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When Judith O. Hopkins started medical school in 1974, she had to sign a contract promising to not get pregnant.
This was not the most egregious form of sexism she would face in her career. Seeking a residency in emergency medicine in 1977, she was told point blank that she would not be considered.
“I was really interested in emergency medicine, but the first emergency medicine programs were all run by either surgeons, or in the case of the Bowman Gray School of Medicine—now the Wake Forest University School of Medicine—it was being run by the head of gynecology,” Hopkins said in a conversation with The Cancer Letter.
“He wasn’t interested in women, and he was very, very quick to tell you he wasn’t interested in women.”
Despite the challenges of being a woman doctor in the 70s, Hopkins thrived professionally. After a 50-year career, she is the recipient of the 2024 NCORP Harry Hynes Award. She has been the principal investigator of the Southeast Cancer Control Consortium since 1993 and has been a PI of the Southeast Clinical Oncology Research Consortium NCORP since 2014.
The Harry Hynes Award is given annually to NCORP PIs for outstanding contribution to clinical trials and community research. The award recognizes local community researchers who embody the attributes of the leadership and commitment demonstrated by Harry Hynes, a native of Ireland who came to Wichita, KS, in 1960 and went on to develop one of the nation’s first Clinical Community Oncology Programs in 1983.
Not welcomed in emergency medicine, Hopkins ultimately ended up in oncology.
When she landed a residency at Winston-Salem, Hopkins was mentored by Charles Spurr, a Dana-Farber transplant who had done “some of the original work with nitrogen mustard at the National Cancer Institute that eventually led to curative therapy for Hodgkin’s lymphoma,” Hopkins said (The Cancer Letter, June 22, 1990).
Spurr was forward-thinking in more ways than one. He predicted the importance of community oncology, and he encouraged Hopkins to take a job as the attending oncologist at a new clinic in Martinsville, VA—even though she was still technically a fellow.
Said Hopkins:
Dr. Spurr had a great deal of foresight and understood that with all of the oncology programs training oncology fellows, they were not going to be able to have positions for all of those trainees within medical centers. So, it only made sense that those trainees were going to go out into the community.
And with well-trained doctors in a specialty like oncology, why would you go to a medical center if you could get the same treatment in the community? So, he had the foresight to understand that over time, the vast majority of people were going to be treated in the community.
So, he worked with leaders, who also had a lot of foresight, at the National Cancer Institute, and they were part of a program called the CCOP program, which was the precursor to the NCORP program. And as part of that, he wanted to try to provide oncology services to all of the smaller communities surrounding Winston-Salem. So, Martinsville is about an hour away.
And he didn’t have enough faculty to staff Martinsville, and he promised the surgeon that was in Martinsville that he would put an oncologist—and a quote “attending” oncologist—in Martinsville. So, I finished my oncology fellowship six months early so I could be called an attending.
The job in Martinsville was formative for Hopkins, and it prepared her for her eventual shift from academic oncology to private practice.
“It was great training for me,” Hopkins said. “And it forced me to learn how to make decisions and to look at research and be able to apply the latest and the greatest so that I could keep up with everything that was going on in the community and at the academic medical center.”
Her private practice—which eventually merged with and was bought by Novant Health—began as a three-physician operation in a 1,000-square-foot converted house. But once the practice joined the cancer center at Novant Health, Hopkins began to notice the downsides of larger practices.
“The problem that nobody anticipated is, yes, there’s a great economy of scale when you have a cancer center, but patients start to feel like a cattle call when you have these huge waiting rooms and everybody’s sitting in a waiting room, and then they get called back to a sub-waiting room for the lab, and then to a third sub-waiting room while you wait for the physicians,” Hopkins said.
As referrals from nearby communities grew, Novant Health established two satellite locations. One location—in Kernersville, NC—became Hopkin’s full-time gig. Hopkins continues to work there three days a week in her semi-retirement.
“The nice thing about satellites is that they’re very small, they’re very intimate, and they’re in the community in which the patient lives,” Hopkins said. “I had the privilege of starting a satellite in Kernersville. And then eventually, we went from a half a day in Kernersville to five days a week, into three medical oncologists and into a radiation therapy suite and 20,000 square feet and a hospital and the whole kit and caboodle.”
