The agency says it brought in your new patients. The front desk isn't so sure. The report counts clicks and form fills and stops before anyone asks whether the patient booked, showed up or paid.
Meanwhile a typical practice buys its website from one company, call tracking from another, reviews from a third, email from a fourth, and a dashboard to stitch them together. Each bills monthly. None of them reads your schedule.
A DSO multiplies it. Locations run different practice management systems, budgets are split without knowing which ads bring patients, and every acquisition adds another vendor. Inside the 50+ practice DSO we work with, that was seven systems and no single view.
Each vendor answers for its own piece. Nobody answers for the patient.