His medical degree from the University of Pennsylvania was a necessary passport to practicing medicine, but Spencer Foreman learned his special skills much earlier – growing up near his uncle in Philadelphia.

“He gave me a window into a very complex world,” Dr. Foreman, president and CEO of the Montefiore Medical Center, said of his uncle, Dr. Simon Forman. “Medical schools tend to be stiff, formal, and very hierarchical. They give out a degree if you work hard for it. But they are a trade school. My uncle taught me that medicine is truly all about people.”

Dr. Foreman’s father, Samuel, a lawyer and educator, was naturally disappointed that his only son did not choose to head for the bar. But his mother, Frieda, was delighted. In the homeland of Ukraine that she and her husband shared, to have a physician in the family was a sensational accomplishment.

In the event, nine of Dr. Foreman’s relatives entered medicine.

“We certainly had a version of a family group practice,” Dr. Foreman said.

The insights he gleaned from his uncle, coupled with what he characterizes as an I never stop working style, helped him develop a reputation in his specialty, pulmonary physiology. A long stint in the U.S. Public Health Service offered opportunities to become an administrator. As president of Sinai Hospital of Baltimore, he reinforced his management skills and attracted the attention of headhunters across America.

“If you’re any good at all, your phone never stops ringing,” Dr. Foreman said of headhunters.

One of those headhunters persuaded him to join Montefiore 20 years ago. The Bronx facility had been founded in 1884 by leaders of New York’s Jewish community to care for patients with tuberculosis and other chronic illnesses. Named in honor of Sir Moses Montefiore, a well-known philanthropist of the time, the hospital had become moribund by the time Dr. Foreman was asked by its board to head it.

“Montefiore was in serious difficulty,” he said. “It was badly managed. Its infrastructure in finance and human resources was woefully inadequate. It was a failing institution in a failing borough.”

So why did he accept the assignment?

“I did considerable research before accepting the job,” Dr. Foreman said. “I saw that Montefiore had significant assets. It had a very good faculty. It had a rich history of serving the community. The more I dug in, the more I thought that the hospital had great promise.”

He stopped to reflect more on the question.

“I suppose that deep down, I liked Montefiore,” Dr. Foreman said. “It was urban, smart, and it had no pretenses. Culturally, it fit my sensibilities.”

Those sensibilities may have also contributed to the generally agreeable reception he received, although, as Dr. Foreman put it, “When the new boss comes in, some love him and some don’t. Some people said the place was unmanageable. Others said, ‘You’re dead.’ “

The warnings did not inhibit him.

“I was determined to build a new management team,” he said, alluding to the fact that he brought in trusted associates from Sinai Hospital. “I was determined to hold the institution to the highest possible standards.”

That meant streamlining internal audits. It meant ensuring that attention to patients was enhanced. It meant introducing information technology. It meant working with Bronx borough officials and the police to upgrade security in the neighborhood.

And it meant fund raising.

“The contemporary hospital chief is most often judged by his ability to bring in funds,” Dr. Foreman said. “We were initially driven to organize ourselves better just as a survival strategy. But success is seldom static. An institution has to keep growing, because the community’s demands for better health care keep growing.”

If that’s the criterion for success, then Dr. Foreman has more than met the test. Montefiore’s budget was $350 million when he took over in 1986. It is $2 billion today.

“For the last 18 years, we’ve been consistently profitable,” he said. “You’d be hard-pressed to find another facility like ours.”

His facility has become the largest stand-alone hospital in the city, with a staff of 12,000 that includes 700 private physicians, 800 interns, and 1,300 full-time faculty members. Since 1963, the 1.6 million-squarefoot facility is also the teaching hospital for Yeshiva University’s Albert Einstein College of Medicine.

“Our profitability has enabled us to see 450,000 patients on a repeat basis each year,” Dr. Foreman said. “And on top of the caregiving, there’s our role in the community.”

That role involved the establishment of a company to buy blighted blocks in Montefiore’s neighborhood. It involved launching a campaign to eliminate graffiti. It involved the creation of a system of primary-care physicians with links to the hospital.

Montefiore’s community role has also involved opening two large outpatient centers and a children’s hospital. That institution, Children’s Hospital at Montefiore, gained global attention in 2004, when its physician successfully separated twins that had been conjoined at the head.

“We are a good corporate citizen,” Dr. Foreman said.

He’s also widely regarded as a good citizen of Montefiore itself. That’s because Dr. Foreman started a mentorship program to encourage young physicians.

“There’s always been the teacher in me,” he said.

Is he tempted to return to practicing medicine even while he continues in management?

“Of course the temptation is there,” Dr. Foreman said. “But only a circus rider can manage two horses at the same time. I’m not a circus rider. In my world, you can only ride one horse at a time.”