Brad Berk is a little impatient. A man who has held beating human hearts in his hands is anxious about having his photo taken. Lean, with a chiseled face and graying temples, Berk strides quickly and purposefully out of his office just off Strong's main lobby toward where the photographer is setting up. With a rushed delivery that also sounds somewhat rehearsed, Berk shares a grand vision for URMC's future. It can be summed up in one word: growth.

Getting there will mean the most aggressive investment in research talent and new facilities since the UR's founding.

As head of the University of Rochester Medical Center, Berk oversees a $1.8 billion operating budget for an institution that employs more than two-thirds of the university's 18,000 employees. The schools of medicine, dentistry, and nursing fall under his purview, as does the area's largest hospital system.

Under President Joel Seligman, the UR is on an expansion binge. He has committed to building on its almost Ivy League image by making the UR one of the country's top-tier research universities. While Seligman is, in some respects, the university's front man - making speeches, shaping the brand, mixing with community leaders - much of the responsibility for growth sits squarely on Berk's shoulders.

URMC received nearly $250 million in research funding in 2007, says Berk, the bulk of it coming from the National Institute of Health. And the Robert B. Goegen Hall for Biomedical Engineering and Optics, the Aab Cardiovascular Research Institute, and the Wilmot Cancer Center represent more than $100 million in new construction since early 2007.

And URMC is planning on $300 million more in new construction, Berk says, for an outpatient joint-replacement center, a new pediatric facility, and a new clinical science building by 2012.

The 54-year-old cardiologist still sees patients and maintains his own research lab. He was chosen for the CEO position with the help of more than a half-dozen search committees. Back in his office after the photo shoot, a more relaxed Berk reveals the one characteristic that probably landed him the job - he's competitive. He wants a bigger, better, and more prestigious med center. Berk is aiming high - think Johns Hopkins.

While cancer, cardiovascular, immunology, musculoskeletal, and neuromedicine are URMC's five main areas of research and treatment, Berk wants URMC to invest heavily in the emerging sciences, too. URMC has received grants for research into stem cells and the field of regenerative medicine, biomedical imaging for better disease detection, and genomics to unravel the mystery of how human genes interact.

It's too early to tell if the investment in URMC will raise the institution's profile to a top research university. But an anti-viral vaccine that can help prevent some cancers in women and a handful of incubator businesses that URMC has spun off, Berk says, is encouraging.

In an interview with City Newspaper, Berk talked about URMC's expansion, research, and his advice to the presidential candidates on how to improve health care in the US. The following is an edited version of that interview.

City: The 2020 Commission announced its response to the request by area hospitals to increase their bed capacities. You didn't get approval for the 123 new beds you asked for. How will that impact URMC?

Berk: It has actually worked out well. But let me start with why we made that request. We have been operating at code red, which means we are above our capacity, and have been for about five to six years. Usually we are not at red on Mondays because a lot of patients get released over the weekend. But by Wednesday or Thursday, we're right back up there. And patients who are brought into emergency and should be admitted to a room aren't because there are no beds.

Now what the Commission did was approve 71 beds, what we call "physical" beds that we can add right away. But they also approved our request to go forward with PRISM, our new pediatric and image sciences tower. There will be an additional 112 beds in the pediatric tower once it is completed in 2012. And as pediatrics vacates the fourth floor of the Medical Center where it is now, we can replace that area with beds. So the Commission recognizes that we need the 123 beds, and we will get there by 2012.

There is an assumption out there that URMC can't grow much more, at least not on this campus, because you're running out of land. How much further can you expand in terms of building new space?

Right now, the Medical Center is 7 million square feet. We can double essentially to about 14 million square feet.

Part of that growth is what we call compaction. A lot of what we currently have is spread out. We have a lot of surface parking lots. If we convert them to buildings with parking garages and green space, it enables us to use space that right now is just a lot.

You're getting some resistance to your expansion from nearby neighborhoods. You just went through that with the new HighlandHospital ramp garage. As this expansion continues, how are you going to maintain good relations with your neighbors?

We actually just had a town meeting with the local neighborhoods and explained to them exactly what we're doing. Our whole goal is to improve the neighborhoods and to make them more attractive places to live. When we were at the meeting, it's easy to see that a lot of the people who live around here also work here. And one of their biggest concerns, ours too, is traffic. One of the best ways to mitigate the traffic issue is to create an environment where people feel encouraged to walk to work. That's what we're planning to do around Mt. Hope. [Berk is referring to the UR's development plans for a pedestrian-friendly mix of retail, offices, and housing at the former Wegmans site on Mt. Hope Avenue.]

We're changing the times when people start and leave work because 5 p.m. is currently when everyone leaves. If we had some people leaving at, let's say, 4:30 and later, at 5:30 there would be less congested traffic.

