Orthopedic and MSK marketing for multi-site groups

Orthopedic groups are usually described as referral-driven businesses, and that description is true of the operating room and false of the clinic front door. A patient with a knee that has hurt for six months, a shoulder that failed on a Saturday, or a teenager who came off a bike does not wait for a primary care appointment to be told where to go. He searches, he reads, and he books whoever can see him.

The two halves need opposite instruments. The direct half is a conventional acquisition problem with an unconventional constraint — availability — and it responds to media, to local search and to a schedule that can absorb the demand. The surgical half is won from the referring physician, and buying media into it is spending money in a room the decision is not made in.

Groups get into trouble by picking one description and running the whole business on it. We measure the two separately from the first week, because the mix between them determines almost everything about where money should go.

The complaints in this market cluster tightly. New patient volume is reported by clinic but nobody can say what share arrived direct rather than referred, so the marketing budget is defended on a number that mixes the two. The surgical conversion rate is either unknown or is a figure somebody built by hand once. Access time varies from three days at one clinic to five weeks at another inside the same group, and nobody treats that as a marketing fact. The physical therapy line, where the group owns one, is measured as a cost centre rather than as a demand channel. And the ambulatory surgery centre — which is where the economics of the group actually live — sits at the end of a pipeline nobody has drawn.

Behind all of it is one structural complaint: the group is measured on visits, and the money is made on cases.

This is where consumer demand in musculoskeletal care actually lives, and it is organised by condition rather than by specialty. Knee pain. Back pain. Rotator cuff. Sports injury. A patient searching those terms is not looking for an orthopedic group; he is looking for someone who can tell him what is wrong and when he can be seen.

That has two implications for how a group is built online. First, the useful structure is a condition line, not a physician roster — pages built around what the patient has rather than around who treats it, with demand and reporting following the same split. Second, the competitive set is wider than it looks: physical therapy, chiropractic, primary care and urgent care are all answering the same query, and several of them can offer an appointment sooner.

We size and instrument this half first because it is the half that responds to work. It is also the half that feeds the other one — a meaningful share of surgical volume in a well-run group originates as a direct clinic visit that never involved a referring physician at all.

In this market the binding constraint on conversion is almost never creative. It is the next available appointment. A patient in real pain will take the first credible provider who can see him quickly, and a group whose average time to a new patient appointment is four weeks is losing the majority of its direct demand before any of it reaches a marketing report.

The frustrating part is that access is usually variable rather than absolute. Inside the same group, one clinic can see a new patient in three days and another cannot see one for a month, and the media is being bought as if they were the same. Frequently there is same-week capacity in the group somewhere and no mechanism to route demand to it.

So access time is instrumented as a marketing input: measured per clinic and per provider, reported next to new patient volume, and used to decide where demand is directed. In several of the diagnoses we run, the finding is that the group does not need more demand — it needs the demand it already has pointed at a different building. That is what a new patient volume shortfall usually turns out to be in this category: a schedule finding wearing a marketing complaint.

Surgical volume in an orthopedic group arrives through other physicians, and we are not going to propose buying media against it. The decision happens in a primary care office or an emergency department, and no amount of consumer advertising is present in that room.

What is worth doing is measuring the referral, which almost nobody does properly. Which practices referred this quarter and which stopped. How long the consultation note took to come back. Whether the referring office could book directly into the schedule or had to leave a message. How many referred patients were contacted, scheduled and actually seen — and how many were lost in the gap between the three.

That last chain is where the loss is, and it is entirely inside systems the group already owns. A referral capture rate is a real number, it moves, and it moves for operational reasons that can be fixed without a campaign.

Saying this plainly also protects the engagement. Work aimed at the direct half should not be scored on surgical volume it was never pointed at, and stating that at the start is how that argument gets avoided.

Both belong here and neither is an audience of its own. Podiatry has genuine account density — several platforms run well over a hundred offices — but no identifiable marketing buyer at platform level and no published market data to write against. Pain management has regional platforms, no marketing executive at any platform whose leadership is public, and no operator association of any kind. Those are service lines inside a musculoskeletal group, not markets with their own page.

Inside a group they behave differently from each other and both are usually under-instrumented. Podiatry carries real direct consumer demand — heel pain, ingrown nails, diabetic foot care — and is frequently the group's cheapest new patient. Pain management sits between the conservative and surgical pathways, which makes it the line most likely to be measured on somebody else's outcome and the one most often reported as a cost centre.

We measure both as their own demand and their own conversion, inside the group's reporting, rather than dissolving them into a single new patient count.