Einstein Medical: Local Search Is in Our DNA By Ted Ricasa on October 30, 2012

For nearly eighteen years, Einstein Medical has been in the local search game. In fact, when we developed DocShop.com, our acclaimed directory of elective healthcare professionals and first local search product, Google and Bing didn't even exist. We were there before there was a search engine optimization industry, before there was social media as we know it, even before the excimer laser was approved by the FDA for use in LASIK surgery. Simply stated, we have experience in local search that no other SEO company can match. And here's the proof...

There is no substitute for experience. The phrase has been used in the healthcare field for as long as there has been a healthcare field, and for good reason.

Think about it. If you had to undergo a surgical procedure, what sort of doctor would you entrust your health to? Would you choose a doctor who has performed that procedure only a handful of times? Or would you prefer someone who has been performing it for years and has a history of successful results? Someone who has witnessed the evolution of technology in his or her field and developed a deeper understanding of the surgery through years of trial and discovery?

Compared to the field of medicine, the Internet marketing industry is still in its infancy. Yet when you consider how quickly technology advances these days, even a year can seem like a long time. Six years ago, nobody owned an iPhone or an Android smartphone. In the first two quarters of 2012, nearly 245 million of these devices were sold to a public now largely reliant on them.

Given the lightning pace of change in the twenty-first century, tech-related businesses can thrive one year and be redundant the next. This makes Einstein Medical’s nearly two decades of experience in local search not only impressive, but unprecedented. In fact, we were developing local search platforms before Google existed and before Microsoft even got its feet wet in the search engine pool.

Through seventeen-and-a-half years of evolution, adaptation, and innovation, Einstein Medical remains at the forefront of local search strategies for elective healthcare practices. Here is the story of how we began – and why experience is as important in local search as it is in medicine.

From humble beginnings…

(The original location of Einstein Medical to the left; to the right, within walking distance, the beautiful Pacific Ocean)

Indeed, there is no substitute for experience. And there is no experience like being in the right place at the right time.

When Einstein Medical was founded in 1995, we were fortunate enough to be in precisely the right place at precisely the right time. This wasn't purely a matter of luck, however. We had a vision that we believed in wholeheartedly. Across the country, ophthalmologists were beginning to invest in expensive lasers. The word LASIK was starting to pop up in magazines and news reports, and the idea that lasers could be used to liberate people from their glasses and contact lenses was becoming increasingly mainstream. Something big was about to happen. We predicted that there would soon be a large-scale migration of physicians from managed to elective health care.

We also believed that emerging computer technologies would play a pivotal role in how these elective healthcare pioneers marketed themselves. From a 2012 perspective, these pre-Google times might seem like the Dark Ages of the Internet, but revolutionary changes were being set into motion. Soon, people would be searching for information on the Web very differently from the past. As we set up shop in a 500-square-foot storefront in La Jolla, we decided to leave the "Catholic Bookstore" sign on the front of the building. We knew we were onto something, and we didn't want to tip our hand just yet.

Long on vision, even longer on guts

(DocShop.com as it appeared in 2004)

Like most start-up companies, Einstein Medical was established partly on a shared vision and partly on a mixture of ambition and faith.

Our vision was to concentrate the collective purchasing power of entrepreneurial physicians across the country into a national marketing fund. This fund would be used to purchase national ads that would appear on network television and in major news publications and airline magazines. These ads would direct consumers to DocShop.com.

DocShop.com was the first major product launched by Einstein Medical, and it remains our flagship product nearly eighteen years later. DocShop.com was the first ever online consumer directory of physicians, surgeons, dentists, and other practitioners in the elective healthcare field. The goal of DocShop.com was simple, but powerful. We wanted to create a resource that would allow consumers to search for experienced, reputable healthcare providers by location and by specialty.

There was absolutely nothing like it at the time. When visitors entered DocShop.com, they would first see a map of the country. They could then click on their state, and finally their metro market area, which was based on the Nielsen breakdown of local television markets. There they would find an exclusive list of specialists. Although we didn’t realize it at the time, we had created our own early version of local search.

As hard as it may be to believe now, this was a time when you could not simply enter a query into a search engine and have relevant results returned. In fact, the phrase "search engine" wasn't even part of the average computer user's vocabulary yet. But that was about to change.

What in the world is a "search engine"?

(The not-so-symmetrical Yahoo! Search home page from November 1996)

Imagine that some divine hand picked up the Library of Congress and shook it like a cup full of dice. Tens of millions of resources would be randomly scattered. All of the information would be there somewhere, but it would be nearly impossible to find anything specific. This was the Internet of the early nineties. Unless you happened to know the specific location of an online document, good luck finding it.

