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Editor’s Note: The following article appeared in the New York Times and focuses on NYAM Trustee Steven Safyer and his efforts to transform health care in the Bronx.
Dr. Steven M. Safyer, the president of Montefiore Medical Center, never said a word to the burly man standing next to him in a hospital gift shop demanding to know who was responsible for removing all the candy bars. Though it was Dr. Safyer who had banned candy, soda and deep-fried foods from hospital premises, as part of an anti-obesity campaign, he simply waited for the tirade to end and then stepped up to pay for his bag of cashews.
“I confess I didn’t intervene because I am sensible,” he said.
The man behind the largest hospital system in the Bronx — one that delivers nearly a third of the babies born in the borough — remains largely unknown, by choice. But behind the scenes, where he holds court with political and business leaders while speaking in the language of a community activist, Dr. Safyer has become one of the most powerful figures in a borough of 1.4 million residents facing a growing health crisis from obesity, diabetes, asthma and chronic diseases.
So when state and city health officials wanted to save a bankrupt Bronx hospital in Westchester Square, they asked Montefiore to step in to continue providing services. When Mayor Michael R. Bloomberg proposed a citywide ban on supersize sodas last summer, he did so in the lobby of a Montefiore hospital, flanked by Dr. Safyer and physicians.
And when Bronx leaders have sought to promote economic development in the area, they have counted on the medical center’s expansion — a $142 million ambulatory care center is under construction — to draw businesses and visitors, and even named Dr. Safyer to a task force on redeveloping the Kingsbridge Armory, a key project, though the hospital has no direct stake in it.
“He’s not a household name, but when Steven Safyer speaks, a lot of people listen,” Rubén Díaz Jr., the Bronx borough president, said. “When Steven Safyer wants to take on a task, a lot of people want to be helpful.”
Dr. Safyer, 63, took the helm of Montefiore in 2008 after three decades at the hospital, starting as an intern and resident who later spent years caring for inmates at Rikers Island. Today, he oversees four hospitals and 125 health clinics across the Bronx and lower Westchester County with a staff of 18,332 — making it the borough’s largest employer — providing services from primary care to fertility treatments and outpatient cardiac procedures.
The position gives Dr. Safyer, who lives on the Upper East Side and earns $2.1 million a year in salary and bonus, outsize influence in the Bronx.
In Montefiore’s version of a war-room session last fall, Dr. Safyer, in a gray pinstripe suit, told 100 employees, many in white coats and surgical scrubs, that the hospital provided comprehensive medical care to about one-third of Bronx residents, and emergency or non-routine care to another one-third — all in one of the poorest, and most health-challenged, urban communities in the nation.
“Health care is a human right, not a privilege,” Dr. Safyer said firmly.
Dr. Safyer exhorted the employees to work together to find innovations as the hospital sought to expand to serve more people while lowering its costs.
“There’s no private equity,” and there are no private investors there, he said. “We need to provide for the future and we need to have a positive bottom line.”
Dr. Safyer is the latest in a line of influential Montefiore leaders, including Dr. Martin Cherkasky, a confidant of former Mayor Edward I. Koch, who have helped shape the history of the Bronx. The hospital chain started in 1884 on the Upper East Side as a home for patients with chronic illnesses. It later moved to Harlem and then to the Bronx, evolving into a full-service medical center focused on care for the poor and underserved, and becoming one of the first hospitals to set up a home health care agency and a social work department.
In recent years, it has sought to move away from a standard fee-for-service pay model to one in which insurers pay upfront for complete patient care.
“There are many places that provide sophisticated medical care,” said Dr. Allen Spiegel, dean of the Albert Einstein College of Medicine of Yeshiva University, whose students and faculty practice and conduct research at Montefiore through a close partnership. “There are relatively few places that are as responsible for the social and community care as Montefiore. This combination is somewhat unique in the country.”
A big part of the job is politics. Dr. Spencer Foreman, Dr. Safyer’s predecessor, said he had cultivated relations with local and state officials. “In a big, diverse world like health care, influence is a big commodity,” Dr. Foreman said.
