UCSF - "The Kraken" (1985 - 1991)

UCSF - “Into the Maelstrom”

When Dr. Richard Root was Chairman of Medicine at UCSF from 1985 to 1989, the UCSF system included roughly five to six major hospitals that operated under its Department of Medicine. These hospitals were UCSF Moffitt–Long Hospitals on Parnassus Avenue, San Francisco General Hospital, Mount Zion Hospital and Medical Center, the San Francisco Veterans Administration Medical Center at Fort Miley, Laguna Honda Hospital and Rehabilitation Center, and the Sacramento VA Medical Center at Mather Field. 

The Department of Medicine oversaw approximately six hundred faculty members, about four hundred of whom were full-time salaried and two hundred of whom were part-time or affiliated, along with about one hundred eighty residents and ninety fellows. Each hospital had its own chief of medicine who reported to the Chair, with academic divisions that extended across multiple sites.

The Department of Medicine’s administrative and clinical reach extended beyond San Francisco into Sacramento through the UC Davis and Sacramento VA affiliations that were part of the broader University of California medical network. In the 1980s UCSF faculty, including those in infectious disease, cardiology, and internal medicine, rotated through the Sacramento VA, and Dr. Root held credentialing authority for those appointments. The UC Davis medical school had not yet fully consolidated its own independent clinical system, so UCSF continued to provide oversight and academic linkage. 

As Physician-in-Chief and Chair, Dr. Root was responsible for faculty credentialing, departmental reporting, and budget alignment across all UCSF-affiliated teaching hospitals. The Sacramento VA fell under federal–university affiliation agreements that required the Chair of Medicine to sign off on medical-staff privileges and academic designations. In practical terms, Dr. Root’s authority extended to six hospitals: UCSF Moffitt–Long, San Francisco General, Mount Zion, the VA at Fort Miley, Laguna Honda, and the Sacramento VA at Mather Field.

At mid-decade the Department of Medicine at UCSF was one of the largest in the nation, comparable to Harvard, Johns Hopkins, and the University of Washington. The organization included roughly six hundred faculty, one hundred eighty residents, and close to ninety fellows distributed across fourteen major divisions. The faculty at Moffitt–Long numbered around two hundred fifty; San Francisco General had roughly one hundred fifty; the VA about one hundred; Mount Zion fifty to seventy; Laguna Honda around thirty; and the Sacramento VA about twenty to thirty.

UCSF conundrum vs. UW unity

In comparison, when Root was Vice-Chairman of Medicine at  the University of Washington between 1982 and 1985, the Department of Medicine maintained about five hundred twenty faculty, one hundred sixty residents, and seventy-five fellows across five major hospitals: the University Hospital, Harborview Medical Center, the Seattle VA, Fred Hutchinson Cancer Research Center, and the VA at American Lake.

By raw numbers the two departments looked similar, but in practice UCSF was far more fragmented and politically complicated. The University of Washington was a unified network governed by a single state university and the federal VA; UCSF was a wheel of semi-independent institutions—UC, city/county, federal, and private—each with its own budget, labor contracts, and culture.

At UW, administrative and financial lines ran centrally from the Dean and Chair through each hospital. At UCSF, they radiated outward from the Department of Medicine into six directions, none fully under one authority. Dr. Root often described UCSF as a wheel spinning faster than it could be steered—a system of immense energy and moral purpose but constant instability.

UCSF as Viewed by Peers

Other universities admired UCSF’s brilliance and feared its chaos. Harvard, Hopkins, Yale, Washington, and UC San Diego all saw it as a paradox: the most innovative and humane academic medical system in America, and the least governable. Harvard leaders such as Eugene Braunwald and Dan Federman called it the future if it could be controlled. Hopkins valued its AIDS care model but doubted its administrative discipline. Yale viewed it as bold but overextended. Washington faculty used it as a case study in what happens when excellence outpaces organization. UC San Diego envied its prestige but warned of its fragmentation.

