Questions on SEO

Small therapy practice I helped get setup...not great but it works. Hits 5-10 referrals a month thru the website.

My question is with a limited budget do we focus on local SEO GMB...or start to clean up the website the tags and technical optimization?

The budget reality is 3 to 4k a year is all that's in the budget for this...if a 3rd therapist comes on then 5-6k is what the budget goes to.

Thoughts or suggestions? We tried low hanging fruit initially...but how do you get to page 1 or 2 vs national companies or hospital systems ranking for therapist near me or therapist city name? You gotta go where the searches are at...

Any advice on general direction I should be looking? I keep hearing horror stories of seo work just not delivering.

Thank you for your time.