What is SEO? How does it work? And just what exactly do SEOs do all day (if anything)?
In this article, we answer just that. By the end, you’ll understand the core components that make up a successful campaign to optimize your online visibility.
For many business owners, search engine optimization (SEO) remains a shadowy concept — a service they know and believe that they need, but one that they don’t well understand. As with anything, paying for something one doesn’t quite comprehend is nerve-wracking and frustrating.
And with good reason! SEO is expensive. Unlike becoming a surgeon, there is no evaluative body that certifies SEOs: no diplomas, no maintained standards, no accreditations, aside from easily obtained certificates from Google or another software.
And to be frank, there are a lot of disreputable characters in the SEO business — those using outdated methods, glorified web designers, and flat-out grifters. There are others whose price is right, but what could they possibly be doing for such a low price? Often, not much.
Below, I want to break down what SEO means in 2018, and I want to do so into four main aspects: technical, content, link authority, and local SEO. It’s similar in nature to our SEO service page description, but this post represents a much more comprehensive look at the factors that comprise these four major aspects, and, in a still very general sense, it covers about 95-99% of what matters in making your site shine at the top of Google results.
Pillar #1: Technical SEO
This basically refers to how well your site is operating. Google wants to know that you’ve got a quality site it can confidently to send people to (I tend to personify Google) so that they’re going to have a good user experience. I’m going to get to user experience a little later — it’s somewhat of a hybrid between a couple of different concepts.
Usually, what we’re looking at when we talk about technical SEO is going to be the site itself.
- Coding – How the site is literally built. Is it up to date? Is it validated by the W3C?
- Site Speed – Does your site load quickly, especially on a mobile device? Do the photos, videos, and other imagery load quickly also?
- Site Structure (or Architecture) – Has the site been well organized? Are your pages and categories ‘siloed’ — that is, are you organizing your content around concepts?
Does your site have broken pages — pages that no longer exist, that some other page is linking to? Is Google able to easily crawl your website and index the content? Do you have schema markup on your page, helping Google to properly organize your page within its own index? These are all aspects of technical SEO. If you don’t know the answers to those questions, you can follow some of the links I put in this section, or you can get a technical audit of your website from trusted professionals (ahem).
Last word on site speed, with respect to mobile: poor speed can kill your user experience and your ability to convert leads. 40% of internet users “bounce” from a site that takes more than 3 seconds to load! That’s a crazy stat. Site speed should be seen as the most important metric of your technical SEO read-out.
- PRO TIP #1: Use a hosting service with Content Delivery Network (CDN). Works great for sites with a lot of photos!
Pillar #2: Content Strategy
Content is that which is on the site – the stuff that you’re reading, looking at, or watching or listening to. It goes for any written content, photos, audio-visual material, and infographics.
What are the important aspects of content?
People want to actually read it. This is more important than ever because Google has gotten a lot better at detecting quality content, both indirectly and directly.
Indirectly: meaning through metrics like how much time people spend on the page. Things like bounce rate. or pages per session (how many pages that they’ve looked at). Some people call it stickiness: how often they stay on a site and how often they come back.
And then there are ways of measuring it directly. Some of the easier ones to discuss are things, like page length.
Page length is something that often is viewed with skepticism by clients because they think no one’s going to read 2,500 words or so about a procedure. The stats bear out that indeed they do! If you’re interested in the subject, you tend to want to know a lot about it, especially if you’re getting something like a surgical procedure. Aside from this, Google believes that a worthwhile article on a subject could not possibly do the subject justice in short form.
(And just to show you we practice what we preach, this post is 4870 words!)
Another factor is the reading level. There are several types of readability tests, like Flesch-Kincaid, that purport to measure quality. It’s uncertain how important this is, but a good rule of thumb is to write to your audience. If it’s too technical, you may lose people; if it’s too simple, you may affect your authority.
In some cases, you might ask yourself: “Is it entertaining?” That could be a form of quality, especially in the context of a larger content marketing strategy. It doesn’t necessarily fit the procedure pages, but it might fit some of your blog posts, if that’s something that you want to expand upon in order to establish your brand.
