It was a nasty phenomenon – religious discrimination against the Jews in New York City – that in 1852, eight years before the US Civil War, led to the establishment of the oldest voluntary hospital in the US. After other New York hospitals kept Jews off their staff and out of their wards, philanthropists in the community took the initiative and were not ashamed to call it the Jews’ Hospital.Today, what developed into Mount Sinai Hospital has been ranked 16th out of almost 5,000 medical centers throughout the US by the US News and World Report and is among the top 10 in four medical specialties – geriatrics, gastroenterology, cardiology and otolaryngology (ear, nose and throat).The nine men representing a variety of Jewish charities agreed on a vision for free medical care for indigent Jews in the city. Three years later, the 45-bed hospital was opened in what was then a rural neighborhood on West 28th Street between Seventh and Eighth Avenues.Although the hospital was a sectarian institution, it accepted emergency patients of any religious affiliation.During the first few years that it functioned, most patients were immigrants to the US. As the Jews’ Hospital was a charitable enterprise, its directors depended on donations from Jewish friends and members, as well as payments from the government, to provide enough to subsidize care.During the Civil War, the hospital expanded to treat Union soldiers.Later, to reflect its broadened mission and maintain its eligibility for state and city support, the Jews’ Hospital officially abandoned its sectarian charter in 1866 and was renamed Mount Sinai Hospital. Eleven years later, it moved to a new 120-bed facility on Manhattan’s Lexington Avenue between 66th and 67th Streets.In 1904, the new 456-bed, 10-pavilion Mount Sinai Hospital was dedicated on Fifth Avenue at 100th Street, and that is where it is today, with 1,171 beds.Interestingly, way back in 1887, Mount Sinai published the first description in the US on a disease called “familial amaurotic idiocy,” a rather unkind name for Tay-Sachs disease, a genetic disorder diagnosed mostly in Ashkenazi Jews that has been nearly wiped out due to pre-marital and pre-pregnancy testing.The hospital sent medical units to both World Wars. Of the 24 physicians and 65 nurses serving in World War I with Base Hospital No. 3 of the US Army Medical Corps in France, the majority of doctors and nurses were from Mount Sinai. During World War II, nearly 900 Mount Sinai physicians, nurses, staff members and trustees saw wartime service.Mount Sinai’s affiliated unit, the US Army 3rd General Hospital, served in North Africa, Italy and France. Nine doctors, nurses and other Mount Sinai personnel died during military service.Although Jews are still among the prominent donors, Mount Sinai – the oldest voluntary hospital (owned and run by a voluntary organization) in the world, they are not the majority of its patients.Prof. David Reich, the hospital’s president and chief operating officer, says that it offers a glatt-kosher kitchen, and on any given day, this provides between five percent and 7% of all the hospital’s meals. These represent not only kosher-consuming patients, visitors and staffers, but also Muslims looking for halal meals and others who regard kosher food as more healthful. The statistics show that Mount Sinai is now far from being a “Jewish hospital,” but the cultural influences are still present.And Reich is Jewish too. In an interview with The Jerusalem Post during his visit, he said that New York City is a different melting pot today than it once was. The prominent cardiac anesthesiologist was here on his ninth visit to attend the 23rd International Congress of the Israel Society, which was held for three days at the Tel Aviv Hilton.His first visit, as a youngster, was as part of the Conservative Movement’s Camp Ramah program, and he learned some Hebrew on that trip. He also recalls spending two months in 1980 at Jerusalem’s Shaare Zedek Medical Center as a medical student and living in the capital’s Neve Sha’anan quarter.Reich received his bachelor of science degree with highest distinction from Pennsylvania State University.He then graduated from Thomas Jefferson Medical College in Philadelphia and did his residency in surgery at the University of California at Los Angeles, followed by specialty training in anesthesiology and sub-specialty training in cardiothoracic anesthesia at Mount Sinai Hospital. He became chairman of anesthesiology at his hospital a decade ago after being co-director of cardiothoracic anesthesiology there since 1990. Since then, he has published more than 100 peer-reviewed articles, 30 invited articles and editorials and 30 book chapters.His hospital boasted 2,510 physicians, 1,097 residents and fellows, 2,278 nurses, 58,332 inpatient discharges, 644,527 outpatient and 102,639 emergency room visits last year.He had thought of becoming a surgeon, but finally decided to focus on anesthesiology.“I graduated from medical school knowing that I liked the operating room much more than working in hospital clinics. In surgery, it was nurses in the intensive care unit who suggested I get into cardiac anesthesia, as I seemed to like taking care of patients during and after operations. By then, I was sure I didn’t want to continue as a surgeon. One of my early mentors, Prof. Joel Kaplan, came to the hospital in 1983 to be head of the anesthesiology department, so I joined him there in 1984,” he recalled.He is well aware of the fact that surgical patients never choose their anesthesiologist, but are keen on paying extra to get the “best” surgeon.“When I mentor medical students who are deciding what specialty to go into, I tell them that if they emotionally need praise and credit, anesthesiology is not for them. There is little fame and glamor. You have to be filled with what you do.”The public perception of the anesthesiologist is of a doctor who is behind the scenes, Reich continued.