Speakers
Dr. Eric Kaiser
Interim Chair
Department of Intensive Care and Resuscitation
Anesthesiology Institute, Cleveland Clinic
United States of America
Eric Kaiser has been an anesthesiologist and intensivist for over 20 years working in private practice and at the Cleveland Clinic.
At the Cleveland Clinic, he has served as medical director of the 95-bed Cardiovascular Intensive Care Unit and the director of the Center for Critical Care. In that role, he developed new and novel programs to improve patient care and safety. He served as the interim chair of the department is currently the Executive Vice-Chair.
Dr. Kaiser graduated from The Ohio State University College of Medicine and completed his residency and fellowship at the Cleveland Clinic. He subsequently earned a Master of Medical Management degree from Carnegie Mellon University.
His primary areas of practice and interest are postoperative cardiac surgical critical care, mechanical circulatory support, and clinical operations.
The U.S. healthcare system has gradually moved toward mid-level providers (advanced practice nurses, anesthesia assistants and physician’s assistants) most of whom wish to practice at the “top of their license”. While this is occurring in multiple specialties, it is very apparent in Anesthesiology where CRNAs provide anesthetics with and without the supervision of an anesthesiologist or other physician.
The presence and expansion of the CRNAs has been driven by history, economics, and supply and demand. A detailed analysis of the economics may not reveal the savings that commonly appear on the surface, nevertheless there is an ever-increasing need for more anesthesia providers in light of physician shortages, the aging population of anesthesiologists and of patients who are living longer with chronic diseases.
To their credit, CRNAs have increased their educational requirements and formalized their training programs and certification over time. They have a national certifying board, a professional society, and their programs are transitioning from master degree requirements to doctoral. The result is a generally well-prepared trainee.
There is an ongoing effort for CRNAs to work independently of physicians with some success. This often is a decision made at the level of state government or by hospital policy. At my institution, we support and require the anesthesia care team model which includes an anesthesiologist and other anesthesia providers and CRNA or trainees.
Additionally, there are the unintended consequences of the increasing need for more anesthesia providers. CRNA programs draw primarily from the pool of bedside nurses which are already at critically low levels. Further, there are many nurses who enter bedside nursing solely to provide them the opportunity to progress to a CRNA program. The broader implications to the national healthcare system should therefore be considered.
