The Fourth Part of a discussion of Game Theory based on the book Co-opetition
Friend or Foe ?
In the game of business, who are your friends and who are your foes ? Sounds like an 
easy question. You have three groups of friends and one group of foes right? Customers, suppliers and complementors are all on your side, while competitors clearly are not.
In fact we know that can’t be quite right. People understand intuitively that along the vertical dimension of the Value Net there is a mixture of cooperation and competition.
It’s cooperation when suppliers, companies and customers come together to create value in the first place. But when the pie has to be divided up, customers press for lower prices and suppliers want their slice too. So its competition when it comes to dividing the pie. It’s the duality that best describes your relationship with customers and suppliers.
In a hospital setting a GI Doctor is considered a friend, they have no vested interest in the expense or revenue generated by anesthesia, and appreciate the anesthesia provider that can let them focus on their task; but move to a free standing endoscopy center and suddenly the revenue of anesthesia services comes into play and your piece of the pie becomes very tempting.
Added Value
The key to understanding who has power in any game is the concept of “added value”. Added value measure what each player brings to the game. Take the size of the pie when you and everyone else are in the game, then see how big a pie the other players can create without you. The difference is your added value.
It’s hard to get more from a game than your added value. What you can take away from a game is limited by what you bring, and what you bring is your added value. If you ask for more than you bring, what you’ve left for everyone else to divide is less than the pie they could create without you. Why should they agree to this ?
Let’s step away from theory for a moment and take a hard, honest look at your situation. Maybe you work in a mega-practice working for “the man” or 
perhaps you work in an independent setting where you are “the man”. What value do you add to this practice ? What happens when the case load drops and there are too many providers or someone else moves into town and offers a better deal ? Are you expendable, replaceable by a new grad or an AA ? What do you bring to the table besides your fork ?
We’re not talking about competition with other providers but rather complements to the anesthesia service. Is your practice or group stronger and more valued because of you ? Prove it !
An obvious complement to an anesthesia service is a chronic pain service. You could encourage a pain practioner to provide this service, but beware, it might be better to provide this service yourself. Yes, it is quite a commitment and in comparison to your anesthesia practice it may not make much money, but it complements your service AND now you are viewed as someone who brings customers in and therefore makes the pie bigger (and adds value).
Michael L. Whitworth, MD sent a message using the contact form at http://crnabiz.com/site/contact.
Just FYI, your encouragement of CRNAs to just go out and practice chronic pain management is ill advised. CRNAs have zero training in their CRNA programs in interventional pain management and very little in medication management long term. That is not the focus of their programs. I conducted a survey last year that found NONE of the CRNA programs offers training in interventional pain medicine, and the CRNAs are clearly just going out and learning in ersatz weekend courses what physicians with pain fellowships and years of training are doing. We do not believe this is acceptable and such CRNAs are considered to be providing substandard care outside both their area of training and their scope of practice. Obviously you will disagree, but your perspective is not shared by hundreds of thousands of physicians that have made statements that interventional pain is the practice of medicine. This will probably be decided by the tort litigation courts when disasters occur by CRNA interventional experimentation.
Pardon me, doc, but some of those “hundreds of thousands of physicians that have made statements that interventional pain is the practice of medicine” are referring hundreds of thousands of patients to CRNAs on a regular basis! I don’t disagree that there are pain processes that will do better in the hands of boarded pain practitioner….and I regularly refer to two with whom I have a collegial relationship….one of whom is another CRNA with a PhD in pain management and the other is an MD, boarded in pain management. Both have great outcomes for our communities’ patients and both are glad to be of service to these people who are hurting and can find no other pain practitioner to come to our rural community to help them. Don’t worry, doc, even with those of us that are becoming more and active in interventional pain, there’s still plenty of folks hurting that may want to use your services.
Hi Dr Whitworth
It appears the FTC does not agree with your ascertain as I am sure you are aware. Additionally, there is very limited training (or none) for medical students, interns and anesthesia residents in either interventional pain and long term medication management, it isn’t a secret. While I agree with you that a person with extended training such as a fellowship trained individual will have greater expertise the reality is that there is no requirement to have fellowship to practice for any provider. In fact, a family trained physician could start pain management from their office tomorrow. So it seems disingenuous to me that you would be so concerned about CRNAs, certainly the VAST MINORITY of people practicing pain management, when you have alot of work to do cleaning up your own house.
You worry about managing your professions scope of practice and we will worry about managing ours.
Mike
I agree that CRNAs should not read an article or book and go out and start performing interventional pain procedures. That is certainly putting a nail in the CRNA coffin! However, it is interesting to note that I took the SPPM cadaver pain management course in Kansas City in 2002 and Michael Whitworth was one of the instructors. In my group of 6 students, there were 2 CRNAs and 4 physicians. Of the 4 MDs, one was a neurologist, 2 PM&R trained and one was an anesthesiologist. Other than the anesthesiologist none of the physicians had ever done a single epidural!And, the PM&R guy seemed to be totally lost when practicing the procedures on cadavers. These guys were not as prepared to perform these interventional procedures as myself and the other CRNA. Amazing to think that having MD/DO behind your name makes you totally qualified to perform these procedures. So, that means that your childs pediatrician or your friend the psychiatrist is much, much more prepared to perform these procedures than the lowly CRNA…!