You Rank #1 on Google. Do You Still Need to Run Ads?

Let us start with where the instinct comes from, because it is a good one. If a patient searches "dermatologist near me" and your site is the first organic result, you are already showing up for free. Running an ad on that same search means paying for clicks you might have gotten anyway. For a practice owner watching every dollar, that looks like waste, and sometimes it is. Nobody should pay for traffic twice without a reason.

But two things have changed the math. First, the Google results page itself looks nothing like it did a few years ago. Second, there is actual data on what happens when a business that ranks well turns its ads off, and the result surprises most people.

What "ranking #1" actually looks like in 2026

Here is the uncomfortable part. Ranking first organically no longer means being the first thing anyone sees. Open Google on your phone and search for almost any medical service. What loads first? Usually a couple of paid ads at the very top. Then, more and more often, an AI generated answer that tries to answer the question without sending anyone anywhere. Then a map pack of three local listings. Only after all of that does the first organic result, your hard won number one, finally appear, often a full screen or two down.

So the real estate you "own" by ranking first has been pushed down the page by everything stacked above it. Even in the old, simpler layout, the top organic result only ever captured a slice of the clicks. Long running click through studies, like the ongoing analysis from Backlinko, have pegged the first organic position at somewhere around a quarter to a third of clicks. The other two thirds go elsewhere: to ads, to the map, to the AI answer, to results two through ten. As the space above your listing fills up, that slice only gets thinner.

None of this means SEO stopped mattering. It matters more than ever, which is exactly why we treat healthcare SEO as the foundation of any practice's online presence. It just means that "I rank first" and "I am the first thing a patient sees" are now two different sentences.

The data: what happens when you turn ads off

This is the study every practice owner should know about. Google ran a long series of what it calls search ads pause studies. The setup is simple: take advertisers, switch their search ads off, and measure how many of those lost ad clicks get recovered by their own organic listings instead. If ads were just buying traffic you would get for free, the organic clicks would jump up to fill the gap.

They did not. Across the studies, Google found that on average about 89% of the clicks generated by search ads were not replaced by organic clicks when the ads were paused. You can read Google's own summary of the search ads pause studies directly. In plain terms: nearly nine out of ten ad clicks were incremental. They were visits the business would simply have lost if it had leaned on its ranking alone.

Even more telling for this exact question: the studies looked at advertisers who already ranked in the top organic spot. Among those, roughly half of the ad clicks were still incremental. So even when you are number one, running the ad was not pure duplication. A real chunk of those patients were only reachable because you occupied both the paid and the organic result at the same time.

Why does that happen? Because people do not read a results page top to bottom like a document. Some patients click the first thing that matches their intent, which is often an ad. Some skip ads on principle and scroll to organic. Some tap the map. When you show up in more than one place, you catch more of those different habits. Disappear from the paid slot and you simply miss the people who were going to click an ad, ad blindness or not.

Three reasons the top organic spot still leaks patients

The incrementality data is the headline, but there are three practical reasons a first place ranking leaves money on the table if you skip ads entirely.

Competitors can sit above you instantly. A rival practice down the street can turn on Google Ads for your best keyword this afternoon and appear above your organic listing by dinner. They can even bid on your own practice name. We wrote about that specific tactic in whether you should bid on competitor names, and the flip side is just as real: if you are not defending your own terms, someone else can plant their flag on top of them. Your ranking took months. Their ad took ten minutes.

Ads control the message, organic does not. Your organic result shows whatever title and snippet Google decides to pull. An ad lets you say exactly what you want: "Accepting new patients," "Same day appointments," "Most insurance accepted," plus a direct call button and a link straight to your booking page. For a patient who is ready to act, a tailored ad with a booking link can convert better than a plain blue organic link, even if both point to the same site.

Ads turn on and off with demand. SEO is slow and steady. Ads are a dial. If you have open chairs next Tuesday, a cancellation to fill, or a new service to launch, ads put you in front of ready patients today. Your ranking cannot be dialed up on a Tuesday afternoon. This is the real power of running both together, and it is the core idea behind the full patient acquisition system we build: SEO for durable, compounding presence, and ads for speed and control on top of it.

So when can you actually skip ads?

We are a marketing agency, so you might expect us to say "always run ads." We will not, because it is not true for every practice. There are honest cases where leaning on SEO alone is the right call, at least for now.

• Your schedule is already full. If you are booked out for weeks and turning patients away, spending to create more demand you cannot serve makes little sense. Fix capacity first, then grow.
• Your market is small and uncontested. In a rural town where you are the only practice of your kind and nobody is bidding on your terms, a strong ranking and a complete Google Business Profile may genuinely be enough.
• Your budget is truly tight. If you can only fund one thing, build the SEO and reputation foundation first. It keeps working after the spend stops, which ads do not.

But notice the pattern. Each of those is a reason to delay or limit ads, not proof that ranking first makes them pointless. And every one of them can flip overnight. A new competitor opens, a bigger group starts advertising in your city, you add a provider and suddenly need to fill a calendar. The practices that get caught flat footed are usually the ones that assumed a good ranking made them untouchable. For a deeper comparison of the two channels and when each one wins, we laid it out in Google Ads versus SEO for medical practices.

Our honest take

If your practice ranks first organically, congratulations, that is real and it took work. Protect it, keep investing in it, and do not let anyone tell you SEO is dead. But do not confuse ranking first with owning the patient. In 2026 the top organic result sits under ads, an AI answer, and a map, and Google's own data says that pausing your ads hands most of those paid clicks to whoever is still bidding. For your highest value searches, the ones that bring in the patients worth the most to your practice, running ads on top of a strong ranking is usually the smart move, not the wasteful one.

What we tell every owner is this: do not run ads everywhere out of fear, and do not skip them everywhere out of pride in your ranking. Pick the handful of searches that actually drive booked, profitable patients, own both the paid and the organic result on those, and let SEO carry the long tail. That mix is what we design, measure, and tune inside our patient acquisition system, so the dollars go where they bring patients and nowhere else.