“But that doesn’t diminish value of role. We can educate the public, but we don’t insist that patients choose their own anesthesiologist. We just want them to have the safest experience.”The Philadelphia-born physician said that when he was a student, one had to spend one year on residency in anesthesiology. Today, the basic specialty takes three or even four years. There are additional one-year residencies in sub-specialties like palliative medicine, plus a few years for research.Although there is a severe shortage of anesthesiology specialists in Israel, “in America they are now relatively better paid and thus [there are] fewer manpower [shortages].In the 1990s and early 2000s, there was indeed a problem for US hospitals to get anesthesiologists. Now it is very popular, including among women,” said Reich. “About half of anesthesiologists at Mount Sinai are women. There are family-friendly arrangements so they also have time to have kids.”The fact that there is no real shortage of specialists in the field means that anesthesiologists generally do not overwork themselves.“They should not have very long shifts, as this leads of inattentiveness, and that is potentially dangerous.”Although he is a very busy medical administrator, Reich sets aside time to work as an anesthesiologist for five or six hours one day a week so his skills do not get rusty.“I’m lucky. You learn as a clinical physician in the operating room that administrative crises can wait for a few hours until the surgery is over. It’s quote common for hospital directors to continue to do some clinical work. You maintain a good perspective when you do. I work with residents learning cardiac anesthesia, and cooperating with surgeons and young doctors improves my performance.”After obstetricians, anesthesiologists were for many years plagued by threats of malpractice suits.“Fortunately, the field has seen a major decrease in malpractice cases in the US in the past few decades due to the adoption of new technologies,” said Reich. “There used to be quite a few cases in which the breathing tube was pushed into the esophagus [food tube] rather than the trachea [breathing tube]. In obstetrics, too, there are fewer lawsuits as specialists realized that they had to adopt certain safety practices such as more cesareans for breech births. In any case, the State of New York now gives funding for infants harmed during birth, so there are fewer lawsuits.”IN 1881, a training school for nurses was established at the hospital, introducing professional nursing care to a facility previously served by untrained male and female attendants.The Mount Sinai Hospital School of Nursing closed in 1971 after graduating 4,700 nurses.It is unheard of in Israel for medical centers to establish their own medical faculties. It was unusual in the US. But in 1968, Mount Sinai set up, in affiliation with The City University of New York, its Icahn School of Medicine in 1968. It was the first medical school in the US to grow out of a non-university in more than 50 years. Today, it has 550 medical students, 272 doctoral students, 98 joint MD/doctoral students and 598 postdoctoral fellows. It is ranked 17th among American medical schools.Located in the Annenberg building adjacent to the hospital, the school’s benefactor is American-Jewish merger- and-acquisition businessman Carl Icahn, for whom it was named after he gave a $200 million gift. The first class consisted of 36 students, only four of whom were women.Last year, Reich’s hospital became part of a major integrated healthcare entity called the Mount Sinai Health System. It is headed by Dr. Kenneth Davis and includes seven hospitals in the New York metropolitan area: Beth Israel Medical Center on Manhattan’s Lower East Side; Beth Israel Brooklyn in the borough’s Midwood section; Mount Sinai Queens; the New York Eye and Ear Infirmary; Roosevelt Hospital on Manhattan’s midtown/West Side; St. Luke’s Hospital; and, of course, Mount Sinai.The network of facilities is aimed at improving quality outcomes, increasing efficiency and expanding access to primary and specialty care across a citywide network.Reich noted that the Israeli and American medical systems are very different, and he is not an expert on Israel’s, which is known to be very efficient and gets big bang for the buck. The share of the gross domestic product per capita spent by Israel’s system is half that in the US, and comparative health statistics show that we have higher longevity, lower infant mortality and other positive statistics compared to that of Americans.“My politics are relatively liberal, so I am a big believer in the Obamacare healthcare reform. Everyone should enjoy basic healthcare. But we have to bend down the curve of health costs,” the hospital director said.Reich knows of Israelis who came to his hospital for training and of Israelis’ reputation for being innovative, independent and even brash.“We follow standardized pathways, but there is still room for creativity,” he said. But a large section of students, doctors and researchers are from the Far East and Eastern Europe, some of them from very poor backgrounds.“They become very talented scientists. Maybe they find no opportunity at home or American culture attractive,” said Reich, as the reasons for many of them to stay.Because of the multicultural diversity in the New York population, he continued, his hospital puts special emphasis on catering to cultural competence, with a multitude of languages on signs and medical translators, and creating systems to encourage minorities. “It’s important to be responsive to the communities we serve,” he says.The next time he comes to Israel, Reich concluded, he would be eager to see more of the local hospitals and how they differ from his.