‘Spike’ Foreman Rides Into His Retirement
This article is from the archive of The New York Sun before the launch of its new website in 2022. The Sun has neither altered nor updated such articles but will seek to correct any errors, mis-categorizations or other problems introduced during transfer.

Dr. Spencer Foreman — “Spike” to all who know him — has been running hospitals for nearly four decades.
His colleagues at Montefiore Medical Center sing his praises. Other New York hospital executives solicit his advice; they credit him with reviving health care in the Bronx, and they see him as an integral voice in New York health care.
Yet the longtime president of Montefiore Medical Center, who is expected to step down next month, recently observed that New York’s health care system is broken.
“We haven’t yet changed the system,” he told The New York Sun. “There is no magic formula for the health system, but there are some principles which I think could guide it.”
With the state’s Medicaid budget the largest nationwide, Dr. Foreman said Governor Spitzer has yet to effect change. “I don’t think he’s come to grips with how to change the system yet,” he said.
Dr. Foreman said the health care system was not cohesive. “We’ve got the most profligate, expensive health care system in the world, and our health care system is not expensive because prices are high, it’s because utilization is high,” he said.
In large part, he faults the fee-for-service model of care. “If you get paid twice as much for doing two as you did for doing one, there’s tremendous incentive for doing two of anything.”
Dr. Foreman arrived at his office riding a motorized scooter, which he has come to rely on in the months since he was diagnosed with a malignant brain tumor. His decision to retire came a full year before the diagnosis and it was part of a planned transition of leadership at Montefiore. Dressed impeccably in a dark blazer with a red pocket square, Dr. Foreman reflected on his new role as a patient. “It’s not a preferred state,” he said, with a chortle. Sobering, he added, “I’m 72 years old and things happen to old men. Nobody knows that better than a doctor.”
As he leaves Montefiore, where he has been chief executive since 1986, Dr. Foreman is saying goodbye to an institution that is far different than the failing one he took over.
Today, Montefiore has a $2.2 billion annual operating budget, up from a $350 million operating budget two decades ago. The 1,122-bed hospital handles nearly 250,000 emergency room visits each year. It also runs more than 30 ambulatory care sites, and in 2001, the hospital opened a $120 million, nationally recognized Children’s Hospital.
“Every dollar we got, or could borrow, or could beg — by begging, I mean, philanthropic dollars — we pumped into the plant, built new buildings, renovated all the old buildings, and expanded all over the Bronx,” Dr. Foreman said.
Raised in Philadelphia, Dr. Foreman attended the University of Pennsylvania School of Medicine. He trained as a pulmonary specialist and then served for several years in the U.S. Public Health Service. By age 33, he was appointed chief of medicine at a Health Service hospital in Baltimore. Two years later, he was tapped to run the facility.
Dr. Foreman traces his management skills to his childhood, when he worked in an uncle’s retail store in Philadelphia. At age 12, he became a stock boy and shortly thereafter, he was waiting on customers and honing skills he would use as a hospital executive. “I had a sense about business and about customer service,” he said.
Dr. Foreman chose medicine, he said, because it was his ticket to a respectable profession. “What I didn’t envision at that time was that my instincts for management would get incorporated into my professional life,” he said.
After his stint in the Health Service, Dr. Foreman ran Sinai Hospital in Baltimore for 13 years. He later accepted the job at Montefiore because the hospital was “not unmanageable, it was simply unmanaged,” he said. “Where others saw daunting challenges, I saw opportunity.”
By Dr. Foreman’s account, key components of his success in New York range from the recognition of the Bronx as a viable location for a hospital; the expansion of Montefiore’s emergency services; the early adoption of health information technology; and the creation of risk-transfer care, a system in which the hospital behaved like an HMO and took on the financial liability of providing health care.
That system is currently seen as a nationwide model, and as Dr. Foreman prepares to step down, his colleagues have heaped on the accolades.
Union officials said Dr. Foreman helped to improve labor relations in New York, leading to a powerful alliance between the hospital industry and health care employees. “In 1989, it was a period of confrontation,” the former head of 1199 SEIU United Healthcare Workers East, Dennis Rivera, recalled in a telephone interview. But after the successful negotiation of a union contract, “We started working together,” Mr. Rivera said. A former president of the American Hospital Association, Richard Davidson, said he has known Dr. Foreman since the 1970s when both worked in Maryland. “He was never satisfied with the status quo,” he said.
More recently, industry insiders described Dr. Foreman as a central voice behind the Pataki-appointed Berger Commission, which was charged with overhauling the hospital system. Last year, the commission recommended closing nine hospitals statewide and five in New York City.
“I think the issue of the downsizing of the health care system was one of the gifts he gave to the Greater New York board,” the president of the Greater New York Hospital Association, Kenneth Raske, said. “He said we have to consolidate resources, which is what he’s doing in the Bronx.”
From Dr. Foreman’s perspective, the Berger Commission was necessary because competition has not kept the hospital industry in check. In New York, he said, “If a hospital gets intro trouble, somebody runs in with a bucket of money to try to keep them open for a while.” The shuttering and restructuring mandated by the commission, he said, would force the “rightsizing” of New York’s hospitals. “We will have a smaller system which will reduce the amount of competition because you won’t have to build and build and build in order to fill your beds,” he said.
Dr. Foreman’s will be succeeded by Dr. Steven Safyer, a professor of medicine and professor of epidemiology and population health at Albert Einstein College of Medicine, for which Montifiore is the teaching hospital. He has served as Montefiore’s senior vice president and chief medical officer since 1998.