An example of entertaining content is “Dr. Miami.” Controversial though he may be, he used the distribution method of social media, primarily Snapchat, to get that content out. It really did feed his whole content marketing strategy and increased his visibility. Something to consider.
You use words that are relevant to your topic.
This is an informal way of talking about keyword optimization, which you might consider technical because it involves keyword research, volume statistics, and coding such as metadata, but it’s just properly framing the topic of the page. Do you have the keyword that you’re trying to optimize the page for in the URL? Do you have the title properly optimized for the theme of the page? Did you actually use the keyword you’re trying to optimize the page for? You’d be surprised how often people forget!
Metadescription should of course include your target keyword or keyphrase, but it’s best to think of metadescription more as an ad you might write for AdWords. Because you’re trying to entice somebody to click on it. You don’t necessarily want a snippet that comes from your website, although it can be good if you have a good snippet from it – that gets into rich snippets. If you have a really good piece of content, Google will pull it back as a good example of the content you’re looking for. People tend to click on a lot on rich snippets. It’s a good source of taking up Google real estate (more on that in another post).
I like to talk more about “thematic pages” rather than trying to stuff keywords or thinking: “Okay, I’m going to get this keyword optimized by writing it exactly 147 times, giving me a keyword density of 10%.” Obviously, that doesn’t work anymore. What does work is writing about a topic sufficiently well enough to have all of the necessary information about that subject on the page. If you’re writing about rhinoplasty, do you talk about the things that relate to rhinoplasty? A good way of checking that out is looking at something like a Wikipedia page and seeing if the bullet points or the divisions of Wikipedia page, or some of the bolded anchor texts on that page are on your page. Are they subjects that you address on your major pages?
This is sometimes referred to as Latent Semantic Indexing or LSI. It basically means that you have the keyword cloud that Google expects on any given subject that relates to that keyword. The more robust that page is, the more likely you’re going to rank for the related keyword. Again, it’s not just the keyword that has the highest volume, but it’s all of the related keywords. Because people search so many different ways, you want to have as many possible iterations of their questions and ideas about that subject on your core page. If you have a subject that you can expound upon even more, that’s when you would want to break that page off to a separate page.
An example here would be ‘revision rhinoplasty’. Revision rhinoplasty is searched for sufficiently to warrant its own page and have the requisite amount of words. How many, you ask? I think 2,000 words should be considered as standard.
It answers people’s questions.
People go online to get answers to their questions. If you want people to visit your website, you better have those answers. What do they need to know about the procedure? How should they prepare for surgery? What special techniques, if any, do you use? What should people know, but didn’t know to ask?
Do you have before and afters of the procedure, so I can see what I might look like afterward? What costs are involved (this is always a tricky one, but pages with costs get much better conversion rates, and descriptions with prices get better click-through rates)?
*Pillar 2.5: User Experience
The two of the 4 pillars that I’ve talked about — technical SEO and content — both comprise what is referred to as User Experience, often known as UX. Sometimes people write this as UX/UI (user experience/user interface). This means, as a user, how is your experience? How do you enjoy using this website? And this factors in a lot of the things we’ve already covered.
All of these things fit into the category of UX. UI is more again on the technical – that would have to do with the navigation. Are there calls-to-action? Are you able to actually use the site?
And then there is RankBrain: Google’s artificial intelligence. Google’s Andrey Lipattsev called it the 3rd most important aspect of the Google algorithm, after content and links. This is how Google learns which websites are better results for various searches.
RankBrain has some stripped qualifications as well. One of them is YMYL (Your Money or Your Life). It means that if you go to this website, are you in potential danger of having either your finances or your livelihood and health affected by this website.
This means that they will be much more strict about the content on a doctor’s website than they are for, say, a website selling t-shirts. That is something to consider when writing. It has to be expert-level content that responsibilty deals with the subject matter at hand. You don’t want to have a novice putting together your content because you are too busy to write it or make sure that it is a reflection of your belief in your procedures. The higher the quality level, the better people are going to pay attention to it. And the less risk you have with respect to RankBrain. There’s no good reason to write bad content.
