How much should a clinic spend on ads compared to the agency fee?

So if an agency charges you $3,500 a month to run Google Ads, you should be putting at least $3,500 a month into the ads themselves: a total of about $7,000. If that number does not work for you, the answer is not a smaller ad budget under the same fee. The answer is to buy less.

The ratioWhy the ratio matters more than either number

An agency fee buys you thinking, building and management. Ad spend buys you the actual clicks. Pay for one without enough of the other and you get a predictable failure.

Too much fee, too little spend is the familiar one. Somebody pays $5,000 a month for management and puts $1,000 into the ads. The agency does good work on an account too small to produce enough data to optimise. Google's own page on Smart Bidding says some of its strategies "rely on a minimum volume of historical conversion data", and in our judgment a budget that small in a competitive medical category rarely produces it. Six months later nobody can say whether it worked, because there was never enough volume to tell.

Too much spend, no management fails more quietly. The money goes out, the clicks arrive, and nobody is checking which searches triggered the ads. Accounts burn budget on searches for a competitor's doctor by name, free alternatives, and job seekers looking for work.

Real numbersWhat this looks like at our published prices

Using our own prices, because we think an agency that will not publish a number has already told you something. The middle column is the floor, not a target; the right budget for a channel depends on what a lead costs in your category, which is what the ad spend calculator works out.

Ad spend is paid directly to Google or Meta from your own account. It never passes through us and we never mark it up. That matters for this calculation, because an agency that bills you for ad spend has a reason to want that number higher.

There is also a one-time setup: $4,500 on the tiers above $3,500 a month, $1,500 to $2,000 at Launch, and $1,500 for organic-only work, which needs far less. The full list is on the pricing page.

Buying lessWhen the honest answer is to buy less

This rule disqualifies people, and we would rather say so here than on a call after you have got your hopes up.

If your total marketing budget is $4,000 a month, you cannot buy a $3,500 paid retainer, because that leaves $500 for ads and the ads will not work. What you can buy is search and AI visibility work with no paid ads at all, which is priced from what we actually produce rather than off a tier.

If your budget is $2,000 a month, paid ads with an agency fee on top are out, because the fee alone would be the budget. What $2,000 buys is organic work sized to it, search and AI visibility priced from what we produce, or three months of running the ads yourself to learn what a lead costs before anyone else's time is worth paying for.

ExceptionsTwo exceptions worth knowing

Before a product exists, the ratio does not apply. If you are launching something and there is nothing to sell yet, ad spend stays small, about $1,500 to $2,500, and the money goes into creative and building instead. You are not buying clicks, you are buying the thing the clicks will eventually point at.

Organic-only work has no ad spend at all, so there is no ratio. Search and AI visibility work is priced from what gets produced: the articles, the pages, the fixes and the reporting.

Ask thisThe question to ask any agency

"What ad budget do you recommend alongside your fee, and what happens if I cannot afford both?"

An agency that answers the first part and goes quiet on the second is planning to take the fee anyway. The other eleven questions are in what to ask a marketing agency before you hire them, and the one that matters most on the day you leave is in who owns my website, ad account and data if I leave the agency.