DocShop.com represented on a more focused scale what students, researchers, and engineers around the globe were trying to accomplish on a massive scale. They were working to find a way to catalog all of the information contained on the World Wide Web and make it accessible through a searchable user interface. It turned out that 1995, the year of our founding, was a watershed year in their attempts:

In January, Jerry Yang and David Filo move "David and Jerry's Guide to the World Wide Web" to its current domain at yahoo.com. By October,Yahoo! is averaging half a million visits per day and is consistently ranked among the top-ten most-visited websites 1.
Also in January, the six-month-old search engine Lycos expands its catalog of online documents to 1.5 million, the largest collection at the time 2.
Eleven months later, AltaVista premieres the first full-text searchable Internet database, comprised of 16 million documents 3.
During the summer, a Stanford student named Sergey Brin shows a prospective student named Larry Page around the university campus. They argue nearly constantly during this first meeting, so they probably have no idea that one day they will collaborate to revolutionize the Internet by creating Google.

It would be several more years before search engines could be relied upon to deliver relevant results for local searches. Nevertheless, the seeds of search as we know it had been planted.

The elective healthcare "Big Bang"

Meanwhile at Einstein Medical, our bet that the elective healthcare market was about to enter a period of explosive growth turned out to be a good one. In fact, if there was ever a "Big Bang" in the industry, a strong argument could be made that it occurred during our first two years in existence. And we were fortunate enough not only to witness it, but also to be a part of it.

Consider the events that occurred in the various elective healthcare markets during our first year of operation:

Laser Vision Correction

In November 1995, the FDA approves the use of the excimer laser for the correction of nearsightedness in photorefractive keratotomy (PRK). This is the first time the agency has approved a laser to be used in refractive surgery.
Refractive laser centers around the country devote a collective $100 million during 1996 to promote PRK and to educate the public about the benefits of using lasers in eye surgery 4.
Four years after it had first been performed in the United States as part of a clinical trial, LASIK becomes more widely available as an "off-label" use of the excimer laser in 1995. In 1996, approximately 64,000 people undergo either PRK or LASIK 5 in the United States. In 1997, roughly 87,000 people undergo LASIK alone 6 - an entire year before an excimer laser is approved by the FDA for use in the procedure.
Drs. Junzhong Liang and David R. Williams continue their ongoing research into using wavefront technology to measure and correct aberrations in the cornea. In clinical tests, they are able to correct higher order aberrations, the first time in history this has been achieved. They present their results at the 1997 meeting of the Association for Research of Vision and Ophthalmology, laying the groundwork for custom LASIK and PRK 7.

Plastic Surgery

In 1995, The American Society of Plastic and Reconstructive Surgeons (ASPRS) launches Plastic Surgeons Online, a subscription-based service that allows surgeons to post and answer questions about complex cases. It also presents its first virtual conference, on rhinoplasty 8.
As part of then-ASPRS President Elvin G. Zook's 1994 initiative to improve the public perception of plastic surgery, the organization launches its first public website in 1996 9.
In 1995, the American Society for Aesthetic Plastic Surgery (ASAPS) is awarded a grant to research the psychological effects of cosmetic surgery on patients. The two-year study finds that cosmetic surgery has positive effects on patients' quality of life and their perceptions of their well-being 10.
In its August 24, 1996 issue, the New York Times publishes an article about the increasing number of doctors transitioning from managed to elective health care. Among other factors contributing to this trend, the article cites the unwillingness of insurance companies to cover "new laser procedures" such as skin rejuvenation and hair removal.
ASPRS statistics show that an increasing number of men are undergoing cosmetic surgery. Compared to 1992, there was an 80 percent increase inmale face lift surgery in 1996, while there was a 42 percent increase in brow lift 11.
The trend toward public approval of plastic surgery for cosmetic purposes continues. According to the American Academy of Cosmetic Surgery, approval rose by 50 percent between 1982 and 1992 12. By 2002, the year that the hit ABC program Extreme Makeover helped cosmetic surgery cross over into popular culture, more than half of the American population will approve 13. By 2007, the approval rate will reach a record 62 percent 14.

Cosmetic and Restorative Dentistry

A 1995 issue of FDA Consumer magazine features a report about the dental lasers then approved by the agency for use in soft tissue applications. The article also looks forward to the future of laser dentistry, predicting that lasers will be used in a wider variety of applications in years to come. One year later, the FDA approves the use of lasers in hard tissue treatments.
On July 1, 1995, CNN Money magazine publishes "Getting the Smile You Want at a Price You Can Afford." The article focuses on improvements in cosmetic dentistry treatments and technology, emphasizing the fact that "elaborate treatments that were once mainly the province of the Hollywood set are trickling down to Main Street." Teeth whitening, porcelain veneers, and dental bonding are highlighted.
In 1996, the FDA approves the use of the light technology photopolymerization in professional teeth whitening treatments 15. The resulting power bleaching technique offers a more efficient and effective way for patients to dramatically whiten their teeth.

