You are being chosen on evidence you didn't put there
A patient picking a practice compares four of you in about six minutes. Same hero photo, same list of services, same “gentle, caring team,” same new-patient special. Nothing in that comparison is about you, so they decide on whatever is left: the star rating, the distance, and whether somebody answered the phone.
That’s not a marketing problem you fix with more ads. Paid traffic into a site that looks like everyone else’s just raises the cost of being indistinguishable. And the reviews that actually decide it are being left — or not left — because of what happens at the front desk, which no agency touches.
The practices that pull ahead do one thing differently: they give a stranger a reason to believe them before the first call.