Dr. Safyer serves as chairman of the Greater New York Hospital Association, an influential industry group, which has given him a greater voice to lobby in Albany. He was on a governor-appointed task force that recommended sweeping changes in the way the state paid for Medicaid patients, many of which were adopted by the state. In 2011, Montefiore and other hospitals sought legislation to cap malpractice awards paid by hospitals at $250,000. While the cap was not adopted, the hospitals did receive some financial relief: a medical indemnity fund that pays for care for children born with defects. That fund, created through a tax on hospitals that deliver babies, helped lower malpractice premiums, hospital officials said.
“I’m not 6-foot-8 and 300 pounds of muscle,” Dr. Safyer said. “You have to use persuasion. You have to figure out what the levers are. We’ve had tremendous success in the last couple years.”
Bronx political leaders and consultants said Dr. Safyer was not one to yell or threaten but was so relentless in laying out his arguments over and over again that it could be very hard to say no to him. “He is an extremely forceful and effective advocate for the hospital and its interests,” said Assemblyman Jeffrey Dinowitz, a Democrat whose district includes Montefiore.
But a traditional power broker, Dr. Safyer is not. He does not wine and dine politicians, and by his own admission, does not count any of them among his inner circle. Instead, Dr. Safyer was described repeatedly as a low-key and effective leader by politicians, Montefiore employees, and even community activists, including some who worry the hospital is becoming too big and powerful and gobbling up neighborhoods.
State Senator Gustavo Rivera, a Democrat, said he mispronounced the doctor’s name for months — calling him Dr. SAFE-r — without the doctor saying anything. His name is pronounced SAF-yer, and when the senator realized his mistake, he apologized.
“He said, ‘That’s fine,’ ” Mr. Rivera recalled, adding: “When I think of the unfortunately petty people I know up here in Albany, the smallest things can set them off. He understands the power he has, but he’s humble.”
In his immaculate office at Montefiore, Dr. Safyer finished a working lunch recently with hospital executives who briefed him on state and federal health care legislation. From a health standpoint, his meal was beyond reproach: chunks of broiled salmon and lentil soup.
Under Dr. Safyer’s direction, Montefiore has become a leader in anti-obesity efforts in the Bronx. It has offered zumba classes and cooking demonstrations in waiting rooms, and brought a farmers market to hospital grounds. It has worked with local officials to sponsor community health fairs where its doctors take blood pressure readings and give free diabetes and H.I.V. tests.
Dr. Safyer said he found social activism early. He grew up in Malverne, on Long Island, the older son of a paper salesman and a Holiday Inn manager. (His brother, Andrew, is now dean of the school of social work at Adelphi University.)
In middle school, Dr. Safyer attended civil rights rallies for school integration, and at Cornell University, where he aspired to become a labor lawyer and earned a bachelor’s degree in labor relations, he protested the Vietnam War. Later, he said: “I decided that my mother was right and that it would be good for me to have a profession.”
He returned to New York to take pre-med classes at Columbia University. He enrolled in medical school at Einstein, where he met his wife, and completed his residency in Montefiore’s social medicine program, which viewed medicine as an instrument of social justice and sent doctors into poor and underserved neighborhoods. His wife, Dr. Paula Marcus, is a geriatric psychiatrist at Montefiore; both of their daughters also work at hospitals.
Dr. Safyer volunteered for the National Health Service Corps, which paid medical school tuition in return for service in poor areas, and he was sent to the Montefiore health program at Rikers for three years. He became so absorbed that he stayed for a total of eight years, becoming the director and persuading city officials to build a separate hospital for tuberculosis patients to help contain a disease that seemed poised to make a comeback.
“Some people would advise me not to get into every fight,” Dr. Safyer said. “But any fight that’s with merit, I consider tackling because I think it’s kind of my responsibility. I have a platform that allows me to do things, and where I can, I do.”
Andrew J. Martin
Director of Communications
The New York Academy of Medicine
1216 Fifth Avenue
New York, New York 10029
Reporters: to arrange interviews with NYAM medical and urban health experts, contact
Andrew J. Martin, Director of Communications
212-822-7285 / email@example.com
This report identifies opportunities that build on both the Patient Protection and Affordable Health Care Act (ACA) and New York’s ongoing efforts toward improving the health of its 19 million residents.
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