He was already Dean of the Rutgers New Jersey Medical School, a pediatrics professor and a doctor who still sees patients at nights and on weekends. So why would Robert Johnson also agree to chair University Hospital's Board of Trustees?

He didn't exactly have a choice.

One of Gov. Chris Christie's final acts before he left office in mid-January was to designate Johnson chairman. Johnson replaces former Gov. Donald DiFrancesco, who resigned amid questions about the duties of his former assistant.

Johnson is a good fit, having been there at the hospital's beginnings at its central ward location and understanding where it needs to go in the future.

In 1972, he graduated from the medical school he now runs, and has devoted his career to improving the health of the city's residents.

"I was here before the first shovel went into the ground" when the construction on the hospital's current location began in 1977, Johnson said. "I was a student, a resident, and a faculty member there training the students, so I know how important University Hospital has been to the health of this whole state. It's been a safety net for people in this city for 100 years, and it has done a fine job doing that."

In a recent interview, Johnson described how the city's rising economic fortunes would translate into better health for Newark residents, as well a path to mitigate University Hospital's chronic financial struggles.

At age 71, Johnson said he can't imagine retiring -- not when efforts to combat some of the city's most stubborn health threats are paying off.

"I work out seven days a week. I'm in the gym every morning at 5 o'clock," he said, a broad smile creasing his face. "I feel great...I cannot imagine not doing this."

Digging out of a hole

University Hospital is the only public acute-care hospital in the state. The 467-bed institution relocated 40 years ago to city-donated land with a mission: to help Newark recover from the 1967 riots by meeting the city's public health needs.

The financial cost of that legacy is steep.

The hospital spent $48 million -- more than any of the 71 other hospitals in the state -- to treat uninsured patients in 2016, according to the most recent state figures. The hospital will receive $48 million in charity care reimbursement this year, according to the state Health Department.

The hospital also has historically received a special appropriation to cover costs, such as the $33 million the state is sending this year to cover pension costs.

In Fiscal Year 2018, the Hospital's operating budget is $666.5 million with a loss of approximately $36 million, said Board member Annette Catino, the finance committee chairwoman. But that's $11 million less than last year, she said. The hospital's success in meeting quality standards programs, such as in reducing admissions for Medicare patients, has earned it more federal aid, she said.

Johnson credits hospital CEO John N. Kastanis and his management team with finding ways to save money. "Things are looking up. Our bond rating is up," he added.

(The state Health Care Facilities Financing Authority extended University Hospital $255 million in bonds in 2015. In November, Fitch Ratings affirmed the hospital's "BBB" rating, which means expectations of default risk are low.)

When asked whether he envisioned a time when University Hospital would not be in the red, Johnson replied with a question.

"Do we envision a time in which indigent people have health care?" Johnson said. The political climate on Capitol Hill strongly suggests the answer is no, he said.

"In reality, we will continue to have communities within our country who do not have insurance and won't be able to get the care they need," Johnson said.

Robert Johnson discusses the health issues facing Newark. (Jeff Granit | For NJ Advance Media)

Choosing not to compete

An influential 2015 study by Navigant Consulting concluded there were too many hospital beds in the Newark area to be economically feasible.

Look for University to compete less and rethink which services it will continue to offer, Johnson said.

"We need to identify our real competitors, because I think our real competitors are... across the Hudson River and Delaware River."

Hospital officials are in talks to transfer their inpatient pediatric beds to Newark Beth Israel Medical Center, part of the RWJBarnabas Health system, because the demand has plummeted. The decline was so significant, it forced Rutgers, New Jersey Medical School to cancel the recruitment of first year pediatric residents for the 2018 program year," University Hospital spokesman Richard Remington said.

If this occurs, "we anticipate placing nearly all of our current inpatient pediatric staff in new positions," Remington added.

Since 2013, RWJBarnbas has had a management consulting agreement with University Hospital. Expect that relationship to grow, Johnson said.

"There's going to be some type relationship with the Barnabas System. Right now it's not absolutely clear," he said. (A takeover or merger is not under discussion, as University is a public hospital, he said.)

"There has to be a reorganization of hospitals in this city," Johnson said. "We do need to have some way of providing the care to the people who need it. We do not need to duplicate all of those things all over the city."

The demand for "high-cost care" -- surgerical procedures, treating people with serious infectious diseases, and trauma care -- remain strong, he said. These are mainstays for the hospital.

As medical school dean and board chairman, Johnson said his goal is to grow the number of primary care doctors. "We don't have a lot of private practices in the city," he said.

Newark's promising prognosis

Over the arc of his career, Johnson has seen the steady decline in Newark of teen pregnancy, HIV infections and crime. More recently, these improvements have overlapped a period of economic rebirth, as Whole Foods and Audible.com have opened their doors in Newark. In his State of the City address Wednesday, Mayor Ras Baraka boasted there's $4 billion worth of development in the pipeline.

"It's not all about doctors and nurses and hospitals. It's things like schools, housing and employment -- all of these things are important and the hospital has to work with the community.

"We are at point where we see a positive future, and that is something that will result in more jobs, and more jobs will lead to better (health) care."

Susan K. Livio may be reached at slivio@njadvancemedia.com. Follow her on Twitter @SusanKLivio. Find NJ.com Politics on Facebook.