I have just finished doing 25 account optimizations for dentists and doctors for one of my clients. What I found was that by dropping the cost per click and moving the advertiser to an average setting of 4 to 7, we were able to nearly double the number of clicks and nearly triple the number of impressions.
Everyone wants more clicks, but are you willing to trade a bit of page placement to get them. Ego can force many advertisers to overpay Google AdWords in the effort to own the top spot on the results page. What I have found is that conversions are not typically ad position sensitive on AdWords. This is not the case on Yahoo where position does seem to impact conversions.
It is very important to note that on all of the optimizations we did for the doctors and dentists not every account reacted favorably to the changes, but over one half of the accounts and more likely closer to two thirds did experience improved results.
So don’t leave cash on the table for Google to take and pocket, make a careful and thoughtful review of your account and then review again periodically. Advertiser come and go on AdWords so the price that you pay is dynamic and will change over time and based on the season.