Building Back After Katrina

Oct. 1, 2006
Part 2 of a series on Dr. Martha Carr

Part 2 of a series on Dr. Martha Carr

WRITTEN BY Cathy Jameson

This series is not only a story about Hurricane Katrina victim Dr. Martha Carr, of Mandeville, La., and her comeback with help from Cathy Jameson, CEO of Jameson Management, Inc., and Consultant Julie Hanson, but it is a guideline for anyone seeking insights on:

proven methods of practice development that are valuable to any practice;

how to handle challenges, no matter how many and how great; and

how to prepare for disaster.

Financial protocol

Knowing that many of Dr. Carr’s patients would be in financial straits, Hanson and I advised Dr. Carr to get involved with CareCredit, a patient-financing organization that agreed to waive all fees for Dr. Carr. She did it immediately, and CareCredit provided her with complimentary training. This financial option allowed Dr. Carr to receive payment immediately for the treatment she provided. In addition, it was important that she avoid carrying accounts on her books. She had to generate cash flow.

Dr. Carr had paid her team’s salaries with her credit cards so they could afford to work with her. This, along with her office being closed for several weeks and having no cash flow, put her in financial difficulty. We had to focus on financing immediately.

CareCredit also helped patients in the area who were trying to put their lives back together. Dr. Carr and her team learned how to present patient-financing options, overcome objections, and build their practice using the service.


One of Dr. Carr’s sources of stress was going so far into debt trying to preserve her practice, pay necessary bills, and pay her team although there was no income within the practice because of the hurricane’s devastation. The next step was to organize her payable system.

Dr. Carr identified every bill that was due.Then, each month, she paid something to everyone. She contacted each vendor to rectify her debts.

Once she paid off the smallest bills, she used the amount she had been paying on those to increase her payments on another debt.

I advised her to negotiate with credit card companies for lower interest rates and to even consider taking on some of the 0 percent interest-rate credit cards that could chip away at the principle instead of interest. Dr. Carr took out a home-equity loan and tried to readdress her personal financial situation with regard to low interest rates and an overall budgeting plan.

She hadn’t set up an emergency fund, so Dr. Carr accumulated difficult debt. She knew that getting out of debt would be slow because so many of her patients had evacuated and now had needs greater than regular dental appointments.

Hygiene retention

Dr. Carr’s hygienist did not return after she evacuated, so another hygienist replaced her.Even though the doctor’s schedule wasn’t full, we wanted her to be available for emergencies and restorative care. We encouraged her to hire the new hygienist, and then, we helped build the hygiene retention program.

Dr. Carr needed to secure as many patients as she could. It was difficult to find many of the patients because so many had evacuated. In addition, there was no telephone communication, so all attempted correspondence had to be done by mail. Nevertheless, people responded. They filled the hygiene schedule and even created a need for more hygiene days in the schedule.

Emergency patients

We encouraged Dr. Carr to be in the office even though she might not have many patients scheduled for a particular day. We said, “You never know when the phone might ring.”

She had so much time that she could spend quality time with each emergency patient, take great care of each, and convert many of them to “forever” patients.

In addition, she placed an ad in her local newspaper announcing that she was open for care and available to see regular patients and evacuees who might be displaced from their normal dental homes. The response was impressive.

Charging in times of need

Dr. Carr felt guilty charging people, but she learned that charging is a must. While dentistry is in the health care field, she came to realize the importance of maintaining a business, too. If you don’t run a smart business, you have to close your doors. Then everyone loses. Charging a fair fee for your service is part of running a smart business - you must charge to ultimately meet their needs.

She had the right to reduce her fees when she thought it was appropriate, but she realized that she must charge for her services.

“Julie did an analysis of my fees,” Dr. Carr said, “and found that some of them were at the 20th percentile nationally, so she helped me understand what just increasing to at least the 40th or 50th percentile could do for the practice.”


We recommended that Dr. Carr advertise regularly in her local newspaper and stay in regular contact with her existing patients. She placed an advertisement and sent a special mailing to her entire patient family as a Thanksgiving newsletter. She wanted to let everyone know that the practice was open. Plus, she emphasized the importance of preventive care and reinforced the value of a professional dental cleaning and oral-health evaluation. In addition, she offered a 50 percent reduction on tooth whitening.

She was surprised at how many people called and scheduled. The response was so great, she had to buy new supplies and make more time available. Cash flow became more comfortable and some previous patients came back, at which time she encouraged them to stay involved with the hygiene program.

She placed “address correction requested” on the outside of envelopes so she could know whether people were leaving for good or planning to return. Then she sent another letter at Christmas, again offering a 50 percent fee reduction on tooth whitening. She had thanked everyone in November for their support. Turnover issues, however, postponed Dr. Carr’s goal of sending another letter expressing thanks and giving patients teeth-whitening discounts during the holiday season.

“I lost my front office person of nine years right at Christmas,” Dr. Carr said. “Then, we found out that my long-time assistant was moving. The job market in the post-Katrina area is very difficult.Prior to Katrina, we could have placed an ad in the paper and gotten a quick response. Post-Katrina, we placed an ad for front office and got one response. My hygienist ended up taking that position. Then, at the end of April, we placed an ad for our assistant, but ended up having no time for on-the-job training with my experienced assistant.”

So, the third mailing became a spring letter that Dr. Carr finally sent in June because of the turnover and training adjustments. Repetitive mailing proved to be crucial, and Dr. Carr believed what we told her, “The last thing you want to do, even in a cash crunch, is stop marketing.”

Dr. Carr says it’s true. “I felt that I needed to batten down the hatches financially and save all my pennies for paying bills rather than take additional marketing hits, but mailings definitely paid for themselves.”

Case acceptance

In addition to getting patients in the door, the entire team had to have excellent case-acceptance skills to encourage patients to proceed with presented treatment and maintain regular hygiene appointments. Hanson coached the team so more patients would accept treatment. Because the office used CareCredit, patients could finance the dentistry without being financially stressed.No one needed any more stress.

Team building and training

Not only is Dr. Carr preparing for the birth of a baby in the fall, but dealing with the multiple team member turnover issues that developed required flexibility and focus.

Now, with a new hygienist, new assistant, and a hygienist who became the business manager, Dr. Carr has adapted to what feels like an entirely new team.

To be continued

We will continue to report on Dr. Carr’s progress in upcoming issues. Please keep her and all our fellow Americans who continue to recover from Hurricane Katrina in your thoughts. Each of us will face trauma in our lives. It is with a positive attitude, faith, loving friends, and family that we recover. Perseverance is critical. When we face our challenges and work through them, we are stronger on the other side.