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Look At The Past Before You Fear The New Year

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Look At The Past Before You Fear The New Year

Hello, my dear fellow search marketer, and welcome to 2023.

It’s time to make some New Year’s resolutions, or at the very least, be prepared to make some changes for the new year.

Unlike my New York Jets, there is ample opportunity to drop the crappy “guru” you’ve hired, forecast out a budget (even in a recession), play with a new bid strategy, make memes about Performance Max/GA4 and give Bing (I still refuse to call it Microsoft Advertising) the fighting chance it deserves.

Also, don’t forget to migrate your Twitter ad budget to something actually stable.

So, let’s discuss what you should be doing now, what you went through in 2022, and what you need to do in 2023.

Think of this as a really nerdy and “snarkastic” visitation of three ghosts.

What Should You Be Doing Right Now?

It’s the beginning of 2023, so you’re running a bit late – but you can still make up for lost time.

Forecasting A 2023 Budget

You’ve seen how to forecast search budgets year after year: the old “determine impression share (IS) lost due to budget and had 3%-5% increase in CPC assuming strategy stays the same” method.

Then the pandemic came along, and forecasting got a little iffier. Now, that method lacks some weight.

The reality is, if you keep with that approach, fine, not the end of the world, but understand that cost per click (CPC) growth, especially on brand terms, saw some obscene growth in 2022 (starting around April).

Why? There are a variety of theories, but for now, let’s just call it “inflation.”

If you keep the typical approach, expect to add anywhere from 10%-15% on brand CPC growth YoY in Q1 and, likely, more along the lines of 4%-7% growth on non-brand. This comes from our own in-house estimate – yours should vary.

Next, the ugly elephant in the room – Performance Max – appears. But it gets more complicated if you migrate smart shopping over to Performance Max as well.

There are two ways to forecast this, and honestly, neither will be all that accurate or insightful – I apologize in advance.

  • Look at Google’s recommendation tool, see what it says for growth on a budget (because we all know it never says less), take 15%-25% off that growth level (kill off the buffer), and try that.
  • Or, gradually scale upward of 5%-10% from your current budget, assuming you hit budget caps consistently while flexing up and down for seasonality.

As I said, neither option is great.

If you want to adjust your search strategy (not applicable for Performance Max), look at your IS lost to rank and work the fancy formula that PPC Hero posted a little ways back.

It’ll help you understand where your current strategy/bids are, causing you to miss opportunities.

This is a good time to pace out your budget (if you’re like me, you have a planned budget to spend for literally every day of the year, which will vary based on anticipated demand).

Content Calendar/Seasonal Flighting Planning

Often this is not as applicable if you’re new to a piece of business, but it should 100% be part of your plan.

If you aren’t new to the business and you haven’t done this, then you are Mr. Wilson of the Jets and deserve to be benched.

Make sure you know your deals, seasonality for peaks and lows, and everything you want to do creatively and budget-wise.

It allows you to get all of your assets built way in advance, approved, and scheduled for deployment.

Screenshot from author, December 2022

Assessing What You Didn’t Do

Life and work get busy. This happens to all of us. Odds are, you had laid out some plans for 2022 that you could not execute.

Now is the time to determine what builds, testing, flighting plans, etc., you never got around to doing last year and reprioritize them to determine if you should try them out in 2023.

I like to use this thought process when doing that evaluation:

Was this for “fun” or a necessity (i.e., Is this effort something that would’ve definitely made a business impact, or something just to try out and see if it could help or hurt)?

  • If it was a necessity, then I hope you have a good excuse for why it wasn’t done and put it on the books for 2023.
  • If it was for “fun,” file it away for a rainy day.

Was there a business implication (positive or negative) by not doing this?

  • If no, then no harm/no foul, and you can try it eventually.
  • If yes, then get it ready for 2023, and have a good explanation as to why it wasn’t done.

Consider what you’ve been through.

Much like dealing with your strange aunt/uncle who said something grossly inappropriate during the holidays, you need to sit down and process what did happen to your SEM campaigns in 2022.

This helps you decide if it was all good, all bad, or somewhere in between and what you need to consider carefully in 2023.

Look at both the big things and the small things.

Performance Max

If you migrated into Performance Max by choice or by force (anyone using Smart Shopping or local search), it likely made both a negative and a positive impact on your year.

Negative: You literally have no idea when/where your ad is showing, and all you can think (and you’re probably right) is that Google has thrown some of your direct-to-consumer (DTC) funds away on a really bad Google Display Network placement.

At the same time, you have very little information or ability to explain to your boss why Google has basically relaunched the SMB-targeted Adwords Express as a 2.0 version and just ruined your transparency.

