Sometimes the marketing isn't the problem. The math is.

Field notes from Mike · Published 2026-10-12 · ~6 min read

A few times a month I get on a call with a physician who wants to build a seven-figure service line, and somewhere in the first fifteen minutes it becomes clear that marketing is not the constraint.

The practice is good. The physician is credentialed and genuinely skilled at the thing they want to promote. The website needs work, sure, and the ad account has the usual problems. But none of that is what will stop them. What will stop them is that the number of people within driving distance who have the condition, know the treatment exists, believe it works, and can pay cash for it is smaller than the number of patients the goal requires.

That is an uncomfortable thing to say on a sales call. I have gotten better at saying it anyway, because the alternative is taking the engagement, running a technically excellent campaign, and watching both of us fail slowly over twelve months.

So here is the arithmetic. Run it before you hire anyone, including us.

Start at the goal and work backward

Most practices start with a budget and ask what it will produce. Start with the goal instead and ask what it requires.

Take a revenue target and divide it by your average case value. That gives you cases per year. Divide by twelve for cases per month. Then walk it backward through your own conversion rates: how many consultations does it take to produce a case, and how many inquiries does it take to produce a consultation.

Say the goal is $1 million from a procedure that bills $6,000. That is about 167 cases a year, or roughly 14 a month. If half of your consultations convert, you need 28 consultations a month. If a third of inquiries become consultations, you need somewhere north of 80 qualified inquiries every month, forever, for that one procedure.

Write that number down. It is the demand your marketing has to find.

Now size the market honestly

This is where it usually comes apart, because the instinct is to look at metro population and feel encouraged. Five hundred thousand people sounds like an enormous number next to 80 inquiries a month.

It is not the relevant number. Work through the filters:

Who is actually in range. Not the metro area. The realistic drive time for this specific procedure. People will travel four hours for a surgeon they researched for months and will not travel twenty minutes for something they consider routine.

Who has the condition. A real prevalence estimate for that population, not a hopeful one.

Who knows the treatment exists. This is the filter almost everyone skips, and for emerging treatments it is the one that decides the outcome.

Who can pay for it. If it is cash-pay, the share of that group with several thousand discretionary dollars, which is a very different number than household income suggests.

What share you can realistically win. You are not getting all of them. There are competitors, hospital systems, and patients who will simply never choose you.

Multiply it through and compare it to the number you wrote down earlier. Either the goal is reachable, or something other than the marketing has to change.

The two very different kinds of "too small"

When the numbers do not work, it is almost always for one of two reasons, and they are not equally fixable.

The first is a competition problem. Plenty of people in your area want this, they know exactly what it is, and they are choosing someone else. Rhinoplasty, knee replacement, Invisalign. The demand is established and someone is capturing it. This is genuinely a marketing problem, and it is the kind I can help with. You are fighting for share of an existing market.

The second is an awareness problem. The people in your area do not know the treatment exists, or do not believe it works, or do not think of their symptom as something a doctor can fix. A lot of regenerative medicine sits here. So do several interventional approaches to headache, certain longevity services, and most treatments that arrived faster than the public's understanding of them.

This is not a marketing problem in the usual sense. It is category education, and it behaves completely differently. It is slower, it costs more, the content has to teach before it can sell, and a meaningful share of the value you create gets captured by the competitor down the street who benefits from a market you paid to educate.

I am not saying do not do it. I am saying do not budget for it as though it were the first kind. Practices get into trouble by financing a category-education project on a share-capture timeline.

What we can and cannot do

We can find the people who already want this and get to them before your competitors do. We can make the case for you over the alternatives. We can shorten the distance between someone's first search and a booked consultation, and we can make sure you show up when someone asks an AI assistant about the problem.

What we cannot do is make someone feel like they have a problem they do not have. Nobody can. There is no campaign, no budget, and no landing page that creates a patient who does not perceive a need. Demand can be found, captured, and shaped. It cannot be manufactured.

That is not pessimism, it is just where the line is. And knowing exactly where it sits is what makes the rest of the plan realistic.

What to do when the math does not work

The good news is that a failed calculation usually points at a fix, and it is rarely "give up."

Widen the geography. Telehealth where the treatment allows it, deliberate out-of-market patient acquisition, or a second location in a market the math actually supports. We do this analysis for practices evaluating expansion and new locations, and it is the same arithmetic run in a different direction.

Lead with the demand that already exists. This is the one I recommend most. Do not advertise the emerging treatment to a market that has never heard of it. Advertise the problem people already know they have, the knee pain or the headaches, and introduce your approach once they are in the room. You are buying attention at established-demand prices and converting it at your own margin.

Widen the offer. Adjacent services with existing demand can fund the newer one while you build the category.

Lengthen the timeline and fund it properly. If you are committed to the emerging treatment, treat it as a multi-year education effort with a budget that matches.

Or move the goal. Sometimes the honest answer is that this service line supports a strong six-figure practice rather than a seven-figure one, and the seven figures has to come from somewhere else.

Why I bring this up on the first call

Because I would rather have an awkward fifteen minutes than an awkward year.

A practice that understands its own ceiling makes better decisions about everything downstream: what to spend, what to build, when to expand, and what to stop promoting. And when the math does work, which it often does, we both go into the engagement knowing what the number actually is instead of hoping.

If you want to run this for your own practice and the numbers are not obvious, send me what you have. This part is not a project. It is a conversation and a spreadsheet, and it is worth having before anyone spends money.

Mike Funkhouser is the founder of Practice Growth Co, a healthcare marketing agency focused on patient acquisition for specialty medical practices.