Google Ads management is the recurring work of keeping an account pointed at patients: reading search terms, blocking waste, pacing the budget, testing ads and staying inside healthcare policy. This guide lists that work task by task, so you can judge an agency, a freelancer or a managed tool by what it does rather than what it promises.
Demand on the buying side is fierce. "Google ads management" draws 880 US searches a month at $97.51 a click, and "google ads agency" 2,400 at $104.20 (Google Ads Keyword Planner data via DataForSEO, US, 12-month average to Sep 2026). Agencies pay that much to reach you, which tells you something about the margins in the business.
What Google Ads management involves each week
Good management is mostly routine, done consistently. Here is what a well-run practice account sees:
| Task | How often | What it prevents |
|---|---|---|
| Review the search terms report | Daily or weekly | Paying for job seekers, students and wrong-service searches |
| Add negative keywords | Same time | The same junk search returning next week |
| Check spend against the monthly ceiling | Weekly | Surprise invoices from busy days |
| Confirm calls and forms are recording | Weekly, and after any website change | Bidding blind after a tag breaks |
| Check ad and asset policy status | After every edit | Ads quietly limited or disapproved |
| Test new ad copy against the current best ad | Monthly | Stale ads and rising costs |
| Review Google's recommendations before accepting | Weekly | Broad match, new networks or bid-strategy switches nobody approved |
| Report leads by service, not clicks | Monthly | Optimizing for traffic instead of patients |
If a manager can't describe how each line happens in your account, that is your answer. For a deeper self-check, audit your Google Ads account with our 30-point checklist.
If you want an outside view before you hire anyone, get a free marketing audit. It scores your ads as one of six channels and lists the top fixes.
Agency, freelancer, in-house or managed add-on
Each option suits a different practice. Use this as an evaluation checklist rather than a ranking.
| Option | Good fit | Ask before signing |
|---|---|---|
| Healthcare marketing agency | Multiple services, larger budgets, want strategy plus execution | Who works on my account weekly? Do I own everything? |
| Freelancer | One or two campaigns, a direct relationship | What happens when they're sick or busy? |
| In-house (you or staff) | Simple account, someone with protected time | Who covers the routine in busy months? |
| Managed add-on or software | You want the daily routine done inside fixed limits | What can it change without asking me? |
Whoever you pick should be able to answer five questions in writing:
- Which tasks happen daily, weekly and monthly?
- Which changes are made without asking, and which need my approval?
- How are calls counted, and what is the minimum call length?
- How do you keep patient information out of Google?
- If we part ways, what do I keep?
How Google Ads management is priced
Management fees follow a few common models, often combined:
- Flat monthly fee. Predictable. Check what's included and whether it rises with spend.
- Percentage of ad spend. Scales with budget, which rewards the manager for raising spend. Ask who approves increases.
- Setup or onboarding fee. Covers building campaigns and tracking. Ask whether you keep that work if you leave.
- Minimum term. Three, six or twelve months. Short terms are easier to exit if the routine never happens.
The cost drivers are the number of services and campaigns, how much landing-page and tracking work is included, reporting depth, and whether creative is bundled. Compare offers by total annual cost at your planned spend, not the headline rate. We cover typical arrangements in Google Ads management pricing.
Be wary of any pitch promising a set number of new patients or leads. Nobody controls search demand, competitors' bids or how your front desk handles calls.
Account ownership and access: the non-negotiables
The account holds your keyword history, conversion data and years of learning. Losing it means starting over. Before any work begins:
- The practice is an admin on its own account. Google's admin level is the only one that can grant access, change access levels and unlink manager accounts (access levels (opens in a new tab)).
- Billing is on the practice's card or invoice, in the practice's name. Ad spend goes to Google, not through the agency.
- The agency gets standard access or a manager-account link. Standard users can edit campaigns but can't remove you.
- Conversion actions are documented: what each one counts and where the tag lives.
- No lock-in. No clause claiming the account, campaigns or data belong to the agency.
Red flags: the agency created the account under its own login, invoices you for "media" with a markup you can't see, refuses admin access, or won't show you the account at all. More on what to look for in marketing agency contract terms.