Negative: You did the auto upgrade of a local campaign to Performance Max and discovered how many bugs there are, or you let Google create your YouTube video, and the music makes it far more cringe than you had hoped.

Positive: Especially for those running foot traffic campaigns, you’ve (hopefully) seen cost per store visits become somewhat more cost-efficient, and your ecommerce (for those running Smart Shopping) has seen an improvement in the cost per action (CPA).

Positive: Performance Max is slowly becoming more reliable, and the ability to move to other verticals that are leads driven has become an opportunity.

Google Analytics 4 (GA4)

I’ll go ahead and say what we’re all thinking (and it has been published multiple times already):

My god, this analytics platform was clearly made by someone who clearly only interacts with barnyard animals and has a vision and not by someone who did a user focus group.

If you somehow managed to survive the implementation of GA4, you’re now, more than likely, cursing it out due to lack of intuitiveness or more frustrated they rolled it out without a bounce rate or even conversion rate until months later.

All is not lost, though; I highly recommend deploying it immediately (if you haven’t already) and running it concurrently with GA UA, so you can work out the kinks and learn the platform while accruing historical data.

You may feel like Google decided to wake up and choose chaos with this platform and probably lost a few weeks of your life trying to understand it – so keep it in mind when you evaluate what you didn’t get around to doing in 2022.

Bing Multimedia Ads

You saw the hype for them in September, especially on the video side, and thought: Finally, Bing is getting into the video ad game.

But then you realized you needed a raw video file to upload it and how little it would rotate.

Big hopes, big opportunity, but just no volume.

Twitter

I know this article is SEM focused, but I would be remiss if I didn’t address this, as it is still biddable media.

Every brand has different views on brand association, but if you have even a hint of brand safety concerns on GDN, MSAN, YouTube, etc., then do not advertise on Twitter until it gets itself straightened out.

Some of these changes in 2022 impacted you in different ways, good or bad.

The question is, can you learn from them, use them, and progress in 2023, with or without them?

What You Need to Do In 2023

I’ve done several of these “What to Expect in the New Year for SEM” articles over the years, but the last two of these could never have anticipated what is going on now… again.

With that being said, I will go with what I believe is mostly going to happen, and you can take it with a grain of salt:

  • The NY Jets will not make the big game – just accept it.
  • CPCs, especially for Q1, will be higher than any other Q1 on record (especially brand terms), so be prepared to find a way to explain why and for your money make to become less cost-efficient.
  • There will not be a decline in demand/search volume until there is an increase in unemployment (ala 2007-2009 recession), so be prepared to address the uptick in volume.
  • Google will become less transparent, somehow.
  • Bing will eventually do whatever Google does.
  • If you work with healthcare brands, prepare to get rid of GA UA quickly due to HIPAA compliance.
  • Absolutely most important, use 1st party data as long as you can – but you need to get extremely good, and fast, at building in market audience segment groups and go all Criminal Minds/FBI profiling a serial killer mentality on targeting.

Have I scared you yet? Good.

2023 will be a wild year in search, and you must be prepared for it.

But you cannot move forward until you evaluate and process the past. Once that is done, you can plan out the future.

Best of luck, search marketers. We’re all going to need it.

More resources: 


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Google’s Indifference To Site Publishers Explained

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Google inadvertently reveals reasons that explain their seeming indifference to publishers hurt by algorithm updates

A publisher named Brandon Saltalamacchia interviewed Google’s SearchLiaison in which he offered hope that quality sites hit by Google’s algorithms may soon see their traffic levels bounce back. But that interview and a recent Google podcast reveal deeper issues that may explain why Google seems indifferent to publishers with every update.

Google Search Relations

Google has a team whose job is to communicate how site owners can do well on Google. So it’s not that Googlers themselves are indifferent to site publishers and creatives. Google provides a lot of feedback to publishers, especially through Google Search Console. The area in which Google is indifferent to publishers is directly in search at its most fundamental level.

Google’s algorithms are built on the premise that it has to provide a good user experience and is internally evaluated to that standard. This creates the situation where from Google’s perspective the algorithm is working the way it should. But from the perspective of website publishers Google’s ranking algorithms are failing. Putting a finger on why that’s happening is what this article is about.

Publishers Are Not Even An Afterthought To Google

The interview by Brandon Saltalamacchia comes against the background of many websites having lost traffic due to Google’s recent algorithm updates. From Google’s point of view their algorithms are working fine for users. But the steady feedback from website publishers is no, it’s not working. Google’s response for the past month is that they’re investigating how to improve.

What all of this reveals is that there is a real disconnect between how Google measures how their algorithms are working and how website publishers experience it in the real world. It may surprise most people to learn that that this disconnect begins with Google’s mission statement to make information “universally accessible and useful”  and ends with the rollout of an algorithm that is tested for metrics that take into account how users experience it but is 100% blind to how publishers experience it.

