Skip to Content

The State of SEO in 2016 ... So Far.

Let's Connect!

The State of SEO in 2016 ... So Far

SEO best practices change constantly. Strategies that were previously commonplace are now considered harmful. Effective tactics employed not too long ago are now no longer enough. Search engine optimization has come to encompass so much more than what users can see on your webpage, and many are struggling to keep up. Attend this webinar for an insightful discussion about the current state of SEO as we know it. From the relationship between structured data markup and rich snippets, to the ever-increasing importance of video, to tips on how to survive a redesign or domain change, you'll learn where it's most beneficial for you to focus your efforts and how to make the most of your SEO tactics.

Video Transcription

Hey, guys, today we'll be talking about the state of SEO in 2016, so far. Emphasis on the so far because, let's be honest, at any given moment, things could change. In fact, Google has said in the past that it could be running something like 50 to 200 experiments at one time across different devices, demographics, and users. This helps them test improvements to their search functionality and how content displays on the search engine results page. By the end of the year, they'll have run around 6,000 different experiments, and all that the SERPs at the end of that year are in some way, whether large or small, different from how they appeared at the beginning. So let's dig a little bit more into that.

Layout of Google SERPs

So, how exactly have search engine results pages changed recently? Frankly, it's been a while now since the majority of what's on the results pages are made up primarily or solely of organic search results. Now, you're lucky to see an organic search result peak out above the fold, so to speak. Long gone are the days of 10 blue links presented without clutter that take you directly to the website you need to get the information you want.

That's just not so much what happens anymore. Nowadays, search engine results pages look a little more like this. You have your ads at the top, a local A-B-C pack of locations underneath, and a knowledge panel to the right.

Google's increasingly commercialized SERPs

Or something like this that's even more commercialized. You have four ads at the top, a featured snippet talking about wedding rings underneath, and paid shopping results to the right. And even this view looks different than it would have a month ago because recently, Google stopped displaying PPC ads in the right-hand column of search engine results. They now appear only at the very top and the very bottom of a SERP, excluding the paid shopping results that can appear in the right column, of course.

Google's medical knowledge panel

Even when we look at something of a less commercialized nature and more focused on healthcare, like the query "heart attack," you're still not getting that classic list of search results like you used to see. Again, you have the ads at the top, a few organic search results underneath, a related questions card below those, and a medical knowledge panel to the right. There's a lot going on here, and it has a lot of people freaking out. It's no longer enough to try to rank high organically for a keyword or key phrase. Even if you could say you ranked on the first page for this query, you're still buried far down the page underneath a news results block, which even appears below the fold, and several other organic search results.

Frankly, you might as well not be ranked at all at that point because Google has made it so users no longer need to go beyond the information Google presents to them on the search results page. If you came to this page looking for basic information about what a heart attack is, what it's symptoms are, how you treat it, what can cause you to be at risk for one, or what happens to your body when you have one, you don't need to do anything more than stay on this page to find out. You can get all the information without drilling down into any website content.

This is particularly concerning for us healthcare marketers. It was hard enough trying to compete against the likes of Mayo, the Cleveland Clinic, and WebMD when you're trying to rank for condition specific information. Now, we need to compete against the big dog of search itself, Google, and the information it's now providing users about medical conditions. Normally, the content Google places in knowledge panels is scraped from sites appearing on the first page of Google search results. Google used to create the knowledge graph content completely on its own, but realized very quickly that the knowledge people want access to was increasing in need faster than they could manually create it. So they made the switch.

What's interesting about their newer medical knowledge panel content, though, is that this is custom, manually created visual and text content from Google. After noticing that large quantities of untrustworthy junk articles were popping up when users searched for healthcare topics, Google decided it needed to be more prudent in how it presented useful information of this kind to users. So, Google struck up a partnership with a team of medical doctors, the Mayo Clinic, and other healthcare organizations and along came the medical knowledge panel.

Google partnered with Mayo for the medical knowledge panel

It first started out in a simple form, and only existed for more popular search terms. It's now started to expand in complexity and breadth. As you can see from the current medical knowledge panel on the right about measles, it's much more eye-catching in color and iconography and has more in-depth information that shows up automatically fully expanded in the right column of the SERP. As you can see in the left screenshot of a recent desktop search for measles, your eye doesn't pay much attention to the organic links. It's drawn pretty quickly to the right to read the information there as well as the related questions card midway down the main column.

