Men and women in hospital management: just a slight feminine touch

Older men in white coats still dominate the management of hospitals in all four Visegrad countries, reflecting overall social patterns in the economy. Although female managers are still rare, change is slowly underway, as future generations of medical doctors will predominantly be women.

Photo: Bratislavska zupa

Hospital management – at least in the case of the 10 biggest hospitals – is still dominated by men in all V4 countries. Similarly to other fields of economy, women as managers are still quite rare also in the health care sector. The regional exceptions are Poland and Slovakia where representation of male and female managers is balanced. In case of Poland this balance is absolute – 50:50, in Slovakia women make up 41% of all 10 biggest hospitals' managers. Therefore, even though the situation in the remaining countries is not so rosy, the regional average is 38% female managers among the 10 biggest hospitals in each country. In Hungary women make up more than one third of all managers; the regional laggard is the Czech republic with only 27% women.
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Dr. Andrea Ficzere, a petite lady with curly hair, laughs when asked about her professional experiences. Ficzere is the general director of Uzsoki Hospital in Budapest, a fairly big institution, with 868 beds and 1,400 staff members. Its oncology and orthopedic departments provide services for some three million people. “I do not think the health sector differs much from other Hungarian sectors. In most hospitals you tend to have three to five directors, and typically the nursing director is the only leadership position filled by a woman. The top management is predominantly male, while the staff is mainly female,” Ficzere says.

A similar situation also exists in the Czech Republic and Slovakia, where the highest levels of hospital management are almost exclusively male territory. Yet, according to the data compiled by the V4Revue, 1 Poland, an exception among V4 countries, is clearly undergoing a “gender revolution” in hospital management. Incredible as it seems, six of the ten biggest Polish hospitals are currently under female leadership.

Poland as a frontrunner

According to the data collected, the ratio of female hospital directors in Hungary, the Czech Republic and Slovakia – at least among the ten largest institutions – tends to be much lower. In the Czech Republic only two big hospitals are under female leadership, and interestingly, neither of those directors are trained doctors.

The case of Dana Jurásková, the director of the General University Hospital in Prague (the Czech Republic’s fourth largest institution), is perhaps the most interesting of all the V4’s leading ladies.  She began as a ward nurse, then worked her way up through the ranks, completed a degree in management and even tried her hand at politics, serving as Minister of Health during the caretaker Jan Fischer-government from 2009 to 2010. 2

In Slovakia and Hungary the picture is gloomier, with only one big hospital out of the ten largest in each country led by a woman. Miriam Lapuníková at Slovakia’s Banská Bystrica and Andrea Facskó at Hungary’s Szeged University Clinic are the only examples of women who have made it to the top of the hospital management ranks.

Like her Czech colleague, Lapuníková was not trained as a doctor, but a manager, which makes Facskó the only female hospital manager with a medical degree in all three countries’ top hospitals. Hungarian health expert Erzsébet Nógrádi-Tóth told the V4Revue that the Hungarian healthcare system prefers to hire directors that are medical doctors, who complement their education with management studies, as opposed to the Czech or Slovakian systems, which trend more towards hiring general managers without a background in medicine to take over hospitals.

Below the ranks of general directors or CEOs, the gender balance somewhat improves. Managing a big hospital, much like running a company, is a complex challenge that requires an excellent team, and women tend to have certain roles and tasks here – mainly in nursing and finance.

Poland is the clear frontrunner in female representation at this level too. Of the 64 management positions counted by the V4Revue, women occupied 31% to almost 50%. There were even some hospitals where women filled the majority of management positions. For example, a hospital in Toruń, where Sylwia Sobczak serves as general director, has five women on an eight-chair board. 3 A clear correlation between female CEOs/general directors and a more gender-balanced board was discovered, some female directors even giving half the positions to their female colleagues.

Obviously, we have to note here that within medical management positions, medical directors are still predominantly men, whereas nursing directors are almost exclusively women.

Women commonly occupy managerial positions in HR, sales and finance, and in certain cases even IT management positions; and women are promoted as nursing, financial and sales directors much more than they are promoted as medical or deputy directors of hospitals. 4

The other three V4 countries lag miles behind Poland in female representation in management positions overall. Slovakia comes in second, with women occupying 31 of the 75 (41%) managerial positions in the ten largest hospitals. However, there was only one case of a woman making it to the job of medical director – the other divisions with high female leadership were nursing, finance or HR. Twenty-three of the 65 managerial positions (35%) were held by women in Hungary, while only 24 of the 89 positions (26%) were held by women in the Czech Republic.