Some of the complaints about Google’s algorithms:

  • Ranking algorithms for reviews, travel and other topics are favoring big brands over smaller publishers.
  • Google’s decision to firehose traffic at Reddit contributes to the dismantling of the website publishing ecosystem.
  • AI Overviews summarizes web pages and deprives websites of search traffic.

The stated goal for Google’s algorithm decisions is to increase user satisfaction but the problem with that approach is that website publishers are left out of that equation.  Consider this: Google’s Search Quality Raters Guidelines says nothing about checking if big brands are dominating the search results. Zero.

Website publishers aren’t even an afterthought for Google. Publishers are not not considered at any stage of the creation, testing and rollout of ranking algorithms.

Google Historically Doesn’t Focus On Publishers

A remark by Gary Illyes in a recent Search Off The Record indicated that in Gary’s opinion Google is all about the user experience because if search is good for the user then that’ll trickle down to the publishers and will be good for them too.

In the context of Gary explaining whether Google will announce that something is broken in search, Gary emphasized that search relations is focused on the search users and not the publishers who may be suffering from whatever is broken.

John Mueller asked:

“So, is the focus more on what users would see or what site owners would see? Because, as a Search Relations team, we would focus more on site owners. But it sounds like you’re saying, for these issues, we would look at what users would experience.”

Gary Illyes answered:

“So it’s Search Relations, not Site Owners Relations, from Search perspective.”

Google’s Indifference To Publishers

Google’s focus on satisfying search users can in practice turn into indifference toward publishers.  If you read all the Google patents and research papers related to information retrieval (search technology) the one thing that becomes apparent is that the measure of success is always about the users. The impact to site publishers are consistently ignored. That’s why Google Search is perceived as indifferent to site publishers, because publishers have never been a part of the search satisfaction equation.

This is something that publishers and Google may not have wrapped their minds around just yet.

Later on, in the Search Off The Record  podcast, the Googlers specifically discuss how an update is deemed to be working well regardless if a (relatively) small amount of publishers are complaining that Google Search is broken, because what matters is if Google perceives that they are doing the right thing from Google’s perspective.

John said:

“…Sometimes we get feedback after big ranking updates, like core updates, where people are like, “Oh, everything is broken.”

At the 12:06 minute mark of the podcast Gary made light of that kind of feedback:

“Do we? We get feedback like that?”

Mueller responded:

“Well, yeah.”

Then Mueller completed his thought:

“I feel bad for them. I kind of understand that. I think those are the kind of situations where we would look at the examples and be like, “Oh, I see some sites are unhappy with this, but overall we’re doing the right thing from our perspective.”

And Gary responded:

“Right.”

And John asks:

“And then we wouldn’t see it as an issue, right?”

Gary affirmed that Google wouldn’t see it as an issue if a legit publisher loses traffic when overall the algorithm is working as they feel it should.

“Yeah.”

It is precisely that shrugging indifference that a website publisher, Brandon Saltalamacchia, is concerned about and discussed with SearchLiaison in a recent blog post.

Lots of Questions

SearchLiaison asked many questions about how Google could better support content creators, which is notable because Google has a long history of focusing on their user experience but seemingly not also considering what the impact on businesses with an online presence.

That’s a good sign from SearchLiaison but not entirely a surprise because unlike most Googlers, SearchLiaison (aka Danny Sullivan) has decades of experience as a publisher so he knows what it’s like on our side of the search box.

It will be interesting if SearchLiaison’s concern for publishers makes it back to Google in a more profound way so that there’s a better understanding that the Search Ecosystem is greater than Google’s users and encompasses website publishers, too. Algorithm updates should be about more than how they impact users, the updates should also be about how they impact publishers.

Hope For Sites That Lost Traffic

Perhaps the most important news from the interview is that SearchLiaison expressed that there may be changes coming over the next few months that will benefit the publishers who have lost rankings over the past few months of updates.

Brandon wrote:

“One main take away from my conversation with Danny is that he did say to hang on, to keep doing what we are doing and that he’s hopeful that those of us building great websites will see some signs of recovery over the coming months.”

Yet despite those promises from Danny, Brandon didn’t come away with hope.

Brandon wrote:

“I got the sense things won’t change fast, nor anytime soon. “

Read the entire interview:

A Brief Meeting With Google After The Apocalypse

Listen to the Search Off The Record Podcast

Featured Image by Shutterstock/Roman Samborskyi

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20 Confirmed Facts About YouTube’s Algorithm

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20 Confirmed Facts About YouTube's Algorithm

Instead of counting the number of clicks or views a video gets, YouTube’s algorithms focus on ensuring viewers are happy with what they watch.

