Last week Google made an announcement that raised a few eyebrows within the search marketing community: They’ll be adding paid ads to the standard three-pack of top local business results, meaning the three-pack would include two organic results and one paid ad.
Currently, Google’s standard local pack highlights the first three business search results, as determined by search engine relevance and physical proximity to you. Chances are, you’ve had a patient who first visited you because Google told them your office was closest to them or because your name came up first in Google local results. The local three-pack is a desirable. (We recently wrote about local stack, as well as how to optimize your listing.)

The change is still in testing, and Google hasn’t yet decided when to roll out the new ad option or what, exactly, it will look like. Regardless, it will be a significant change to introduce paid advertising to the top organic results, and naturally many business owners who depend heavily on local search results aren’t happy about the prospect.
Here’s what it means for you.
The Three-Pack
As shown above, Google’s standard local pack features listings for three local businesses, including basic information like location, distance, and hours of operation, accompanied by a map. A “More Places” button gives users access to a full list of businesses, but three-pack honors go only to the top three businesses as determined by search engine relevance and physical proximity.
Or at least that’s how it used to be.
The Ad Pack
In April, Google began a gradual rollout of its ad pack—paid listings positioned above the local three-pack. For desktop users, the ads look more or less like all of the other paid Google listings. Mobile users get a slightly different experience: The ads look slightly more like organic local listings, with some of the same information—locations, hours of operation—with the standard “Ad” indicator next to “Nearby businesses” at the top of the list.

Deceptive? Arguments can be (and have been) made for and against. The paid ads do look distinctly different from the local results in the three-pack—they’re more colorful, and they appear above the map, rather than below it. Still, a user who isn’t paying attention could find themselves selecting a listing for a dentist who paid for placement, rather than a dentist nearby. Even more attentive users still may find themselves scrolling down a list of half a dozen paid results before getting to the organic results they were searching for in the first place.
The Two-Pack
This is where things get interesting.
In the new format—which is, remember, still in testing and not yet seen in the wild—the paid result appears within the three-pack, at the top of the listing, and is completely identical to the other listings except for the “Ad” designator. SMX attendee Joy Hawkins tweeted a blurry photo of the screenshot shown at the workshop (which has not been officially approved for distribution), which would indicate that the current iteration looks something more or less somewhat like this:

This is, of course, a mockup, as the actual three-pack ad is still in testing.
If Google goes through with this proposed format, SEO efforts to get businesses into that precious three-pack will be that much more challenging—now, they’ll be vying for one spot out of two, rather than one out of three. For paying advertisers, of course, it will simply become that much easier to buy their way into the top three.
To Panic or Not to Panic?
Don’t panic. As noted above, the three-pack advertising is still in testing, and we can only speculate about what it will look like and how it will behave when it finally rolls out. (Hawkins does report that Google is testing one- and two-page ad packs above the newly monetized three-pack but probably won’t go further than that.)
For the foreseeable future, your practice’s current SEO efforts will be just as effective in the New Local as they were in the old. If you make yourself easy to find, patients will find you—even if they have to sift through a couple of paid listings to get there.
How to Rank in the New Local
Google’s algorithm, named Pigeon, is designed to provide more accurate and relevant search results for users looking for local businesses. The initial rollout was… less than successful, but gradual tweaking has resulted in fairly positive results. This, combined with Google’s slimming of their old local seven-pack to a more mobile-friendly three-pack, has made it that much more important that practices stay optimized to stay at the top of the list.
If you aren’t already taking steps to maximize your practice’s ranking, here are a few things that you should be doing:
1. Clean up your listing
Avoid keyword stuffing, avoid multiple listings, and avoid misleading URLs. All of the things that Google disapproves of with websites are similarly displeasing when it comes to business listings.
2. Optimize for mobile
Is your site mobile-friendly? It should be. To gain Google’s “mobile-friendly” designation—which is a real thing—be careful not to use software that isn’t supported by most mobile devices, size your text and images so that they’re easy to view without too much zooming or scrolling, and size and space your links to be easily clickable by less-than-dainty fingers.
3. Keep your local profiles updated
Patients are relying more and more on online reviews to make medical decisions—and Pigeon pushes review sites like Yelp and Healthgrades to the top of the pile, sometimes above the business’s own site. So make sure that all of your online profiles are complete, accurate, and consistent.
4. Optimize your Google My Business page for the size and type of your practice
More on that in this blog post. Doctors should consider whether to present themselves as a practice, a practitioner, or both, and use that as the basis for developing your page.