The quality of the links and content can make or break your practice’s Web site

Investing in an Internet strategy requires serious consideration for medical practices today. The statistics alone represent a clear indication that the Internet is here to stay, is progressive, and is a priority for today’s consumers.

• More than 100 million consumers use the Internet to seek health care information each year, according to Harris Interactive Inc.

• Sixty-three percent of consumers say they would switch health care providers if they found credible content, e-mail communications, or scheduling online, according to Jupiter Research.

• Seventy percent of information seekers say their health care choices were influenced by the Internet, according to Pew Internet Research.

• Surveys show that 77% of the people seeking health care information want to get it from a physician, according to Cyber Dialog.

• Forty-six percent of information seekers are most frustrated with irrelevant hits and 36% are most frustrated with lack of content credibility, according to Jupiter Research.

By the same token, many practices have invested thousands of dollars into Internet strategies and many hours of educational time to be kept abreast of the ever-changing Internet environment. Other practices opt to have a practice Web site for the simple purpose of establishing credibility with Internet-savvy consumers who have contacted the practice about a procedure or provide a referral source for Internet friends. In this case, it is most important to be certain that the Web address appears on all printed in-house material, traditional advertising, or public relations initiatives, and is reviewed over the phone with all prospective patients that call into the office.

Other practices have taken greater steps to achieve high-ranking, first-page positions on various search engines. Internet information seekers typically enter a specific procedure name and possibly a local area market into their search box to locate information about a specific procedure. In fact, because much media attention is focused on plastic surgery, consumers are intrigued enough to visit the Internet after watching a televised segment or reading a printed article about plastic surgery.

Often, Internet information seekers interested in plastic surgery may visit as many as 100 Web sites in a year to make an educated decision regarding whether to proceed with visiting a plastic surgeon’s office or sending an e-mail to the surgeon to request more information. In the end, the one criterion that remains constant is linking Internet information seekers to the strongest results that relate to their specific request on a search engine.

John Pellman, Jr, of MedNet Technologies explains: “Any true relational link that takes place between a practice Web site and a reputable company will help the doctor’s Web site significantly.”

The Basis of Search Results
To understand the value of linking to the right information, we must first understand the genesis of Internet search results on the top search engines. Search-engine results are the listings searchers see when they type a specific word into the search box. These words may be specific or general terms relating to plastic surgery.

Specific terms such as the practice, surgeon, or procedure name, or the geographic location, may be one way for a prospective patient to search. General terms such as “breast augmentation” are also used to obtain more information.

The search engines typically display paid advertisements at the top and side of the page, as well as many “organic” listings (free listings based on search-engine ranking) on the center of the page. Recent findings by Jupiter Research, a media research company, show that only one in seven Internet users clicks on paid ads. Although more than 5 million Web sites provide information on breast augmentation, fewer than 10% of Internet searchers look beyond the first page of search results. This means that most consumers use the organic listings on the first page of the search engines for information.

It makes sense that consumers and search engines alike are most interested in Web sites that provide credible, valuable content. Even better, if the Web site can become a valuable resource, a source for a wealth of credible information, then both the consumer and the search engine are better served.

As George Marosan, MD, FACS, a plastic surgeon in Bellevue, Wash, explains, “Patients are much more aware about the differences between plastic surgeons and procedures. It is clear that they come to the Internet to receive more educational information. For this reason, I have found it important to provide differentiating content and links to other credible resources, such as the American Board of Medical Specialties, ASPS, and ASAPS.”

However, in plastic surgery, many Web sites are competing for the top-level positions. Therefore, it is difficult for a particular Web site to be listed on the first page in the organic listings. Also, search engines change a Web site’s ranking without notice. To obtain prominent listings, a specific strategy is needed that separates, in the eyes of the search engines, your practice’s Web site from your competitors’ sites.

The Medical-Practice Web Site
To satisfy an information seeker on the Internet, a medical-practice Web site requires quality educational content about the specific procedures offered by the practice. Links to or from other credible relevant sites can provide great reference material, which is welcomed by consumers and search engines alike.

Links Bring Them In
Good links are virtual votes of confidence for consumers, relative Web sites, and search engines. As Dan Goldstein of Page 1 Solutions explains, “Links are not a distraction from the practice Web site, but provide an added value to the information seeker—making your site more of a resource, which makes it more likely that the information seeker will contact the practice.”

One thing is for certain: We cannot ignore the importance of information seekers on the Internet. As Lawrence Korpeck, MD, who practices in Boca Raton, Fla, explains, “We receive up to 50% of the patients in our practice from the Internet. Links have been an important part of this achievement, including our direct advertising. Our patients have come in better informed due to our cross-linking strategy.

“We cross-link with a peer-reviewed plastic surgery content provider, relevant technology companies, referring professionals in the local community, and media outlets that have produced press appearances for our practice. Linking has definitely leveraged our practice Web site.”—LR

Select page titles and meta tags located on the Web site (developed by the Web-site development company) create “calls to action” for the search engines to better identify the nature of the Web site. Also, satellite Web sites that focus on specific procedures linking to and from the core practice Web site have been known to separate one practice’s search-engine-ranking score from another.