Although we would expand DocShop.com to include each of these markets by the end of 1998, our initial focus was on LASIK. We realized, however, that a national multi-media promotional campaign was not necessarily the most cost-effective way to drive consumers to our directory. After all, the product was geared toward Internet users. What better way to get their attention than through the Internet?

A dollar spent on Yahoo! was going to drive far more traffic to DocShop.com than a dollar spent on CNN. We set our sights on the fledgling search engines.

Cornering the market

Modern Internet users are a savvy bunch. They know how to search, and search engines are responding with the desired results more efficiently and effectively than ever. In fact, according to a February 2010 study conducted by iCrossing, "roughly 95.3 percent of all non-branded natural search traffic comes from page-one of the SERPs [search engine results pages]." This means that less than 5 percent of users even bother with the second-page results.

In the mid-90s, however, Internet users often had no choice but to search through multiple pages of results to find what they were looking for. Useful resources were as likely to be buried on page eight as they were to be found on page one. Because of this, the banner ads that frequently appeared at the top and bottom of results pages did excellent business in those days. Consumers would click on the ads, grateful that they didn't have to wade through hundreds of results to find information about a product or service.

With this in mind, Einstein Medical bought the keyword "LASIK" on the top ten major search engines of the day:

America Online (AOL)
Yahoo!
Netscape
Lycos
Webcrawler
HotBot
AltaVista
LookSmart
Goto
Infoseek

There was so little traffic for "LASIK" at the time that we could only acquire the term from AOL by buying a bundle of more desirable eye care terms. At that point, they threw in "LASIK" for free.

By the end of the decade, however, more than one million people had undergone LASIK in the United States 16, and the term had become our crown jewel. DocShop.com received thousands of visitors a day, driven by both our organic search engine rankings and the banner ads that appeared at the top and at the bottom of every page of results. Anyone searching for information about LASIK on the Internet would inevitably encounter our directory.

We continued to increase the profile of DocShop.com by working with new search engine companies whenever they entered the field. In fact, Einstein Medical was the first advertiser on MSN Search when it was launched. Ours was a test case that was arranged through sheer chutzpah on both ends. We called Microsoft directly to enquire about having our banner ads appear on its new search engines. Our call was fielded by an ambitious intern who had the courage to act on his own rather than refer us up the chain of command.

(Einstein Medical President and blog author Ted Ricasa at the Microsoft Headquarters in 2000, when the company unveiled its then-new butterfly logo and brand campaign)

Although we were pleased with the success of DocShop.com, we also realized that we could not afford to become complacent with what we had accomplished. The growth of the elective healthcare market was unprecedented, while the Internet landscape was shifting radically from month to month. In DocShop.com, we had created a model that fused these two ever-changing industries. We were on top now, but we would have to continue to evolve if we expected to stay there.

I need a website…why, exactly?

From our earliest days, as now, we searched continually for new ways to improve conversion rates for our clients and the overall experience for our users. DocShop.com gave us a strong foundation to build upon. Prospective patients who clicked on a physician's listing would find the physical address, the phone number, and a brief description of his or her practice. This basic information was a good start, but how could we better serve those prospective patients who wanted to know a little more about a practice before making contact?

At this point, most of our clients either did not have websites or had websites that were very rudimentary, often consisting of one or two pages with little information. We stressed to our clients that they needed to have websites that:

Combined engaging photos and text to tell the story of their practices
Conveyed what was unique about their practices
Educated prospective patients about the procedures they offered
Introduced themselves and their staffs
Explained the technology featured in their offices
Encouraged prospective patients to make contact

Again, we didn't realize it at the time, but we were anticipating another essential element of local search. Both search engines and prospective patients are seeking information that is timely, relevant, and comprehensive. A website should essentially be the virtual extension of a physical practice. This was a concept that was not well understood at the time, but would soon further distinguish our clients from the rest of the pack.

Incidentally, there were not a lot of companies in the business of building professional, boutique websites for elective healthcare practices in the late nineties. This led to some of our clients asking whether we could provide such a service.

Our answer? You bet we can. (That, however, is another story for another blog post.)

Act globally, think locally

By the end of the decade, Einstein Medical was dominating the search results for LASIK-related terms. Every one of the top spots on all ten of the most popular search engines belonged either to us or to our clients. Our clients were receiving national recognition from peers and patients alike. In fact, they were being flooded with calls and emails from people wanting to know more about LASIK.

