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Medical evolution

AMA president-elect initially just sought steady work

By Peggy Peck
MedPage Today Senior Editor

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Medicine went from a steady job to "a compassionate and caring profession" for Dr. J. Edward Hill.



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TUPELO, Mississippi (MedPage Today) -- Dr. J. Edward Hill is a week away from being inaugurated as the 160th president of the American Medical Association, which is no small accomplishment for a man who says he became a doctor because he wanted a steady job.

When Hill relates that he chose medicine not because of his dedication to the health of the people, but because he wanted a steady job, he knows he is being disarming. This is his approach.

A family physician at the North Mississippi Medical Center in Tupelo, Hill has worked hard at distancing himself from the darkening image of the AMA, an image that in recent years has become one of a self-serving group dedicated primarily to protecting the incomes of its dwindling numbers.

For long-time observers of the AMA, Hill, as a leader of this group, is either a true exception to the rule or a brilliant chameleon.

His job long ago assured, Hill's new goal, he says, is to make the AMA the undisputed champion of public health by aggressively campaigning for "health education in every public school in American and by, finally, addressing the problem of the uninsured."

Cynics may scoff, but Hill makes a compelling case for his professed dedication. He has plans, he says, to shift the AMA momentum from one of lip service to one of action. He began this process, he adds, in his previous role as chairman of the AMA board of trustees.

AMA presidents are often known for speeches about the need to reform medical malpractice laws or to increase Medicare payments to physicians, both causes near and dear to the membership. But Hill says that he plans to let others champion those causes, which he says are important, but are not his primary focus.

"I plan to lay out a comprehensive plan for health education in schools," he says. "I'm not talking about sex education, I'm talking about health education. Education that will help kids make the right choices about everything from diet and exercise to seat belts in cars and helmets for bike riders. That includes making the right decisions about sex, but it is much more than that," he says.

"This is going to cost money, real money to develop curriculum, train and hire teachers," he says. Hill plans to travel the country pressing the case for his comprehensive health education plan. And at the same time he is going to press for reform to open up health care to the uninsured, something, he says, that should have been taken care of long ago.

Hill says he joined the AMA by default. When he started practicing in rural Mississippi, he joined the county medical society "because that's what everyone did," but his membership in the county society in those days required him to join both the state medical society and AMA. He got his introduction to AMA meetings because he accompanied his wife to a national session of the AMA Auxiliary, now called the AMA Alliance.

At that time, the AMA offered scientific programs at its meetings, and Hill "spent all day going to these scientific sessions." Then he ran into two doctors from the state medical society, who were members of the AMA House of Delegates. "They asked me where I had been and I said, 'Why I've been attending the AMA meeting.' "

The delegates quickly steered Dr. Hill to the other AMA -- the one that makes policy decisions that affect all doctors in the United States, whether they are members or not. "That was my introduction to organized medicine," Hill says.

Up through the ranks

Hill says he liked the doctors he met at the AMA House of Delegates and he eventually worked his way up the ranks in the rough-and-tumble world of medical politics until he was elected to the AMA board of trustees, again a surprising outcome.

"I figured I would run and lose, but at least I'd get some name recognition," he says. "But I won."

On the board, Hill again worked his way up the ladder and became chairman, a job that he loved. "I would have stayed as chairman if I could have done that," he says. In some respects, the presidency of the AMA is a demotion from the role as board chairman.

But, decades before Hill became a leader in organized medicine, he says medicine was no longer just a job for him.

Asked about this transformation from pragmatist to idealist, from work-a-day doctor to public health advocate, Hill doesn't hesitate, "July 20,1969. That was the day that changed my life as a doctor."

That July day would actually be historic day for America, but for Hill it was another work day, just weeks after he had marked his first anniversary at a health clinic in Hollandale, a Mississippi delta town where 3,000 residents eked out a living from cotton, which was no longer king.

Hill's road to Hollandale began during his undergraduate years at the University of Mississippi where he was studying civil engineering with a vague notion of following in the footsteps of his father, an engineer with the Army Corps of Engineers. Hill grew up in Vicksburg, Mississippi, where his dad worked with other engineers on Mississippi River projects.

