Throughout her life, Dr. Michelle Krause has always felt the pull of caring for others. As a girl, she knew the responsibility of helping look after her younger siblings; as a medical student, she focused her attention on choosing a specialty that kept her at the bedside. And even as she has moved up the leadership ranks at the University of Arkansas for Medical Sciences she still makes rounds to remind herself what matters most in medicine.
"I think you really have to be true to yourself and I really like taking care of patients," she says. "That's why, I think, I really like being where I am. I've been very fortunate that people allowed me to advance in a career doing what I like. I don't know if everyone has that same experience."
To understand how important caring for the sick directly is to Krause, one needs only look at the remarkable events of 2020 and the onset of covid-19, when she was put in charge of UAMS' clinical efforts regarding the pandemic. It was a monumental task that dominated two years of her life.
"They were long days; we would not go home, especially during the testing and the vaccines until everyone was done," she says. "Long days every day. It was a commitment, but it was one we had to make."
Back then, Krause could have been forgiven for shedding the patient load portion of her responsibilities or even now, with her latest promotion to interim chief executive officer of UAMS Medical Center and senior vice chancellor for UAMS Health. But, she says, retaining the ability to continue face time with patients was and is non-negotiable.
"I still see patients every week and even transitioning into this role, as I have taken on more administrative responsibilities, I haven't stopped that clinical practice," she says. "I really like taking care of sick people. Previous CEOs have not maintained a clinical practice, but that's not something that I'm going to follow. I need to be true to me and true to me is taking care of patients."
"I have known Dr. Krause from her time as a nephrology fellow at the University of North Carolina," says Dr. Cam Patterson, UAMS chancellor. "It was clear then that she was a leader who could get things done. She leads with firm but non-demonstrative authority. She always seems to solve the most difficult challenges, no matter how tough. She has a can-do attitude without ever making anything about herself. That inspires the rest of our leadership team at UAMS to be our better selves."
IT RUNS IN THE FAMILY
If anyone was destined to be a doctor it was Michelle Krause, following in father Dr. Fred Whittier's footsteps right down to specializing in nephrology. She also gained medical genes from her late mother, Joan, a nurse who died of ovarian cancer when Michelle was 5. The loss bonded the future physician and her three siblings, one older sister and two younger brothers.
"After my mother's death, we realized that we had to rely on each other," Krause says. "I think my sister and I grew up very quickly. Did a lot of household chores, tried to make sure the boys were ready to go to school, just kind of keeping everything together.
"I do think we had core family values and a very traditional upbringing, but different in some respects because of the loss of my mother."
Adding to the us-against-the-world-mentality was the family's changing scenery. Krause would live in several locations growing up, as Dr. Whittier took advantage of career opportunities in Kansas City; Columbia, Mo.; Morgantown, W.Va.; and finally Canton, Ohio. Despite the many moves and demands of his job, Krause's father actively kindled her developing interest in medicine.
"He would round on the weekends he was on call," she says. "A lot of times he would take me with him. We didn't have the same patient privacy or visitor policies that we have now. [My father] knew I was interested in medicine, so I would just sometimes go round with him in the hospitals and it'd give me that little exposure."
Krause attended the University of Cincinnati for her undergraduate and medical school, then matched to the University of North Carolina for her medicine and nephrology residency and fellowship training. As that training approached its conclusion and she began to think of her next move, Little Rock was nowhere on her radar. That is, until a chance meeting of colleagues at a national convention.
'I HAVE THIS PERSON'
"My division chief at Chapel Hill met up with Sudhir Shah, the division chief at UAMS at the time," she says. "My division chief said, 'I have this person. Are you looking for somebody like her?' He's like, 'I'm looking for somebody exactly like her.'
"I met my boss in San Francisco and he's like, 'I found you a job, but I will not tell you where it is.' I showed up the next morning for breakfast and I met Sudhir and it was just very comfortable. I was like, 'Little Rock, Arkansas? Arkansas?' He's like, 'You've got to come out for a visit.' I came out here and I'm telling you, it felt like home. I just walked in, the doors were open and people were friendly."
Krause's family was against the idea and almost talked her out of it. But when Shah called for an answer, she went unexpectedly with her gut.
"Sudhir called me and he was like, 'Well, what do you think? I'd like to offer you a job,'" she remembered. "I generally stick to my decisions, and I had prepared myself to say no. But on that phone call I said, 'OK, I'll take it.' Shocked myself. Didn't talk to my family for weeks. Couldn't tell them. Then I just came here and stayed. Very crazy. Very not me.