And on mobile, as you can see in the screenshot on the right, you have to scroll pretty far down before you even get to non-Google provided content about your query. Google is, again, presenting users with what's possibly the only information they need about the topic they're researching right on the search results page itself.

In fact, Moz found that when you take into account all the blocks of ads, paid shopping, local packs, snack packs, enhancement, knowledge graph, verticals, and more, only roughly 3% of the 10,000 search results they sampled contained the classic 10 blue links, which is kind of scary, frankly. If people aren't finding your site in SERPs or if they are but don't need to go to your page to get the information they need, then what are we, as digital marketers, supposed to do about that? How can we continue to promote our services in a way that still reaches people?

Well, frankly, by adapting and by starting to think of search in totally different ways. Because it's not just about browsers anymore. Search is everywhere, and we need to change how we think about it to make it work for us.

A couple days ago, I got something in the mail I've been really looking forward to testing out. I don't know if it's because I work a lot with search, or if it's because I've finally given into the fact that AI will someday rule the world and my mind has decided it's okay with it. But I couldn't wait to get my hands on Amazon Echo, or Alexa, as I like to call her. And while Echo has a lot of cool features, one of my favorite games to play with it is to compare how the different ways I ask a question will either get me the answer I want or completely confuse the system.

For example, earlier in the month, I asked, "Alexa, what's the latest election news?" It recognized that as being related to the topic of politics, which it has a specialized news station for and immediately started playing for me an NPR presidential election update. I was pretty impressed, but I wanted to give it a little bit more of a challenge, so I asked, "Alexa, what were the results of last night's primaries?" Nothing. Zip. Zilch. Nada. The thing had no idea what I was talking about. Its system wasn't able to connect the idea of a primary to the idea of an election, which meant it couldn't connect that to the topic of politics and the radio station it could play for me that contained that content.

So, I quickly took advantage of the feedback section of my Alexa app and let Amazon know, politely of course, where its system wasn't able to make the connection between what I was asking for and the information it had available to give me to answer my request. Moving forward, this will help Amazon link more related topics together so its systems can answer more sophisticated questions without you having to try to rephrase your question to get the answer you want. It's all about ease and convenience.

The new focus of seo is about topics, optimizing for entities and new ways to search

As digital marketers living in an ever more complex world of search, we have to do something similar for our own web presences to make sure we're found online by those who need or want our services. We have to help the systems, and machines, and algorithms understand what our content is so they can match it more easily to user queries. It's about connecting the searcher to the information they seek, and, in some cases, getting it to them without them even having to come to our website.

We need to move away from thinking about things in terms of pages on a site, and instead, start thinking about our digital presences in terms of optimizing for an entity. We need to move away from thinking about traditional keywords and keyword stuffing, and instead, think about our content in terms of topics that contain relevant and select keywords and phrases that tie everything together. We need to stop thinking about search within the confines of a browser, and instead, acknowledge that it's everywhere and can pop up at any time in new and different formats and by new and different names. I'm looking at you, Siri, Cortana, and Google Voice Search.

Lucky for us though, there are systems we can put in place and strategies we can use to help remedy the situation to help healthcare providers and organizations pull into search results at the right time and in the right way when your users are primed to convert into patients.

So, how do we move forward in this crazy world of search that seems to change by the day, leaving us struggling to catch up? We have to give search engines as much information as possible in a way they understand it to give our digital presences a shot to show up somewhere and somehow in a search results list. And it might not be in the traditional way you'd expect, which is your website. As we've seen, there are many different ways right now to pull into search results. While it's a little anxiety inducing for some, given that it means there are fewer and fewer visible 10 blue link organic search results for us to try to populate in, it's actually something we should start to see as an opportunity. A way for those who have had a hard time in the past competing for certain terms to try new and different ways to get their content to a visible part of the page.

And part of that is focusing less on keyword stuffing, which I hope most everyone listening here has heard by now, and more on keyword and key phrase rich content focused on topics that answer user's questions. But before we get into some of the ways we can work within the reality of Google's ever changing search results pages, we need to pause and touch on something we've all heard before but that bears repeating, mobile friendly matters. Let me say it again, mobile friendly matters. And really, frankly, it's mattered for a while, but Google made it even more important when the first "mobilegeddon" hit last April, and money sites that weren't yet mobile friendly took a hit on how they were appearing in search results.

