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Ultimate Google Possum Guide For Healthcare Practices

Medical practitioners, and practice managers, have you noticed a difference in your Google search rankings lately?

Google’s ‘Possum’ update has impacted search rankings for practitioners, medical parks, and medical practices of all sizes.
Last month Google updated its local search algorithm, referred to by digital marketers as ‘Possum’.  All categories of healthcare providers from Cardiologists to Urologists, and every practitioner in between, will likely encounter fewer listings on the first page of Google.

Read below for some of the details, rationale, and 6 actions to help patients find your practice on Google.

What would motivate Google to kill almost all but 1 of your practices search results?  

Though they are known every year for April Fools jokes. This isn’t Google playing a Halloween trick, your listings are not dead, they are just playing dead.  Unlike a possum though, this wasn’t an involuntary or instinctive response.

A Penalty or a Filter? – Here’s Google Rationale

This was a “quality” update to Google’s search algorithm. The intent of which is to provide searchers querying Google’s search engine more diverse, and less spammy search results. This is not a penalty, it’s a filter to provide increased diversity, and a reduction in search results deemed spammy. As a result, this filter produces more unique listings, giving searchers (consumers) a greater choice in which links they could click to match what they are looking for, and presumably leads to a greater chance of the searcher finding the search results relevant.


Particularly if you were using older SEO tactics or if the SEO strategy deployed was determined by Google to be intentionally misaligned with the results the search algorithm is designed to display, your practice was probably affected more severely.

Unfortunately there are many digital marketing agencies that have relied on these low quality, high output methods and although the past 2 to 3 years they have worked well quickly producing high search ranking results, Google has deemed some of these strategies as a weakness, and are not favoring them in the same way they once did (for example, it is still important to have as many complete business listings as you possibly can get, but they will no longer all display on the first page).

….Hence the quality improvement.

Google doesn’t want anyone other than themselves to influence the way their product is used. One of the ways they look to increase the chances that search results displayed and are not artificially produced, is evaluating the probable intentions the searcher, and combining that with the type, frequency, and value of activities that allow a website to appear in their search results.

‘Google favors authenticity, they favor the most local result, they favor the most bona fide provider of specific medical services produced by a high quality healthcare practice, using well structured efforts to market themselves, where there are no shortcuts.’

If your SEO strategy prior to the update was to dominate as many search results for your practice on page 1 as possible, you are in good company.

Though there are still the same number of place in the search results, you can no longer occupy more than 2 of them. Possum favors more unique results, which take precedence over well optimized results. Understanding how Google evaluates if you deserve that attention, and how they model and rank that data, will prevent you from being filtered from search results, putting your practice in position to grow and serve more patients.

Google’s new filtering property: Government and Business Status

This new ability by Possum to favor unique results wouldn’t be possible by simply relying on reported Business Name, Address, and Telephone number (NAP) entered on a website and listed on Google.  One of the primary reasons from moving away from solely relying on NAP was the ease in which this information can be listed, and artificially listing your business in a place where it is not.

In Addition to NAP, Google is now also aware and filtering search results based on your actual business license, and rumor is, even your tax filings; making it no longer possible to identify your business in a locality that you are not actually present in (example: The two city hospitals you perform surgery in, and the suburb practice where you evaluate and diagnose).

They created this restriction, in part, because it became relatively easy for businesses to completely flood the search results with their business website, regardless of where the search was coming from.

For example, if a searcher were looking for a chiropractor, prior to the update, it wouldn’t be unusual for that searcher to see Google search results that were well outside of a practical driving distance, even though that dermatologist might have been the best in the world. Google’s assumption is that their is an element of convenience that the searcher needs filtered for them, so they can easily receive that chiropractic treatment.

You couldn’t possibly be at all locations at all times, so Google wants you to pick your primary one, and be the very best provider in that spot.  If you are successful enough that you’ve dominated the market in your local area, to the point where you can still take on new patients in another area, they assume that you would want to open up an office in that local area.

In the prior example, the result that is in closest proximity to the searcher looking for you online will appear. If all three locations (your office, the two hospitals) are somehow all equidistant to that searcher, then only the most optimized location, that Google deems to be the best fit would appear. In this way, the patient will no longer see just one medical practice listed multiple times in a single search.

Google wants to make sure you are there to greet folks walking into your door. If you’re not ever physically present or rarely present, and aren’t formally registered as a separate business at that address they assume there is a better option for the patient searching for service.


This new distinction gives Google confidence that your business physically exists in that location, and that you are very likely to actually be operating and present within that building so that consumers who search for you can find your business and walk into your office to receive the service they searched for.

Google obviously deems this distinction as very important, they understand that patients (and searchers in general) not only want a high quality business or medical practice taking up one of the very limited spots on the first page of search results, but of nearly equal importance is the accessibility and proximity of the business that can provide that service.

Opossums: More Diversity, Less Spammy

These changes had an affect on Local, Organic, and Paid Advertising search listings.