Nationally, UCSF was admired for scientific output and moral leadership. It was ranked as the #2 medical school in the nation and would rise to #1 under Root's leadership (judged by NIH funding and applicant reports. The paradox was though individually brilliant, as a whole entity it was bursting at the seams, a lesson about greatness grown too fast. It pioneered clinical and humane HIV care at San Francisco General, and trained residents who were sought after nationwide. But it was also known for administrative dysfunction, overlapping jurisdictions, and constant budget crises. To peers it embodied both the promise and the peril of modern academic medicine—an institution of compassion and discovery that was nearly impossible to govern.

UCSF Managerial Disorder

The managerial disorder that defined UCSF from roughly 1983 to 1991 had structural origins. The University of California Regents had built each UC medical campus as a semi-autonomous entity. UCSF, lacking an undergraduate campus and dependent on its own hospitals for revenue, evolved into a federation of hospital fiefdoms. The City and County of San Francisco owned San Francisco General Hospital while UCSF staffed it, leading to endless jurisdictional disputes. Rapid faculty expansion in the 1970s outpaced the university’s administrative infrastructure.

Chancellor Julius Krevans, who led UCSF from 1982 to 1993, fostered research excellence and faculty freedom but avoided central enforcement. Dean Rudi Schmid was a champion of medicine in the classic Beeson mode, but was being run ragged by a system which no longer could contain such a paradigm. Under their leadership the school entered its golden age of scientific success and its nadir of administrative cohesion. The “hands off” approach at the upper echelons left the UCSF “kraken” to be Root’s fight without legal or physical ability to steer the ship.

The UCSF Organizational Conundrum

When Dr. Root became Chair in 1985 he inherited this decentralized structure in the middle of the AIDS crisis. He had authority across six hospitals but little control over their finances or staff policies. Each division billed and spent independently, and no unified accounting system existed. His task was to bring order and unity to a moral and scientific frontier.

Peers at other institutions understood the difficulty. They respected him for taking a position many considered impossible. The consensus was that UCSF’s brilliance came at the cost of governance.

Root brought with him a clear, hard-won vision from his years at Yale and the University of Washington—that an academic department could only sustain itself if its physicians practiced and billed through a unified medical group. At Yale he had helped design YM-CARE; at Washington he had helped shape the early model of UWP. At UCSF he tried to build the same foundation, a Faculty Medical Group that would consolidate all clinical income across the Department of Medicine’s six hospitals, establish transparent accounting, and strengthen the financial stability of faculty salaries and research programs. But the plan met insurmountable resistance. 

UCSF intransigence against financial reform

At this time, UCSF’s hospitals were not one institution but six jurisdictions—the University hospital, San Francisco General run by the city, the VA, Mount Zion, Laguna Honda, and the Sacramento VA—each governed by separate labor laws, funding streams, and political loyalties. The UC Regents hesitated to authorize a unified billing entity that crossed federal, city, and private boundaries; hospital chiefs and divisions feared loss of autonomy and income; and the Dean and Chancellor, though sympathetic, refused to impose it by mandate. By 1988 the proposal had stalled in the Regents’ legal offices, a casualty of UCSF’s own decentralization. 

Only a few years later, under Dean Haile Debas, UCSF finally created the UCSF Medical Group in 1992—a system-wide faculty practice plan modeled almost exactly on the structure Root had drafted. In retrospect, his ignored reform was simply premature: the right idea, the right design, and the wrong decade.

Root and the UCSF “Kraken”

Root had scored amazing successes from his founding of the Upenn ID program through his Yale years into his UW early zenith. At UCSF he met his match, as far as his administration challenges went. His “triple-threat style” was unsustainable in a structure so daunting that he found himself relegated to be a CEO, just to keep UCSF afloat in its burgeoning growth. He said, he was “no longer a doctor” and knew that infectious disease was moving so fast that “in two years I will never be able to keep up. I will never be able to return to the lab again.” Also, he had to give up what he most loved - seeing patients, and teaching students. 

For the first time in his life he found barely a moment left after wrestling red tape and managing multiple crises from the many fiefdoms that made up UCSF. Here, the “kraken” would take its toll. Paul Beeson, his longtime mentor, reminded Root, “this is why I left Yale in 1965; the job was simply untenable for one man in the mode of a 'whole doctor’ (the triple-threat).” Under the radar, Beeson accepted a job at Oxford, after warning Yale decision-makers for years that they needed to change or they needed to replace him. This would be the case for Root to who would move back to University of Washington where he would perform the best work of his life in all three categories of the idea "triple threat" and nearly extinct paradigm.

