Advocate for unity: Incoming AMA president

Cecil B. Wilson, MD, has addressed many audiences to talk about the American Medical Association's position on health system reform. He's gone wherever he was needed: the halls of Congress, large physician association meetings -- and his wife's bridge club.

Betty Jane Wilson invited her husband, the AMA's president-elect, to speak to her club when it met at the Wilsons' Winter Park, Fla., home. Members often had debated the not-yet-passed health system reform bill during card games. Dr. Wilson gave a short speech, then was peppered with questions, including one about a commonly cited, mythical part of the bill: death panels.

By the end of the discussion, Betty Jane Wilson said, the bridge club felt thankful and more enlightened. Dr. Wilson's calm, reasoned demeanor was a big reason why.

"He's the most diplomatic person I know," she said.

Colleagues and family say it's such poise amid pressure that has readied Dr. Wilson for his next challenge as he moves to the helm of the American Medical Association as president in June: How to bring doctors together in what Dr. Wilson himself characterized as an historic yet divisive era for medicine.

"We have gone and we are going through a bruising time with health system reform, and we as physicians are questioning ourselves and each other in the same way that the country is questioning itself about what we are doing and what is the right course to take ... and that has resulted in a lot of conflict," he said.

Those divisions should not, however, break the common ground on which physicians continue to stand, Dr. Wilson said. "The reasons we need health reform have not changed: The system that we have is not working well for patients or for physicians."

Reform's passage in March was only the first step, he said. "We have a lot more work to do, and it will be increasingly important for physicians to join together so that we can provide the maximum influence to get changes made and make the most of implementation."

Friends who describe Dr. Wilson as a proven leader say his career is marked by service -- to his family, his country, his patients and fellow doctors -- that will serve him well in the AMA's top post.

The son of a Methodist minister, Dr. Wilson said his father modeled for him what it means to connect with the local community and to serve others. Dr. Wilson was born in Columbus, Ga. But his father's ministry kept the family moving across the state, giving Dr. Wilson the opportunity to see different places and meet new people from an early age.

He earned his medical degree in 1961 from Emory University in Atlanta. He credits his wife with helping to put him through medical school by teaching second grade. They met on a blind date in high school in Macon, Ga., and were married while they were both at Emory.

After med school, the Wilsons shipped off to a naval hospital in Portsmouth, Va. It was the first of 10 years of military service, beginning as a flight surgeon, that took him, his wife and two sons as far as Okinawa, Japan, where their daughter was born. Dr. Wilson rose to the rank of commander, and, after completing a residency in internal medicine, finished his service in 1971 at a naval training hospital in Orlando, Fla.

A unifying force

He set up private practice in nearby Winter Park that year. Since then, he has dedicated himself to patients and to improving the practice of medicine, colleagues said. "Family has always been extremely important to him. But his patients came first and foremost," Betty Jane Wilson said.

They always got his undivided attention, said Jay M. Hughes, MD, a retired Winter Park internist who practiced in the same office as Dr. Wilson for two decades. Dr. Hughes said he also saw how Dr. Wilson kept his calm in tense circumstances.

He recalled walking by Dr. Wilson's office once and seeing him sitting with his feet up, staring out the window. When Dr. Hughes asked what he was doing on such a busy day, Dr. Wilson said he was thinking.

"I said, 'We don't have time to think. We're doctors.' But he was mulling over how he was going to handle a particular patient's problem," Dr. Hughes said. "He's always been able to handle things calmly, without getting flustered ... and with all the controversy going on, we need that character to lead us through."

As Dr. Wilson prepares to rally the nation's physicians, he finds himself in familiar territory. He was instrumental in uniting the American College of Physicians and the American Society of Internal Medicine in 1998 into one voice for internal medicine. He helped merge the two organizations into what is now the ACP -- the largest medical specialty society in the U.S.

The fourth AMA president to hail from Florida, Dr. Wilson also has been a voice for doctors and patients in his home state.

In his more than 20-year tenure at the Florida Medical Assn. -- where he served as president in 1997 and in numerous other roles -- he helped expand a statewide physician volunteer program to treat indigent patients and get legislation passed ensuring prompt payment by managed care companies. Dr. Wilson also was appointed to state task forces on various health care issues.

"He has a passion for medicine," said FMA Senior Vice President E. Russell Jackson Jr., who worked closely with Dr. Wilson. "Wherever he goes, he brings those insights, and at the same time, he really listens" to physicians' and patients' concerns.

That receptiveness carried over into Dr. Wilson's various AMA positions. Over the years, he made it a priority to meet every member of the House of Delegates personally, Jackson said. Despite the controversy health system reform has sparked within medicine, "one of the things he will do is be a unifying force."

As AMA president-elect, Dr. Wilson has spent the past year talking up health reform in the states and rubbing shoulders with congressional leaders to make sure physicians' voices were represented. He has fielded tough questions on numerous national television programs, as well as in his hometown, where he was once approached at a restaurant and asked if he would change his position.

Yet Dr. Wilson said the storm has left him undeterred. He likened his career and life philosophy to sailing, a favorite pastime that has taken a backseat to his full agenda. Sailboat models and a picture of an earlier adventure to Bermuda adorn his office and home, which sits by a small lake in Winter Park.

"A sailboat is about the trip, and a powerboat is about getting there. I really think it is about the trip in life," he said. "Where we are now is a pretty neat destination. But it's what you do along the way that is meaningful."

AMA goals for reform

Dr. Wilson called the health reform debate exhilarating because of its far-reaching impact on the country. "At some level, the difficulty of it makes it even more exciting ... [and] adds to the importance of it."

By and large, health reform will bring meaningful improvements to patients' and physicians' lives, Dr. Wilson said. But it's by no means perfect. As implementation takes shape, he said physicians must come together now more than ever to keep out the kinds of regulations from government and insurers that increasingly have come between physicians and patients.

"When I'm in the room with a patient ... the practice of medicine is just as fulfilling as it was many years ago," Dr. Wilson said. "But when I step out of the room and see the things my staff or I have to do to interact with this outside world -- that adds little or nothing to the quality or safety of patient care -- that's the hassle and challenge physicians have." One way the AMA is addressing this is by working to help define the boundaries of an independent payment advisory board and physician performance measures in the reform law.

At the same time, the AMA will push to add some critical elements, Dr. Wilson added. High on the list is a permanent solution to the Medicare physician pay situation, which continues to elude Congress. President Obama in April approved a third delay in about as many months to an impending 21% pay cut, this time until June 1.

"The fact that Medicare is paying physicians the same as it did in 2001 means that this program is no longer reliable," he said. Social conversations will bring up the question, " 'Do you know any doctors still taking Medicare patients?' ... What we are suggesting to Congress is do something before it becomes a catastrophe."

Another ongoing priority for the AMA will be addressing health behaviors and taking a preventive approach to problems such as substance abuse, smoking and obesity, which will be key to reining in an estimated more than $2 trillion in annual health care spending, Dr. Wilson said.

The AMA also will continue to promote tort reform to plug what he called another drain on the system's costs: defensive medicine. But accomplishing those goals takes solidarity, he said.

Betty Jane Wilson said her bridge club appreciated Dr. Wilson's efforts to reach out that day. "It helped them understand a little better, even if they disagreed," she said.

Dr. Wilson hopes to continue building those bridges with the nation's doctors.

"My hope is we can find a way, as we move through this, to have healing, and to recognize that we all have different opinions about how to approach a problem, but in the end we do have common goals."