The ads are on. A report lands in the inbox. Someone forwards it with a note that says it looks fine. And you still cannot tell whether the month put anyone new through the door.
That is the gap I look for first. An agency can be busy and still not be accountable. Posts went out. Money was spent. Impressions went up. None of that is a customer.
A lot of the owners I sit with run a dental practice or a med spa, so I will talk about patients. The hole is the same in any business. A lead is a call or a form. A customer is someone who booked and showed up.
On a US dental account, a cost per lead around $73 or around $85 can be a perfectly ordinary line. Those are the two recent search medians I use, and they are written up in healthcare advertising benchmarks. Ordinary is not the same as good. Here is the arithmetic I walk through, as an illustration, not a promise. Three thousand dollars in a month. Fifty leads. Sixty dollars each, which looks healthy next to either median. Twenty book. Fourteen show up. The person who arrived cost $214. The report was proud of the $60. The schedule needed the $214.
A med spa report has the same hole. I am less willing to grade that one against a published average, because there is no clean national number for a consult. That is in what med spas pay per consult. The question is still who sat down.
What I want from the relationship
A goal you can say out loud. “More marketing” is not a goal. A number of new customers this quarter, from a channel you can name, at a cost you are willing to pay, is a goal. If you run a practice, name the treatment. New-patient exams are not implant consults. A Botox consult is not a membership. If the agency cannot say which goal they are working on, you do not share a definition of the job yet.
A report you can finish in one sitting. I want four things in it. What you spent, split between the agency fee and the money that went to ads. What shipped. What changed in leads, bookings, and people who showed up. What they are changing next. If the report is late, or it stops at impressions, that is the issue. It is not paperwork.
A named person, and a rhythm. Weekly or monthly. One main contact. A normal reply time, and a way to raise something that cannot wait. You should not have to chase a basic update. Changing direction every two days also makes the work worse. Pick a cadence and keep it.
Someone has to own the “why.” Agencies are often strong once the plan is clear. Trouble starts when this month looks like last month because that is what they know how to repeat. You do not have to write the strategy yourself. You should know who set the current priorities, and what would change if you moved money from one offer to another.
When it is a pattern
One slow month is not a reason to fire anyone. Patterns are. Activity language and very little on results. The same missing number in month three that you flagged in month one. A new charge nobody explained. You chasing updates, or rewriting their copy. A plan that never moves when the business does. A new account contact every few months, with no handoff.
One of those can be a direct conversation. Several at once means a reset, or an exit.
If you want a second read on the report you already have, bring it with you. On a consult I will tell you whether I would push the agency, change the brief, or stop treating activity as a full book. If you want someone on your side of that table after the call, that is Marketing Operations & Oversight.
