A med spa in the Mountain West switched from a service-specific Google Ads structure to a Performance Max campaign at the recommendation of their previous agency. Budget: $4,200 per month. Month one PMax results: 89 leads at $47 CPL. The agency called it a win.
Practice Growth Co was brought in to review the account six months later. The practice's consultation booking rate had dropped from 58 percent to 31 percent. No-show rate had increased from 24 percent to 44 percent. The coordinator reported that a third of the leads were people who had already been patients, had been referred by existing patients, or had found the practice through other channels and searched by name.
PMax had been capturing referred and branded traffic, patients already in the pipeline, and counting them as new leads. The actual new patient acquisition cost was nearly double what the CPL suggested. And the high-intent service-specific traffic that had driven the practice's previous results was being deprioritized by Google's algorithm in favor of the easier-to-convert branded queries.
PMax can work in healthcare. But it requires understanding exactly what it is doing, and what it is not.
PMax for Healthcare: What Performance Max Actually Does
Performance Max is a Google Ads campaign type that gives Google's algorithm control over budget allocation across all of Google's advertising inventory simultaneously: Search, Display, YouTube, Gmail, Discover, and Maps. Instead of a practice managing separate campaigns for each channel, PMax runs one campaign and lets Google decide where to spend the budget in real time based on what it predicts will convert.
The appeal is obvious: less management overhead, Google's full optimization power applied across all channels. The challenge is also obvious: the practice loses the ability to control where the budget goes.
Google's algorithm optimizes toward whatever conversion action it has been given. If the conversion action is a form submission, PMax will find the cheapest path to form submissions across all available inventory. That often means:
Branded traffic. Patients who are already searching for the practice by name convert at high rates on form submissions. Google's algorithm quickly learns this and routes budget toward branded queries, traffic the practice would have captured through organic search anyway.
Display and YouTube retargeting. Website visitors and social media audiences convert on Display and YouTube retargeting at lower CPL than cold search traffic. PMax will route significant budget toward these audiences, which can be valuable as awareness but produces a different patient quality than high-intent search.
Low-competition display inventory. PMax can fill impression volume with inexpensive display placements that generate form submissions at low CPL but with low patient intent.
The result is often a lower blended CPL than intent-based campaigns, and a worse downstream conversion rate, because the patient mix includes more branded and display-driven leads alongside genuine high-intent search prospects.
“From the Field: PMax is not a bad tool. It is a misunderstood one. Google is doing exactly what it says: finding conversions at the lowest cost across all channels. The problem is that "lowest cost conversion" and "highest quality patient" are two different optimization objectives. PMax is optimizing for the first. Healthcare practices need to be optimizing for the second.”
Performance Max Healthcare: When It Adds Value
PMax can be a legitimate part of a healthcare Google Ads strategy in specific circumstances. The key is understanding what it is good at and positioning it accordingly.
PMax as an awareness layer: For practices in highly competitive markets where service-specific search CPLs are prohibitively high, PMax can add Display and YouTube awareness at a lower cost than building separate awareness campaigns manually. The qualified leads still need to come from intent-based campaigns. PMax generates awareness that may reduce the number of touches required before a patient converts on a search campaign.
PMax for high-volume general dentistry or routine care: Lower-consideration healthcare services with shorter decision cycles, general dentistry new patients, routine vision care, urgent care, have a flatter consideration curve. The intent gap between branded and non-branded traffic is smaller. PMax's tendency to optimize toward easy conversions is less problematic when the "easy" conversions are still genuinely valuable.
PMax for geographic expansion: A practice opening a new location in a new market can use PMax to discover which ad placements and query types perform in that market before committing to a fully structured intent-based campaign. Treat it as a market research tool with a fixed budget and a defined testing period, not as the primary acquisition strategy.
PMax Healthcare Advertising: The Controls You Must Have
If PMax is used in a healthcare Google Ads account, several controls are non-negotiable. Without them, the campaign will drift toward the easiest traffic rather than the most valuable.
Negative Keyword Lists
PMax respects negative keywords applied at the account level. A comprehensive negative keyword list must be built and applied before PMax is activated. This list should include:
Brand and provider name terms, to prevent PMax from capturing branded traffic that would otherwise be handled by the branded campaign (if one exists) or by organic search.
Research and information intent terms, to prevent PMax from running on informational queries that produce form submissions from patients who are not ready for consultations.
Condition and symptom terms without solution intent, "what is rhinoplasty," "how long does dental implant healing take," "does Botox hurt", informational searches that PMax will convert into form submissions from curiosity-driven visitors.
Geographic exclusions, any locations outside the practice's realistic patient draw area.
Asset Quality Control
PMax uses the creative assets provided (headlines, descriptions, images, videos) to build responsive ads across all channels. Healthcare practices must ensure that all PMax assets are compliant with HIPAA and platform advertising policies. PMax can serve creative on channels the practice may not have independently set up, YouTube, Gmail, Discover, and noncompliant creative served on those channels creates regulatory risk.