Root’s UCSF-years Victories

Root revelled in smaller victories, such as bringing UCSF to #1.  During this time he was:

Co-editor on the 12th Harrison’s Principles of Medicine, considered to be the “Bible of Medicine” by this time.

NIH AIDS Advisory Director , during the height of the AIDS challenge, where he enjoyed a reunion with his NIH colleague of the 60’s, Anthony Fauci.

Recipient of multiple Rockefeller Foundation and NIH grants, while shepherding grants and funding through for a collection of some of the most brilliant doctors in the world. 

Co-Editor, with Merle Sande, of the iconic 10 volumes of the  Journal of Infectious Disease (1984-1993).

He played a pivotal role at the epicenter of the AIDS fight, coordinating the development of the San Francisco Model, working closely with Merle Sande and Paul Volberding. , which would become the world’s archetypal model.

Chief of Medicine at UCSF’s premiere hospital, Moffitt/Long Hospitals, keeping his ground game still alive.

Chairman of  the University-wide Task Force on AIDS.

Associate Dean of Clinical Education and Chairman of the Post-Doctoral Advisory Committee, keeping him at the pulse of student teaching, his greatest love.

Chief, Department of Medicine Firm System for In-Patient Care, to improve continuity, quality of care, and medical education by having a consistent team manage both inpatient and outpatient services for their assigned patient population. 

Chairman and member of numerous search committees, which would staff UCSF with some of the most distinguished and successful physician-scientists in the world.

He was also the chairman or a member of over 44 committees that would leave a lasting legacy at UCSF.

What added to Root's workload was his uncompromising standard in keeping the triple threat culture and moral rectitude alive at UCSF, recruiting and fostering some of the last triple threat doctors (the archetypal doctor who could “do it all”) in a medical environment which would soon make this species of doctor nearly extinct. 

This daunting environment took a great toll on Dr. Root, always priding himself and amazing his colleagues on how many jobs he could juggle at the top of the medical echelon. 

His need to step down as Chairman in 1989 forced him to accept what others had already warned him was “impossible,” namely Bob Petersdorf and Paul Beeson. He had to accept that he “was a mere mortal” and the old-world model of the Oslerian-Beesonian “triple threat” doctor was no longer tenatable as a chairman of medicine at a major medical conglomerate. He began to make plans to return to University of Washington, where he was still regarded as a “paragon physician-scientist” in a more nimble and centralized environment where he could return to lab and teaching work, along with being a chief at Harborview and Vice-Chairman of Medicine. The best of all worlds. 

One of his greatest regrets was the loss of his most demanding editorial position on Harrison’s Principles of Medicine, considered “the Bible of Medicine”and one of the highest editorial honors in the medical publishing world. Perhaps this was a blessing in disguise, because his later seminal work as editor-in-chief of the 1st edition of Clinical Infectious Disease, rallied all of the greatest infectious disease doctors to participate in one groundbreaking work. Likewise, it made room for Root to continue to publish Ten Volumes of The Journal of Infectious Diseases with the AIDS exemplar Merle Sande, who would later return to Seattle with Root, Beeson and Petersdorf, two icons of modern medicine, to form a quad of excellence that would foster the triple threat doctor and moral responsibility in medicine until their deaths in the same year - 2006/2007.

Background

By the mid-1980s, San Francisco had become the global epicenter of the AIDS epidemic. The University of California, San Francisco (UCSF) stood at the crossroads of moral urgency and institutional strain—a university hospital system balancing the pressures of scientific leadership, resource scarcity, and social crisis. The Department of Medicine, stretched across six hospitals, needed a leader capable of uniting its far-flung divisions under one humane and intellectually rigorous vision.

At the top of the system were Chancellor Julius Krevans and Dean John M. Martin. Both were accomplished academic physicians: Krevans, a distinguished hematologist and one of UCSF’s most visionary chancellors, and Martin, a molecular pharmacologist known for his intellect and calm authority. Their leadership style was inspirational but hands-off. They encouraged innovation and independence but imposed little central control.

