The return on investment for marketing, especially healthcare, can not only be difficult to measure, but also difficult to track. It may be a year or more before the payoff occurs. In a competitive market it is essential that your name be constantly in front of the public and physicians.
But does it have to be high dollar? Yes and no. For a formal program , the effective "dollar" amount is typically in the $150,000 and up range. One program that I worked with spent $1 million a year just on one program to a rural market of 750,000. Another program spent $3 million in one year with a new competitor entering the picture. Another program capitalized on the name by hiring several people to create "touch" or contacting marketing.
I believe that many persons in your market can name you as a health care provider, but adding the personal touch and creating the relationships with physicians, payers, and the public will be the new decisive model.
Next level of marketing to be combined with personal touch? e-healthcare. Check out this web site for some ideas: http://www.strategichealthcare.com/