Brian Evans, MD, who practices in Beverly Hills, Calif, has witnessed the value of an effective Web site firsthand. He explains, “Information seekers are interested in multiple venues of information. The results that I have witnessed from cross-linking with other sites have increased the number of visitors to my site severalfold.

“I advocate cross-linking with credible sources and media outlets that have produced an appearance for your practice. Providing the link is relevant to plastic surgery topics. These links have not been a distraction to my business. In fact, my patients appreciate the opportunity to be better educated through my Web site.”

Quality content and references presented on a Web site through links are important not only to search engines and Internet information seekers, but to the medical organizations as well. The American Society for Aesthetic Plastic Surgery (ASAPS) decided to make Web-site review part of the candidacy process after viewing plastic surgery Web sites to find those with irrelevant content, improper information flow, lack of appropriate board-certification disclosure, and links to advertising companies that have an implied association with a questionable business.

As Barry DiBernardo, MD, chair of the electronics communications committee at ASAPS, explains, “The American Society of Aesthetic Plastic Surgery has found it disdaining for an ASAPS member to have an association with companies that provide inappropriate content or links to companies that have a direct or indirect association with a business that has a poor reputation. For this reason, it has been important to build safeguards against the association of inappropriate content on an ASAPS member’s Web site.

“To take it a step further, we review candidates’ Web sites to ensure ASAPS represents aesthetic surgeon’s Web sites of the highest technical quality and on moral and ethical grounds as well. Standards in photography are equally important to ASAPS.” It is recommended to check the Web site guidelines provided by the medical organizations to determine if your Web site meets the evaluation criteria.

The search engines have taken a strong stand in the evaluation of Web-site content as well. Search engines employ human and computerized editors to decide which position each Web site will occupy for each particular results page, relating to a specific medical procedure name or health care concern.

For this reason, it is extremely important to formulate a strong content objective that meets the needs of patients and the search engines alike. In fact, selecting content that is out of context, without relativity to specific consumer needs, is frowned upon by the search engines.

As Ryan Miller, founder and president of Etna Interactive, explains, “No other advertising vehicle assigns penalties for providing out-of-context content or to the overzealous. But, online, it is very common for search engines to penalize sites that try too hard to manipulate results and force their way to the top.”

Search engines may actually blacklist your Web site from appearing on the Internet if you display irrelevant content. The criteria that search engines use to evaluate Web sites is as ever-changing as the Internet environment itself, and few components remain constant.

First, we need to know the odds of receiving top-ranking positions within the organic free-listing area of the search-engine results page. When search engines evaluate Web sites, they perform a relative comparative analysis. As Miller further explains, “If three sites appear nearly identical, the search engine will rank higher the Web site with the most relevant, natural-looking, inbound links.”

Understanding Search Engines
According to Dan Goldstein, president of Page 1 Solutions, “If the goal of your Web site is to obtain new cosmetic surgery patients, your site has to be on the first page of the search-engine results for searches relating to cosmetic surgery in your market. To accomplish this, you must provide thorough and useful information about cosmetic surgery for your visitors and optimize each page of your Web site. In addition, your site must have strong link popularity, including links to and from peer-reviewed content, medical organizations, and reputable technology companies whose services the practice utilizes.”

Search-engine optimization is the process in which a Web site undergoes redevelopment to properly and best communicate its keywords to search engines. Search engines rank Web sites based on several factors, including:

• unique content with pertinent keywords in the body;

• link popularity that reflects the number of high-quality incoming links the Web site has; and

• other variables, such as the architecture of the site, the visibility of your content, the underlying code, and how natural your site appears to the search engines.

How to Win the “Link Vote”
• Become a unique resource. Provide original, fresh content. Write articles about plastic surgery for publications, and request a link from the publication to the page in your Web site that remarks on the same topic. Write a press release or opinion editorial article that formulates your specific editorial viewpoint about a plastic surgery topic. Then, share this information with relevant directories and online news portals in exchange for a link on their sites.

Consider posting a link to your directory or online news portal article on the relevant page within your Web site. Be selective in choosing the “right” directories and online news portals in which to share your views.

Freshen your content to score points. Weekly tips, newsletters, and new links posted on the Web site help search engines and consumers make the right decisions about you.

Give the consumer the best result. Consider answering all of the consumer’s questions so that you can be rewarded with their presence in your practice. Links should not be a distraction, but an added value to the information seeker. 

Evaluate the integrity of Web-site content. Answer the question, “How does this content help visitors to my Web site and the search engines produce good results for information seekers on my site?” If your answer shows that the content meets all the criteria, then publish the content on your site or provide a link to it if it is not your own.

Outbound and inbound links. Feature links to and from medical-organization Web sites, universities, peer-reviewed plastic surgery articles, referring surgeons or other professionals, and noncompetitive colleagues. Such links will attract other credible sites to link to you.