We also want to create incentives for people to use off-site shuttles, which can work better for some employees instead of driving around looking for parking.

And ultimately we are working with the state for a new interchange at 390 that would allow people to exit at Kendrick Road. Kendrick is nice because it goes along the river and will take people off Mt. Hope and the side streets.

What about across the river on the Plymouth Avenue side?

We'll be working toward more east-west access to the river. Right now, if you went west from my office you would barely know that the river is right there. We want to open it up on both sides and make the river inviting to people. We don't want it to be a dividing line with some people on this side and some people over there.

Some of your critics look at URMC as the 700-pound gorilla in the room, and that your growth is monopolizing.

Well, that's one of the arguments, but let's look at it. Genesee Hospital and St. Mary's Hospital closed because of the pressures that the Berger Commission recognized was happening throughout the state. If you have an old facility with very substantial capital needs and you don't have sufficient occupancy, you're not financially viable. The UR didn't close those hospitals. Those hospitals closed because their financial situations were inoperable.

This is happening in many parts of the state. There were 50-something hospitals closed by the Berger Commission. Genesee and St. Mary's happened to precede that, but currently all of the hospitals in the Rochester area are filled to capacity. And they're all in the black, which is unusual. So we are certainly not monopolizing the services.

Second, Rochester should be ecstatic and embrace the size of the Medical Center with open arms. We're the largest employer in the area. Every year we add more than 600 jobs to the community and in many ways we are an economic engine. Think about it: we're the 25th largest academic medical center in the country in a small city of a million people. That's very unique for Rochester. We're bringing in more than $250 million just in research work that wouldn't be here if we weren't here. SUNY Syracuse by comparison brings in about $20 million to that community.

This is a knowledge-based economy we're in and one of the peaks of a knowledge-based economy is an academic medical center. So in my view, if we go from the 700 pound gorilla to the 1,000 pound gorilla, that's a good thing.

But is there a danger of becoming too big?

If you look at what's going on around the country, academic medical centers are growing by becoming conglomerates. The largest employer in New York City now is New York Presbyterian, which combined the hospitals of Cornell, Columbia, and Columbia Presbyterian. They've all come together because it gives them the efficiencies of scale in their clinical mission, and opportunities to create larger research programs. And as medicine becomes more technology-driven, to be able to offer the full range of services requires hospitals to have an enormous infrastructure.

An example is pediatric cardiac surgery. We really are the center between Columbia to the south, Boston Children's Hospital to the east, and Cleveland Clinic to the west. We're the only other place with a dedicated pediatric ICU for the post-operative care of these kids. You really need the combination of expertise and technology to pull this off.

Another example - we just recruited an endovascular neurosurgeon. This is a guy who can enter a person's brain through their arteries and treat a stroke by removing the clot. To do that, though, he needs the latest and greatest imaging technology to enable him to determine where the part of the brain is that needs to be rescued. We're going to be building a neurointensive-care unit to treat these people to provide the really sophisticated care they need. Now this guy wouldn't come here if we didn't have a large neurosurgery program.

It's confusing sometimes to hear about research because people want to know what it means to them. Is there something that looks promising that we haven't heard much about?

We have a lot of intellectual property that looks very promising. I could go through every area and point to something. But the thing is, you really can't predict what is going to pop. But one example of something that might happen is something Craig Jordon, an expert in stem cells, has been working on. He has developed a natural compound that comes from the feverfew plant. The compound regulates the division of leukemia stem cells and prevents them from growing, which means it could prevent the disease from developing. And it is about to go into phase 1 clinical trials, which is phenomenal.

We're heading toward the fall political season and health care is a big issue for many people. What advice would you give the candidates in the area of health care?

The Commonwealth Fund in 2007 issued a report on a high performance health system. And I would encourage them to look at their findings. They have made some recommendations that would greatly improve the health care system.

The first and most important thing people need to do is change their behavior. Prevention is the most cost-effective thing we can do.

I'll give you an example. I saw a patient yesterday, a 46-year-old guy who has been treated with medicines for his triglycerides for 20 years. High triglycerides, we know, contribute to heart disease and stroke. About three months ago, he was feeling terrible. He was mowing his lawn and he was feeling so terrible he went to emergency. Turns out he wasn't eating right, and a few other things.

First, we took him off all of his medicines, and we had him sit down with a nutritionist. We went over his diet very carefully and put him on a simple exercise program. We kept him off his medicines. And when I saw him yesterday, he was a changed person. He looks and feels great. He's lost about 12 pounds. His triglycerides are normal. He doesn't need to be on any medications. With some very simple behavior changes, he has changed his life.