Local Listings: More Diverse Results

Local Search Listings (Google Map Listings) are also known as Google’s local 3 pack.  Located after the paid search results, and under the Map, you will see three businesses listed, here I typed “Chiropractor Dallas”:


Notice that none of the listings are the same.  Prior to September 1st, it was possible to list your practice three times, in all three results, or even three different practitioners in all three results (or a combination of the two). This did not jive with Google’s notion of good performance from it’s search algorithm, and was often easily manipulated.

Google views search diversity as an advantage to consumers who, when searching for, say a Orthopedic Surgeon or Dentist (or any medical professional service, condition, or treatment), would benefit from a wide variety of options instead of seeing one option (one practice group or multiple providers at a single location) listed multiple times in local (and organic search) results.  

The advantage to Google here is two-fold: additional unique results for service presumably means searchers will continue using Google to find the widest range of options that could potentially suite their intent, and it also makes Google products more attractive to medical practices as they control the largest audience and make it easier than ever to do business with them.

Organic Listings: Less Spammy Results

Organic Search Listings are listed below after the ads, below the map, below the local 3 pack.  This is where some serious and noticeable change occurred.


Google’s interpretation of spam might be a little different than what you might be thinking here. Because we were all so used to seeing spammy results over the past several years. They are of course including flagrant misuse of any tactics that produce bad search results or results that are intended to violate terms of service  to gain and manipulate a competitive advantage, but those results were already are being filtered (…and potentially penalized, and then deindexed) by Google if the violation was deemed intentional.

In this case, Google is simply encouraging diverse search results by filtering (not removing, not deindexing) websites that are listed multiple times (both organically, and in local search). This prevents the same medical practice from being listed multiple times. This is something that was a bit of a holy grail for search engine marketers for years.  In some cases, professional services, and medical practices were listed in the top five or more organic search results, and all three of the local results!  

It produced a lot of success for medical practitioners who had the budget, practice unity, and started digitally marketing their practice earlier than others.  With this new change, this is a thing of the past. The filter, however doesn’t tell searchers what they ‘should’ click, just what they ‘could’ click…

Pay Per Click Listings: Unique Results

Pay Per Click advertising search results are the very first three listings a searcher is presented with (above organic, local, and directly above the Map results)

adWhat searchers ‘should’ click, versus what they ‘could’ click.

Of Google’s 2015 Q4 revenue: $21.3 billion USD, it is estimated that 90% comes from Google combined advertising properties, and 2016 Q4 is projected to net even larger increases. These advertising properties include a product from Google called Adwords, Google’s Pay Per Click advertising program.  



Since the update, it is no longer possible to bury other practices who simply aren’t doing any marketing or website optimization by flooding the search results with multiple website pages and business citation listings.

It is now more difficult to appear locally and organically (there are only a limited number of spots on the first page), adwords results just received a big shot in the arm, making Google Ads some of the most valuable real estate.  They are the most prominent, effective, and like monopoly hotel’s most expensive way to drive search results.

6 items to positively impact your online marketing

Below is a small unordered list, including 6 effective initiatives that will help you get started, and in light of the Possum update, things that you can do to ensure it has a positive impact. As a result of these Possum changes, and the way that Google now identifies a business, searchers will now only see one, or possibly two results on the first page of Google, regardless of the digital marketing tactics that are being used. With limited search placements available, it is now more competitive than ever to get those top few spots and to appear in the first page of the search index.

All practitioners who wish to market their practices online, need to be diligently presenting their practice, practitioner specialities, treatments provided, and conditions treated in a manner that substantiates what Google’s algorithm will provide to patients looking for medical service.

# 1 Claim all of your practice business listings on the most informative directory websites starting with the top 70 most authoritative, and working towards a goal of 350.

Websites like superpages, yellowpages, healthgrades, may no longer show up multiple times in the first page of search queries, but they are still a significant indicator to Google that your business is proactive and thoughtful about presence online. It’s also not something that can be easily shortcut, as claiming these listings often requires SMS, phone, or some other verification that requires a human to perform.

It is critical when creating your profiles on these websites that your Practice name, address, and phone number, are listed precisely. 100% consistent punctuation, formatting, and spelling are so important, that if you are unable to achieve that level of perfection, you might consider not doing it at all.

# 2 Add each practitioner’s profile across the many dozens of quality medical professional directories. Be consistent with the doctor’s profile page listed on the practice website.

Because no more than 2 listings will ever display in Google’s Local 3 Pack as a result of the ‘Possum’ update, your ideal goal should be 3 practitioner placements in the local results, and your practice’s website listed in the first placement of the organic search results. This requires practitioners to claim their profiles (and have a good organic search strategy).

If you have more than 3 medical practitioners, and they are not competing for the same services, all three spots could be available in the local listings to a single medical practice.

