• August 01, 2019
  • Advice
  • Matt Marquart

Starting out on a long journey

Businesses need customers. New businesses, just starting out on the journey, need customers quickly.

Getting a new business, with no online presence, to start ranking in local search and getting customers through the door is simultaneously exciting and challenging. I’m going to detail the steps and tactics we used to set up and optimize a regenerative medicine practice in a large metropolitan area of the US.


The Client

The doctor has been successfully practicing in neurology and pain management for years. But he’s also taken a keen interest in the exciting field of regenerative medicine, in particular stem cell therapy and platelet-rich plasma (PRP). Stem cell therapy is often equated with controversy, but this type of stem cell therapy – using adult stem cells that are extracted from and used by the same patient in a simple outpatient procedure – has been used in treatments for orthopedic conditions for decades and raises no ethical questions. 

After honing his skills with one of the world’s leading stem cell doctors, the client was ready to open his new practice.


The Competition

By nature of being in a metropolitan area of over 5 million people, the competition is quite hot. On the one hand, there are large medical institutions to battle against. On the other hand, approximately a third of the competition are not primarily focused on regenerative medicine. They provide it, but their categorization (in Google My Business and other directories), reviews, and website content aren’t optimized around it.

As always with Google My Business (GMB), there is also a smattering of spam listings to contend with.


The Starting Point

Nothing. Zilch. Nada. No GMB page, no reviews, no citations, no unstructured citations, not even a website. This was a journey from the very beginning.


Building a Beautiful Website

Since the website was going to be the most time consuming aspect, this was where we began. The web, search, and content teams put their heads together to draw up a content plan and arrange the site architecture. 

The search and content teams were dreaming up the content, how it all connected together and what widgets and features would be needed to embellish the content and make it come alive. On occasion, the web team would bluntly dash our hopes, but most of the time they managed to serve up exactly what we asked for.

These sort of content plans never pass through without some hiccups along the way. There will always be something we left out, something unexpected or some new information. 

In the end, we were left with a shiny, new, and beautifully-themed responsive website where would could just drop the content in. 


Creating High-Quality Content

The content team had a lot of work to do. 36 pages in total and 26 that fell into the long-form content category. We brought in a professional medical editor with expertise in regenerative medicine to oversee the work and go through everything with a fine-tooth comb. We did this for two reasons.

Firstly, this project was happening in the backdrop of E-A-T and frequent Google algorithm updates on quality, especially related to medical sites. Secondly, it’s pretty irresponsible to publish health and medical content without medical expertise. Medical content should always have been produced or edited by those with the required knowledge. It’s nice of Google to catch up.

Our editor answered everything we asked with kindness and patience, even though, at times, it must have felt like dealing with students failing to get into Biology 101. We learned a huge amount on the topic without even scraping the surface. For the record, an adult stem cell looks something like this:

Stem cell close-up


Each piece of content went through two quality checks with a third check made once the page was ready on the development site to catch any errors that might have come up with moving the content around.


Structuring Content with Schema

Personally, I love the structured orderliness of schema and I’m always looking to see what markup we can add. I’ll admit I spend too long digging into all the possibilities. 

For this client, we, of course, added local business schema under the MedicalClinic type. We also added some medical-specific stuff like memberOf and MedicalProcedure. 

As with all our clients, the schema was in the easily manageable JSON-LD format which can be added anywhere on the page.


Citations – Checking for Duplicates

Soon after the client was signed up we delved into GMB for existing listings of the doctor and his current practice.

His new practice is across the hall from his current practice, but it’s a completely separate entity with different services and different patients. 

Although the address was the same other than suite number, everything else was different – a different phone number, different website, a different name, and different signage.

Its proximity to his current practice meant we had to be diligent with existing listings, although it helps that the new practice won’t have the practice: practitioner format (as a single-practitioner, that option would be available).

The doctor had multiple listings at previous locations he’d been practicing at, there was a listing for his current practice, and a practice: practitioner formatted listing for his current practice. But with different names, categories, and phone numbers, we were confident they wouldn’t interfere with the new regenerative medicine business.

The client was moving into a large office block but, as we were getting closer to launching the site, he was still in discussions with the property manager over his suite number. He had been assigned a temporary suite number but it wasn’t finalized.


Building Citations – Quality Over Quantity

We decided to move ahead and build citations without a suite number. It’s been known for some time that Google doesn’t even take into account suite numbers. It’s not the written address that confirms the location, it’s the physical latitudinal and longitudinal coordinates that an address gets translated to. A suite number doesn’t affect the coordinates. 