The medical field’s strong male dominance may change in the future, since men clearly constitute the minority of new medical graduates. The imbalance is striking. Last year in Slovakia and Poland, 77% of medical school graduates were women (in Slovakia in 2009/10 the ratio had reached 89%). The Czech Republic follows with 65% and then Hungary with 58% (data from 2011/12).

Before celebrating women’s increasing numbers in medicine, it is worth noting that gender experts remind us that women tend to dominate professions where money is scarce, or once they do outnumber men, the salaries paid that profession drops. 5 The decreasing interest male students have in medicine is partially due to the sad fact that most doctors, especially in their younger years, are seriously underpaid in all the V4 countries.  6 It is difficult to predict when and how the medical universities’ gender revolution will impact top-level health management: the best paid jobs are still the most difficult to conquer for women in all areas.

Ready for a career change

The few women that have already made it to the top do not consider themselves “extraterrestrial creatures,” but their success did require a special mix of talents. Regardless if they were originally a nurse or a doctor, they primarily had to become managers and demonstrate an ability to lead, even in a man’s world.

“Yes, I’m ambitious,” Dana Jurásková admitted in an interview with Ona Dnes, the weekly supplement of the daily, MF Dnes. 7 After obtaining a Nursing Pedagogics degree at the Department of Philosophy at Charles University, Jurásková majored in Social Health Provision at Palacky University’s Medical Department, and then finally completed her MBA at the Prague International Business School. When asked whether she was born to be a boss, Jurásková answered, “I used to be the chair of the class, too.” Although she is now divorced, she explained that the only area she had refrained from commanding was her home. The household had been her husband’s jurisdiction; he took the children to kindergarten and organized the family life.

“I am a fighter,” Andrea Ficzere explains to the V4Revue. As director of Hungary’s Uzsoki Hospital, her path was somewhat similar to Jurásková’s. She worked as a neurologist for 14 years, but later became more interested in management. After completing her education with a management degree, she worked for a medical supply company. What makes Ficzere’s example even more peculiar is the fact that she is an outlier of the so-called “Budapest clan,” as she put. Being a woman and coming from the provinces is considered two strikes against you in Hungary. “In the beginning nobody believed that I could succeed,” she acknowledges.

She has spent almost four years at her current position, introducing a brand new IT system and setting up a VIP department to increase revenues, and she feels accepted and supported by the staff. She puts special emphasis on creating a friendly hospital environment, with flowers, coffee, book shops, and an area for children. “We are here for the patients and they need to feel that,” she explains.

The first Slovak woman to lead a major hospital, Miriam Lapuníková, is proof that women can conquer this world without a medical degree. Lapuníková has worked for the Roosevelt University Hospital in Banská Bystrica for a decade, serving as the deputy finance director for the last five years. At first glance, she might also be a “dual outcast,” as a women and an outlier to the medical profession, but she sees it differently. “It does not really matter whether a director has a medical or economic background – at least in my view – he or she must be a manager in the first place,” she said in a television interview shortly after she was appointed, adding, “I really make an effort to communicate with doctors daily, without that, nothing is possible.” 8

What matters for her, is the hospital’s atmosphere and the patients and employees’ well-being. Her initiative to open a kindergarten for employees’ children in the hospital even made some echo in the national press. The inspiration, as she explained in an interview with Pravda, came from the employees themselves: “During a recruitment interview, one mother told me that it would be great if she could have her two kids in a nursery nearby. So we adopted the idea and began to develop it further,” she explained. The initiative was highly appreciated by both doctors and nurses, making it easier for many to reconcile work and familial obligations. Even then-Deputy Health Minister Mário Mikloši praised it as an inspiration for larger hospitals elsewhere. 9

Barbara Bulanowska, the director of the largest Polish Hospital is not a trained medical doctor either. In an interview with Gazeta Krakowska, she explained that originally she was an idealist, driven to change the huge problems she had seen in health sector. This motivation took her off her original course of studies in the humanities, landing her in the School of Public Health. “Most of the students were doctors, economists, or lawyers, and then me, a graduate in humanities. When someone asked me why I chose the School of Public Health, I replied that I could then become a director of a hospital. All my classmates laughed,” she remembered. 10

But she was serious about her plans, believing in clear objectives and persistence. As a single mother, she had extra difficulties reconciling familial and financial responsibilities. “I did not believe in myself, but I was motivated to work for my children,” she said. Her personal motto became, what does not kill you, makes you stronger. “My professional life was not easy: no position was given to me with a lick and a promise. I had to win the contests and then work hard to gain the trust of my superiors and subordinates,” she explained.

