At one time or another, most practitioners will experience one or more of these marketing conundrums. Here are my ideas...published mostly to spark yours. Hope it's helpful.

1. “We’re a small new clinic and don’t have the budget to compete with the established practices…but we know that we’re good at what we do.”
While most of us need a website designed for good lead generation, you may not have the money for that right away. Eventually you have to bite this bullet financially and create lead generation systems that center around your website, so create a savings account for your website and make it a short term goal.
At the beginning of your search for patients, however, your marketing can be done on a very low budget. Giving talks, writing articles and blogs on a Wordpress or Blogger page, Tweeting and creating a Facebook Fan club, or volunteering with groups of people in your community cost you nothing but time, which at the beginning of your practice you probably have more of than you’d prefer!
Brochures can be purchased cheaply or created and printed out on your color printer in small batches for a few cents apiece.
Do spend the $50+ it costs for 1000 nice business cards and don’t go anywhere without them. Remember that the ability and willingness to talk to anyone and everyone about what you do and to hand them a card with a smile is some of the cheapest and most effective marketing you can do.
2. We've been in business for awhile and never done much marketing before. With expanding local competition, we need to implement some kind of marketing plan. We have some budget for this but don't know where to start.
Regular marketing activities must be built into your schedule. In other words, make appointments with yourself, write them into your calendar, and keep them no matter what.
What will you do during those appointments? Start with creating a description of your perfect patient (musicians, climbers, golfers, lawyers, mothers with babies, people who want facelifts, etc.). Where do these people hang out? What publications/blogs might they read, what clubs to they join, what websites do they frequent, where do they volunteer? Whatever the answers to those questions are should suggest the first steps in your marketing plan.
If you can speak or if you can write or if you like to play golf or play music or climb mountains, do those things for and with the people who are your “perfect patients.” Each appointment with yourself represents time to write those articles, participate in those clubs and volunteer activities, make phone calls to organizations needing speakers, create a blog and the subsequent required Twitter and Facebook and LinkedIn posts to make those posts more widely read, find and sign up for a Health Fair booth (and create the plan for that event), or write a brochure about your specialty or a script for a short video on that subject for your website. Keep track of which activities actually produce patients and do more of them as much as possible.
3. We have more & more competitors popping up and grabbing our patients…and making it hard to distinguish our clinic from the competition.
Write down a list of all the ways in which your clinic, services, and skills are different from everyone in a 10-mile radius. Have you been in practice for many years? Do you have an easy-access parking situation? Are you on a bus line? Do you offer a specialty in your practice? Do you have a brilliant bedside manner? Do you have a children’s play area, great research files for your patients, offer classes, dietary counseling, free reflexology before treatments? What else? If you cannot think of anything, write a list of how you’d like to distinguish yourself and what it would take to make that happen. Then, when you do public talks or write marketing copy for your website and brochures, emphasize these differences. If you want your current patients to know every way in which your clinic is different from others, make a small “Did You Know?” poster or flyer and post it in the bathroom.
Finally, I suggest stronger follow-up with patients such as bonding calls or emails with new patients, improving your patient education materials, and working on all the free/not free materials you offer to prospective patients on your website.
4. We’re getting killed on price by new, young practitioners who are offering lower priced services.
Remember that many people don’t make decisions about their health care based on price! Studies done on almost any type of product show that people do not usually go for whatever is the cheapest; they go for what feels like the least risk. How do you lower people’s risk? First, by doing the best professional work that you can do, day in and day out. Second, by participating in your community because people like to buy products and services from those they know and trust. Third, by running your office like a well-oiled but human and humane operation. Fourth, improve the lead generation and follow-up systems on your website (another blog coming soon about this aspect of marketing.) Finally, make sure your patients know you want and appreciate their referrals. You can even put a short statement on the back of your card that says something like “The greatest compliment you can give me is the referral of your friends and colleagues. Thank you for your business.” Then charge what you need to charge to live your life both with integrity and with fairness to yourself.
5. We’ve spent a ton of money on advertising and marketing, but don’t seem to be getting much bang for the buck.
Remember that few of us choose our healthcare providers based upon ads in the paper. It is a far more effective strategy to give talks, teach classes, write articles, join organizations, be a volunteer, or even start a blog and work on connecting it to your website or building a Facebook Fan Club. Such activities make you a de facto “expert” and are far more likely to bring you patients than buying ads.
If you want to spend money on marketing, spend it on building a really well-designed website with good search engine optimization, easy to use opt-in and interesting "entry points" for people to communicate or interact with you. List yourself on every web-based marketing on every health-provider listing service you can find..that's a better expenditure of your money.
For many more ideas on marketing your practice, see Points for Profit: The Essential Guide to Practice Success for Acupuncturists by Honora Lee Wolfe, Eric Strand, and Marilyn Allen, from Blue Poppy Press as well as lots of archived blogs by me right here at www.bluepoppy.com.