"My college roommate came from a family of doctors," he says. "I used to go home with him for weekends and I got to know doctors and I liked them." This was in 1960, when engineers did not easily find jobs, but his acquaintance with this medical family made him realize "that doctors always had pretty good, steady jobs."

Long hours, good pay, steady work

So, in his senior year he dropped engineering, took some pre-med courses and applied to medical school.

"Back then it wasn't that difficult to get into medical school, which was good because I wasn't a very good student," he says. "In fact, I never became a good student until my senior year of medical school when I got married. Getting married got my grades up because I had a stable relationship and stopped carousing around."

On Thanksgiving Day 1963, Hill married Jean Ware, who was studying to be an x-ray technician when he met her. "I had to get some money to get married so I joined the Navy. The Navy paid my medical school tuition, paid for my books and paid me a stipend, which meant I could afford to get married," he says.

After graduating from medical school he spent four years in the Navy, eventually ending up at Bremerton Naval Station near Seattle, Washington, where "we would take care of the wounded from Vietnam. Casualties would be flown over the Pole to us, so we got them 36 hours after injury."

Those two years at Bremerton were mostly spent in surgery, and the skills he learned there would be put to use for 26 years practicing "Third World medicine in the Mississippi delta," which is an ideal location for a family physician because they are trained to be the utility infielders of medicine. They deliver babies, set broken bones and do minor surgery while also treating measles, mumps, diabetes and high blood pressure. They also sew up wounds.

By the time his tour of duty was up, he and his wife had two daughters, a toddler and a newborn, and a deep desire to return to the rural South where both grew up. "We thought, naively I realize, that back in these small communities we could protect our children from the evils of urban America -- drugs and violence -- and we wanted to be back close to our families."

So, they moved to Hollandale, where Hill and two medical school classmates took over a health clinic from a retiring doctor.

A life-altering experience

"The clinic was the only health facility for miles. It was open 24 hours a day, 7 days a week," he says. His two partners burned out after just a year, so he brought in another friend, Dr. John Estess, as a partner. "We practiced together for 26 years and never had a disagreement. I don't think there are many medical practices that can make that claim."

So, on July 20, 1969, Hill and Estess were just settling into practice together. Early that morning Hill got a call from a local farmer. "He told me that the wife of one of his farm hands had delivered a baby two days earlier, but she was still bleeding. He asked if I would come out and see what I could do."

Hill got in his family station wagon -- "that was our emergency services vehicle" -- and drove the 17 miles along the Sunflower River bank to the farm. In a shack there he found the woman. "She was in shock. I couldn't get a blood pressure on her," he says. He was able to stop the bleeding by giving the woman a shot of pitocin, a drug used to make the uterus contract. But he knew the woman was too weak to be moved back to the clinic.

"So, I got back in the station wagon and drove back to clinic where I typed and matched her blood," he says. "I picked up two units of blood and headed back to the farm. I'll never forget the way she looked when I hung that first unit of blood; I had to hang it on a nail in the wall." The transfusion stabilized the woman so that "I could put her and the baby in the station wagon and take them back to the clinic."

That night, "I went home and turned on the television. Neil Armstrong was walking on the moon. I couldn't sleep that night or for several nights after that because I couldn't get over the fact that a woman in Mississippi almost bled to death because she didn't have basic medical care the same day that Neil Armstrong walked on moon."

Proudest achievement

A few days later, Hill went to his partner and proposed a plan: They would organize a maternal child health program. Together he and his partner lobbied the county officials to build a 42-bed hospital. "Our county had one of the highest infant-mortality rates in Mississippi -- and Mississippi has just about the highest infant mortality in the country -- but after three years we dropped the infant mortality rate to below the national average and we kept it there."

The secret, he says, was a team approach. "We used nurse midwifes, we trained hospital dropouts to be midwife assistants and nurses aids," he says. "We had mandatory home health visits for two years after delivery. We were, I think, about 35 years ahead of our time."

"That program is the proudest accomplishment of my career," he says. And that day, July 20, 1969, was the day that Hill made the leap from medicine as a steady job, to medicine as "a compassionate and caring profession."

That's the day, he says, that he will be remembering on June 21, 2005, when he takes the oath of office as the 160th president of the American Medical Association.

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