JOINT BASE CHARLESTON, S.C. –
The Naval Health Clinic Charleston's dermatology clinic is home to the Navy's top producing dermatologist.
It's almost destiny that Capt. George Butler, NHCC's staff dermatologist was commissioned an officer in the Navy and became a doctor. He has two brothers who are retired Navy officers and three sisters who are nurses. Additionally, his son is a freshman at the U.S. Naval Academy. To say service and medicine is the family business would be an understatement.
At any given time, the Navy has between 30 to 35 dermatologists world-wide. Both military and civilian medical practitioners use a metric grading system called the relative value unit.
According to Joseph Miller, NHCC data quality manager, "Relative Value Units are the data points that the Military Health System has decided to use in evaluating provider productivity. It originates with the Medical Group Management Association, a civilian organization that monitors practice patterns and production in the civilian community.
At the end of the fiscal year, the Navy calculates all of the dermatologists RVUs and then ranks them from highest to lowest. Since 2012, Butler has been ranked number one.
"Capt. Butler has been the number one RVU producing dermatologist in the U.S. Navy every year since FY 2012," Miller said.
However, for Butler it's about helping the people he treats on a daily basis, not about being the Navy's top dermatologist and having the most RVU's.
"We get people in with very common things, disfiguring conditions; acne scaring, etc. As mundane as acne is, some people don't realize how gratifying it can be to improve self-esteem by improving the way they appear, not to mention their overall health," he said. "Then of course, on the other side of that, there are those with very dangerous diseases like melanoma. They come in for a routine screening and find an early melanoma that can save their lives. They are very grateful for that."
Butler routinely participates in Grand Rounds at the Medical University of South Carolina in downtown Charleston.
"For those more difficult [cases] we'll arrange for those patients from the Navy, Air Force, Coast Guard to be presented , [here] they have a number of dermatologists looking at the patients, giving opinions and discussing how to proceed with the work up on treating patients," said Butler.
On any given day, Butler will see between 15 to 25 patients, depending upon the severity of each case.
"If you are removing a large melanoma, it could take two hours or, if you are taking care of someone's acne, that could take 15 minutes."
Butler also has to factor in the time for other procedures such as freezing warts, surgical removal of skin cancers and laser procedures for both cosmetic and medical conditions. At NHCC he is authorized to do other cosmetic procedures.
"The Department of Defense allows military dermatologists, plastic surgeons and Ear Nose and Throat specialists to maintain proficiency with some of the skills they ask us to maintain in the civilian community," he said. "So that would be like Botox, which is the most common, some cosmetic laser treatments to improve people's appearance as well as acne scars."
According to Butler, the success of the dermatology department at NHCC is a direct result of the clinic's leadership.
"One notable thing, in terms of being productive, the command is very supportive of how they can make us more productive and what they can do to make things run more smoothly," he said. "That gives you enough people so that while you finish with one person, someone else is getting another [patient] prepped. If I'm performing multiple surgeries, I can bounce over to another technician who is preparing for surgery."
Butler has served in the Navy for nearly 27 years but he hasn't always been a doctor.
Upon graduating from the U.S. Naval Academy in 1984, he completed nuclear power training and became a line officer aboard submarines. Butler began his medical training in 2002 and has spent 10 of his last 13 years as a dermatologist here in Charleston.
Butler attended the Uniformed Services University of Health Sciences medical school, which is a federal medical school located in Bethesda, Md.
"I didn't find out till later in the process when I was applying for medical schools but half of the people that go to USUHS medical school have prior military service," said Butler.
It wasn't until a rotation in dermatology during medical school that he found his calling.
"I found that I like the combination of clinical medicine, minor surgery and laser treatments," Butler said. "Additionally, dermatology allowed me to see a wide range of patients from pediatrics to senior citizens, which I enjoyed."
When 2015 comes to a close, so will Butler's Navy career. Even though he plans to retire, he still finds what he does challenging and humbling.
"Medicine is challenge, I like that," he said. "I like continuing to serve. I've been in the military a long time; it's a patriotic thing, taking care of people who have sacrificed a lot.
It's humbling because [dermatology] can be very difficult. There are a lot of instances where you have to pull books out and try to diagnose a condition that you may have never seen before. [This job is] very one-to-one and you have to be able to relate to senior officers as well as a dependent wife who is 19 years old."