Hopkins appreciates the intimate setting of a satellite practice within the community.
“We don’t have to have shuttles to take people to and from their cars. They can park right outside the building and walk in, and they can see the medical oncologist, go to the lab, go to radiation therapy, get their chemotherapy—all on one floor.”
When she’s not seeing patients, Hopkins is hard at work on her farm.
“There’s something very soothing about getting on a tractor and cutting grass,” Hopkins said. “All the troubles of the world, you can kind of lose, because you have to keep the tractor in a line or else you mess up.”
Hopkins spoke with Jacquelyn Cobb, associate editor and reporter with The Cancer Letter.
Jacquelyn Cobb: Dr. Hopkins, thank you so much for taking the time to speak with me today, and congratulations on winning the Harry Hynes Award.
Judith O. Hopkins: Thank you.
I would love to walk through your early life a little bit, because it’s so interesting. You were originally interested in emergency medicine, but you weren’t able to land a residency because of sexism.
JH: That is a correct statement.
I’d love to hear a little bit more about what it was like to be a woman doctor in 1977, 1978.
JH: So, I went to the University of Virginia for medical school, and there were 24 of us in a class of 138. So, that in and of itself was a little bit discriminatory.
And in order to get into medical school, you had to state that you would not get pregnant.
Are you serious?
JH: I’m very serious. Because, you see, my husband and I were married. So, in one of the interviews, I had to state that we would not have children.
Which you wouldn’t even be able to ask in this day and age, but yes. Back then, you could ask all kinds of things. And tell <laugh>, as my husband says in the background.
So, we were in a program at UVA in a kind of a window where there are not enough doctors. And so, they were experimenting with doing medical school in three years. And since we were married and we didn’t have a lot of money, we decided to go into that three-year program.
The good news about that was that you got through medical school in three years. The bad news was you had to make a decision on what you wanted to do for your residency before you ever did any clerkships. So, it made it a little challenging. But as part of our program at UVA, we had to ride on the rescue squad.
And so, we basically were the forerunners of the EMTs of today. We learned how to resuscitate and intubate and shock and read rhythms and all that sort of stuff. So, I’d done a lot of that.
And so, I was really interested in emergency medicine, but the first emergency medicine programs were all run by either surgeons, or in the case of the Bowman Gray School of Medicine—now the Wake Forest University School of Medicine—it was being run by the head of gynecology.
And he wasn’t interested in women, and he was very, very quick to tell you he wasn’t interested in women.
So, my husband was very enamored with the pathology program at Wake Forest. So, he wanted to come. And at the time, I hadn’t done any clerkship, so I had no idea. So, I thought, well, okay, I’ll do internal medicine for a year, and then I can decide what I want to do after that.
And so, I did internal medicine, and I guess I was pretty good at it, because the cardiology folks and the oncology folks both wanted me to be fellows for them. And I enjoyed oncology more than I enjoyed cardiology, so I went to oncology.
What drew you to oncology over cardiology?
JH: I really liked the thought that by doing clinical trials, you might be able to actually cure cancer. I wanted to be in a field where I thought I could make a big difference in people’s lives.
That would’ve been 1977, 1978. And at that point, there really was no interventional cardiology. I mean, basically it was, listen to the heart and look at an EKG, and echocardiograms were just coming into being, and there was no such thing as cardiac cath.
And so, it was just different. I might have chosen cardiology if we’d had interventional cardiology and stents and all that kind of stuff. But yeah, I’m pretty happy with where I went and where I currently am.
You started talking about your residency at Winston-Salem. And I’d love to hear a little bit about your mentors, Dr. Charles Spurr and Dr. Hyman Muss. How did they influence you and your career?
JH: So, Dr. Spurr was the head of the oncology program at the Bowman Gray School of Medicine. And he had done some of the original work with nitrogen mustard at the National Cancer Institute that eventually led to curative therapy for Hodgkin’s lymphoma.
And he was very interested in clinical trials, and Dr. Muss was recruited out of Dana-Farber in Harvard, and he was very interested in breast cancer.
And my husband was a pathologist and was doing a lot of breast work. And so, it just kind of all rolled into one. He was doing pathology and I was doing the clinical and Dr. Muss was very active in research. And so, it just kind of all dovetailed together.