When interviewed by the V4Revue, most of the women serving in hospitals’ leadership positions refrained from calling themselves feminists, nor did they admit a preference for more women on the hospital boards. In this respect, the attitudes held by successful women in the health sector does not differ much from those held by successful women in the overall economy: they both tend to prefer gender-diverse boards and working environments.

“I actually like to work with men, but I also think we have to strike a healthy gender balance in all leadership positions,” admits Ficzere. “When I hire a new colleague, I never really consider gender, but professional curriculum and their ability to make decisions,” she explains. Jurásková says she has never felt pushed aside for being a woman, and admits her preference for hiring women, because she believes women excel at quick decision-making. “We do not contemplate for too long, instead we simply go with a solution,” she says.

Women here, just like in the business world, are also confronted with difficult aspects of being both a woman and a boss. Both Jurásková and Ficzere point out that women inherently love to be driven by approval, but leadership often requires a toughness and painful decision-making. This might be a reason why many women refrain from these positions.

“As a boss you have to be demanding, which does not comingle well with our protective, emphatic female role,” explains Jurásková. “You don’t want to hurt anyone, but you must say unpleasant things. Not all women appreciate that,” she says. 11

Ficzere also acknowledges that her position is not always comfortable: “It is good to be emphatic, but after some time, you have to become tougher. I’d love to be liked by all the staff, but in this position it is impossible,” she says, and then adds, “yes, I’m sometimes criticized by my male colleagues as being too tough.”

Feminization has its drawbacks

Although the largest hospitals are still directed by men, and they still outnumber women on hospital boards, there is a very visible female dominance in the region’s healthcare sector. Women not only constitute the majority of those graduating from medical school, but medical doctors and physicians in general. According to OECD survey, the share of female doctors in all four Visegrad countries was already over 50% in 2013, and was steadily increasing. 12

In all four countries, there is a long list of “female medical specializations,” including ophthalmology, neurology, pulmonology, radiology and gastroenterology. Pediatrics is also traditionally a sector where women tend to excel. Women are also moving into the mid-level management ranks, many serving as ward directors, and interestingly, there is a growing number of female oncological ward directors.

Many, even some female doctors, believe healthcare’s feminization is problematic: “Healthcare is being significantly feminized, although not as much as education, for example. Yet I still consider the trend harmful to the sector,” says Jurásková.

However other specializations like surgery, traumatology or to a lesser extent, gynecology, are still dominated by men. Gynecology is considered by many to be one of the highest paid specializations in medicine (especially in Hungary due to “gratitude” payments), 13 while surgery and traumatology are specializations that require high physical endurance, some operations lasting five to six hours.

Ficzere believes that there are certain physical limits for women (because long hours and operations require physical strength), that should be taken into consideration. Interestingly, Facskó had an initial interest in surgery, but then was “convinced” by male colleagues and family members to choose a “lighter version,” of medicine, settling on ophthalmology.

This is a trend rather than an exception. As Marie Čermáková, a sociologist focusing on gender issues, pointed out in an interview with the Czech news magazine, Respekt, women do not always willingly choose the so-called “female specializations”. “Much more frequently, they are submitted to the strict rejections or “fatherly advice” of ward directors,” Čermáková says.

In the same article, Marie Pešková, the headmaster of the First Surgical Clinic of the General University Hospital in Prague, explains that “ward directors always give preference to men, because knows they won’t leave.” In her opinion, men and women do not have the same chances in surgery.

“It is not that men are more skilled or respond better to risky situations, but because some women must take maternity leave, which holds them back. By the time she comes back, her colleagues of the same age perform more complex operations while she has to start from scratch again,” Pešková claimed, and then added, “if surgeons are to stay at the top, they have to dedicate all their time to work.” Having no children herself, she believes female surgeons must decide whether they want to keep up with the men in their specialization, or take care of their children. 14

Night shifts versus family life

Because of the nightshifts and the long and stressful working hours, one of the biggest challenges for female doctors is striking a balance between their careers and family lives. Ficzere confesses that she is a divorcee, but her children are now 20 and 19 years old. Nevertheless, she believes that in the 21st century, women with clear ambitions can achieve their goals. “The glass ceiling was created by women, who were afraid to succeed. It is a pretext that tells women they do not have enough time, but I find time for sports, culture and family,” Ficzere says. “It’s not so complicated; you just have to learn to delegate tasks and manage your time well,” she assures.