Many thought the effects of that had evened out, and the effects of that first wave really have, for the most part. But if you were paying close attention to my phrasing, you'll have heard me say, "First mobilegeddon," which can only mean one thing. Mobilegeddon 2.0 is coming. Google recently released information about the immanent nature of this second wave, and it's coming soon. May, in fact. Pages that pull into search results that aren't mobile friendly could get dinged even more than before if they don't make a shift toward optimizing their site for different devices.

Yes, mobile friendliness is still only one of the many factors that Google takes into consideration when it's deciding which sites to rank where, but that doesn't mean it's not important and that doesn't mean Google doesn't consider it increasingly more important as mobile search continues to grow. And that doesn't mean your users don't deserve a better experience when they visit your site. In fact, according to Google, 72% of users want mobile friendly sites, which makes sense given that mobile search traffic has surpassed more than 50% of total searches. Though Google, in somewhat typical fashion, has declined to release the exact number. Sometimes I think they just like to keep us guessing.

It's because of this that Google now creates its search results features for mobile users first and then adapts them to desktop instead of the other way around. And Google even runs most of its search experiments on mobile platforms first before desktop users get a hint that a change might even be coming. In this example of a desktop search for the best movies of 1983, you can see Google's focus on the mobile experience pretty clearly illustrated. On desktop, the carousel of movies released in 1983 looks awkward and juts dramatically to the right, far beyond the boundary of the main column of search results. That's because the carousel was developed with mobile users in mind.

Now, when you look at the same search on mobile, the results display much cleaner and look better organized. The screenshot on the left shows what initially pops up when you search the query, and the screenshot on the right shows the tiled layout of movies from 1983 that pops up when you click the "more movies" arrow at the bottom of the left screenshot. So, what's the takeaway here? Think mobile first. If your site isn't mobile friendly, it's time to take steps in that direction. The side effects of remaining in the past will begin to compound more and more over time. It's in your and your users' best interests to make the switch and make it quick.

Example of keyword stuffing

Now that we have that covered, and you're hopefully sufficiently motivated to make the move to a mobile friendly site if you don't have one already, let's move onto talk a little bit more about keyword strategies and topic based, high quality evergreen content. As I'm sure many of you know, keyword stuffing used to be a common ranking strategy. SEOs would try to cram as many relevant keywords as possible onto a page to try to ensure that the page would show up at the top of Google's search results lists. If you can believe it, some would even place words on the page that were the same color as the background so the words wouldn't show to users but could be read by search engines.

But Google's no idiot. It realized that content and these practices weren't valuable or created with the user's best interests in mind. Just look at this example of keyword stuffing, "We are a dog food company that sells quality dog food. Our varieties of dog food are the best types of dog food on the market. If you want to buy the best dog food available, you should buy that dog food from us." It's pretty mind numbing. And Google knew it, so it took action and updated its algorithm to reflect the importance of building great content that would get users the information they want. And a lot of sites took a hit and have continued to take hits over time as Google has made more updates to how it filters search results.

The first major update, Panda, focused on rewarding high quality content and doing away with keyword stuffing. Penguin aimed at reducing link farming and improving how SEOs write link anchor text. Hummingbird changed the game and focused on semantic search and user search intent. And pigeon centered on local search and returning relevant results within close proximity to the user. And can I just say, by the way, that it is much harder than you might think to find a cute picture of a pigeon, but back to why we're all here.

More SEOs started focusing on creating useful, evergreen content, which was great. But we've now arrived at a place where we've gone too far in one direction and need to move back toward the middle, to find a happy medium, a balance between making sure you're ranking for certain keywords and key phrases and ensuring you're answering user's queries with quality content that sounds natural.

So, what does this mean? It means keywords and key phrases aren't dead. They're very much alive and should be a part of your content development strategy, but you need to think about them a little bit differently. Instead of trying to rank for everything under the sun related to the topic of your page, try to focus and flesh out your page or section content based on what you know users want to find when they land on your site. Don't ask yourself how you can best rank for a certain search term. Ask yourself how you can best answer a searcher's query. It's all about user search intent, and it should be the focus of your website content.