Conversion Action Specificity
Configure PMax to optimize toward the highest-value conversion action available, ideally, appointment bookings or completed consultation request forms, not page views or phone call connections that may include existing patient calls.
| PMax Setting | Recommended Configuration | Why |
|---|---|---|
| Negative keywords | Account-level list covering brand terms, information queries, research intent | Prevents budget routing to easiest-converting, lowest-value traffic |
| Conversion action | Completed consultation form or appointment booking | Optimizes toward patients, not visitors |
| Budget | 20-30% of total Google Ads budget max | Supplements intent-based campaigns, does not replace them |
| Brand exclusions | All practice names and provider names excluded | Keeps branded traffic separate from PMax reporting |
| Geographic targeting | Zip code or radius specific to realistic patient draw area | Prevents spend in areas where patients won't travel for care |
Source: Practice Growth Co PMax configuration recommendations for healthcare clients, 2025-2026.
When to Avoid PMax in Healthcare Google Ads
PMax should not be the primary campaign type, or in many cases, should not be run at all, for high-consideration healthcare procedures in most markets.
High-consideration elective procedures: Plastic surgery, dental implants, All-on-4, elective orthopedic surgery, GLP-1 enrollment. These procedures involve long consideration periods, high CPL, and patient quality that is highly sensitive to the intent level of the traffic source. PMax's tendency to optimize toward the easiest conversions is most damaging in these categories, where the gap between a genuine high-intent search lead and a display retargeting lead is enormous in terms of downstream conversion value.
Small budgets: PMax requires data volume to optimize. A practice spending $1,500 to $2,500 per month on Google Ads does not have the conversion volume for PMax to optimize meaningfully. Intent-based campaigns will produce better results at these budget levels because the practice is directing all spend toward the highest-probability conversion traffic.
New accounts: PMax needs historical conversion data to optimize. In a new account with no conversion history, PMax has nothing to learn from. Intent-based campaigns build the conversion data that could eventually support a PMax layer, but PMax should not be the starting point.
For the full campaign structure framework including when to use different campaign types and how to allocate budget across an intent-based account, the Google Ads for healthcare practices pillar covers those decisions in full.
FAQ: Performance Max Questions from Healthcare Practices
My agency is recommending PMax for my practice. Should I be concerned?
Ask the agency two questions: what conversion action is PMax being optimized toward, and what negative keyword list is applied to the PMax campaign. If the answers are "form submissions" and "we don't have a negative keyword list yet," those are significant concerns. PMax without negative keywords in healthcare will drift toward branded and low-intent traffic immediately. A thoughtful PMax recommendation should include a clear rationale for why PMax is appropriate for the specific practice, a negative keyword strategy, and a plan for monitoring lead quality, not just CPL.
How do I know if PMax is cannibalizing my branded traffic?
Run a search term report from your PMax campaign and segment by query type. Look for branded terms (practice name, provider names) appearing in the PMax search term data. If they are, PMax is capturing branded traffic and reporting it as new patient acquisition, inflating the campaign's apparent performance. Remove branded terms from PMax via brand exclusions and compare pre- and post-exclusion CPL and consultation conversion rates.
What is a reasonable budget to allocate to PMax if I decide to run it?
No more than 20 to 30 percent of total Google Ads budget for a practice that decides PMax is appropriate. PMax should supplement intent-based campaigns, not replace them. The core patient acquisition work should still happen in dedicated service-specific campaigns. If PMax is performing well in its awareness role, budget can be maintained or modestly increased. If it is draining lead quality from the account, reduce or pause it.
How long should I run PMax before evaluating its performance?
Sixty days minimum, PMax needs that time to optimize. But evaluate quality metrics (consultation attendance rate, treatment acceptance rate by lead source), not just CPL. If PMax is producing cheaper leads that attend at 20 percent rates while service-specific campaigns produce more expensive leads that attend at 60 percent rates, the PMax economics are worse despite the lower CPL.
PMax in healthcare can work, but only as an awareness supplement with strict negative keyword controls and a realistic understanding that it is not optimizing toward the same objective as a well-structured intent-based campaign. Practice Growth Co evaluates whether PMax is appropriate for each healthcare client's specific market, budget, and patient acquisition goals. Book a Strategy Call →
Mike Funkhouser is the founder of Practice Growth Co, a healthcare-focused patient acquisition agency specializing in Google Ads, Meta Ads, SEO, and AI search optimization for specialty medical practices. He has helped plastic surgery groups, orthopedic clinics, med spas, and specialty practices build scalable, measurable patient acquisition systems across the US.
Sources and Citations
- Google Ads Help — About Performance Max Campaigns — Google documentation on Performance Max campaign structure, asset requirements, and optimization behavior
- Google Ads Help — Brand Exclusions for Performance Max — Google documentation on excluding branded traffic from PMax campaigns
- Practice Growth Co — Performance Max Campaign Analysis Across Healthcare Google Ads Accounts — Proprietary Practice Growth Co campaign data, 2025-2026