Suite numbers are, of course, helpful for customers. But we had to strike the right balance between getting things done quickly and getting them done right. We made the assumption that a fraction of traffic would come from directory sites so a missing suite number there wasn’t going to be critical. 

As soon as the suite number became official, the plan was to drop it immediately into the GMB address but leave other citations as they are.

After running the address through the UPS address validator, we focused on building citations only on the top 50 citation sites, and even some of them are now falling into disrepair. 

The health-specific directories are more complex. We built practice citations where possible and handed over the necessary information for listings that required phone verification.


Completing the Google My Business Profile

Google’s verification process is becoming more stringent, and it’s about time. Although it causes more headaches for us and the client, ultimately it benefits everyone (except the spammers) if only real businesses appear in Google’s local and map results.

After a post card got lost, Google asked for video verification. However, while we waited on the client to make the video, we checked back in the dashboard daily knowing that, sometimes, phone verification appears as an option even when Google have asked for video evidence. We used this loophole to get the listing verified although it’s also a bit of a worry that illegitimate businesses can also slip through the net like this. 

There’s something appealing about a pristine and unsullied GMB listing. It didn’t stay that way for long.

We filled out the profile as completely as possible, other than the relatively new short name field that is. With reported bugs and a supposed link between adding a short name and having the listing suspended, we thought it would be wise to hold off until the issue was fully resolved.

Google My Business short name field

The new short name field has been linked to suspended GMB accounts in an apparent bug.


GMB Categories

At the same time as content was just getting underway, we also spent some time doing category research. Analyzing competitors wasn’t straightforward because of the aforementioned large medical establishments for whom regenerative medicine is often an auxiliary service. There was a huge amount of category variation in listings ranking for key terms.

Stem cell category diversity - 5 listings, 5 different GMB categories

For an important keyword, 5 listings displayed 5 different GMB primary categories.


We effectively filtered the large medical establishments from our research because their ranking power was likely being pulled from its organic strength, rather than anything they were doing in local, and even less likely related to what they were doing with regenerative medicine.

In the absence of any category explicitly related to regenerative medicine, we concluded that “Medical Clinic” was to be our primary category.

We also took the time to fill out the “Services” tab because…why not provide Google with more information on the practice’s services?  


Measuring Success

Prior to the the site going live, we set up keyword tracking in Bright Local so we could get an immediate baseline against which to gauge progress.

We mostly use keyword tracking as just one of many measuring sticks. As rankings are so fluid and hyper-localized, we use them to spot trends rather than fretting about specific rankings. 

As the client’s location is on the outskirts of town and fairly isolated from its competitors, we decided to track rankings from several random points throughout the city as it’s likely the client would dominate in its own zip code. Unless a business has an intense hyper-local focus, it’s usually a good strategy to track from different points around the city from where you can realistically draw customers.

We also set up a new Google Analytics property with three separate Views – a completely unfiltered view, a view for testing, and a clean view to use for reporting. In the latter, we added known spam filters, created goals, and set up traffic alerts to catch unusual activity. 

Our entire team browses with the Google Analytics Opt-out Add-on browser extension to filter out internal traffic. It’s not perfect but we decided it was the most effective solution for us to avoid distorting Google Analytics data.


Pushing the Website Live

After we placed content into the dev site, we worked with the design and video teams to create some pretty stunning graphics and videos to complement the written content. 

When we had everything we wanted on the pages, the web team made a final check that everything looked and worked as it should. This was also the time of the final QA content check.

As pages were ready, they passed on to the client for feedback. When all content had received the green light, the switch was flipped and suddenly two months of work was out in the open.

We set up Google Search Console and submitted a polished XML sitemap for crawling and indexing. The majority of pages were indexed within a couple of days. Those that Google reported as crawled but not indexed were, upon manual inspection, actually indexed. A new Search Console, same outdated data…


Earning Reviews

Reviews are an area where a new business are almost certainly lagging in relation to the competition, so it’s important to address it quickly and get a review process in place to get a steady stream of reviews flowing.

With it being a new practice and staff having enough on their hands with new systems and software behind the scenes, we figured it wasn’t the best time to integrate review requests into their workflow. Instead, we stressed the importance of simply reminding customers about reviews and provided a link to directly leave a Google review that they can use in email and other communications.


Next Steps

Local SEO isn’t just a on-time gig. We’ll continue to build out expert and appropriately edited content, work on earning more reviews, and keep adding to and updating GMB as changes happen, which, at the current rate, is about twice a month.

Stay tuned for a later follow up post where we’ll report on the search presence progress we’ve made for this client.