If you wanted to find a doctor in 1975, you asked your neighbor. Or maybe you flipped through the Yellow Pages.
What you almost certainly didn’t do was read through reviews, scroll through Facebook, or click on a sponsored search result.
For Nurse Practitioners building a practice today, it’s worth understanding where healthcare marketing came from, because the fundamentals haven’t changed as much as you’d think.
They Refused to Advertise
For most of American history, healthcare marketing didn’t exist.
Because the one organization with perhaps the greatest influence in shaping US healthcare considered it unethical.
The American Medical Association’s (AMA) first Code of Ethics, established in 1847, explicitly condemned advertising as “derogatory to the dignity of the profession.”
Physicians who solicited patients publicly were lumped in with snake oil salesmen who plastered newspapers with claims of miracle cures.
The AMA was drawing a clear line: we are not them. A physician who advertised was, by professional consensus, placing himself in questionable company.
That stigma has persisted for over a century and continues to influence how healthcare providers think about marketing today.
While the AMA revised its Principles of Medical Ethics in 1957, it still considered soliciting patients unethical, and physicians who violated the norm risked censure and professional ostracism.
The prohibition wasn’t merely a guideline; it was a cultural identity. Medicine was based on public trust. It was not a commercial transaction, and advertising would have implied otherwise.
What finally ended the ban on advertising wasn’t a change of heart, but a lawsuit.
FTC Intervention
In 1975, the FTC accused the AMA of restraint of trade, arguing that the advertising ban was anticompetitive.
By 1982, the Supreme Court agreed, and almost overnight, the very rule medical professionals had followed for 135 years became outdated and no longer matched the law.
But adoption was slow at first.
Many physicians remained personally resistant to advertising, viewing it as beneath their professional standing.
The first to change were hospitals, driven by the rise in for-profit competition and managed care. Another factor was the steady increase in patient involvement in making their own healthcare choices.
How Practices Grew
So, how did small practices start and grow before advertising as we know it today existed?
They had only a few channels at their disposal, which had to do most of the heavy lifting.
Interestingly, most of them may look familiar to you.
Word of Mouth
In a pre-Google world, a provider’s reputation traveled through personal networks.
Neighbors talking over the fence, coworkers recommending a specialist, or a family member sharing a trusted name.
For smaller practices, reputation was everything.
A provider known for competence, kindness, and accessibility could build an entire practice through referrals alone, especially in smaller towns where relationships often spanned generations.
Physician Referral Networks
These networks were the most formal marketing channels at the time. Primary care providers referred patients to specialists they trusted, and specialists would refer back to providers if someone needed one.
Those relationships were built over time through hospital privileges, medical society memberships, and professional familiarity.
A new provider in town would visit local practices, introduce themselves, and build personal rapport that would eventually lead to referrals.
These networks took years to build and couldn’t be easily replicated by competitors.
Yellow Pages
Before Google, patients turned to the back of the phone book to find healthcare providers.
A display ad, not just a one-line listing, could successfully set a practice apart from others.
For many smaller practices, the Yellow Pages functioned much like a Google Business profile does today. These ads were more condensed, listing the most important details about a practice.
Pre-Internet, practices were built by speaking at various clubs, sponsoring a Little League team, giving public health talks, writing a newspaper column, or volunteering at a health fair.
Community Involvement
While none of it looked like advertising, it accomplished the same thing: building trust and visibility.
Interestingly, this mirrors closely what we now call content marketing. While the channel may have been different, the goal was the same.
Traditional Advertising Joined the Mix
Once healthcare marketing gained greater acceptance, local newspapers became the go-to for announcing new services or locations for a practice.
Direct mail campaigns, including flyers and postcards, grew in popularity for wellness reminders and educational materials.
Radio was used effectively for elective or cash-pay services, such as dentistry, chiropractic, and vision care.
Billboards and signs were also used successfully. A well-placed sign near a busy intersection or hospital was its own form of raising awareness and trust.
Why It Matters for NPs Today
The digital era may have transformed how marketing is done today: the channels, the volume, and the targeting.
However, as you may have noticed, the underlying dynamics are essentially unchanged:
- Patients seek trusted recommendations
- Providers compete on reputation, and
- Good provider-patient relationships drive referrals
For NPs and other providers alike, knowing this history can be useful.
It points out that the practice that did well before the internet did so by becoming respected, visible, and a trusted member of its community.
And the same applies today, even though it may be through participation in new community events and organizations.
- The Yellow Pages? Your Google Business profile is the new Yellow Pages.
- Your patient reviews are the new word of mouth.
- Your LinkedIn article or community health seminar is the new newspaper column.
- Sending coupons via direct mail is the new Facebook marketing.
While the internet and social media may have replaced the neighbor’s fence, they haven’t replaced what the neighbor said. Your neighbor telling you, “You can trust this provider; they really listen, they took good care of me,” is still what drives everything.
Building a successful, thriving practice has always started with earning trust. The tools may have changed, but the foundation hasn’t.
How do you feel about marketing your practice? Love it, hate it, or somewhere in between?
Let us know; leave your comment below.
By Johanna Hofmann, MBA, MAc., regular contributor to the NPBusiness blog and author of “Smart Business Planning for Clinicians.”