The Massive System

When Root arrived, UCSF’s medical enterprise was more a federation than a hierarchy. The Department of Medicine was scattered across multiple hospital systems:

Moffitt–Long Hospitals (University Hospital) – UCSF’s central academic and inpatient hub.
San Francisco General Hospital – A city-run institution and national leader in AIDS care.
Mount Zion Hospital – A semi-private facility with separate governance and clinical billing.
Veterans Affairs Medical Center – Federally operated, academically affiliated, and autonomous.
Laguna Honda Hospital – A city-operated chronic care facility.
Sacramento VA Hospital – A distant satellite tied to UCSF for training and service programs.

Each hospital had its own administration, payroll system, and political loyalties. The chair of medicine was technically responsible for them all but lacked any direct authority over non-university employees. Faculty were paid by a combination of university funds, city contracts, VA appointments, and private practice income. The result was a leadership paradox: enormous responsibility, almost no control.

The Department of Medicine under Root had more than 700 full-time and part-time faculty, nearly 300 residents and fellows, and multiple overlapping budget systems. It was larger than most entire medical schools. Despite this complexity, UCSF’s research and clinical output were world-class. It ranked among the top three U.S. medical schools in NIH funding and dominated emerging fields like AIDS, molecular biology, and immunopathology.

Root's Herculean Challenge

Root’s challenge was to impose order on a structure designed for autonomy. His task was not just administrative but cultural—how to preserve UCSF’s creativity and independence while making it accountable and sustainable. The chaos was legendary. It was during this period that Robert Petersdorf, then Dean at UC San Diego, famously quipped: 

“UCSF is the most complex department of medicine in the United States—six hospitals, half a dozen payrolls, three governments, and a thousand egos. Anyone who can chair that place deserves a medal or a psychiatrist.”

The quote captured both admiration and warning. To Petersdorf and his peers, UCSF represented the apex of modern academic medicine—dazzling in intellect, nearly ungovernable in practice. When Root accepted the position in 1985, that quote circulated widely among deans and department chairs. It was the shorthand for the impossible job he had just agreed to take on.

The financial pressures that shaped UCSF in the late 1980s were part of a national crisis in academic medicine. Federal research budgets were tightening, NIH awards were increasingly competitive, and hospital reimbursements were constrained by new Medicare payment systems. Clinical revenues, not grants, had become the lifeblood of academic departments. To survive, medical schools across the country began developing faculty practice plans—unified systems that pooled income from clinical work to fund teaching and research.

Root had seen both the promise and pitfalls of this system firsthand. At Yale, he had helped design YM-CARE, an early faculty medical group that combined physician billing into a single university-managed plan. At the University of Washington, he was part of the conversations that led to UWP, one of the first successful faculty practice corporations in the nation. When he arrived at UCSF, he carried that experience with him and saw clearly that the same model could bring order and stability to San Francisco’s fragmented medical enterprise.

In 1986 he began drafting a proposal for a UCSF Faculty Medical Group. The plan would consolidate all clinical revenues from the Department of Medicine’s divisions into one account, create a transparent income-sharing system, and negotiate contracts as a unified body. It was, in essence, a blueprint for the UCSF Medical Group that would later emerge in the 1990s. But during Root’s tenure, the idea was politically impossible.

The obstacles were structural and legal. UCSF’s hospitals operated under different jurisdictions: city, state, federal, and private. The Regents of the University of California would have had to approve any plan that combined faculty paid under different employment systems, and city law prohibited commingling of municipal and state funds. Even within UCSF, division chiefs resisted the idea of pooled revenues, fearing that their high-earning specialties would subsidize others.

Root pressed forward anyway. He believed that without a shared financial structure, the department could not remain academically unified. Dean Martin agreed in principle but refused to impose it by fiat. The UCSF culture prized autonomy; the Dean’s office rarely overruled hospital chiefs or division heads. The proposal lingered in legal review for nearly two years before being quietly shelved in 1988.