"What surprises me all these years later is how fortunate I feel that UAMS took a chance on me. I wasn't planning to come here. But I think if I would have gone anywhere else, I wouldn't have stayed the 21 years I have and really loved every minute of every day, for the most part. This just seemed to be the place for me to call home."
HELPING THE CRITICALLY ILL
In joining the UAMS nephrology department, which deals with disease of the kidneys, Krause joined an already stellar team of specialists from administration down to the front lines. Nonetheless, she made an immediate impact in bridging the gap between research and patient.
"Nephrology was very, very strong when I joined," she says. "The core group of nephrologists when I came here were really science nephrologists working in the laboratory, doing that kind of research. I helped move it toward the patients and took it out of the laboratory and allowed us to participate in clinical trials both on a local level and on a national level. That way, we could test things to try and see if we could improve the care we gave patients who had kidney failure or who were at risk.
"We also looked at therapy changes, medication, things you could do to support patients who had chronic kidney disease or dialysis to see if we could improve their survival. The focus of the research that we were moving into at that time was looking at slowing the progression so someone didn't end up on dialysis or, if they had kidney failure, how we could help them live longer."
The job also fulfilled her long-held desire to treat critically ill patients, as kidney ailments are often the direst conditions a person can have.
"When you look at people's labs or things about them dealing with kidney failure, most everything is abnormal," she says. "That can be very scary because it means they are really sick. But I enjoy working with very sick people. That's where I think my talents lie."
Krause's commitment to the most gravely ill earned her the admiration of fellow physicians, such as Dr. Steppe Mette, who preceded Krause in her new roles.
"Dr. Krause is an exceptional physician because she is able to integrate her phenomenal medical knowledge with the pragmatism of patient care while bringing the human touch to every patient interaction," Mette says. "She does not waver from bringing evidence-based knowledge to patient care. This commitment to the science of medicine is balanced with her utter attention to having her patients in the center of the care team's focus.
"I have a high regard for Dr. Krause as a physician, as a health care leader and as a person. She knows what is important and what is not, how to prioritize, and the importance of self-care to maintain resilience as a health care professional. I deeply admire these traits, ones that will make her successful in any endeavor she undertakes."
Krause says her specialty differs from others for its relatively slow pace of curative innovation compared to other medical areas. Whereas technology has equipped specialties such as cardiology with pacemakers and even artificial hearts, such is not the case in nephrology.
"I wish that I could say that the advancement of the treatment of kidney failure has changed in the last 30 years, but we still have patients on dialysis and we still have patients who get transplanted," she says. "Dialysis was widely offered to patients in the early '70s and we're basically doing the same therapy today. We may have slowed some of the progression, but we haven't found a cure yet.
"The kidney is very complicated; it does so many different things in the body, regulating almost every electrolyte, a lot of hormonal effects, a lot of effects to the body that we probably don't even know. Where we would do better is to prevent the kidney from ever failing, but that takes a lot of effort on an individual's part to control diabetes or take medicines they may not like for high blood pressure and things like that."
LEADING THE COVID-19 TEAM
The onset of the covid-19 virus made kidney patients' prognosis, as with all gravely ill people, that much more complicated. This helps explain why, despite her already heavy workload, Krause was willing to step to the forefront at a challenging turning point in medical history.
"I was asked to lead the clinical covid response the moment we had our first patient," she says. "That included the level of care we were going to provide in our ICU and our hospitals, the correct way of putting on PPE and helping devise a testing platform both here at UAMS and throughout the state."
The pandemic tested everyone's mettle in health care, but despite the titan challenges of serving patients, protecting staff and educating the general public, Krause distinguished herself amid the chaos. Under her calm, steady leadership, a system of drive-thru triage was developed as were service line responses including a mobile testing program, vaccine clinics and monoclonal antibody therapy.
"The big one we developed were the vaccine programs," Krause says. "We went everywhere. We offered it to everybody who qualified when there really wasn't another option, especially early on."
"Michelle is an empathetic and caring physician," says Sandra Meredith-neve, UAMS senior nursing director. "I have seen her go above and beyond for her patients and employees. During the covid pandemic, she didn't hesitate to put on her scrubs and PPE to work in the triage drive-thru evaluating and treating patients.
"When we were struggling to manage all the employees who were on quarantine, she actually spent hours calling them to get an update on their health status. She became incredibly concerned about one employee she contacted in particular, so she ordered and arranged for the employee to have labs drawn and then followed up with appropriate medical interventions for them."
PROTOCOLS AND PROCEDURES
Krause says the knowledge gained during 2020 and 2021 has resulted in new protocols and procedures that are paying dividends for UAMS across the board.