And then you successfully opened a clinic in Martinsville. What was it like opening a clinic as a fellow? Was that normal at that time?
JH: That was not normal. Dr. Spurr had a great deal of foresight and understood that with all of the oncology programs training oncology fellows, they were not going to be able to have positions for all of those trainees within medical centers. So, it only made sense that those trainees were going to go out into the community.
And with well-trained doctors in a specialty like oncology, why would you go to a medical center if you could get the same treatment in the community? So, he had the foresight to understand that over time, the vast majority of people were going to be treated in the community.
So, he worked with leaders, who also had a lot of foresight, at the National Cancer Institute, and they were part of a program called the CCOP program, which was the precursor to the NCORP program. And as part of that, he wanted to try to provide oncology services to all of the smaller communities surrounding Winston-Salem. So, Martinsville is about an hour away.
And he didn’t have enough faculty to staff Martinsville, and he promised the surgeon that was in Martinsville that he would put an oncologist—and a quote “attending” oncologist—in Martinsville. So, I finished my oncology fellowship six months early so I could be called an attending.
And we took a whole team—we took nurses, we took the chemotherapy—and we would go and get there early in the morning, usually get there about seven, and we would usually stay till about seven at night. And we would see people in clinic, we’d see people in the hospital, we’d give chemotherapy in the clinic and in the hospital, and then we’d get on the road and come home.
So, it was great training for me. And it forced me to learn how to make decisions and to look at research and be able to apply the latest and the greatest so that I could keep up with everything that was going on in the community and at the academic medical center.
In your experience, what is the difference between working in an academic center and a community oncology center?
JH: You know, the biggest difference, honestly, is the number of people you have to answer to.
In an academic medical center, you have the dean of the medical school, and you have a head of internal medicine, and then you have a head of the oncology section.
And so, you had three separate people who were trying to take a little piece of you and direct you to do various things. And about a year and a half after I became an attending, I got pregnant. And I knew I wanted to be able to have some time to be with what turned out to be my son.
And so, the current dean of students at the time was a female. And I went to her and I said, “How have you managed to craft a career in academics and family?”
And she said, “Well, first of all, I don’t have a family, and it’s very difficult to craft a career in academics if you want a family.” She said, “Unless you want to be a dean of students or you want to be a section head, you should go into private practice.”
So, I started looking at private practice opportunities, and two of the fellows who had trained two years before me were out in practice in our community. And so, I interviewed with them and I went and joined them.
And at the time, that made me the only female oncologist in Winston-Salem, Greensboro, or High Point.
So, I built a niche—a lot of women felt there was a void. They wanted to have female physicians for their breast cancers.
And at the time, there was no gyn-oncology specialty. So, we also treated ovarian cancer and uterine cancer and cervical cancer. And so, sort of by default, I became a female oncology specialist.
The private practice that you went into with the two older fellows—that came to be Novant Health?
JH: So, at the time, there were two medical oncologists that were in one practice, and then there were the two fellows that I joined that were in another practice. And both practices practiced at Novant Health, but we were independent private practices.
And we merged in about 2009. And then we moved into the Novant Cancer Center in about 2012. And then we got bought by Novant, in 2015 or 2016, something like that.
Your private practice seems to have had success. You opened two satellites and then one of those satellites became your full-time gig. I’d love to hear just what it felt like to be a part of a rapidly growing, successful practice.
JH: We started out in a converted house.
So, there were three of us in the converted house. And we were in that house for a year. And then we moved to a new office building and we had a modern, state-of-the-art chemotherapy room. We went from 1,000 square feet to probably 6,000 or 8,000 square feet. And it was great. We had nurses and chemotherapy-certified nurses.
And then, of course, everybody got into this thing about, “Oh, you have to have a cancer center.” So, we merged both practices. And then we moved into the cancer center. And the problem that nobody anticipated is, yes, there’s a great economy of scale when you have a cancer center, but patients start to feel like a cattle call when you have these huge waiting rooms and everybody’s sitting in a waiting room, and then they get called back to a sub-waiting room for the lab and then to a third sub-waiting room while you wait for the physicians.
