"We automatically look to purchase drugs when drugs become multi-source," says William J. Madden, the director of the UHS pharmacy, referring to when more than one company sells a drug. "We can look to purchase drugs at a reduced rate."

Cutting costs, however, can be tricky. Telling doctors that their services will cost more is a delicate matter, and can be easily bungled.

Dr. Firmon E. Hardenbergh, chief of opthalmology, says that when he came to UHS in 1989, he successfully lobbied for the elimination of a $10 charge on all visits to the eye clinic. But this year, the UHS administration imposed a $20 fee for "routine eye examinations and contact lens evaluations/refittings," according to a memorandum written last fall by Thompson.

But before adding the new fee for the eye exams, administrators forgot to tell their chief opthalmologist, Hardenbergh.

Students will benefit from this focus on cutting outside costs if UHS responds by increasing the number of services it offers.

As it stands now, UHS doctors often accompany patients to nearby hospitals for any kind of surgery. Dr. David Brooks, UHS's acting chief of surgery, accompanies patients to Brigham and Women's Hospital.

Such involvement by salaried doctors helps control costs. "My predecessor did not operate," says Hardenbergh. "But I'm doing much of the major surgery. That's a savings because I'm on salary."

There may be more changes. The chief of surgery who will replace Brooks, a part-time employee, will work full-time at UHS. And Hardenbergh says UHS may develop an ambulatory surgery center inside the health service.

"The feeling is there may be sufficient interest to support that," says Hardenbergh. "The decision for that would be based on anticipated volume."

But improvements, everyone recognizes, require up-front expenditures of money. The trick is fitting them into the budget.

Rosenthal seems to be moving most quickly on technology. He's equipped UHS with an informational database that keeps doctors and administrators up to date on new developments in medicine.

"There's a payback, isn't there?" says Director of Nursing Bonita A. McCormack. "If you have better technology, you can operate more efficiently down the line."

And by the end of the year, doctors say the computer system, which already allows physicians to call up patient information in their offices, will allow them to access more outside databases and transmit prescriptions directly to the UHS pharmacy.

"Beginning later this year, all providers--doctors and nurse practitioners--will be equipped with stand-alone computers that will be linked with one another, patient records and outside databases," Wanzer says.

Dr. Mary Wolfman's office in the East wing of the third floor, she says, is a testament to the need for renovations. She sits at her desk. Her examining table, less than 10 feet away, is covered with files and papers.