What to do when your Google Ads rep calls.

I've been managing Google Ads accounts for healthcare practices for years. And I'll say this plainly: 2025 and into 2026 have been the most aggressive I've ever seen Google Ads reps get with their outreach.

Clients are getting called multiple times a month. They're getting emails framed as "account alerts." They're being told their accounts are underperforming and that Google's team can help fix it — for free. Some of these calls are genuinely well-intentioned. Most of them are pushing recommendations that would increase Google's revenue at the expense of yours.

Here's what I tell every client when they ask what to do when the rep calls.

Understand what a Google Ads rep actually is

Google Ads reps are sales representatives. Their job is to increase spend on the Google Ads platform. That is not a criticism of them personally — it's just the reality of their role. They are evaluated on whether the accounts they manage increase budget and adopt Google's recommended features. They are not evaluated on your cost per lead, your show rate, or how many patients you actually book.

This creates a structural conflict of interest. The recommendations that look best from Google's perspective (more spend, more automation, broader reach) are often the ones that look worst from a healthcare practice's perspective (less control, lower lead quality, compliance exposure).

That doesn't mean every rep recommendation is wrong. But it means you need to evaluate each one independently rather than treating the call as a consultation with a neutral expert.

The recommendations they push the hardest right now

Here's what I'm seeing practices get pitched constantly:

Performance Max campaigns. This is the one I push back on most aggressively for healthcare. PMax gives Google control over where your budget goes across all of its networks: search, display, YouTube, Gmail, Discover. You cannot see the individual placements. You cannot apply negative keywords the same way you can in standard campaigns. For a healthcare account where a lead from someone searching "knee pain home remedy" is worthless and a lead from someone searching "knee surgeon near me" is worth $3,000, handing Google that control is a serious risk. PMax can work as an awareness layer with very tight asset group control. It should not be your primary lead generation campaign.

Broad match keywords. Reps love pushing broad match because it expands the search terms your ads appear for, which increases impressions and clicks — and spend. In healthcare, broad match without obsessive negative keyword management is how you end up paying $15 a click for people searching symptoms, home remedies, or information completely unrelated to booking an appointment. I run predominantly exact and phrase match in healthcare accounts for a reason.

Auto-applied recommendations. This one is the most insidious. Google will ask to enable "auto-apply," which lets their system automatically implement recommendations in your account without your approval. I have never seen auto-apply improve a healthcare account. I have seen it add irrelevant keywords, change bid strategies mid-flight, and expand targeting in ways that tank lead quality before anyone notices.

Raising budgets before fixing efficiency. Almost every rep call I've heard about includes some version of "your account is limited by budget." Sometimes that's true. Often it means Google wants you to spend more money getting the same quality (or lower quality) of leads at higher volume. Before increasing a budget, you need to know your current cost per attended appointment and cost per started treatment — not just your CPL. More spend on a broken funnel is just more waste, faster.

What's actually worth listening to

I'm not saying ignore everything. A few things reps bring up that are genuinely worth considering:

Account structure feedback. If a rep flags that your campaign structure is outdated or that you have ad groups with too many keywords sharing a budget, that's a legitimate technical observation worth investigating.

New ad formats. Sometimes reps have early access to beta features or new ad formats. Not all of them are relevant, but they're worth hearing out.

Reporting and attribution tools. Google periodically updates conversion tracking and attribution features. A rep who walks you through a new measurement capability is offering something useful.

The pattern I'd suggest: listen, ask questions, and then do nothing immediately. Take the recommendation back to whoever manages your account and evaluate it against your actual performance data before implementing anything.

How to handle the call

A few practical things:

1. Do not give a rep access to make changes in your account directly. They will ask. Decline politely. You want to review any recommendation before it's applied.
2. Ask the rep to send their recommendations in writing. This gives you time to evaluate rather than making decisions on the phone.
3. Check the Recommendations tab in your account and turn off any auto-apply settings that are currently enabled. Go to Recommendations, look for the "Auto-apply" section, and review what's checked. Most accounts I inherit have at least a few auto-apply settings turned on that the client didn't intentionally enable.
4. If a rep references your account performance, ask them to clarify what metrics they're looking at. Reps often report blended account performance that includes branded campaigns — which always look great because they're capturing people already looking for you. Ask specifically about non-branded campaign performance.

The bigger picture

Google Ads is still one of the highest-ROI patient acquisition channels available to specialty medical practices. The platform works. The reps are not the platform — they're a sales layer on top of it. Treat their advice the way you'd treat advice from anyone with a financial interest in the outcome: consider it, verify it, and make your own call.

The practices that get the most out of Google Ads are the ones running tight, well-structured accounts with clear conversion tracking and a healthy skepticism toward any recommendation that primarily benefits the platform rather than the practice.