And so, the nice thing about satellites is that they’re very small, they’re very intimate, and they’re in the community in which the patient lives. So, I had the honor and privilege of starting a satellite in Lexington, NC. And I had the privilege of starting a satellite in Kernersville. And then eventually, we went from a half a day in Kernersville to five days a week, into three medical oncologists and into a radiation therapy suite and 20,000 square feet and a hospital and the whole kit and caboodle.
And that became your full-time location.
JH: That is my full-time location. That is correct.
It was pretty interesting helping to plan a 50-bed hospital in a small community, and creating basically a mini cancer center.
And you get to stay really intimate and stay within the community.
JH: Yeah. We don’t have to have shuttles to take people to and from their cars. They can park right outside the building and walk in, and they can see the medical oncologist, go to the lab, go to radiation therapy, get their chemotherapy—all on one floor.
Was your practice affected by Hurricane Helene?
JH: Hurricane Helene did not really affect our practice in Kernersville or in Winston-Salem.
But my farm is two hours west and we lost about 100 trees. And our entrance fences got squished when all the trees came down, so we’re still cleaning up the mess.
But it didn’t affect any of our buildings, and it didn’t affect any of our equipment. Our chickens were a little traumatized and stopped laying eggs for about a week and a half, two weeks. But they’re back to laying eggs.
So, I think everybody’s doing okay.
You’ve been a PI for the Southeast Cancer Control Consortium for nearly 30 years. You’re also on the Symptom Management and Health-Related Quality of Life Steering Committee and you’ve been involved in Breast Oncology and Local Disease Task Force and the Cancer and Aging Research Group. You’ve been involved with Alliance and URCC and NCORP clinical trials. What drove you and continues to drive you to be so involved in research?
JH: Well, I think it goes back to both of my mentors, Dr. Spurr and Dr. Muss.
The only way you’re going to actually change how patients are treated and potentially reach cure is if you do research and you compare the standard of care to new and evolving treatment options.
And so, the advantage of first the CCOP program and then the NCORP program is that it allows patients to have the opportunity to participate in the best clinical trials available in the world right in their community.
And the information that we gather helps determine whether or not a new drug is beneficial or if a combination of drugs is beneficial. And so, it allows patients to actually contribute without having to go to Boston or New York or Texas.
Particularly, if you happen to have metastatic cancer and you have a limited amount of time that you’re going to live, traveling to a major cancer center to get the best that’s available is a time toxicity.
Even if you got a direct flight, it’s two hours to Texas to MD Anderson, and it’s two hours to Boston. And you gotta go to the airport early. And so, when you have a year or less to live, or one or two years to live, it’s a whole lot easier to spend as much time as possible with your family if you’re getting the best treatment available right in your community.
I’ve never heard the term time toxicity.
JH: Yes, that is a very recognized toxicity. It’s much newer in our toxicity lexicon than, say, nausea or vomiting or neuropathy. But it is a real measure that we look at to try to help us determine when we’re trying to create a clinical trial. One of the things we want to do is make sure that we’re not adding additional office visits or additional lab draws.
We want to try to coordinate all the visits so that patients don’t have additional time toxicity.
How different was oncology when you started in the 80s? What’s changed?
JH: I think that the thing that has changed the most is that when we first started doing clinical trials in 1977, randomization involved a series of sealed envelopes.
So, we had a three-by-five card file and there would be a hundred cards in sealed envelopes, and you would pull out a card and it would say the patients in treatment arm one or treatment arm two. Of course, today that’s all done by a computer.
And it’s a much more accurate randomization than a card file.
And I think that the other thing that is much different is patient reported outcomes. There was no such thing as patient reported outcomes.
And so, the toxicity profile that we ascribed to new treatments, I would dare say was probably not accurate. Because unless the patient reported it to us or we specifically asked about it, we didn’t have a clue.
And I think that particularly things like neurotoxicity and chemotherapy-induced cognitive impairment were well under reported and documented before we started looking at patient reported outcomes.
Unfortunately, like many oncologists, I have also had cancer myself, so I am a cancer survivor. So, that has colored my approach to treating my patients and I think it’s made me a better oncologist, much more attuned to the toxicities associated with our treatments.