Links are scrutinized by all; so should you. Monitor links that may be added to your site without your approval. Make sure there is a clause in your hosting-company contract that requires your approval of link additions. These additions may be difficult to detect, appearing simply as a procedure name or the name of the hosting company. You must scroll over the words with a mouse and try to click on them to determine whether they are links. In some cases, the links appear as underlined words.

• Seek directory firms that help with your link-popularity strategy. If you choose a directory that will not assist with link popularity, then ask precisely what you are paying for. Some Internet-development companies may block links from your directory listing. A blocked link will appear when the listing is scrolled over with a mouse as your Web address with additional letters at the end of the Web address, such as blocklink. An unblocked link will appear as Unblocked links can help with link popularity.

• Own your content. When engaging in the services of a Web-site-development firm or search-engine optimization company, ask if you will own all the content on your Web site. Be certain this is summarized on your Web-site–development contract. —LR

Before starting the optimization process, it is important to determine where your Web site ranks with the various search engines. Once optimization is complete, you need to check again every 30 days to ensure that your Web site’s ranking status is maintained. For best results, you have to install tracking tools to measure your success. Some search engines drop a site’s ranking after few weeks’ time.

In fact, as Lain Downs, executive director of Centre PC, explains, “The development of an effective Internet strategy for a practice today must incorporate both search engine optimization and the right links, such as those to a referring product or a published article.

“At the same time, the strategy varies between urban and rural areas. Traditional advertising and word-of-mouth referrals alone are no longer applicable to meet the needs of so many consumers who search the Internet after seeing a televised appearance or printed article.

“Practices today must develop a multilayer media strategy, specific to the geographic area. The Internet is a very powerful medium in today’s marketplace, regardless of a practice’s other marketing efforts.”

Outside of quality Web-site content, it is crucial for practices to develop incoming links from other Web sites that are well established and have commonality with the practice’s Web site. Some of the most effective ways to develop quality is targeting links from directories and other related sites, reciprocal link exchanges with related sites, fee-based directory submissions, and targeted link buys.

After the optimization process is complete, you need to submit your Web site to search engines, directories, and links pages, including Yahoo!, AltaVista, HotBot, Google, Netscape, MSN, Lycos, and AskJeeves. In addition to these submissions, you need to add fee-based directories such as Yahoo! Directory Looksmart, Microsoft bCentral, and several other high-quality directories that can add to your link popularity.

Consider purchasing links in physician-locator tools offered in plastic surgery-specific directories. And last, if your Web site has indexing issues, you need to create and submit site maps to Google and Yahoo! via their respective programs. Take into consideration that Yahoo! no longer accepts automated submissions so that no company can allege submitting you to Yahoo! with its software.

Link Popularity
Many companies sell “link popularity” and promise improved rankings through the purchase of text links. You can purchase text links on newspaper Web sites, television station Web sites, and other linking sites. However, purchased links provide questionable returns.

As David Evans, PhD, MBA, founder and CEO of Ceatus Media Group, explains, “We have not found purchased text links to be cost-effective. The most effective means of building link popularity is very time intensive. You have to take the time to build individual links with other sites one by one.

“For example, if you have a surgeon associate in another city—who is not your competitor—contact him or her and suggest a link exchange with his or her practice Web site. Over time, these links can add up to better rankings on Google.”

It is also important to identify the “popularity-ranking” level of your Web site and any Web site you plan to link to or from. The popularity-ranking level is a system used by some of the search engines to evaluate the strength of your Web site. Though there have been mixed reviews about the validity of popularity-ranking tools, it might be interesting to go to Google, under the toolbar titled “page rank,” to research your Web site and those of others.

As David Stringham, president of Looking Your Best, explains, “Link swapping has always been an important part of a practice’s Internet strategy, providing that the Web sites each hold high-ranking positions.” In fact, if a Web site that you are planning to link to does not have a high-ranking position, ask why not and become familiar with its plan to achieve a high-ranking position.

In the end, linking to and from the right Web sites may hold a high-value proposition. However, you won’t know unless you investigate both sides of the story. And remember, the criteria that search engines use to establish the Web site’s ranking position can change from time to time.

Quality is Key
A common mistake in a link-popularity strategy is believing that the quantity of links is most important. Quality of links is most crucial to a link-popularity strategy.

• “Link farms” and “bad neighborhoods” are red-flag indicators to search engines. Because of this association, your Web site may be blacklisted from appearing on the search engine due to lack of credibility.

• Links from Web pages that have established credibility on the Internet can enhance a Web site more than a Web site without links.

• Understand what services providers are going to extend to you. The use of submission services and doorway pages may be red-flag indicators to a search engine.

The question of content on a practice’s Web site is not a subjective issue; it is an objective issue. This is true from the perspective of the search engine and relevant Web sites that consider linking to your Web site. This is also true from the perspective of the Internet information seeker, who will reward you with his or her presence in your practice and possibly a referral to friends after receiving the right information. PSP

Lesley Ranft is a contributing writer for Plastic Surgery Products.