This article examines how YouTube’s algorithms work to help users find videos they like and keep them watching for longer.

We’ll explain how YouTube selects videos for different parts of its site, such as the home page and the “up next” suggestions.

We’ll also discuss what makes some videos appear more than others and how YouTube matches videos to each person’s interests.

By breaking this down, we hope to help marketers and YouTubers understand how to work better with YouTube’s system.

A summary of all facts is listed at the end.

Prioritizing Viewer Satisfaction

Early on, YouTube ranked videos based on watch time data, assuming longer view durations correlated with audience satisfaction.

However, they realized that total watch time alone was an incomplete measure, as viewers could still be left unsatisfied.

So, beginning in the early 2010s, YouTube prioritized viewer satisfaction metrics for ranking content across the site.

The algorithms consider signals like:

  • Survey responses directly asking viewers about their satisfaction with recommended videos.
  • Clicks on the “like,” “dislike,” or “not interested” buttons which indicate satisfaction.
  • Overall audience retention metrics like the percentage of videos viewed.
  • User behavior metrics, including what users have watched before (watch history) and what they watch after a video (watch next).

The recommendation algorithms continuously learn from user behavior patterns and explicit satisfaction inputs to identify the best videos to recommend.

How Videos Rank On The Homepage

The YouTube homepage curates and ranks a selection of videos a viewer will most likely watch.

The ranking factors include:

Performance Data

This covers metrics like click-through rates from impressions and average view duration. When shown on its homepages, YouTube uses these traditional viewer behavioral signals to gauge how compelling a video is for other viewers.

Personalized Relevance

Besides performance data, YouTube relies heavily on personalized relevance to customize the homepage feed for each viewer’s unique interests. This personalization is based on insights from their viewing history, subscriptions, and engagement patterns with specific topics or creators.

How YouTube Ranks Suggested Video Recommendations

The suggested videos column is designed to keep viewers engaged by identifying other videos relevant to what they’re currently watching and aligned with their interests.

The ranking factors include:

Video Co-Viewing

YouTube analyzes viewing patterns to understand which videos are frequently watched together or sequentially by the same audience segments. This allows them to recommend related content the viewer will likely watch next.

Topic/Category Matching

The algorithm looks for videos covering topics or categories similar to the video being watched currently to provide tightly relevant suggestions.

Personal Watch History

A viewer’s viewing patterns and history are a strong signal for suggesting videos they’ll likely want to watch again.

Channel Subscriptions

Videos from channels that viewers frequently watch and engage with are prioritized as suggestions to keep them connected to favored creators.

External Ranking Variables

YouTube has acknowledged the following external variables can impact video performance:

  • The overall popularity and competition level for different topics and content categories.
  • Shifting viewer behavior patterns and interest trends in what content they consume.
  • Seasonal effects can influence what types of videos people watch during different times of the year.

Being a small or emerging creator can also be a positive factor, as YouTube tries to get them discovered through recommendations.

The company says it closely monitors success rates for new creators and is working on further advancements like:

  • Leveraging advanced AI language models to better understand content topics and viewer interests.
  • Optimizing the discovery experience with improved layouts and content pathways to reduce “choice paralysis.”

Strategies For Creators

With viewer satisfaction as the overarching goal, this is how creators can maximize the potential of having their videos recommended:

  • Focus on creating content that drives high viewer satisfaction through strong audience retention, positive survey responses, likes/engagement, and low abandon rates.
  • Develop consistent series or sequel videos to increase chances of being suggested for related/sequence views.
  • Utilize playlists, end screens, and linked video prompts to connect your content for extended viewing sessions.
  • Explore creating content in newer formats, such as Shorts, live streams, or podcasts, that may align with changing viewer interests.
  • Monitor performance overall, specifically from your existing subscriber base as a baseline.
  • Don’t get discouraged by initial metrics. YouTube allows videos to continuously find relevant audience segments over time.
  • Pay attention to seasonality trends, competition, and evolving viewer interests, which can all impact recommendations.

