I have been yakking about the concept of working at your "highest and best use" for many years now. This phrase comes from a real estate appraisal concept that maintains that the highest value of a property is when its use is consistent with market conditions. (Having a prison on beachfront property is probably not getting the highest value from the property.)

For non-appraisers, I believe the concept of highest and best use means we will achieve our highest value when we can maximize our efforts to make the most impact. Unfortunately, if you are a controlling personality, you may have trouble with the concept of off-loading jobs and responsibilities that someone else can accomplish easily or that do not need your level of expertise. The truth is, though, that the ability to leverage yourself and your effort is the key to profitability. It's also the core of providing the best service to your clients.

You may have informally embraced this concept and encouraged others in your firm to take on your activities that are repetitive or easily duplicated. Many growing firms hire back-office support before adding any additional advisors. Often, though, an informal policy makes it too easy to suck you back into the responsibilities that others should be handling for you.

If the informal policy describes your current strategy, it's time to think about this process in a more formalized way to ensure that you are functioning in the role that is most suited for your capabilities, creativity and expertise-your highest and best use. This reality dawned on me while visiting a physician's office a few months ago. I guess I should start at the beginning, which really set the stage for my aha! experience.

SEEING THE LIGHT

My call to make an appointment about a knee problem was routed to the physician's scheduler. The scheduler was trained to ask questions about my health issue to determine the urgency of my appointment and how long the physician might need to deal with my issue. He asked me to bring several things with me and told me what to expect when I arrived at my physician's office.

When I arrived for the appointment, before I saw any one, I was led to an imaging room so they could have a good picture of my knee. After that, I was led to the examining room. In a few minutes the physician's assistant (PA) came in to examine me and ask more health questions. He was capable and competent and not once did I feel that I was being "pawned off" to someone of lesser skills. He discussed my x-rays, explained certain protocols and answered my questions.

Then the doctor walked in, reviewed the x-rays and explained that he concurred with the PA's diagnosis. He asked if I had questions, but the PA had answered most of them. He asked if I wanted to take the first step in the protocol (a shot in the knee) and when I agreed, the PA returned, delivered the excruciatingly painful shot with the help of a comforting nurse. Once this was completed, the nurse led me to reception where I was given another appointment for follow up injections. At the next appointment, I saw only the PA, who administered the shots.

All told, I saw the doctor for about four minutes, but they were important, reassuring minutes. He wasn't hurried; in fact, he stayed as long as I wanted him to, but it was clear that he and this team were in perfect sync, and he provided the final judgmental overlay in the case. The rest of the visits were spent with the PA, nurses or other specialized-care professionals who treated me competently and efficiently.

HOW THE SYSTEM WORKS

Doctors are usually compensated on a productivity basis, utilizing an industry-standard system known as RVU-relative value units, that is the non-monetary numeric value of the types of services rendered within the practice. Simplistically, units are assigned to levels of relative doctor involvement in the visit. The units are higher for higher skilled services.

For example, a doctor removing earwax might receive at 1.88 RVU, while a hip replacement might warrant a 37.6 RVU. The values reflect what it takes to accomplish each service. This method helps keep the physician focused on using his or her skills appropriately and encourages off-loading of those activities that do not.

All right, I hear some of you grumbling...why should doctors even think about this stuff? They are concerned about healing and patient care, not tracking their productivity. Actually, they are in the business of medicine. They are not worth much to their patients if they are out of business. They want to spend time focused on patient care, but they know they won't have time if they don't prioritize that time in some way.