Pillar #3: Link Authority — The Power behind SEO
When most people talk about SEO, they talk about technical SEO and content. You don’t hear a lot about links. I’m not sure why. But digital marketers don’t often talk about this to the general public. I think it’s a point of real interest, to not only in the population at large, but solely to have an honest and complete discussion about how SEO works. Most people aren’t really aware of how much links affect SEO.
When Google started, Sergey Brin and Larry Page wrote their dissertation at Stanford, entitled ‘The Anatomy of a Large-Scale Hypertextual Web Search Engine’, which described their original algorithm in detail. The algorithm was completely based on links. From the thesis:
PageRank is defined as follows: We assume page A has pages T1…Tn which point to it (i.e., are citations). The parameter d is a damping factor which can be set between 0 and 1. We usually set d to 0.85. There are more details about d in the next section. Also C(A) is defined as the number of links going out of page A. The PageRank of a page A is given as follows: PR(A) = (1-d) + d (PR(T1)/C(T1) + … + PR(Tn)/C(Tn))
Here’s the gist: a website is considered authoritative if many sites link to it (quantitative), but it is more important to have authority sites linking to it (qualitative).
It’s basing the quality of a website on how many links they have and who’s linking to them, and it’s all interrelated because, as infinite as it may seem, the internet is ultimately a closed circle despite the billions of websites in it. They all interlink in some way. Some websites don’t have any links and are seen as low-quality; whereas there are some sites that almost everybody has a link to, and those are considered the “most popular.”
In sum, the sites with the highest link authority are in the best position to be the most visible for the content they have on their site.
This was Google’s idea back in 1996. This simple yet ingenious notion made Google the most powerful and most useful search engine to date.
That said, Google has since changed their algorithm several times. They have realized that it was an easy system to rig, and the top results were not necessarily the best results. People came up with all sorts of quick ways of getting a ton of links to their site and then becoming more visible. Google really wanted to maintain the quality of the websites that they were passing along, so they put quality restrictions on the types of links that you could get.
I personally take issue with many of these changes, but I still believe that Google’s end results are, on average, the best results of any search engine out there.
Today in 2018, links are still very important. Based on much of our research, Google does want to leave links behind as a quality metric; but it really isn’t possible because it’s baked into the system. Maybe someday in the future, or maybe sooner than many of us expect, links won’t be that big of a deal — but as of now, they still are. They still affect how visible a website is.
The quality and quantity of links that you have pointing on your site give you what is known a PageRank. Each page on your website has its PageRank. Your site as a whole has its PageRank. And while Google hides this information, there are several tools that approximate this metric (here’s one and here’s another).
- Fun Fact: PageRank is not named after ‘webpage’, but after Larry Page, co-founder of Google. The more you know . . .
Your internal linking structure also could affect each page’s PageRank. Think of your website as circuitry and “link juice,” as we often call it, as electricity: if you have a lot of connections, you’re going to get more of that electricity or juice to your site. Your website spreads that juice throughout the various pages, based on how you connected all the pages together. So if you have one page that only one other page links to, that’s not going to get a lot of link juice. But if you have a page that every other page links to, that’s going to be seen as one of the most important pages on your website. It’s kind of a microcosm of the Internet itself.
External links are links from other websites to your website. The first question is often, what kind of links do I need to get? Or if Google made quality restrictions, what can’t I get?
Tier 3 Links
The first wave (or tier as we refer to them here at Surgeon’s Advisor) of links that any site should get is trust building links. These are easy links to achieve – they’re not very powerful links but they at least put you on the map. They at least say, ok, I’ve done some work to get my site in the mix on the Internet. These are often profilings which means that you get a link from sites like Facebook, Google+ or Google My Business page, or Foursquare and YellowPages. These are called citation sites.
Often when we get a new client, we establish their website — especially if it’s brand new — by getting you 50 or so standard links that one should have. They are easy to do: not very powerful, but you gotta start somewhere . . .
Tier 2 Links
The next tier: links that you should try to obtain by leveraging relationships — people who you either know or that you have a strong professional relationship with, and that you easily get a link from that points to your website. Simply ask: “Would you mind putting a link to my site on your site?” It works!