Based on years and years of gathering data about how users interact with its search engine, Google has developed a pretty good idea of what users are looking for when they search for certain information, and they've made sure that their search engine returns the types of pages users seek most when searching for certain queries. Google is only as popular as its search engine is useful. If it doesn't return great results, users will stop interacting with it and go elsewhere, which would mean a huge loss of pay-per-click ad income for the search giant. It's in Google's best interests to make sure users get what they want when they visit their site.

So, if you're curious about what users actually want to find when they search certain queries, it's often helpful to search for the term yourself to see what pops up in the top results. Take the heart attack query that we looked at earlier when studying the medical knowledge panels. What can you tell about what Google things users want most when looking for information about heart attacks? Well, for one, they're probably not looking for physicians who treat heart attacks or locations to visit when having a heart attack. From what we're seeing here, Google has determined that users who search for the phrase "heart attack" are most often looking for general information about a heart attack and its symptoms.

It's one of the factors that led Google to develop the medical knowledge panels. If, when users search these terms, they're not looking for medical services, but general, quality information about the condition, why not create the content themselves? That way, they can ensure the information is accurate and updated. It also keeps users on the search results page instead of clicking away, which increases the likelihood users will interact with Google's ads leading to more money its pocket.

So, what can you glean from this information? If you're a healthcare organization that provides care for individuals who've had heart attacks, it's probably not worth your time to develop content about heart attacks with the intent of ranking highly in a SERP for those keywords. Even if users ignore the medical knowledge panel, it's still nearly impossible to beat out big websites with high domain authorities such as WebMD, Heart.org, Mayo, and the Cleveland Clinic. The chances of you popping up in search above them is slim at best.

The same goes for search terms about heart procedures and treatments. If you look up the TAVR procedure on Google, you get general information about what the procedure is, with the primary focus of the search results page centered on the featured snippet pulling in from Hartford Hospital in Connecticut. The same is true on mobile. The results returned focus on learning more about the procedure, not on seeking the services of those who provide the procedure.

Sure, it can be argued that Hartford Hospital is a facility that provides these services, and they're pulling in at the top of the SERP. However, they're not pulling into the results because they're a hospital that provides these services. Because notice there are no local services pulling into the SERP that pertain to my location in Cedar Rapids, Iowa. Instead, Hartford Hospital is pulling into the featured snippet on this page because Google has determined that text on their website best answers the query "TAVR." And that's because Hartford Hospital has developed super in-depth content on the procedure, has multiple videos about the procedure on their TAVR page, and has other pages on the site that also contain certain information about TAVR.

Building out content like that isn't cheap, and it may not be where you most want or need to spend your content development funds. Because when you get right down to it, users who search for this term aren't looking to find a TAVR doctor. They're looking to learn information about the procedure, likely after it's been recommended to them by their current doctor. So, what do you do? You focus your content on the topics that matter most to users looking for websites like yours. You focus on the services you provide and the experts who provide them.

Take this search query, for example. Instead of looking up the broad term "heart attack," we've instead searched for "heart doctor," a phrase more focused on the heart related services a healthcare organization provides to the community. We can see from these results that Google has determined when users search for "heart doctor," they're looking for information about local services that provide heart care. You get similar results when you search for cardiology, cardiologist, heart hospital, and heart care. It's more beneficial for you as the marketer for a healthcare organization to develop well-written, user focused content centered on those key terms and ideas.

Sure, it's still important to talk about heart attacks, different heart conditions, and types of procedures for the sake of giving your users comprehensive information about your services, but your content should be framed within the idea that users are searching for the services you provide and the medical practitioners who provide them. First and foremost, users want to know how you can help them, and it's in your best interests and theirs for you to talk about those things using the words and phrases they use when they're looking for you online and to do so in a way that creates high quality, long-lasting content in the process.

Conversation is king quote by Cory Doctorow

You've probably heard the phrase "content is king" many times as marketers. And content's extraordinarily important, but I think what it leads to may actually be king because it helps drive your content's focus. So instead of thinking about content itself as king, I find it helpful to think about content more in terms of how Cory Doctorow talks about it here. "Content isn't king. If I sent you to a desert island and gave you the choice of taking your friends or your movies, you'd choose your friends. If you chose the movies, we'd call you a sociopath. Conversation is king. Content is just something we talk about."