In Summary – 20 Key Facts About YouTube’s Algorithm

  1. YouTube has multiple algorithms for different sections (homepage, suggested videos, search, etc.).
  2. The recommendation system powers the homepage and suggested video sections.
  3. The system pulls in videos that are relevant for each viewer.
  4. Maximizing viewer satisfaction is the top priority for rankings.
  5. YouTube uses survey responses, likes, dislikes, and “not interested” clicks to measure satisfaction.
  6. High audience retention percentages signal positive satisfaction.
  7. Homepage rankings combine performance data and personalized relevance.
  8. Performance is based on click-through rates and average view duration.
  9. Personalized relevance factors include watch history, interests, and subscriptions.
  10. Suggested videos prioritize content that is co-viewed by the same audiences.
  11. Videos from subscribed channels are prioritized for suggestions.
  12. Consistent series and sequential videos increase suggestions for related viewing.
  13. Playlists, end screens, and linked videos can extend viewing sessions.
  14. Creating engaging, satisfying content is the core strategy for recommendations.
  15. External factors like competition, trends, and seasonality impact recommendations.
  16. YouTube aims to help new/smaller creators get discovered through recommendations.
  17. AI language models are improving content understanding and personalization.
  18. YouTube optimizes the discovery experience to reduce “choice paralysis.”
  19. Videos can find audiences over time, even if initial metrics are discouraging.
  20. The algorithm focuses on delivering long-term, satisfying experiences for viewer retention.

Insight From Industry Experts

While putting together this article, I reached out to industry experts to ask about their take on YouTube’s algorithms and what’s currently working for them.

Greg Jarboe, the president and co-founder of SEO-PR and author of YouTube and Video Marketing, says:

“The goals of YouTube’s search and discovery system are twofold: to help viewers find the videos they want to watch, and to maximize long-term viewer engagement and satisfaction. So, to optimize your videos for discovery, you should write optimized titles, tags, and descriptions. This has been true since July 2011, when the YouTube Creator Playbook became available to the public for the first time.

However, YouTube changed its algorithm in October 2012 – replacing ‘view count’ with ‘watch time.’ That’s why you need to go beyond optimizing your video’s metadata. You also need to keep viewers watching with a variety of techniques. For starters, you need to create a compelling opening to your videos and then use effective editing techniques to maintain and build interest through the video.

There are other ranking factors, of course, but these are the two most important ones. I’ve used these video SEO best practices to help the Travel Magazine channel increase from just 1,510 to 8.7 million views. And these video SEO techniques help the SonoSite channel grow from 99,529 views to 22.7 million views.

The biggest recent trend is the advent of YouTube Shorts, which is discoverable on the YouTube homepage (in the new Shorts shelf), as well as across other parts of the app. For more details, read “Can YouTube Shorts Be Monetized? Spoiler Alert: Some Already Are!

Brie E. Anderson, an SEO and digital marketing consultant, says:

“In my experience, there are a few things that are really critical when it comes to optimizing for YouTube, most of which won’t be much of a surprise. The first is obviously the keyword you choose to target. It’s really hard to beat out really large and high authority channels, much like it is on Google. That being said, using tools like TubeBuddy can help you get a sense of the keywords you can compete for.

Another big thing is focusing on the SERP for YouTube Search. Your thumbnail has to be attention-grabbing – this is honestly what we test the most and one of the most impactful tests we run. More times than not, you’re looking at a large face, and max four words. But the amount of contrast happening in the thumbnail and how well it explains the topic of the video is the main concern.

Also, adding the ‘chapters’ timestamps can be really helpful. YouTube actually shows these in the SERP, as mentioned in this article.

Lastly, providing your own .srt file with captions can really help YouTube understand what your video is about.

Aside from actual on-video optimizations, I usually encourage people to write blog posts and embed their videos or, at the very least, link to them. This just helps with indexing and building some authority. It also increases the chance that the video will help YOUR SITE rank (as opposed to YouTube).”

Sources: YouTube’s Creator Insider Channel (1, 2, 3, 4, 5, 6), How YouTube Works

More resources: 


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7 Strategies From Medical SEO Pros

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7 Strategies From Medical SEO Pros

Healthcare SEO is the secret to helping your organization reach more patients and clients.

SEO can help you rank for useful keywords, connect with patients in your local area, and share helpful information and advice with thousands of people.

To write this guide to medical SEO, we interviewed five experienced healthcare SEOs and content creators. We asked them to share their best advice for helping healthcare businesses grow through effective, ethical SEO:

The core principles of SEO are the same for every type of company. You need to create high-quality content, earn backlinks, and make sure your site is free of technical problems.

But healthcare SEO has some unique challenges:

  • Popular keywords are dominated by huge international brands.
  • Many healthcare companies only serve a particular local area.
  • Google expects medical content to be reviewed by healthcare experts.
  • There can be strict rules and regulations governing how medical information is shared.
  • Healthcare companies often need to market simultaneously to patients, businesses, and clinicians.

In this article, we’ll show you how to solve these problems: from building .gov backlinks to medically reviewing your content.

Content creation is a core part of healthcare marketing, but most medical topics are what Google calls YMYL topics—Your Money or Your Life.

For any topic that “could significantly impact the health, financial stability, or safety of people”, Google tries to prioritize content that demonstrates obvious expertise, experience, authority, and trust (also known as EEAT).