It may require greater relationship building, however. You might reciprocate — reciprocal links can be seen as problematic, but I’m not going to get too much into that right now — or you might do something for them offline. The important thing is to establish your website as something that works either within the community or within a fellowship. Often people are part of organizations, so if organizations can link to you, it’s always a good way of establishing yourself because those are seen as high authority sites. The higher the authority, the better the link that you get from them.
Tier 1 Links
The next wave of links should really be seen in the framework of either a public relations or a content marketing strategy. You create content for one purpose or another, and you leverage that content to get links. The easiest of these is to create an online press release, and you could publish it to something like PRWeb (now Cision). They will give you a link within the press release if you pay a certain price, and they will publish a link that goes to your website.
It could be via anchor text — a hyperlink from a word or a phrase, creating a connection between your website or the page that it’s going to, and the words you hyperlinked. This also can be problematic, as this is a technique that was abused and for which there are now guidelines. You’ll often see anchor text in spammy links — a type of link created in an automated fashion for a low price, around $100 for 100 links to be created, often from a disreputable source that farms out these links at high volume.
You don’t want to overdo linking via keyword-rich anchor text. It should be as natural as possible, such as your business or professional name.
A word more on spammy links: they often are created in what are called PBNs (Private Blog Networks). They artificially create links to your website that are basically valueless — in fact they can actually negatively affect your site.
You can still use anchor text links to optimize for certain keywords, but you want to have a diverse portfolio of what people are linking from — don’t put all your eggs in one basket, or you will raise a red flag. Once you’ve established yourself as an authority, you can play around with various anchor text links and core keywords you want to rank for.
Another form of Tier 1 links is to create a guest post and contact a blog or online magazine. Start with a basic outreach approach: “Hey, I really liked your website. I offer my expertise on plastic surgery topics, and I would like to write an article for you. You would publish this and in return, all I would want is a link back to my website.”
We have really good success doing outreach link building, but if this is something that you want to do internally, you would want to create it like any other kind of a digital PR campaign. You’re probably going to get only a percentage of people in contact so make sure that you research, say if you’re looking to get one or two of these for every one of those, you probably want to get 50-100 potential sites, to get a close rate of 1-2. That’s one form of outreach.
Another form of outreach is to create content that other professionals are going to link to – this is even higher level and it’s going to require a higher level of content. You want to create something that is going to resonate with your peers or any sort of organization that maybe you belong to, and you’re going to have them link to your site because it’s so good. “Hey you know what, I just wrote a really great article. I think it’s going to be of interest. Link to my site and then you can put it on your site.”
It can be as simple as a video or infographic. Say you pulled some really cool data that you think is of interest like a scientific study – that’s something you might consider working into a content marketing strategy, and then you can get links to that based on the quality and merit.
That is the highest level of link building – when you get other people to link to you and share your content without you doing it.
A couple other points:
You can send links to your homepage or to the various pages that you want to optimize. Both are important.
Put simply, all else being equal, your Pagerank determines how often and how prominently you’re going to rank on Google search engines against other of your competitors.
Pillar # 4: Local SEO — Your Best Friend or Your Worst Enemy
Local SEO refers to getting placement in the 3-pack of either Google or Yahoo or Bing or whatever search engine in their map. We obviously focus on Google, but all are important. You want to rank for local searches. People respond to them – even if they don’t visit your website, you have a chance of generating leads because they publish your phone number and address.
There are actually a lot of other services like Google My Business which have expanded to make it more robust across many different industries – some restaurants have menus or you can create reservations, book appointments or send messages directly to you if you want to create that functionality in your office. There are a lot of good things that local SEO can do for you in terms of generating business.
Each location that you have needs to be separately optimized. It’s a really important point. Yes, it’s important to mention your location on your website and in your titles, but that is literally the least you can do. Local optimization requires much more effort.
Local SEO works with the regular algorithm for a search engine — that is to say, that which ranks all queries into a hierarchy — plus some other factors. The 3 main ones are:
This one is pretty simple. The closer your business is to the searcher, the more likely your website is to appear in search. Type ‘restaurants near me’ into your phone as see what comes up. Then, as an experiment, do the same search 10 miles away. Makes sense, right?
