Which US city is the most competitive for healthcare marketing?
On Google reviews, New York: its typical practice has 1.52 times the national review count for its specialty, ahead of Houston (1.41) and Scottsdale (1.29), in our 2026 study of 9,452 practices in 20 metros. On ad prices, San Francisco, which has the thinnest review profiles of all. Competition depends on the channel.
- Deepest review markets: New York, Houston and Scottsdale. Thinnest: San Francisco.
- Most expensive dental clicks: San Francisco ($22.50) and New York ($21.10), planning estimates.
- New York, Chicago and Miami are at or above national review depth and above the median click cost.
- Several large metros pair thin review profiles with costly clicks, which makes reviews the cheaper lever there.
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Organic and paid competition are different questions
"Competitive" means two things for a practice on Google. In the map results and organic listings, it means how much review history and reputation the practices around you have already built. In the ads above them, it means how much other advertisers are willing to pay per click. A city can be hard on one and easy on the other, so we measured both.
For the organic side we use the review-depth index from the State of US Healthcare Marketing 2026: each specialty's city median review count divided by its national median, then the median across specialties. For the paid side we use our 2026 planning estimates for general-dentistry and medical-dermatology clicks, the two categories with metro tables.
The ranking
| # | Metro | Review-depth index | Specialties above national | Practices | Dental CPC | Derm CPC |
|---|---|---|---|---|---|---|
| 1 | New York | 1.52 | 8 of 9 | 555 | $21.10 | $17.60 |
| 2 | Houston | 1.41 | 6 of 9 | 513 | $8.60 | $6.60 |
| 3 | Scottsdale | 1.29 | 9 of 9 | 493 | – | – |
| 4 | Denver | 1.22 | 9 of 9 | 477 | $10.80 | $8.20 |
| 5 | Miami | 1.21 | 6 of 9 | 481 | $11.60 | $9.20 |
| 6 | Atlanta | 1.12 | 6 of 9 | 481 | $7.80 | $5.90 |
| 7 | Orlando | 1.09 | 5 of 9 | 520 | – | – |
| 8 | Austin | 1.05 | 6 of 9 | 460 | $9.80 | $7.10 |
| 9 | Las Vegas | 1.05 | 6 of 9 | 459 | – | – |
| 10 | Chicago | 1.04 | 6 of 9 | 503 | $12.70 | $10.20 |
| 11 | Dallas | 1 | 4 of 9 | 483 | $8.20 | $6.30 |
| 12 | Washington DC | 0.93 | 3 of 9 | 489 | $14.80 | $11.60 |
| 13 | Boston | 0.92 | 3 of 9 | 470 | $17.60 | $13.80 |
| 14 | Philadelphia | 0.91 | 3 of 9 | 487 | $10.20 | $7.80 |
| 15 | Phoenix | 0.81 | 3 of 7 | 225 | $6.90 | $5.20 |
| 16 | San Diego | 0.78 | 2 of 9 | 483 | $9.50 | – |
| 17 | Nashville | 0.75 | 3 of 9 | 441 | $4.20 | $4.20 |
| 18 | Los Angeles | 0.7 | 1 of 9 | 539 | $16.90 | $12.40 |
| 19 | Seattle | 0.69 | 1 of 9 | 442 | $12.30 | $9.60 |
| 20 | San Francisco | 0.54 | 0 of 9 | 440 | $22.50 | $16.20 |
Index: 1.0 = national median for each specialty. CPC: 2026 planning estimates for general dentistry and medical dermatology (New York = Manhattan, San Francisco = Bay Area); "–" = no separate estimate. Practices = businesses in groups of 10 or more.
New York leads by a clear margin: 8 of its 9 specialties sit above the national median. Houston is close behind and leads every metro in three specialties. At the other end, San Francisco's typical practice has about 54% of the national review count for its specialty.
Put the two together and four kinds of market appear
Deeper reviews, pricier clicks
New York, Chicago, Miami. Harder on both channels; New York is the extreme. Win narrow neighborhoods and procedures, and buy clicks precisely.
Deeper reviews, cheaper clicks
Denver, Austin, Houston, Dallas, Atlanta. Organic takes years to win; paid search is the affordable bridge while reviews build.
Thinner reviews, pricier clicks
San Francisco, Boston, Los Angeles, Washington DC, Seattle. Reviews and local SEO are the under-priced lever; keep ads for high-value services.
Thinner reviews, cheaper clicks
Philadelphia, San Diego, Phoenix, Nashville. The most open markets: a steady review routine plus modest paid search can move a practice up fast.
Cut-offs: "deeper" means an index of 1.0 or more (at or above national depth); "pricier" means a general-dentistry click above $10.80, the median of the metros with an estimate. Scottsdale, Orlando and Las Vegas have no separate click estimate and are left out of the quadrants.
