When Dr. David S. Rosenthal '59 became director of the University Health Services in 1989, he was faced with a nearly impossible task.

After years of watching UHS run up budget deficits, University bean counters had decided enough was enough. UHS would have to live within its budget, the University said. Rosenthal would have to sort out the details.

"When I came here, which was shortly before Dr. Rosenthal, UHS was not paying much attention to cost containment because they had not been forced to," says Dr. Sidney Wanzer, the director of the UHS satellite clinic at Harvard Law School. "The University had picked up the slack and subsidized UHS for the deficit."

If runaway costs were the only problem facing the health services, Rosenthal's challenge might not have seemed so daunting. But for all the money being spent at 75 Mt. Auburn St., UHS had serious deficiencies that hurt both student access to the facility and the quality of care they received once they got there.

Technologically, Rosenthal and others realized, UHS was living in the 1970s. Little was computerized. The growing number of paper files had exacerbated space problems. The UHS floor plan had not changed since 1960. Medicine had been revolutionized. File cabinets were kept in elevator landings. Patients waited to see doctors in crowded, drafty hallways.

And the system for seeing patients was, by nearly all accounts, a mess. The first floor walk-in clinic was jammed and frequently chaotic, which left students, never very trusting of the health services, frustrated and angry. Some waited half a day to see doctors. Some yelled and screamed. Some left and found treatment elsewhere, or didn't find it at all.

With all these problems, UHS needed dramatic changes. But how much change could it afford? It couldn't hire more doctors and nurses to shorten the first-floor lines. It couldn't move into a bigger building to solve the space crunch. It couldn't computerize its record system without incurring the kind of huge costs that the University would no longer tolerate.

Rosenthal needed a plan.

After a first year spent learning more about UHS, doctors say, the new director hit on a theme: if UHS could be made more efficient, nearly all its problems could be addressed.

By limiting costly outside referrals, UHS could control the amount of money it spent. By incorporating computer technology slowly, administrators could spend less time shuffling papers from place to place and doctors could spend more time with patients--without putting too large a dent in the budget.

By renovating piecemeal with an eye toward efficiency, space could be conserved and UHS could be made more cost-effective. By changing its appointment system, UHS could serve most sick students faster and reduce waits.

Rosenthal says he, and his plan, are now in their "senior year." According to doctors and students, the director has done enough to graduate, with some honors. But everyone--especially Rosenthal--knows there's still more work to do.

Students know little about the costs of the health care they purchase at UHS. In a Crimson poll of 317 undergraduates last week, 45 percent answered "don't know" when asked what they thought about the cost of UHS care and health insurance.

If students aren't thinking about costs, UHS employees are certainly worrying enough to make up for undergraduates. The new emphasis on cost controls has left clinicians, nurses and administrators talking like financial analysts.

"You examine all those functions that are being done," Director of Nursing Bonita McCormack says of controlling costs. "You create efficiencies. You make sure no duplications are being done."

Deficits at UHS had been large during the 1980s, but in the final years of Wacker's tenure they seemed to be receding. UHS ran deficits of just $71,965 and $43,003 in Wacker's final two years. Since Rosenthal took over, the health service has run a balanced budget, although the total amount of the budget has increased more than 10 percent a year to keep up with rising costs.