Why a $1 Billion Gift to a Medical School Moved So Many People

NEW YORK — A few days before it was announced that a former professor at Albert Einstein College of Medicine in the Bronx was giving the school $1 billion to ensure free tuition pretty much forever, came word of another significant donation, though one not nearly as astonishing in sum or association. Julia Koch, one of the richest women in the world, was giving $75 million to a medical center in West Palm Beach, which, as The Chronicle of Philanthropy noted, serves “one of Florida’s fastest-growing wealthy enclaves.”

Giving to hospitals in places where someone might have a second or fifth house is a favored cause of the rich. A single summer party on Long Island might raise millions of dollars for Southampton Hospital. This facility in Florida would be called the Julia Koch Family Ambulatory Care Center.

The Einstein gift, which came from a 93-year-old woman named Ruth Gottesman, is remarkable not only for its size but also for the absence of any apparent vanity surrounding it, the fortune having been quietly made by her husband, to whom she was married for 72 years. David Gottesman, known as Sandy, an investor and early acolyte of Warren Buffett’s, was not a creature of Page Six or TV, of divorce settlements, $500 million yachts, Davos or social-media diatribes. As the billionaire class has grown, modern philanthropy has become more extravagant in tandem with the egos and expectations driving it, a cry for the kind of political and social influence to which the Gottesmans seemed so pleasingly indifferent.

According to new research from CASE, an organization for academic administrators involved with fundraising, $58 billion in charitable giving was turned over to colleges and universities during the 2023 fiscal year. It was the second highest amount on record, and the number of gifts totaling $100 million or more — 11 of them — surpassed the figure in 2022.

If the news of the Gottesman gift was received with such admiration and excitement, it was in part because it seemed to drown out the noise of transactionalism banging around so much generosity. Rarely had it been louder than it was in recent months when some of the most successful people on Wall Street made it their side hustle to work toward ousting university presidents whose ideologies and management styles were not aligned with their own.

“There’s a wonderful humility to the story,” Amir Pasic, dean of Indiana University’s Lilly Family School of Philanthropy, observed, especially given what he described as a “change in sentiment” among donors, who look at giving as an investment rather than “a community process.” This dynamic is much more prevalent now than it was even 20 years ago.

The Einstein gift is the third-largest ever made to an institution of higher learning. (Michael Bloomberg’s $1.8 billion to Johns Hopkins, his alma mater, leads the list.) Einstein will not displace its namesake to be called the Ruth Gottesman College of Medicine, nor does its benefactor seem to be demanding any other form of grand institutional deference.

Ruth Gottesman has been involved with the school for more than 55 years, first as a specialist in the diagnosis and treatment of learning disabilities and then as a trustee. Gottesman knew, as Pasic put it, “how the sausage was being made at a very intimate level.” What she noticed in particular was the gristle — how tough it was, particularly for anyone hoping to go into the field of primary care, to leave school burdened with the kind of debt a $59,000 a year tuition can carry. Nearly half of all students at Einstein wind up owing $200,000 or more when they leave.

The cost of a medical education is one major factor driving the doctor shortage that Jesse M. Ehrenfeld, president of the American Medical Association, has called a national crisis. In an October speech at the National Press Club, he said the physician shortfall in the United States could climb to at least 37,000 over the next decade, and it might reach 100,000. Some of the greatest need is in family medicine, where the pay is typically much lower than it is among the various specialties. Last year, 217 residency spots in family medicine went unfilled, the highest in any category. By comparison, anesthesiology had just one vacancy — there were zero in residencies for plastic surgeons.

As it happens, the Bronx has the lowest proportion of general practitioners as a function of neighborhood population of any borough in the city. The hope of a gift like Gottesman’s is that it gives students the freedom not to choose neck lifts — that it provides the opportunity to stay in a place like the Bronx and give care where it is needed. And there is another hope too: that it broadcasts a message of how a billionaire might live his or her best life — without terraforming Mars, without Burning Man, without the attempts to stealth-run Harvard University.

This article originally appeared in The New York Times .