In practice, that means that most top-ranking medical content is reviewed by medical experts. Here are some of the top results from the SERP (search engine results page) for osteoarthritis treatments.

Healthline lists the author bios and medical reviewers for each article:

7 Strategies From Medical SEO Pros7 Strategies From Medical SEO Pros

Cleveland Clinic includes a “medically reviewed” badge, and links to a list of editorial standards:

1721037365 874 7 Strategies From Medical SEO Pros1721037365 874 7 Strategies From Medical SEO Pros

WebMD highlights each post’s medical reviewer:

1721037365 579 7 Strategies From Medical SEO Pros1721037365 579 7 Strategies From Medical SEO Pros

And The Mayo Clinic links to their huge list of medical editors:

1721037365 658 7 Strategies From Medical SEO Pros1721037365 658 7 Strategies From Medical SEO Pros

Medical review is so common across health-related SERPs that Caitlin adopted a simple rule for her content creation process: get every article medically reviewed—even a topic like drinking water to lose weight.

If creating hundreds of articles and subjecting them to rigorous medical review sounds complicated, well… it can be. Here’s how the experts handle it:

Create content with non-experts

You might think that all medical content needs to be written by medical experts, but after talking to our experts, most articles were created by writers with no medical qualifications—or even generated with AI.

For many medical topics, it’s easy to find objective, accurate information. Add in a few interviews with healthcare professionals—as Sarah asks her team of freelance writers to do—and properly cite medical references, and non-experts can write decent SEO content.

For more research-heavy or cutting-edge topics, it’s necessary to do deeper research and work with specialized medical writers. Here’s how Caitlin tackled this process, dividing her content into two “buckets”:

  • Common knowledge topics (~70% of all articles): for topics with lots of existing information, Caitlin worked with the content marketing agency Verblio. In a similar vein, Geoff uses AI to write straightforward first drafts.
  • Cutting-edge topics (~30% of all articles): for topics that required heavy research (like the impact of CBD oil on anxiety), Caitlin worked with a specialized medical writer from the agency Writing Studio. When writing about ozempic, Sarah sought feedback from four separate professionals.

Source expert medical reviewers

The SEOs I interviewed sourced their medical reviewers in two different ways:

  • In-house experts: Sarah at Hinge Health had content reviewed by “in-house, member-facing employees”, a mixture of physical therapists, medical reviewers and clinical reviewers depending on the topic.
  • Freelancers: Without the luxury of in-house experts, Caitlin built a network of freelance doctors on Upwork. These were generally fully licensed doctors and medical professionals, half from within the United States and half from other countries.

In all cases, Caitlin notes, it’s important to ask your medical reviewers to check their indemnity insurance. In most countries, clinicians are accountable to medical regulators. Once they put their byline on an article, they are responsible for the advice it offers.

Review for medical accuracy

Medical reviewers should vet your content for accuracy and suggest edits where needed. That often means:

  • Flagging errors and misinformation (like incorrect medical terminology).
  • Adding extra context and information (like extra details about symptoms or treatments).
  • Softening language (avoiding phrases like “best treatment” or “guaranteed to work”).

Caitlin’s workflow looks like this:

1721037365 0 7 Strategies From Medical SEO Pros1721037365 0 7 Strategies From Medical SEO Pros

Learn more about Caitlin’s process in our article, 7 Content Automations used by Real Content Pros.

Publish with clear author and reviewer attribution

It’s crucial to make the medical review as obvious to readers and search engines as possible. Here’s a great example from Caitlin’s previous company, HealthMatch:

1721037365 921 7 Strategies From Medical SEO Pros1721037365 921 7 Strategies From Medical SEO Pros

And another from Sarah’s company, Hinge Health:

1721037366 532 7 Strategies From Medical SEO Pros1721037366 532 7 Strategies From Medical SEO Pros

These examples highlight three best practices:

  • Include a clear, obvious reviewer bio on every article, including their photograph, name, qualifications, and even their area of medical speciality.
  • Link to a dedicated reviewer page, showing the author’s credentials and past experience, and linking to other relevant bylines on the web.
  • Use relevant schema data for the authors and reviewers (but more on that later).

Everyone I interviewed shared the same core challenge: medical SEO is dominated by a handful of internationally recognized brands, like Cleveland Clinic, Healthline, WebMD, NHS, and Mayo Clinic.

With strong link profiles and brand recognition, these companies generally dominate most healthcare SERPs.

1721037366 268 7 Strategies From Medical SEO Pros1721037366 268 7 Strategies From Medical SEO Pros
A 92 DR score means these companies can be very difficult to compete against in the search results.

To work around this constraint, everyone I interviewed chose to focus on low-competition long-tail keywords, before gradually targeting more competitive terms as they started to see results.