The only problem was that many of these calls and emails were coming from people who lived nowhere near the physician they were contacting. In fact, some of them didn't live in the same country, let alone the same state.

This was not necessarily a shortcoming of our strategy, however. Search engine technology had simply not caught up with the local search model we had put into place with DocShop.com. At a time when results for most search terms were haphazard at best, people who were searching for information about LASIK were finding loads of excellent information on the first page. It didn't matter that these experts on the subject might be located hundreds or even thousands of miles away. Thanks to the Internet, the world had suddenly gotten a lot smaller.

This also reflected a basic truth about people who are searching for information about a product or service, but who have not yet transitioned into buying mode. At first, people search globally. They don’t want information about a LASIK surgeon at this point; they simply want information about the LASIK procedure, itself. They are seeking to be educated. DocShop.com provides a dependable portal for them to receive this education. At this point, many of these learners are ready to start behaving as consumers. DocShop.com facilitates this process by funneling these consumers to trusted physicians in their local area. Because their trust has already been earned while they were in the learning stage, they are more likely to continue to use DocShop.com as they enter the buying stage. It’s a model that worked extremely well then, and continues to work in 2012.

For a time, however, many of our clients were buried by inquiries from people all over the world. They had to wade through dozens and sometimes hundreds of emails to find one from a nearby resident. Fortunately, those inquiries from local residents were there, even if it took some digging to find them. DocShop.com was working.

This confirmed to us that:

We were marketing a local product through a medium that produced global results
DocShop.com was helping to solve that issue through our version of local search

We resisted the temptation to replicate the DocShop.com model for every type of localized business that we could. Instead, we intensified our commitment to the elective healthcare industry.

And the beat goes on…

Fast forward to 2012. Now, local search is an integral part of the average person's life. People are accustomed to typing in geographic locations when searching for goods and services. Even when they don't, search engines can detect where they are and deliver geographically relevant results anyway. Any business that wants to improve or maintain its search engine rankings must have a robust local search strategy.

However, the local search landscape is only becoming more mercurial with time. It is constantly shifting and evolving, often in completely unexpected ways. Therefore, a successful local search strategy must be not only robust, but also flexible. It has to be built on a solid foundation, but be agile enough to expand and adapt as quickly as possible. Vigilance is an absolute necessity.

By now, most websites have some form of on-page search engine optimization. Likewise, most business owners are well aware of how powerful a consumer tool local review sites such as Yelp have become. As part of its continuing pursuit of the "next-generation search," Google has simplified and humanized the local search experience through such innovations as Google+, Google Places, and Google Maps. It is essential for a business to be found in Yahoo! Local and Bing Local - not to mention found by Siri. This is all textbook Local Search 101 stuff.

The real trick, however, is staying current with the rapid changes in local search and responding to them before your competition. For instance, when Apple evicted Google from its latest mobile operating system, much was made of the flaws inherent in the initial version of Apple Maps. Yet, that technology is improving daily and figures soon to become a viable competitor to Google Maps. And when that happens, millions of businesses will have to scramble to catch up to early adapters.

New local search engines and data providers are emerging all the time. Is it important that you know what Foursquare, Patch, MerchantCircle, GetFave, and Citysearch are or what they could mean to your practice? Not necessarily. But if you don't, you had better be sure that your search engine marketing company does.

To this day, Einstein Medical remains dedicated to our clients and to our mission of creating exceptional business solutions on their behalf. Indeed, as you read this, we are at work researching and developing new ways to stay at the forefront of the ever-changing field of local search. While we are proud of the nearly two decades of experience we already have in our corner, we are far more focused on the future and how we can build on our history to the benefit of our clients.

The Takeaway

Einstein Medical is no longer the only game in town. The online marketing industry that we helped to create is now heavily populated with search engine optimizers and other web professionals vying for your business. In fact, you probably get phone calls and emails from them more often than you'd prefer.

There is no doubt that a strong local search strategy is now essential to the success of any elective healthcare practice. You know this, as does every SEO company out there. What you may not have known until now is that Einstein Medical was there at the beginning, and that many of the core concepts of search engine marketing are rooted in our history.

Our seventeen years in the business have given us insight into local search and search engine marketing that other companies cannot match:

We were there when Yahoo! was in its infancy.
We were there when LASIK was still being performed as part of clinical trials.
We were there before Microsoft had a search engine, and when MSN Search became Bing.
We were there when Google was born, when it became a search engine giant, and when it established the guidelines to follow when building a website .
We were there when plastic surgery made the transition from a niche market to a public phenomenon.
We were there when "smile makeover" became a household term.
We were there when social media became an important local marketing tool.