Checking the work in Google Ads change history
You don't have to take a monthly report on trust. Google's change history (opens in a new tab) lists changes to your account, campaigns and ad groups for the past two years, including who made each one. Open it from the Campaigns menu and filter by date or change type.
What to look for:
- Regular entries. Negative keywords added weekly, ads edited monthly. Long gaps mean nobody is working the account.
- Who made the change. Changes from the Google Ads interface show the editor's email. Automated changes can appear as "Google Ads system," and API tools may appear under their own names.
- Budget changes you didn't approve. These should never be a surprise.
- Auto-applied recommendations. If someone opted in, Google can add broad match keywords, expand to search partners or switch bid strategies on its own (auto-apply (opens in a new tab)).
Change history shows what changed; it doesn't itself undo anything. Ask your manager how they reverse a bad change, and how quickly. To keep spend inside a hard limit, set up budget pacing and ceilings.
Healthcare-specific management: policy, PHI and call tracking
Three things separate practice management from generic PPC.
Policy. Google's Healthcare and medicines policy (opens in a new tab) restricts prescription drug terms in ads, keywords and landing pages and requires certification for categories such as addiction services. A manager should check new ad text and landing pages before they go live, and explain any "Eligible (limited)" status.
PHI in tracking. Conversion tags should count generic events, never what a patient typed or which condition page they read. A federal court vacated part of HHS's online tracking guidance (opens in a new tab) in 2024 but left the rest standing, so "the ruling made pixels fine" is not a safe summary. Our guide to Google Ads for medical practices covers safe tracking in more detail.
Calls. Many new patients still phone. If an agency adds a call-tracking vendor that records or transcribes calls, that vendor may handle protected health information on your behalf, which can make it a business associate under 45 CFR 160.103 (opens in a new tab) that needs a BAA. This is general information, not legal advice. Confirm how it applies to your practice with a qualified advisor.
What Medfy's Google Ads add-on does, and what it doesn't
Medfy's Google Ads management is a $199/month add-on to the base plan. It does the routine from the first section of this page, inside limits you set:
- Daily search-term reviews and negative keywords, so waste is blocked as it appears.
- Budget pacing with a monthly ceiling you control.
- New ad copy suggestions, checked against healthcare policy before you see them.
- You choose the mode: suggest-only, or let it apply safe changes itself. Budget increases always wait for your approval.
- Every change is logged and reversible.
- Ad spend is paid directly to Google, never marked up.
For how it decides what to change on its own, see automation inside guardrails.
What it doesn't do: it doesn't issue tracking phone numbers or record calls (Medfy's analytics count calls, forms, bookings and directions by source), it doesn't run campaigns for multiple locations, it doesn't make promises about lead or patient numbers, and it doesn't give legal advice on your ad claims. See Medfy pricing for the base plan and other add-ons.
Frequently asked questions
How much does Google Ads management cost?
Pricing follows a few models: a flat monthly fee, a percentage of ad spend, a setup fee, or a mix, sometimes with a minimum term. Compare the total yearly cost at your planned spend rather than the headline rate. Medfy's Google Ads add-on is $199 a month on top of the base plan, and ad spend is paid directly to Google, never marked up.
Should a practice own its Google Ads account?
Yes. The practice should be an admin on its own Google Ads account, with billing on the practice's card, so it keeps the campaign history and conversion data if the manager changes. Give an agency standard access or link its manager account, both of which an admin can remove. Avoid any contract where the agency owns the account you pay for.
What should a Google Ads manager do every week?
At minimum: read the search terms report and add negative keywords, check spend against the monthly ceiling, confirm calls and forms are still recording, review policy statuses after any edit, and test ad copy. Each of those leaves a trace in the account's change history, so you can see whether the work happened without relying on a monthly report.
Can I manage Google Ads myself?
Yes, if the account is simple and someone can protect 30 minutes a week for it. One Search campaign with a few ad groups, phrase and exact match keywords, location set to presence and working conversion tracking is manageable in-house. The usual failure is the weekly routine slipping during busy months, which is exactly when wasted clicks pile up.