You can find these terms easily with Ahrefs. To start, here’s a short-tail keyword, headache, with 121,000 monthly searches and a “Super hard” keyword difficulty:

1721037366 755 7 Strategies From Medical SEO Pros1721037366 755 7 Strategies From Medical SEO Pros

A top-three ranking would be out of reach for most companies, but we can use the Related terms report in Keywords Explorer to find less competitive variations that might be worth targeting.

Here, we’ve set the keyword difficulty to a maximum of 40, and surfaced 976 keywords:

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To stand an even better chance of ranking, we can also filter our results with the Lowest DR filter. In the screenshot below, we’ve limited our search solely to keywords that already have low DR websites (in this case,

In other words, these are all keywords a fledgling website would have an excellent chance of ranking for:

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The topic cluster framework is a way to organize and link between related articles on a website. It makes it easy for both visitors and search engines to easily navigate between related content—other relevant articles are only a single click away.

Caitlin explained that healthcare is “natively suited” to the topic clustering technique. Every medical condition generally has a similar set of patient questions associated with it, making it easy to use similar content templates for many different medical conditions.

Geoff shared a framework he commonly uses with his healthcare clients. For most medical conditions, you can usually group your content into three topic clusters: pre-intervention, intra-intervention, and post-intervention:

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Pre-intervention

These are questions people ask before treatment or surgery:

  • Diagnosis: do I need a hip replacement
  • Treatment options: which method of hip replacement is the best?
  • Cost: how much does a hip replacement cost
  • Images: hip replacement surgery pictures
  • Outcomes: how long does a hip replacement last

Intra-intervention

These are questions people ask about the treatment or surgery itself:

  • Anesthesia: are you awake during hip replacement surgery
  • Duration: how long does hip replacement surgery take

Post-intervention

These are questions people ask after having treatment:

  • Recovery period: how long to recover from hip replacement
  • Anxieties: what are the symptoms of nerve damage after hip replacement
  • “Can I do X”: how long after hip replacement can you drive

You can use Ahrefs to research these topic clusters.

Start by entering a medical condition or topic into Keywords Explorer. Click the Matching terms report to see similar keywords, and then Questions to find related keywords in the form of, you guessed it, questions:

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Here, we’re looking at hip replacement.

With this process, we’ve already found 5,163 keywords relating to hip replacements, like how long does a hip replacement last and how long after hip replacement can i tie my shoes:

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You can click Clusters by Parent Topic to group these keywords together into clusters, groups of keywords that can likely be targeted by the same article. Now we’ve refined our list of potential articles from 5,000 down to 270:

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Backlinks are a core component of effective SEO—and that remains true in healthcare SEO.

If the idea of doing “shady” outreach for a healthcare company gives you shivers, don’t worry: healthcare companies have unique strengths that make it relatively easy to build great backlinks.

Many healthcare companies have strong relationships with government bodies, charitable organizations, and educational institutions, making it possible to earn links from high-DR .gov and .edu domains.

Despina shared the example of HammondCare, an Australian aged care provider. A quick look at their backlink profile reveals 33 referring .gov domains:

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They’ve also snagged 24 referring .edu domains:

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Looking at their backlink profile as a whole, we can identify several easy-to-replicate strategies suitable for all types of healthcare companies:

As Despina pointed out, most healthcare providers are already sitting on a small goldmine of interesting research and accomplishments. Link building can be as simple as asking: what have we already done that we can use to get links?

Many healthcare organizations are local businesses with bricks-and-mortar premises. The process of attracting interest in a specific area is known as local SEO (and we have a full guide here: Local SEO: The Complete Guide).

There are three local SEO strategies that are particularly crucial for healthcare companies: optimizing your Google My Business profile, building NAP citations in healthcare directories, and building local landing pages.

Optimize your Google My Business profile

Most local searches include a “map pack”, a collection of top local business listings in your area. To stand a chance of appearing in these results, you’ll need to claim and optimize your Google My Business (GMB) profile.

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Once you’ve claimed your profile (head to https://www.google.com/business/ and click “Manage now”), you’ll need to fill out as much relevant information as possible:

  • Business or practice name
  • Address
  • Phone number
  • Website
  • Business type (the more specific, the better: orthopedic surgeon is better than surgeon or doctor)
  • Hours of operation
  • Medical services offered
  • Photos of your practice and team

Depending on the nature of your healthcare organization, there may be other types of information you can share. Here’s the GMB profile for The Royal London Hospital, complete with hospital-specific profile information, like number of beds and parent organization:

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For a detailed walkthrough of setting up your GMB profile, read our guide: How to Optimize Your Google My Business Listing in 30 Minutes.