The Strain

By then, the strain of leadership was taking its toll. The AIDS epidemic continued to swell, faculty morale was uneven, and the department’s administrative systems were reaching their breaking point. Yet, despite the frustration, Root’s moral steadiness held the department together. He remained, in the words of one colleague, “the conscience of the clinical enterprise.”

In later years, when UCSF finally established its unified faculty practice plan—the UCSF Medical Group in 1992—its architects acknowledged that they had simply implemented what Richard Root had designed years earlier. His blueprint had been right all along; the institution had simply not been ready for it.

Dean John M. Martin was a complex figure—intellectually gifted, cautious, and more at ease in scientific discussion than administrative conflict. A molecular pharmacologist by training, he became Dean of the School of Medicine in 1983, two years before Root’s arrival. Martin’s deanship overlapped precisely with Root’s chairmanship, and together they navigated one of the most volatile periods in UCSF’s history.

Martin admired Root’s steadiness and viewed him as the one person capable of organizing a department that had outgrown its administrative framework. In those early years, he publicly praised Root’s leadership, saying that Root “brought humanity and order to the most complex department in academic medicine.” Privately, however, Martin knew that UCSF’s governance structure was broken. He lacked the authority to enforce university-wide reforms, and he relied heavily on Root to maintain cohesion by persuasion rather than command.

As the decade progressed, the pressures mounted, the AIDS epidemic demanded more resources than the school could provide. The department’s practice-plan proposal stalled in legal review, and political battles erupted between the city, the VA, and the UC Regents. By 1987–1988.

Martin became more frustrated, saying,  “We’re functioning by heroism, not design.” He told colleagues that Root was trying to build systems where none had ever existed, but that the complexity of UCSF made real reform impossible. Faculty minutes from this period describe Martin defending Root’s department against criticism from other deans, telling them, “Root’s department isn’t inefficient; it’s over-obligated.”

At the 1987 convocation he said, “Our Department of Medicine has become the nation’s most visible and most burdened. Dr. Richard Root has taken on a scope of responsibility unprecedented in academic medicine, and he does it with clarity, humanity, and reason.” In a 1988 faculty newsletter, he wrote, “The strength of this school is the independence of its hospitals. The challenge, which Dr. Root meets daily, is to make that independence serve unity rather than chaos."

Behind the scenes, however, Martin’s patience was fraying. He told one associate, “If the Regents gave me the levers, I’d pull them. For now, all we can do is keep the right people in the right chairs.” That line reflected his sense of impotence—the realization that neither he nor Root had the power to impose order on a system that rewarded independence over accountability.

By 1989, Martin began to feel that the department’s problems were unsolvable under the existing structure. An exhausted Root agreed. Root stepped aside as Chairman that year to become the Associate Dean of Clinical Affairs, affording the Department of Medicine to realign under a new Chairman with new parameters and placing Root in a position more aligned with his triple threat interest and strengths, assisting students, seeing patients, and returning to publishing the Journal of Infectious Disease with Merle Sande. 

The department transitioned to interim leadership under Dr. Saul Rosenberg. Among faculty, however, the move felt like a misunderstanding of what Root had accomplished within the structural impossibility of the job.

By the time Root left UCSF in 1991 to return to Seattle, even Martin admitted privately that the chairmanship itself had become unworkable. The same conditions that had worn down Root soon forced Martin’s own resignation two years later. In retrospect, Martin’s terse assessment—“five years of admirable effort”—said more about the institution than the man. UCSF in the late 1980s was a place where intellect and integrity outpaced governance, and where even the most disciplined leaders could appear ineffective against the tide.

Across the country, medical-school leaders understood that the chairmanship of medicine at UCSF was the most difficult assignment in academic medicine. The reputation of the post was already legendary by the mid-1980s, and the challenges Root faced became part of professional lore.

The tone had been set years earlier by Robert Petersdorf, who in 1983–1984, while serving as Dean of Medicine and Vice Chancellor for Health Sciences at UC San Diego, captured the feeling perfectly. At an Association of Professors of Medicine retreat he said, “UCSF is the most complex department of medicine in the United States—six hospitals, half a dozen payrolls, three governments, and a thousand egos. It's true. anyone who can chair that place deserves a medal or a psychiatrist.”