Distance is something that we can’t control (yet!); however, the more authoritative your site, the farther your reach can be. Some businesses in New York reach all the way in New Jersey because they have such a powerful site.
There are times when businesses will want to place for a nearby city (because the search volume is higher, naturally), but they’re actually in suburbs. That’s not commonly going to happen, because the sites in the city are both authoritative and they have the distance between their searchers.
Name, Address, Phone number standardization: we refer to this as NAP consistency. This means that your name, address, and phone number are consistent across all citation sites. All of them.
Google wants to make sure that they’re sending their customers to a legitimate business that’s actually operating at the listed physical location. It’s not closed; it hasn’t moved. Everything needs to be 100% precisely as is — I’m talking down to the difference between “Suite” and “#” for your office. Maybe they’ll forgive that, but we try to be as precise as possible when making adjustments, because, after all, we’re dealing with computers here.
One editorial point I’d like to make: local SEO for surgeons is a long, endless nightmare.
Why is this? Because of the nature of the industry, for one. Doctors tend to move more than normal businesses. They tend to have multiple people working out of the same office. They have high turnover rates of these people, and one’s name is considered a professional name. If you have a Dr. John in the office with you, and then Dr. John leaves after two years and moves down the street, it’s a problem. If you don’t fix his citation after he leaves, because crawlers will often automatically pull this information from business licenses or other public databases, they can get stuck on the Internet with your location information attached to their business.
If you have multiple doctors and multiple locations, all of those need to be created as different listings. If you have 7 doctors who all work out of 5 locations, you need to have 35 different citations. And they all better be exact. The other approach, which is my recommendation, maintain only one business citation for each location (see Pro Tip #2 below).
The issues are compounded if you have multiple locations, with multiple physicians, or multiple websites for the same practice. Doctors with microsites that link from their location to a new Google My Business or Yahoo citation that they built for another microsite that’s got the same business and is seen as a duplicate location. There are inconsistencies. There are incomplete aspects. Lost account information for citations that were created 10 years ago. I could go on.
There are all these issues and more, problems your average shoe store doesn’t have to deal with. And all these headaches that have to do with NAP consistency. To the best of your ability, you want to try to fix these. Even with a dedicated staff member, this can take months to do by hand. There are, however, paid services, such as Yext or Moz Local that can make standardization easier, but all too often these applications are no magic bullet.
The more reviews you have and the more quality reviews you have, the better and higher you will rank, again all other things being equal.
This is something that people often struggle to do. You should come up with some sort of in-house solution. There are other solutions and services for people that want help. We have one of them — it’s called Aesthetic Reviews. It helps people to get good reviews and to put them toward their various locations. You want to have a strategy for every single location you may have, and you need to make sure that every single one has its own unique listing.
- PRO TIP #2: If you can, consolidate your Google My Business citations into a single citation per location. This increases the number of reviews your location will potentially get, rather than spread them among various doctors, and it maintains those reviews despite the common parting of ways. But this is a choice that each practice should make, based on the willingness of individual doctors to forego their own personal listing.
It’s not always possible and desirable but at least from the standpoint of reviews, it’s easier to consolidate a high number of positive reviews when there is one location for the entire office. So that you don’t have 5 different doctors, you have one organization. I tend to see that had the fastest rise when they have some sort of review strategy.
SEO is a complex subject, but it’s not inscrutable. Broken down, there are 4 main categories that you can take in, comprehend, and ultimately master to make your website and thus your business more visible online.
- Make sure your website is technically sound. It should be built by a professional. It should be hosted by a service that provides a CDN, and it should be mobile-optimized and mobile-friendly.
- Content is king. Write great content on your core pages. Create all types of engaging, interesting, informative content: videos, photos, infographics. Always be creating.
- Links are the currency of the internet. Get quality links, and get a lot of them. Links power the internet. Always be building, building, building. And don’t cut corners!
- Optimize your site for your locations. Local businesses depend on getting found locally. Get good reviews from your patients as often as you can. And if you’re just starting out, avoid the aforementioned NAP consistency pitfalls like the devil.
Stay tuned for more in-depth posts on SEO and digital marketing!