Hire Someone, Hire An Agency, Or Leave It Alone

Three ways to solve this. Only one of them is right for your practice, and it is not automatically the one we sell.

Most owners think the question is which agency. It is not.

The question underneath it is which structure fits a practice your size, at your stage, with your tolerance for managing people. Get that wrong and the vendor choice barely matters, because the arrangement was never going to work.

So here is the comparison written the way we would want it written if we were reading it. Including the parts where we are the wrong answer, which is a real category and a larger one than you would expect.

The Three Structures, Side By Side

Costs left deliberately out of this table. You should price all three locally rather than take a number from a website that wants one of them to look good.

	In-house hire	General web agency	Specialist agency
Time before productive	Three to six months, including hiring	Two to six weeks	Two to six weeks
Depth in your vertical	Whatever the person happens to bring	Usually none. You are one of forty industries	The whole point of the arrangement
Range of skills covered	One person's skill set	Broad, often shallow past the build	Narrow by design, deep inside it
Healthcare compliance	You are teaching it, or nobody is	Rarely considered until something goes wrong	Assumed as a starting condition
When they leave	Everything stops. You start again	Site keeps running, momentum does not	You keep the assets, work is handed over
Who owns the assets	You	Ask before signing. Often not you	You, and it should be in writing
Your time each week	Substantial. You are now a manager	Low, sometimes too low to steer it	An hour or two, mostly deciding
Accountable to a number	Rarely. Salaries are not performance-linked	Usually to a deliverable, not an outcome	It should be, and you should insist

When An In-House Hire Is The Right Answer

There is a size past which paying an agency is worse value than employing somebody, and plenty of practices are past it without realising.

Hire in house if most of these are true. You are running several locations. There is enough work to occupy somebody five days a week, every week. You or somebody senior will actually manage them, set priorities and review output. And you can tolerate the first quarter producing almost nothing while they learn your market.

The failure mode is predictable and we watch practices walk into it repeatedly: a single coordinator hired to do social media, the website, email, ads, reviews and events, reporting to an owner who is treating patients all day and has no time to direct them. That is not a marketing department. That is one overwhelmed person with six job titles, and they will leave inside eighteen months taking everything they learned with them.

When A General Web Agency Is The Right Answer

When what you need is a website, and you need it to be well built, and that is genuinely the whole job.

If you are leaning towards doing it in house, start with the guides, which are written so that you can. Good general agencies build good sites. They have designers, developers and a process, and if your problem is that your site looks like 2014 and loads slowly, a specialist in your vertical brings nothing extra to that particular task.

Where it goes wrong is the month after launch. A site is a starting line, not a finish. If the same firm is then retained to run local search for a chiropractic clinic and has never worked on one, you are paying them to learn a category on your money, and you will hear a great deal about traffic and very little about booked evaluations.

When We Are The Right Answer

When the problem is not that you lack a website but that not enough of the right people are finding you, calling you, and turning into plans of care.

This works when you have a real catchment and real competition in it. When there is a schedule with gaps you can name. When somebody at the practice will answer the phone properly and attend the appointments we book, because no amount of demand fixes a front desk that lets it fall on the floor.

Where we say no

Your catchment is already saturated with our client. We will not take a second practice in the same catchment, and we will tell you rather than quietly take the work.
You have fewer than three hundred contactable past patients and reactivation was the reason you called. The arithmetic does not hold and we will say so on the call.
You need patients this week and nothing else will do. That is an advertising problem with an advertising budget, and search will disappoint you.
Nobody at the practice can own an hour a week. Not because we need managing, but because the decisions are yours and they cannot wait a fortnight each time.

The Comparison Almost Nobody Runs

Every practice weighs these three against each other. Very few weigh them against the fourth option, which is the one most owners actually choose: carry on as you are and revisit it next year.

That option has a price too. It just does not arrive as an invoice, so it never gets compared to one.

It is the evaluations that went to the practice two streets away because they had ninety more reviews than you. The callers at half past five who reached voicemail and rang somebody else. The patients who finished a course of care three years ago, would come back if asked, and have never been asked. None of that appears in your accounts. All of it is money.

Work out that number before you compare anything else, because it is the only figure that tells you whether any of this is worth doing at all. If it turns out to be small, do nothing, with our blessing. If it turns out to be large, the argument between the three columns above matters a great deal less than starting.

Not Sure Which Column You Are In?

Tell us the size of the practice, what you have tried, what it cost and what happened. We will tell you which of the three we would choose if it were our money, and we will say so plainly when that answer is not us.

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Or read what we actually do and how we work first.