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Managing Editor
Scott Harris
sharris@aamc.org

Staff Writer
Elissa Fuchs
efuchs@aamc.org

AAMC Reporter: June 2007

"Spike" Foreman Rides Into Retirement

Spencer Foreman, M.D., president of Montefiore Medical Center

Spencer Foreman, M.D., president of Montefiore Medical Center in New York, recently announced his intention to retire after more than 20 years of leadership at the center. During his tenure, Montefiore—the chief teaching hospital for Albert Einstein College of Medicine and one of the nation's largest academic medical centers—became an integrated delivery system, which incorporates two hospital divisions, a children's hospital, 50 ambulatory care locations, and rehabilitation and home care centers.

Known as "Spike" to his colleagues, Foreman has provided decades of leadership to the AAMC. He served as chair of the association from 1992 to 1993 and was a longtime member of its executive council, along with terms as chair of its Council of Teaching Hospitals and a member of its Liaison Committee on Medical Education. In May, the AAMC renamed its Outstanding Community Service Award in his honor.

What are some of the primary changes you have witnessed in the world of health care in general, and academic medicine in particular, during your career?

I think what has changed as much as anything in the public and private worlds is the expectations about what we can produce in terms of science, physicians, and in our capacity as a medical delivery system. I think that the world expects more of us and that has reshaped much of the medical landscape.

What do you see as your greatest accomplishment during your time at Montefiore?

Well, I started out running a couple of hospitals in the Bronx and ended up running a health system for the whole borough. There has been a sea change in the way we view our responsibilities. When I got to the Bronx, the hospital staffers felt sick patients should come to them. Our view now is that we should reach out to well patients and bring them into our system and prevent them from being sick. We provide a complete, cradle-to-grave kind of system that took 20 years and hundreds of millions of dollars to implement. The Bronx has become a kind of unified health city.

How are education and research incorporated into this model?

Both at the medical school and at the medical center, these areas have been a high priority. We see our missions, as any academic medical center does, as clinical care, teaching, and research. But in addition, we add a fourth branch called community service, and we've built a monumental community service commitment at every level, both in terms of medical and nonmedical areas.

Looking back, is there anything you would do differently?

Of course there is. Nobody has a perfect run. I think the most important thing is to realize that all grand strategies, in my experience, are iterative. You don't see it all in one great flash. You start with some insight, you start with a proposal, you put it on the ground, and you say ‘You know something? We could do the next thing.' And then the next thing happens, and then you say ‘Geez, let's do the next thing.' And that's the way over 20 years we built the Montefiore system.

What are your thoughts on the physician/CEO role at medical schools and teaching hospitals?

I don't think you can run an academic medical center without a physician leader. Now sometimes the physician leader is in the dean's office, sometimes it's in the hospital. But I don't think you can care for people unless you've got a professional insight into medicine. So I'm a very strong advocate of having physician leadership at the academic medical center level.

But a physician has to be qualified. The guy or lady has to be able to speak truth to power. He or she has to be able to stick to their ideas, even if everyone thinks they are nuts. You have to tell the trustees, you have to tell the faculty, you have to tell the governor, you have to tell the newspapers: ‘This is the way it has to be. And if you think it's nuts, I don't care. I'm willing to put my life on the line over this.'

And third of all, you have to have determination…the main thing is to keep the main thing the main thing. So once you decide what your main thing is, you have to go after it and make sure it happens. You can't permit yourself to be talked out of what you believe is the appropriate thing, and everybody out there will try to talk you out of it. We went from being a health institution that was dead broke to a health institution that is the most successful in New York City. And we never looked back. We did it by doing things that nobody else had the courage to do.

You have the longest tenure of current AAMC Executive Council members, and have been involved in the association's governance over the course of the last four AAMC presidents' tenures. Why do you feel the AAMC is important to academic medicine?

The AAMC is academic medicine. It's the heart and soul of the academic medical world. It's the only place where the crossroads of science and clinical care come together in a governance situation. Without the AAMC, we don't have a place to be... to be academic, you've got to be up close and personal with the academic medical community. I don't know how else to do that other than the AAMC. I've been privileged to serve the AAMC. It's been an immeasurable part of my career.

What advice would you offer to academic medicine?

Here's the short answer: We live on the beneficence of the U.S. citizenry. The vast majority of our institutions are tax-exempt organizations. The citizens of the United States of America expect something for that. They expect better care. They expect better science. They expect better everything.

To the extent that we ignore that, we ignore it at our own peril. It's not unreasonable for the country to demand of us the best, the brightest, the most committed effort possible, along with some degree of selflessness. You don't have to wear your hair short and be a martyr, but you've got to see that this is a public benefit effort that we're involved in.... The American public wants science, it wants knowledge, it wants honesty, and it wants integrity. We are capable of doing it, and we shouldn't fail them.