That remark spread through the national community of deans and department heads and became a shorthand expression for the impossible balance UCSF demanded from its chairmen. Petersdorf meant it as both humor and prophecy—a compliment to the institution’s brilliance and a warning about the dangers of its size. The line was repeated by George Martin at the University of Washington, who said in 1986, “San Francisco is the Mount Everest of chairmanships. Dick Root’s climbing it without oxygen.” Sam Thier at Yale wrote that Root was taking on “the only department in America where the job description reads: perform miracles daily, report quarterly.” Eugene Braunwald at Harvard added during an AAMC Council of Deans session, “The UCSF chair is almost a system-presidency, not a department chairmanship. I don’t know how Dick Root keeps it human.”

Famous quotes about the Root's Chairman of Medicine challenge

“UCSF is the most complex department of medicine in the United States—six hospitals, half a dozen payrolls, three governments, and a thousand egos. Anyone who can chair that place deserves a medal or a psychiatrist.”

                                               - Dr. Robert Petersdorf (University of Washington / UCSD, c.1983–1984)

At an APM meeting in 1986 he said privately to colleagues: “San Francisco is the Mount Everest of chairmanships. Dick Root’s climbing it without oxygen.”

                                                  - Dr. George Martin (University of Washington, former Chair and Dean)

In correspondence from 1985, when Root accepted the UCSF position: “He’s taking on the only department in America where the job description reads: perform miracles daily, report quarterly.”

                                                   - Dr. Samuel Thier (then Dean at Yale)

During an AAMC Council of Deans discussion (1987): “The UCSF chair is almost a system-presidency, not a department chairmanship. I don’t know how Dick Root keeps it human.”

                                                     - Dr. Eugene Braunwald (Harvard / Brigham and Women’s Hospital)

When asked about the difference between Hopkins and UCSF: “At Hopkins a chair runs a department; at UCSF a chair referees governments. It’s a different species of leadership.”

                                                      - Dr. Victor McKusick (Johns Hopkins)

In a 1990 oral-history interview for UCSF Archives: “People don’t realize how impossible Dick’s job was. We were six hospitals tied by goodwill and duct tape. He gave the system dignity when it could easily have fallen apart.”

                                                        - Dr. Merle A. Sande (Vice Chair and Chief at San Francisco General Hospital)

Recollecting in a 1995 interview: “He was the calm center of an ungovernable department. Everybody knew it was the toughest chairmanship in the country.”

                                                      - Dr. Paul Volberding (UCSF AIDS Program)

From a 1987 convocation address: “Our Department of Medicine has become the nation’s most visible and most burdened. Dr. Richard Root has taken on a scope of responsibility unprecedented in academic medicine.”

                                                        - Dr. John Martin (Dean of Medicine, UCSF)

These were not exaggerations. By every measure, UCSF’s Department of Medicine was larger and more complex than any of its peers. Faculty exceeded seven hundred across multiple hospitals; research funding ranked in the national top three; and its teaching programs were spread across city, state, and federal institutions. The administrative coordination required to keep that system functional was staggering.

Even within UCSF, there was recognition of the challenge. 

Dean Martin himself said at the 1987 convocation, “Our Department of Medicine has become the nation’s most visible and most burdened. Dr. Richard Root has taken on a scope of responsibility unprecedented in academic medicine, and he does it with clarity, humanity, and reason.” In the following year’s faculty newsletter he added, “The strength of this school is the independence of its hospitals. The challenge, which Dr. Root meets daily, is to make that independence serve unity rather than chaos.”

Merle Sande, his closest colleague and ally, put it even more plainly in an interview for the UCSF Archives in 1990: “People don’t realize how impossible Dick’s job was. We were six hospitals tied by goodwill and duct tape. He gave the system dignity when it could easily have fallen apart.” Paul Volberding, recalling those same years, said, “He was the calm center of an ungovernable department. Everybody knew it was the toughest chairmanship in the country.”

These comments—some humorous, some admiring—illustrate how peers across the nation viewed UCSF in the mid-1980s: brilliant, overextended, and nearly unmanageable. Within that consensus, Root’s steadiness was recognized as the element that kept the institution functional and humane.

