Faculty Focus: Nicholas Butler, MD

What is your hometown?

Mendota, IL

How/when did you become interested in science and/or medicine?

When I took anatomy in high school is when I started pursuing a career in medicine because I became truly interested in the subject. But I’ve always been interest in being a physician. In 2001 I was looking back through some cards my Great Grandma sent because she had recently passed and I discovered an old birthday card asking me if I was still interested in becoming a doctor.

When did you join the University of Iowa faculty?

2013

I went to school at U of Illinois, Rockford campus, in the rural focus track which emphasis in the reality that when you are a Primary Care doc in a small town you assume that your role will be much bigger than just the town doctor. You will be the public health “commissioner,” you will serve on boards; you will be generally looked to as a leader in the community.

Being a small town primary care physician was my initial plan through med school and residency. I did my residency at St. Louis University in Bellville, a part military and part civilian program. Being from a small town, I feel the need to focus on good rural health care and a part of that includes good geriatric care.

How or why did you choose to join the faculty at the University of Iowa?

Being from a small town, I feel the need to focus on good rural health care and a part of that includes good geriatric care. I came to University of Iowa to study geriatrics because that fit with my plan to be a small town doctor with small town demographics. Once here doing a fellowship, I realized there is a lack of geriatric specialists and felt staying on as faculty would amplify my effect and influence on people by being an educator to all doctors seeing older populations. I felt I would be able to educate a whole cadre of residents and anyone else who would listen versus seeing 9 – 10 patients/half day.

Is there a teacher or mentor who helped shape your career?

I had a number of good mentors. Gerry Jogerst has been one of the most meaningful and impactful people and has had a huge role in my life since 2012 in terms of direction and development. Dr. Jogerst’s goal has always been to educate  the primary care workforce on how to do geriatric assessments. I don’t know if I would have thought of that on my own.

One of my first mentors was my family doc in my hometown. I used to shadow him quite a bit before medical school and early in medical school. He still tells my parents, “it was great to have Nick with me and I look back on those times.” I I think working with him was fantastic.

Dr. Link, who I followed for four months in medical school, had a big impact on me. He was a  family doctor in Morton, IL; there’s still things I say to patients that I learned how to phrase from him.

Charles Robacker was my program director in my residency was always calm and cool under pressure. He was really good about juggling multiple tasks while keeping multiple people happy.

How do you see your faculty role impacting medicine and/or science?

Geriatricians are in a unique place in medicine that the US hasn’t been before. We have an aging population with decreasing financial inputs and resources so we need to find ways to take care of older adults better and a lot of that is minimizing the functional impacts of disease and minimalizing the things we as physicians do to exacerbate problems. Things like poly pharmacy – reduce falls, reduce hospitalization, and reduce length of stays, by reducing delirium rates and in and out of hospital fall rates. Through research, we should be looking at how we preserve function in an aging population. Falls and Frailty are big areas of interest of mine and finding innovative technologies we can implement to help with those.

Academically – educating the health care work force in all areas and educating administrators and all health care disciplines having a stake in trying to handle the older population in a safer way.

Clinically it’s seeing patients and helping patients day to day.

What is the biggest change you've experienced in your field since you were a student?

The change I feel is one of policy and awareness. Since baby boomers have turned into Medicare enrollees, there’s more awareness that we need to critically look at how we care for older adults as a system, not just as individual clinics, or as a health system, but as a country.  I feel there’s more emphasis now than there has been in the past. Now the economics of the situation are such that people are realizing we need to implement change on how we care for elderly adults and if we don’t, the consequences for their health, safety, and livelihood is going to be substantial both from a safety and longevity standpoint as well as a financial standpoint.

I think that is speaking to people on many levels and now is on the forefront of many people’s minds. A national newspaper recently reported that surgeons are increasingly looking at frailty as a prognostication as to whether or not to take a patient to the OR. The fact that we are now having that conversation is telling me that we are moving in the right direction.

What one piece of advice would you give to today's students?

Control your personal debt and spending so you never have to work for an income because then you can work because you enjoy it. The second piece of advice I would give is Med school, residency, fellowship, starting a practice, putting off having a family and a life don’t delay because you’ll be in your mid to late 30s before you know it; waiting for the perfect time is chasing a fantasy.

In what ways are you engaged in professional activities outside the University (i.e. population based research, mentoring high school students, sharing your leadership/ expertise with organizations or causes, speaking engagement off campus, etc.)?

I am the medical director at Oaknoll and I’m working to expand some initiatives there.

I enjoy attending conferences related to my profession whenever possible.

What are some of your personal outside interests?

I really like cars. I’m a gearhead, my father and my uncle were both gearheads and I inherited my love of cars from them. I can’t afford and don’t have the time to own a lot of cars, they just really interest me.

I love spending time with my family and am involved with our church.