Most practices can answer it for a handful. The obvious ones. A referral from a named doctor, a patient who mentioned the ad, the one who came from a friend. For the rest, the honest answer is a shrug, or a number from a platform dashboard that is reporting on its own performance.
That gap is the real problem, and it sits underneath every budget conversation a practice has. Without it, “where should we focus next year” is a conversation about which channel people feel best about, and the channel people feel best about is usually the one with the nicest reporting interface rather than the one producing patients.
Two things that make it answerable
Neither of these is a project. Both can start this month.
Ask at the point of scheduling, not on a form. “How did you hear about us” on an intake form is answered after the decision, often by someone who does not remember, and the most common response is the least useful one. Asked out loud by whoever books the appointment, phrased as “what made you call us specifically,” it produces a sentence instead of a checkbox. Write the sentence down. Twenty of those are worth more than a year of platform attribution.
Track the handoff, not just the click. Most practices measure up to the form submission and stop. The distance between a form submission and a scheduled patient is where elective marketing is actually won or lost, and it is almost always the least instrumented part of the whole chain. If you know how many of last month’s inquiries were contacted within an hour, you are ahead of most of the market.
Where to focus next is a real question, and it has an answer
The answer is not the same for every practice, which is exactly why the generic version of this advice is useless. A cataract practice competing with two hospital systems and a refractive practice competing with a national chain are not solving the same problem, and a list of tactics that ignores the difference will be wrong for at least one of them.
What does transfer is the order of operations. Work out what is actually producing patients before you decide what to add. Then look at what has quietly stopped working, because that is usually where the budget is, and moving money out of a dead channel is cheaper than finding new money for a live one.
That is the whole subject of the course our COO, Elaine Honold, is teaching at the American Academy of Ophthalmology annual meeting this October. Course 259, Marketing Your Practice: What Works, What Doesn’t and Where to Focus Next, Saturday October 10, 3:45 to 5:00 PM, in person. It goes through what has held up, what has not, and how to decide where a practice’s next dollar should go. If you are going to be at AAO, it is worth the seventy five minutes.
One channel worth naming here, because it did not exist in the 2019 playbook at all: a meaningful share of patients now ask an AI tool about a practice before they ever reach a website. The age group doing it is not the one most practices assume, which is why it tends to get filed under “later.”
Is AI Recommending Your Practice? is live Thursday, September 24 at 12pm MT. Elaine is covering what decides whether an answer engine names your practice, how to tell whether any of it is working, and five things you can do the following Monday that cost nothing. It is free, and everyone who registers gets our AI Readiness Checklist. Save your spot here.
Or if you would rather start with where your practice stands right now beside your top three competitors across search, local, and AI tools, that is what a Digital Visibility Assessment with Jonna is for. Twenty minutes, free, and you leave with a short list in the order we would fix it.