So, what you need to do as healthcare marketers is use your content to drive the kinds of conversations you want users to have about your services. And make sure you start those conversations with quality content focused on your user's needs. Good content is still of utmost importance. You just have to make sure you're concentrating on the right topics. Don't try to rank for every term under the sun just because it's loosely related to your subject. Instead, focus your content so that it drives the right conversions at the right time among your users. Your content isn't serving its purpose if it's not driving some sort of conversation or transaction that turns users into brand champions for your organization.

And thinking about your content in terms of creating and adding to the right conversations at the right times is important for other reasons, too. Namely, because it may even help your visibility in organic search results as Google begins to pull more heavily from websites to populate the content in its featured snippets. If your content is phrased in a way that makes Google think you're best answering the questions of its users, your content will get pulled into the featured snippet selections, even if you would normally appear below websites with higher domain authorities.

It's all about answering user's questions and doing so in a way search engines understand, which leads us to our next main topic, structured data. Users who visit your site can read your content and understand what it means. If they're reading a physician's profile, they understand they're reading information about a person who provides medical services for a healthcare organization that can help get them well. The same goes for how users interpret search engine results. They can see an address and its associated name and know they're looking at the physical location of a hospital.

Search engines don't always see things the same way though, and can sometimes have a harder time understanding the context of your content. Adding structured data markups, such as schema.org, to your site can help search engines categorize your data and pull it into search results in more appropriate and relevant ways, including into Google's rich snippet features. In fact, your site content isn't even eligible to appear in rich snippet features if you don't have it tagged and categorized appropriately, and that's a huge missed opportunity for your site to pull into a SERP in more ways.

It's our job to make sure we give search engines as much information as possible in a way they understand it so they can use it to populate their organic search results pages. That means moving away from thinking about things only in terms of the words on the page, and instead, shifting to thinking about our content in terms of entities, people, places, and things. In doing so, we're actually teaching search engines how to think, which is a pretty cool thought, and it's the very essence of the Hummingbird update in Google's focus on the semantic understanding of content. The more Google and other search engines learn about content and how to categorize it, the more useful organic search results will be moving forward.

schema.org physician markup in json:ld

So, let's dig a little bit more into what this structured data deal looks like on the back end. Specifically, let's look at how this translates to a provider profile page on a healthcare website. To help Google understand that the content on your provider profile page is, indeed, information about a physician who provides medical services, you can add structured data markers to the back end of the profile to categorize the content and tell Google just that. This ensures Google doesn't have to interpret the page content on its own and removes some of the chances that your content won't be understood correctly by search engines.

For example, in this case, we're telling Google that the type of content on this page is for a physician named James Davis, and that his medical specialties are osteopathic medicine and family medicine. We're also linking this information to the provider's NPI record and letting the search engine know that the information here and the information on that page belong to the same person. Additionally, we're adding other identifiers to the profile, such as calling out which content on the page is an address, detailing that the profile contains ratings information on it, and even identifying that there's information on the page about hours of operation.

Basically, what we're doing is connecting all the dots so the search engines don't have to. We're linking all the bits and pieces of related information about the provider across different types of entities, the people, places, and things that make up the provider content so Google can see it as being smaller parts of a larger whole.

So, what does that look like on the front end? This. Using the structured data markup on the back end makes this provider profile eligible to be shown in Google's search results in an enhanced presentation format, in this case, with the star ratings, and also helps the search engine better understand the content on the page. Going forward, this helps Google and other search engines and operating systems learn how things are interconnected, allowing them to return better results to you moving forward and to allow Alexa at some point in the future to finally understand what I mean when I say, "Alexa, what were the results of last night's primaries?"

But it's not just about connecting the dots between different bits of information on your site itself, you also need to connect your organization to its related data that appears elsewhere. And nowhere is that more evident than in Google's local knowledge panel. The contents of which are controlled in Google My Business. As a healthcare organization, you can appear in this local knowledge panel in one of two ways, as a location listing which you can see here, or as a provider listing which we'll look at here in a minute.

It's important that you claim these listings initially and then maintain them over time as users often don't need or want to go further than this content to get the information they seek. Because of that, it's imperative that you keep the address and phone number updated for all your listings so users don't get frustrated and move onto someone else's content.

Imagine you're on the way to a medical appointment but can't remember your new doctor's address. You look up the doctor while you're on your way and follow the directions to their office that you get from the local knowledge panel. Next thing you know, you're sitting in the parking lot of a building that looks like it hasn't had a resident in months, and why is that? Well, it's likely that the listing wasn't claimed and had incorrect information that auto-pulled from an inaccurate website somewhere, or it's also possible that the listing was claimed but hadn't been updated in a while and that the address that appeared in the listing for the location had relocated months ago.