"Covid showed us as an institution how to excel in a very unstable environment," she says. "Within a day, we had to change everything that we did up here, how you even put on a gown and a mask and walked into a patient's room, and then how you would take those things off.
"We were doing the most state-of-the-art care so that we could keep people alive, get them home, prevent them from coming into the hospital. How could we identify the virus? How do we figure out how to test people when there were no tests available? And when the vaccines came, how could we get them out to everybody as quickly as we could? It was remarkable how the challenge came to be so quickly and how it changed so fast."
As the ripple effects of the covid era continue to widen, it's just one of the challenges that she's prepared to face in her new administrative role.
"We have a great mission to care for Arkansans," she says. "I think most of us truly feel that we should be the best in the state, the best in the region. And I think most of us want to help get us there.
"I also think the financial strain on hospitals is more acute right now coming out of the covid situation. Supply costs are very high, pharmacy costs are high, labor expenses are high, but the reimbursement for health care has not changed. We have to be very creative in how we deliver a high level of care but reduce our expenses."
Straddling that fence starts with prioritizing what's most important, Krause says, to help administration and front line employees alike keep things in the proper perspective while fearlessly challenging the status quo.
"We're looking at every line that we can possibly look at to see if there is a better way of doing things, a more efficient way of doing things, a more cost-effective way of doing things so that we can continue," she says. "It's a nationwide problem and it's definitely a problem in all the hospitals in Arkansas. We're learning from everybody and hopefully people will learn from us. What we won't do is compromise the care that we deliver. We don't give care that's not outstanding."
In describing the way forward, Krause speaks intentionally in the collective. No health system, hospital or clinic succeeds with one person, she says, thus meeting the challenges of the future can only be achieved by a team effort systemwide.
"I've worked with a lot of people and have developed a lot of good professional relationships and I think that's helped me succeed in leadership roles," she says. "When you take care of patients together with other physicians or other leaders, you develop a different relationship. You discover people you can call that will come immediately, or who will stay those hours with you and take care of people with you.
"You tend to rely on each other. Especially during covid, we realized how much we truly relied on each other."
SELF PORTRAIT
Dr. Michelle Krause
• PLACE OF BIRTH: Nashville, Tenn.
• FAMILY: Kent Krause, married May 3, 2003. Children: William Charles age 18, Michael Keen age 16, Caroline Marie age 15.
• MY FAVORITE BOOK IS: "Pride and Prejudice" by Jane Austen.
• I HAVE A PERSONAL MOTTO THAT GOES: "Luck favors the prepared."
• MY FAVORITE FLAVOR OF ICE CREAM IS: Blue Bell Vanilla, maybe with some toppings.
• THE ONE THING I KNOW TO BE TRUE ABOUT ALL PEOPLE IS: Happiness favors those who work with their strengths, even if they are different from your own.
• THE HARDEST PIECE OF ADVICE I'VE EVER HAD TO HEAR IS: To slow down. I tend to move quickly; slowing down and taking time to consider all sides of an issue avoids missteps when a final decision is required.
• THE SECRET TO MY HAPPINESS IN LIFE IS: Living in the present and not in the future.
• MY GUILTY PLEASURE IS: Watching baking shows before bed.
• ONE HIDDEN TALENT NOT MANY PEOPLE KNOW ABOUT ME IS: I am a good house painter.
• THE POINT AT WHICH MY CAREER FELT REAL TO ME WAS: My first day as a faculty member at UAMS performing rounds in the hospital. I had several students, residents and fellows on the team with me and it was at that moment I realized that I was now the doctor in charge, and I was no longer the student. It was definitely an eye-opening moment for me.
• MY PROUDEST WORK-RELATED ACCOMPLISHMENT WAS: Helping to lead UAMS during the covid-19 pandemic, specifically when we opened our first community covid-19 vaccination clinic. The gratitude of the patients and families getting their first vaccine was truly remarkable.
• THE DINNER GUEST I'D MOST LIKE TO HAVE WOULD BE: My mother. She passed away from cancer when I was 5 years old, and I would love her to meet my husband and her grandchildren. I'd also include my siblings, their spouses and children in that. She would have been a fabulous mother-in-law and grandmother.
• THE WORD THAT BEST DESCRIBES ME IS: Loyal
“I wasn’t planning to come here. But I think if I would have gone anywhere else, I wouldn’t have stayed the 21 years I have and really loved every minute of every day, for the most part. This just seemed to be the place for me to call home.” -Dr. Michelle Krause (Arkansas Democrat-Gazette/Cary Jenkins)