Here's why Google pay-per-click is not something you can rely upon to get you profitable new cases to any great extent.

My experience is that since Google is an auction system, you are bidding against your competitors.

Terms like implants and sedation dentistry are quite expensive to buy and there are a lot of competitors. At least 20 in many markets. And so the number of people who are searching for sedation dentistry, or implants, in a given geography, is not all that large, and divided amongst all the advertisers, the volume for a given advertiser is quite low.

Google gives you two ways to geo-target. One is by keyword. Someone types in "sedation dentistry Richmond". Another is by where the searcher is…Google uses tables to determine where someone is geographically mostly by the provider of their Internet access.

So Google often thinks I'm in Atlanta, because that is where Cox Cable is. And when I'm on my Blackberry, I'm in Canada because that's where RIM, the Blackberry people, are.

That's why you should always set up two campaigns in Google. One that geo-targets using Google's geo-targeting capabilities. The other campaign is keyword geotargeted, so you always buy words like:

sedation dentistry richmond va

sedation dentist richmond

sleep dentist richmond

dental implants richmond

dental implants midlothian

And always, always include a geography term in your ad if you rely upon Google to geo-target. So often people will click on ads that should  never have been shown to them because they are nowhere near your area. Make sure you make it clear where you are in your ad! You don't want to pay for a lot of clicks from people who are in the other end of the US.

I've been struggling with this issue for years and it isn't just with Google that there is a problem. Local advertising on the Internet is still in its infancy and there are a lot of issues.

But bottom line…the major problem is one of insufficient volume. This is why Google has outrageous profits…every term gets purchased at a most efficient price, which is at a point where the acquisition of that client, patient or account is barely or not at all profitable…the profit goes to Google.

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