Nowadays, your offsite content is just as important as your onsite content. Same goes for providers. It's important to keep your provider's Google My Business information updated so their contact information and location data populate in the local knowledge panel correctly, helping your provider's patients more easily connect with them when they need it.

Here, the example on the left is a claimed listing, and the address listed here matches the address for that provider on the doctor's official profile page. Whereas, the provider listing on the right is unclaimed, and the name of the location where this provider is located doesn't match the doctor's official profile page. Additionally, the name is written in the wrong order, and the way it's written doesn't follow Google's latest policies for how organizations should display physician names in a local knowledge panel.

Even though it's a more laborious process to individually claim all of your provider's local listings and keep them updated, keeping this information accurate is an important part of the user experience and well worth the effort. Speaking of user experience, there's one area of online engagement that's almost universally frustrating to users, page load speed. Aside from non-mobile friendly web pages, there's almost nothing more likely to cause a fast bounce from your site. Users are impatient and don't like waiting for content, and that's especially true for mobile users.

Social media creators like Facebook and Snapchat know this and have already developed ways to provide mobile users with quick access to the content they want through services such as Facebook's Instant Articles and Snapchat's Discover. And now recently, Google has joined the game with AMP, or Accelerated Mobile Pages, to change the way mobile users interact with their search results page. And while it's still in its infancy, it bears mention here as what the future of mobile search may look like and already does look like for some. Though, that some apparently isn't me because for the life of me, I couldn't get my cellphone to display an AMP result so I could show you a screenshot of it in practice. So I'll have to instead go with giving you a little information about what it is and what to look out for moving forward.

AMPs are basically fast-loading versions of media pages on your website created with AMP HTML developed by Google. Google then caches the content marked with the appropriate tags so it's able to access the information more quickly for mobile users and display it at lightning speed. In fact, Google has said the load speed can be up to four times faster than the normal page load speed for non-AMP pages. While Google's AMP project is still in its infancy, it's poised to expand to other types of website content in the not too distant future. So it's definitely something to keep on your radar as you develop content you think might be eligible for AMP labeled search results sometime soon.

Another type of content that's had ever-expanding importance in recent years is video, and there are things you can do to make your videos work even more for you when it comes to a Google search results page, mainly through the use of structured data markup and video site maps.

I'm sure many of you have seen Google search results like the one here that contain called out videos from sites other than YouTube. Content creators, such as ESPN, are using video as yet another way for them to appear organically in search results pages and drive more traffic to their sites. And as a healthcare marketer, you can too. All you need to do is make sure your content is eligible to appear in organic search results in an enhanced format.

And to do this, ensure your videos are tagged with the appropriate markup so Google can understand your content and pull it into search engine results appropriately. That includes providing Google with an XML video sitemap of all the videos on your site, as well as tagging your videos with structured data that give Google the title, description, and thumbnail for your video. Once Google has this information, your video content is eligible to appear in Google search results in an enhanced manner. This could be a particularly handy tool for healthcare websites that feature physician bio videos and could allow those videos to appear in search results when users look for your physicians online.

There's no guarantee that including the proper markup on your pages will pull your videos into search results, but one thing's for sure, your site isn't even eligible to appear in results in this manner if it doesn't have the markup. So it behooves you to move in that direction so your site is eligible to appear in as many ways as possible in a search results page, which is extremely important as different types of content continue to push organic search results further down the page. While PPC is clearly not in the category of organic search, changes to the pay-per-click landscape are worth calling out here, so you're aware of how they could affect your appearance in search and how you can limit their effect on your content's visibility.

Approximately one month ago, as I mentioned before, Google removed all instances of their PPC text ads from the right sidebar, and initially you might think that sounds great. Less cluttered pages have to be a good thing, right? Well, yes, but also no if you're trying to rank toward the top of the page for an organic search term because when Google removed their right sidebar ads, they also added more paid results to the top and bottom of the main column, increasing the number of ads that could appear there.

