What building authority actually costs, and what drives the number
Updated 2026-08-23 · Atiba de Souza
Why nobody will give you a straight number, what actually moves the price, the three ways practices overpay, and how to work out what your own situation should cost before anyone quotes you.
Every physician asking this has been given the same non-answer: *it depends*. It does depend — but on a small number of things you can identify yourself, which means you can work out roughly where you sit before anyone quotes you.
What follows is the structure of the pricing rather than a price list, because a price list that ignored your situation would be the same non-answer in a more confident font.
What actually drives the number?
Four things, in rough order of how much they move it.
- Whether you are building or maintaining. Building the substrate — deciding the audience, producing the material, fixing the places you appear — is front-loaded and finite. Maintaining it afterwards is a fraction of that. Most quotes blur the two into one monthly figure, which is where practices end up paying build prices forever.
- How much already exists. A practice with a real site, accurate listings and some outside coverage is filling gaps. A practice with one page and a directory entry is starting the substrate. These are genuinely different amounts of work and should not cost the same.
- How competitive the description is. Being findable for a common, heavily-marketed description costs meaningfully more than being findable for a specific one. This is why narrowing who you are for lowers your costs as well as raising your conversion.
- Whether you are also buying attention. Advertising is a separate budget with a separate logic. It buys visits now and stops when you stop. Blending it into the same line item is how practices lose track of which part is working.
Why will nobody give you a straight number?
Partly because it genuinely varies, and partly because a lot of pricing in this field is set by what a physician will pay rather than by what the work costs.
Both are true and the second one is rarely said out loud. Medical practices are known to be well-capitalised and busy, which reliably produces pricing anchored to perceived affordability. That is not fraud — it is ordinary market behaviour — but it means a quote is not evidence of what something is worth, and you should not treat it as one.
The practical defence is to ask what changes if you spend more, and what specifically you would get less of if you spent less. A partner who can answer that precisely is pricing the work. One who cannot is pricing you.
What are the three ways practices overpay?
Paying build prices forever, paying for activity that has no outcome attached, and paying for reach they cannot use.
- Build prices forever. The heavy work of establishing the substrate is finite. If your monthly fee has not changed in two years and the deliverables have not changed either, you are funding maintenance at construction rates.
- Activity with no outcome attached. A retainer that guarantees posts, reports and meetings has guaranteed you inputs. None of those are the thing you are buying, and a practice can purchase them indefinitely without anything changing.
- Reach you cannot use. Being found by people outside your area, outside your service, or outside what they can pay costs the same as being found by the right people and is worth nothing. This is the most common and least visible form of waste, because the numbers all go up.
How should you work out what your own situation should cost?
Start from what a new patient is worth to you, then work backwards — because that number governs everything and most practices have never calculated it.
Two figures make the rest tractable:
- What one new patient is worth over the relationship, not on the first visit. For most cash-pay practices this is several multiples of the first transaction, and using the first transaction alone makes everything look unaffordable.
- How many additional patients per month would change your situation. Usually far fewer than people assume. The answer is often single digits, which reframes the whole budget conversation.
Multiply those and you have the annual value of solving the problem. Any spend should be evaluated against that, not against what feels like a lot of money in the abstract. A practice where eight additional patients a year would be transformative is in a very different position from one that needs eighty, and they should not be shopping for the same thing.
What should you expect to pay for, separately from anyone's fee?
A small number of real costs that exist regardless of who does the work.
- Your own domain and site hosting. Modest, and it must be genuinely yours — see the ownership point in the questions to ask a partner.
- Any advertising budget, which goes to the platform, not the agency, and should always be visible to you separately.
- Your own time. This is the cost people forget and it is the largest one for physicians. The material has to come out of your head, whoever writes it down. Budget the hours honestly — doing it yourself versus having it done is mostly a conversation about this.
Is cheaper ever the right answer?
Yes — when the constraint is not what the cheap option would fix.
If nobody can find you at all, an inexpensive fix to the substrate may unblock everything. If people find you and do not book, no amount of additional visibility helps, and buying more of it is the expensive mistake dressed up as prudence. The right spend is the one aimed at whatever is actually binding, and that is knowable before you spend anything.
Which is the honest reason we publish the diagnostic questions rather than a price. Start with how a physician builds authority outside the exam room if you have not worked out which part is broken yet.