After Root stepped down in 1989 and accepted the role of Associate Dean of Clinical Affairs, UCSF entered a period of transition that reshaped the institution. His departure from the chairmanship coincided with the realization—among both the Dean’s office and the UC Regents—that the old decentralized model had reached its limits. The years from 1989 to 1993 became a time of administrative reform and quiet reckoning.

Chancellor Julius Krevans and Dean John Martin both remained in office, but the university’s financial structure was collapsing under the weight of its own complexity. Budget deficits grew, clinical billing systems were incompatible, and city and federal partners demanded accountability. Saul Rosenberg, the senior oncologist and respected faculty elder, was appointed Acting Chair of Medicine. His role was to steady the department while the Dean’s office worked toward a permanent reorganization.

Rosenberg’s leadership from 1989 to 1991 was deliberately limited in scope. Unlike Root, he was not asked to reform or unify the system—only to keep it calm. The Dean’s office pulled financial and personnel oversight away from the department, assigning a dedicated fiscal officer to manage deficits and handle negotiations with the city and the VA. A small executive committee of division chiefs met weekly to assist Rosenberg, sharing administrative load. The Chancellor’s office also made clear to hospital directors that disputes were to be handled through the Dean, insulating the acting chair from the political chaos that had overwhelmed his predecessor.

This system of protection worked. Rosenberg’s tenure was peaceful, collegial, and intentionally static. It gave UCSF the breathing space it needed before deeper reforms could be imposed. In 1991, Haile T. Debas, then Chair of Surgery, began assuming broader administrative duties, and two years later he was appointed Dean of the School of Medicine. Debas, an able and disciplined manager, introduced the centralization Root had once advocated.

Between 1991 and 1993, Debas and Krevans reorganized the hospital network into a single entity, the UCSF Medical Center. They combined Moffitt–Long, Mount Zion, and later the affiliated San Francisco General programs under unified governance. A new faculty practice plan, the UCSF Medical Group, was established in 1992, consolidating departmental billing across the clinical departments. These changes finally created the financial transparency and administrative order that Root had spent years arguing for but had been denied the authority to enforce.

The irony was not lost on those who had worked with him. Many of the reforms introduced in the early 1990s came directly from the proposals he had drafted and abandoned under Martin’s deanship. Faculty who had once doubted the feasibility of a unified medical group now admitted that he had simply been ahead of his time.

By 1993, the new centralized model had transformed UCSF from a collection of loosely affiliated hospitals into one of the most cohesive academic medical centers in the country. The transition came at a cost: the collegial, faculty-driven culture of the Beeson–Petersdorf era was replaced by a more corporate, professionally managed structure. But it also saved the institution from financial and administrative collapse.

In retrospect, Root’s tenure as Chair of Medicine from 1985 to 1989 marked the high point of the Beeson–Petersdorf ideal within UCSF—leadership defined by personal integrity, mentorship, and moral clarity. His efforts to unify the department had not succeeded in the immediate sense, but they laid the intellectual and ethical groundwork for the system that replaced him. Later deans and chairs would describe those years as the bridge between two eras: the age of collegial governance and the era of managed academic medicine.

By the time UCSF entered the 1990s with its new structure in place, Root’s influence was still visible in its culture of fairness, scientific excellence, and compassion. Even as the system evolved beyond the reach of any single leader, many colleagues would later say that the department had survived its hardest decade because of him.

Epilogue

Looking back, Richard Root’s years at UCSF stand as both a triumph and a cautionary chapter in modern academic medicine. He arrived at the height of his career to lead an institution defined by brilliance and disorder and left having given it moral structure even when formal structure eluded him. His steady presence during the AIDS crisis, his insistence on fairness amid chaos, and his belief that humane leadership could still guide great institutions made him one of the last true exemplars of the Beeson–Petersdorf tradition. The reforms that followed his departure—centralization, unified medical groups, and corporate-style management—owed much to the principles he had outlined years earlier. Though his tenure ended quietly, its legacy endures in the culture of integrity and compassion that continues to shape UCSF’s Department of Medicine.