Be careful when asking for reviews

Earning and responding to reviews is a key part of managing your Google My Business Profile… but there’s a catch for healthcare companies.

In many countries, there are strict rules and regulations dictating how healthcare providers can (or cannot) solicit reviews from patients.

So before you hand out a hundred feedback leaflets to your patients, read up on laws and regulations (like HIPPA) in your location.

Build NAP citations and submit your company to healthcare directories

NAP citations refer to mentions of your organization on relevant third-party websites (including your organization’s name, address, and phone number—hence NAP).

These citations create more ways for potential customers to find you, and they can help improve your site’s overall search performance.

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As a starting point, get your healthcare company listed with the main data aggregators (sites that provide business listings to popular directories), like Data Axle, Localeze, and Foursquare.

It’s also worth getting listed on other popular websites like Apple Maps, Yelp, Yellow Pages, Bing Places, and Facebook.

Geoff shared some of the UK-specific medical directories he sees most often in local healthcare search results (in many cases, these directories have international versions too):

You can learn more about building NAP citations in our guide: How to Build Local Citations (Complete Guide).

Tip

You can use the Link Intersect report in Ahrefs to quickly find relevant medical directories. Enter the homepages for similar healthcare organizations and hit “Show link opportunities.” You’ll see a list of websites that link to some—or all—of these competitors.

Here I’ve run the report using three private hospitals from my local area:

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Based on this result, I’d immediately try to secure a link from the CQC (the UK’s independent healthcare regulator) and Doctify (a review and feedback platform specifically for the healthcare industry).

Create locations and services pages

Despina recommends that most healthcare organizations create location landing pages: web pages that tell visitors (and Google) where your business operates.

Here’s an example from my local sports physiotherapy clinic. For each of the major locations they serve, they’ve created a dedicated website page.

Here’s one focused on the town of Aylesbury, helping them to rank for keywords like “physiotherapy aylesbury”:

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To create great location pages, Despina shares her advice:

  • Use a localized URL structure, like website.com/service/location.
  • Localize your page’s title tags and page header, like Aylesbury Sport Physiotherapy | Elite Sports Expertise.
  • Include sign-up buttons and contact forms near the start of the page (“above the fold”).
  • Showcase social proof, reviews and images.
  • Link between your location pages to help visitors find the best location for their needs (and improve your chances of ranking for location-specific keywords).
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Read Despina’s deep-dive into location landing pages: Location Landing Pages: 6 Crucial Elements Of Local Visibility.

Schema markup is a type of code that allows search engines to better understand the contents of your page. Schema markup can sometimes make your page eligible for rich results, which can help you earn more clicks from search.

Schema markup is particularly important for local businesses. After searching for family practice physician near me, the top spot in the search results is taken up by a local pack SERP feature:

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One of the top results is using Physician schema markup—a specific schema type designed to tell Google that the author is a doctor:

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Here’s the top result for private hospital near me using another type of medical schema markup, Hospital:

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Schema.org also lists a few other medical-specific schema types, like MedicalCondition (for information about specific medical conditions), Drug (for information about a medical drug), and MedicalWebPage (for webpages about specific medical topics).

Here’s the NHS using the MedicalWebPage schema on their #2 ranking article about hip replacement:

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(Although the #1 ranking article from Johns Hopkins doesn’t use any schema—so although it’s useful, using relevant medical schema is obviously not essential for good search performance.)

The healthcare industry has largely relied on self-regulation to prevent the spread of inaccurate content and misinformation, but this is changing.

We’ve already covered Google’s increasing emphasis on EEAT in search content. In a similar vein, Virginia shared that YouTube (also owned by Google) has started to verify content from medical professionals:

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Medical video content with a “From a licensed doctor in the UK” banner.

They promote this content more heavily through their “Health shelf” feature. Here’s the YouTube results page for asthma, prominently highlighting videos “From health sources”:

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As YouTube explains, to be eligible for these enriched search features (and likely earn more clicks and views), content needs to be from “credible health sources”. These sources are vetted in different ways:

“Vetting mechanisms include accreditation, academic journal indexing and government accountability rules.”

Virginia recommends healthcare companies apply for PIF TICK certification. Created by the Patient Information Forum, the PIF TICK is the only independently assessed standard for both print and digital healthcare content creators.

While it won’t guarantee improved rankings through either Google Search or YouTube search, it seems like a smart proactive move given Google’s increased emphasis on EEAT content in healthcare.

Final thoughts

Healthcare SEO is competitive and involves solving unique challenges, like medical review of content, competing with industry giants, and staying compliant with tons of regulations.

This guide should arm you with everything you need to connect with patients and clients and grow your healthcare business—while making the world a little smarter (and healthier) in the process.

Want to ask a question? Connect with me on LinkedIn or X.



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