Especially the toxicities that early oncologists really wrote off as not as important.
JH: Hot flashes, who cares? Night sweats, who cares? Oh well, you got a little nausea.
Do you have an estimate of how many patients you think you have put on clinical trials?
JH: It’s in the hundreds. It could potentially be in the thousands.
I’ve been very blessed to work first with the CCOP program and then with the NCORP program and to have incredible administrative staff in the CCOP and in the NCORP, and then a whole cadre of partners that have helped me recruit and retain patients on clinical trials.
Any successful oncologist in clinical research has to have a huge support team, and I’ve been very blessed to have some of the best. If you don’t have a good clinical research coordinator or you don’t have a good CRA, you may as well hang it up.
My last couple of questions are more personal, because what I read online was really interesting. I would love to hear a little bit about your love story.
JH: So, my husband and I went to the University of Richmond, which at the time that we went had coordinate education.
And what that meant was there was Richmond College, which was on one side of the lake and there was West Hampton College on the other side of the lake. And so, it was like an all-girls school and an all-boys school separated by a lake.
I have also had cancer myself, so I am a cancer survivor. So, that has colored my approach to treating my patients and I think it’s made me a better oncologist, much more attuned to the toxicities associated with our treatments.
But we did have classes together, particularly upper-class classes—specialty classes, you know, major classes. So, I had the best of both worlds. I had an all-girls college and I had a co-ed institution.
And I was blessed to be able to play varsity sports at the University of Richmond. I played field hockey and basketball and lacrosse, and I tried to work all my labs around my practices, which was somewhat challenging.
I met my husband in comparative anatomy class, and my husband is an extraordinarily brilliant man. He was getting 110s or 120s on our exams in comparative anatomy, and the next highest grade was like an 80 or an 85.
He wasn’t going to go to medical school at that point. So, he was killing the curve for all of us who were going to go to medical school and who had to get an A in comparative anatomy in order to get there.
So, thankfully the professor just eliminated his grade and curved everybody else based on the rest of us. So, that’s how I met my husband.
“I hated him,” [her husband is] saying in the background.
It wasn’t quite true, but you know, it’s kinda like, “Who is this guy?”
And then of course, because we were a women’s college, we had a junior ring dance, and in the junior ring dance, the women asked the men to be their dates.
And so, I had actually asked my husband’s roommate to go to junior ring dance, and he had turned me down and said, “Oh, you need to ask Hop.”
So, in desperation, I did ask Hop. And he said, “I’m not sure, let me get back to you after spring break.”
The good news was he thought about it, and he wrote me a letter and said he would be honored to go. So, that’s really how we started dating. And we dated the rest of my junior year and we dated my senior year. And then, he asked me to marry him, and we decided to go to medical school together.
And the rest is kind of history. We started medical school in June. We got married in August and graduated three years later.
Incredible. So, were you the one to convince him to become a doctor?
JH: His mother. He wanted to be a biology professor, but his mother insisted that he either be a doctor or a lawyer or a dentist.
So, he got accepted into every medical school that he applied to, but I only got accepted to University of Virginia and the Medical College of Virginia and Eastern Virginia Medical School. So, we had those three to choose from, and we chose the University of Virginia.
You were involved with your grandfather’s farm when you were younger and now you have your own farm. Did you always know you wanted a farm alongside your dream of being a doctor?
JH: I was one of four [children], and so the farm was someplace that I could escape to away from all the hustle and bustle and noise among my siblings. And so, I loved the farm, and I always wanted to have a farm. And my daughter-in-law is from Kings Mountain, NC.
And so, after they’d been in Raleigh for 10 years, they moved back to Kings Mountain, and we were looking at places where we could have a farm, because my son was interested in farming.
And so, we found a farm in Blacksburg, SC, which is about 12 minutes from Kings Mountain, NC.
And it was 110 acres, and we wanted at least a hundred acres. So, that’s how we got this farm. We bought it in 2015. We built the barn in 2016, built the cabin in 2017, and we just finished adding on doubling the size of the cabin because we’re going to retire here.
That’s the dream!
JH: There’s something very soothing about getting on a tractor and cutting grass. All the troubles of the world, you can kind of lose, because you have to keep the tractor in a line or else you mess up.