And while the number of ads that populate at the bottom of the page might not have that much of an effect on you, the four ads now appearing at the top of the results certainly can. As you can see from this SERP example, the four ads that appear at the top push even the local search results below the visible part of the page. This means your content is getting buried even more than it was in the past underneath various kinds of search results enhancements, and it means you have to try extra hard to appear in a spot where users can find your content.

This is true even more so when you take into consideration that Google's now testing, on a limited basis, adding more white space padding in between ads at the top of the page. As you can see here from this screenshot example that appeared on the SEM post. This pushes organic results down even further, in this case, only allowing one non-paid result to appear in a visible spot.

So, what can you do? For one thing, it's worth examining your PPC strategy to see if there are certain search terms that might necessitate you buying a presence in the SERP rather than crossing your fingers and hoping your content appears near the top. It also shows the continued importance of making sure your content is appearing, and appearing correctly, in Google's local search results. As in many cases, that content will appear first, before the 10 blue links type of content if there are local services associated with a query.

This recent shift in the placement of PPC ads, the appearance of AMP search results, and the ever-changing types of enhanced snippets that allow your content to pull into search results, show how important it is to try to roll with the punches that Google keeps throwing our way, and accept the fact that things might change in a way that causes you to completely rethink your organic and paid search strategy. A recent example of this was when Google stopped pulling into search results the enhanced star ratings that web marketers had been working hard at getting to appear alongside their organic search results. It's an understatement to say people freaked about it, a serious understatement.

As you can see from the Moz graph, the appearance of review stars in search dropped dramatically over the course of several days, and for no apparent reason. What in the world were we, as digital marketers, supposed to do about this shift given how much we'd been touting the importance of ensuring your ratings appear with your search results snippet? Well, after days of digital marketing panic, Google released a statement that basically said the drop in the appearance of the star ratings was a glitch in their system and that they were working to rectify the situation. And as the Moz cast graph shows, the visibility of this enhanced SERP feature quickly made its way back up to its former saturation presence.

Even though the removal of this feature was an accident, I think it gave us all a real glimpse into how much control Google has over how users find and interact with our search results content because really, Google rarely stays the same for long. It's constantly evolving to meet the needs of its users, and let's be honest here, to find new and improved ways to make money from its SERPs.

What does this mean for you? It means you need to continue to focus on creating high quality content that meets users' needs. Google will always, at least as far as I can tell, need to provide users with answers to their queries, and right now, they need our content to do that, so take advantage of it while you can.

Right about now you're probably thinking, "Well, that's all well and good. Thank you very much for overwhelming me with all of this information and scaring me, but what do I do now? What are the most important things I can start doing to help increase my SEO success as quickly and as much as possible?" Well, there are a few things actually, and while I hit on many aspects related to the state of search in 2016 in our time together today, there are a few areas where I think it's most worth your while to focus your efforts.

One, remember that optimizing your site content for search is more important than just optimizing the pages on your site. You need to optimize for and across entities and provide Google with the structured data markup it needs to better understand your content. This helps it appear more robustly in search engine results.

Two, keywords and key phrases aren't dead, but you should implement them with care and precision. Instead of focusing on ranking for certain keywords just because it's loosely related to your topic, instead, create high quality content that's aimed at answering the questions of users seeking out your website. And that may mean focusing less on ranking for condition specific terms and more on ranking as a top healthcare service provider in your area.

Three, claim and maintain your local search listings though Google My Business. More and more users never move beyond the search results page. Ensure that your content that appears there is accurate and represents your organization as best it can.

Four, reexamine your PPC strategy. Because of the many changes in recent weeks to how ads populate in search results and the changes in how Google provides users more and more with their own curated content around medical information, it's worth revisiting where you spend your ad dollars to make sure you're aiming them in the right direction and getting the most from the money you spend.

And finally, number five, ensure you follow the proper steps when you change domains or redesign your site. It's not easy to build up domain authority and a great reputation with Google, so when you have it, for the love of God, make sure you don't lose it. This means that when you redesign your site or change domains, you need to make sure you're properly redirecting links, reconfiguring your domain, informing search engines that your content has moved, resubmitting your site map, and updating external links that lead to your content. For more information on this topic, there's a handy infographic on the Geonetric website that lays out the specific steps you need to follow to make the process as painless as possible.

And, that's pretty much it. Thanks for sticking with me today through all that and letting me sufficiently scare you into finding new ways to improve your SEO strategy. I'm happy to answer any questions that you want to throw my way.