Ángel Franco/The New York Times
Dr. Steven M. Safyer, the president of Montefiore Medical Center, the largest health care system in the Bronx, lobbied for changes in the state's Medicaid reimbursements.
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."
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