In the event that there are more than 3 practitioners in a practice, or if all the practitioners treat the same conditions, do not differentiate their treatments, and put an equal amount of effort into claiming all of their professional listings, Google will actually rotate the placements (sometimes by search, sometimes by time of day, sometimes by day of the week) to give all the doctor’s a fair chance of appearing in the loca 3 pack.  

This means that if a searcher types in “hip replacement surgery”, he might get the most popular orthopedic surgeon’s office on query # 1, and on query # 2 for “hip replacement surgery” the searcher gets one of the hip surgeons at that same practice, while the practice website is listed organically (or not at all).

The depth of content on your website overall, and the additional detail you can provide in practitioner biography pages, is an indicator to Google that you are taking your reputation seriously, and have the credentials to provide the highest quality care within your geography, and in your field of expertise.

# 3 Provide lots of fresh, unique content which is optimized to promote practice service and specialties.

This usually comes in the form of website pages, blog posts, use of social media.

New website content about a service you are trained in, thought leadership on patient care posted on social media, or promotion of a local event. Google’s search prefers to see new content about your practice, even if you only have time for 1 blog a week, your recap blog at the end of the month will still count as a fresh piece (as long as you’re not just simply copy and pasting everything written).

Your proactive approach to promoting your services indicate to Google that you are ready and willing to accept new business. They look for well indexed, highly viewed, and frequently published content with a long history, to validate your willingness to do business with potential searchers.

# 4 For practices or groups that include diverse specialties, be sure to emphasize each specialty.

A bariatric surgeon in the same medical park, or perhaps in the same practice as a podiatrist will not interfere with one another. Both could be displayed simultaneously in the local search results, however that would never happen as they are not targeting the same key search terms.

However, you don’t want to be inadvertently filtered out because you’re not trying to differentiate yourself. It is critical to make Google aware of these specialties; which means that you need to emphasize and use keywords within content, and within your overall optimization campaign and ongoing efforts on your website. This way Google understands when a searcher types in a specific type of medical practice or the various procedures and treatments that you offer, it will match the result to your website, giving you a chance to engage with them.

# 5 Be sure to get a link to any activity your practice is doing with an outside entity. This includes sponsorship’s, media spots (newspaper, radio, TV, online publications), health journals, case and research studies.

Even the local little league baseball teams 3 page website from 2011, will count as a ‘vote’ for your business being reputable, involved in the community, and is interested in marketing their business.

Any announcement listing your practice’s website, or the individual doctor’s profile on some other website is a very strong indicator to Google that you are a quality business that takes active measures to promote themselves. The better indexed, and better ranked, or respected (.edu .gov websites) indicates a more valuable vote to Google.

Getting your name out there and involving yourself in your locality in the eyes of Google means that you are a valued member in the community so you are likely to be present, and ready to serve.  Therefore you deserve to receive the attention of folks that search for you because if you’re concerned with your community, you’re likely to be concerned with the way you practice your medicine.

# 6 Invest in Google Pay Per Click Adwords placements.

A well constructed, optimized Ad that is thoroughly managed will get your website a top placement immediately. It takes time to implement SEO strategies that google favors in it’s local and organic search results.  

Google’s advertising program called Adwords allows you to pay for a top placement in search results. If you don’t have the time to market yourself, but you are successful in spite of that, it’s an indicator to Google that you might have budget to let them advertise for you. There is no shame in paying to play, and often times an initial 3 month Adwords campaign can teach you a lot about what your searchers are looking for, and what you might target to steadily increase your local and organic search rankings.

Investing in Adwords to promote your business is an almost sure way to attract attention to your practice, get patients to your website, and new patients in the door.  If it’s affordable, or especially if you’re in a highly competitive market, Adwords has proven to generate a return on investment, either as a stand alone advertising tool, or in complement with your other marketing efforts.

Use caution when evaluating these changes over the next 30-60 days

When Google releases an algorithm update this massive two things typically happen: as the algorithm re-combs through the data, inevitably it encounters old data which can appear to have similarities to a preferred result.  The preferred result (regardless of it’s age) then get’s re-indexed and might temporarily show up in search results.

For example, a blog, or perhaps a mention of your practice in some old article from 2012 suddenly appearing in organic search listings in the top spot for a searcher who is looking for information related to your services).

It’s a big deal! The last time Google’s search algorithm received an update this large was in 2014, the aptly named ‘Pigeon’ enabled Google’s A.I. to understand and predict the intention of what the searcher typed into the Google search engine. It also improved location based ranking parameters, and instead of relying on explicitly what was typed it also took into consideration the location of the searcher.


It’s very likely that Google will make further additions to refine and filter search results; More will be learned as time moves on from Possum, and new updates are sure to come in the future.

If you are just considering opening a new medical practice, striving to stay independent from large hospital systems, or haven’t considered marketing your practice online, now is the perfect time to start! It’s clear that Google is trying to make it more straightforward to understand how to work with them, instead of around them. With discipline, and a good strategy it’s now easier than ever to bring patients to your website.

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