Your specialty can matter more than your city
A metro index is an average, and the spread inside a city is often wider than the spread between cities. Houston is deep overall but below national in physical therapy. San Francisco is thin overall, though its med spas come within about a fifth of national depth. Miami ranks 5th overall, but its plastic surgery profiles are the deepest in the country by a wide margin, at a median of 295 reviews. Phoenix and Scottsdale, in the same metro area, rank 15th and 3rd.
So the useful question is narrower: how many reviews do practices in your specialty have in your city, and what does a click cost for your services there? The specialty benchmarks and the review benchmark checker answer the first; the city articles linked in the table go deeper for 14 of the 20 metros.
What this means for your practice
- Work out which quadrant you are in for your specialty, not just your city.
- In deep markets, set multi-year review goals and use paid search to stay visible meanwhile.
- In thin but expensive markets, invest in reviews and local SEO first; they are the cheaper route to patients.
- Measure cost per booked patient by channel, so the channel mix follows results rather than habit.
- Re-check yearly. Review depth grows every month, and click costs move with competition and season.
Where our US team can help: healthcare SEO · paid search · local SEO · Google Business Profile management.
Get the full Healthcare Google Reviews dataset + PDF summary
The numbers behind this page, ready for your own spreadsheet or slide deck.
- CSV, 187 rows: national figures for 9 specialties plus every metro with at least 10 practices.
- Fields: average Google rating, median review count, review-count bands, website, phone and hours listed, weekend opening, days open per week.
- PDF summary with the tables, methodology and a citation line.
Public Google Business Profile data for 9,452 US healthcare practices, September 2026. Aggregates only. Free to reuse under CC BY 4.0.
How we know: source, sample, date and limits
Review depth: public Google Business Profile data for 9,452 practices in 9 specialties across 20 metros, collected in September 2026 (the sample behind the State of US Healthcare Marketing 2026). Only specialty-and-metro groups with 10 or more practices count. Index: each specialty's metro median review count divided by its national median; the metro index is the median of those ratios. Click costs: 2026 planning estimates from our dental and dermatology benchmark reports (January to August 2026); Scottsdale, Orlando and Las Vegas have no separate estimate.
- Quadrants are our simplification: "deeper" = index of 1.0 or more; "pricier" = general-dentistry click above the $10.80 median of the metros shown.
- Review counts measure visibility, not quality of care; click costs are planning estimates, not quotes or guarantees.
- Large metros contain many local markets; neighborhood competition can differ sharply from the metro figure.
Want this benchmarked for your practice?
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Related research and services
State of US Healthcare Marketing 2026
The full metro ranking and how it is built.
Which cities have the most expensive Google Ads?
Click costs by metro, three specialties.
Google benchmarks: 9 specialties, 20 cities
Every specialty, city by city.
How competitive is New York?
The deepest market of 20.
How competitive is Houston?
Deep reviews, moderate clicks.
How competitive is San Francisco?
The priciest clicks, the thinnest reviews.
Common questions
What is the most competitive US city for healthcare marketing?
On Google review depth, New York, with a review-depth index of 1.52 in our 2026 study of 20 metros, followed by Houston and Scottsdale. On paid-search prices, San Francisco and New York have the highest general-dentistry click costs in our planning estimates. New York ranks near the top on both.
Which US city is easiest for a new medical practice to get found on Google?
By review depth, San Francisco has the thinnest profiles of the 20 metros we measured (index 0.54), followed by Seattle and Los Angeles. Thin profiles mean a steady review routine can reach the local median sooner, but click costs in some of those metros are high.
What is a review-depth index?
Our measure of how much review history local competitors have. For each specialty, we divide the city's median Google review count by the national median, then take the median of those ratios across the specialties the city reports. 1.0 means the typical practice matches the national norm for its specialty.
Are expensive Google Ads cities also the hardest for SEO?
Not usually. In our data, San Francisco, Boston, Los Angeles, Washington DC and Seattle have above-median dental click costs but below-national review depth, while Denver, Austin, Houston, Dallas and Atlanta have deeper review profiles and cheaper clicks. Only New York, Chicago and Miami are above the norm on both, with New York the clear extreme.
Does this mean I should avoid a competitive city?
No. It means choosing the right channel and setting realistic timelines. In deep review markets, plan paid search while reviews build; in thin, expensive markets, invest in reviews and local SEO first and buy clicks only for high-value services.
A note on this article: it reports aggregate research and explains marketing practice. It is not legal advice, and cost figures are planning estimates, not guarantees of results.
How competitive is your corner of your city?
A free 30-minute call with the US team. We benchmark your practice against your specialty in your metro and show which channel is cheaper for you.