A billion dollar donation (without a billion dollar ego)

That news of Gottesman’s gift was received with such admiration and excitement was partly because it seemed to drown out the noise of transactionalism pounding around so much generosity. Rarely had it been louder than in recent months, when some of the most successful people on Wall Street made it their side income to oust college presidents whose ideologies and management styles were not in line with their own.

“There is a beautiful humility in the story,” Amir Pasic, the dean of Indiana University’s Lilly Family School of Philanthropy noted, especially given what he described as a “change in sentiment” among donors who view giving as an investment rather than “a community process.” This dynamic is much stronger now than twenty years ago.

The Einstein gift is the third largest gift ever to an institution of higher education. (Michael Bloomberg’s $1.8 billion to Johns Hopkins, his alma mater, tops the list.) Einstein won’t replace his namesake with the name Ruth Gottesman College of Medicine, nor does his benefactor appear to show any other form of grand institutional respect to demand.

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 confidential counselor. Dr. Gottesman knew, as Mr. Pasic put it, “how the sausage was made on a very intimate level.” What struck her most was the crunch — how difficult it was, especially for anyone hoping to go into primary care, to leave school with $59,000 a year in debt. Nearly half of all students at Einstein have $200,000 or more in debt when they leave.

The cost of medical education is a major factor causing the physician shortage that Jesse M. Ehrenfeld, president of the American Medical Association, has called a national crisis. In a speech to the National Press Club in October, he said the shortage of doctors in the United States could reach at least 37,000, and as many as 100,000, over the next decade. The greatest need exists in general medicine, where remuneration is generally much lower than in the various specialties. Last year, 217 residency positions in family medicine were lost unfilled, the highest in each category. By comparison, anesthesiology had only one vacancy: there were zero plastic surgeon residencies.