Jurásková did not feel she had missed things due to her career either. “There were times when I worked for 16 hours a day, plus family, children … It was quite the killer, but I managed to raise them, and I had the opportunities to stay at home with them. I liked my job – it was my hobby as well,” 15 she wrote in Vlasta magazine. However, she said she does believe the world needs more feminine input. “We have been living in a world of male values. We talk about success, money and power. However, in order to achieve a life of contentment, people also need health, love and family,” she said.

A balancing act

The research and the interviews have revealed that women’s progress in the health sector is similar to their overall status in society. The fact that women are overtaking men in the health sector, not only as nurses, but as doctors as well, does not mean that more women are getting promoted to the top positions.

A career as a ward director may require even more endurance and toughness than a “normal” career in the business world, since night shifts and weekend duties are essential parts of the package.

Nevertheless, as Poland shows, the glass ceiling can be broken, if the socio-political atmosphere does not hinder those women with ambitions. In the end, most women do not want to replace all men in the health sector, but instead to strive for a healthy balance. Even those at the top.

(The author would like to thank Ms. Zuzana Vojteková and Ms. Agata Mazepus for their invaluable help in translating the Czech, Slovak and Polish interviews.)

 The full data visualisation is available here. In case you would like to receive the full data set for either country or the whole V4, send us an email at rebecca(at)visegradrevue.eu

The article is part of the project “Learning about causes and effects of gender (im)balance in Central Europe” funded by the European Union flag_yellow_high
The content series was created by the V4Revue, not by the funder.

Notes:

  1. The V4Revue listed the 10 largest hospitals (based on the number of beds) in each country, and compared the ratio of men and women in hospital management and ward directors. The research included the medical chambers and the graduates of medical universities.
  2. Management of the General University Hospital in Prague, http://bit.ly/2bSAdGp (accessed August 3, 2016).
  3. See V4Revue’s list of hospital directors and management.
  4. One of the grand dames of Czech politics, Zuzana Roithová was appointed the director of the Prague Faculty Hospital in 1990, then became Chairwoman of the Association of Hospitals, and even Minister of Health in 1998.
  5. Claire Cain Miller, “As Women Take over a Male-dominated Field, the Pay Drops,” The New York Times, March 18, 2016, http://nyti.ms/1UaHS4O (accessed August 16, 2016).
  6. Minimum salaries for doctors in the V4 region in 2011 were between 475 (Hungary) and 1495 euros (Slovakia). Minimum salaries for Germany were over 3800 euros and for Denmark 8300 euros. See: Enrico Reginato & Rosario Grosso, “European Hospital Doctors’ Salaries,” European federation of salaried doctors, Document: F11-071 EN, September 13, 2011, http://bit.ly/1PkYJwN (accessed August 16, 2016).
  7. Martina Riebauerová, “Ministryně Dana Jurásková: Jsem rozená ředitelka, ale doma velí muž,” Ona Dnes, March 28, 2010, http://bit.ly/2bwL8rQ (accessed August 2, 2016).
  8. “Nás Host,” TV Hronka, July 30, 2015, http://bit.ly/2bwLAXf (accessed August 2, 2016).
  9. Stefan Rimaj, “Nemocnica v Banskej Bystrici otvorila vlastnú škôlku,” Pravda, February 22, 2016, http://bit.ly/2bYRdhG (accessed August 16, 2016).
  10. Anna Górska, “Kobieta, która trzyma miliardy złotych na nasze zdrowie,” Gazeta Krakowska, November 21, 2013, http://bit.ly/2bYRktq (accessed August 19, 2016).
  11. Martina Riebauerová, “Ministryně Dana Jurásková,” Ona Dnes, http://bit.ly/2bwL8rQ (accessed August 2, 2016).
  12. OECDiLibrary, Health at glance, http://bit.ly/1HypGpB (accessed August 15, 2016).
  13. “Gratitude money” is, in effect, a bribe in the hope of attaining high-quality health services in Hungary. See: Tetiana Stepurko, Milena Pavlova, Irena Gryga & Wim Groot, “Making Patients Pay: Informal Patient Payments in Central and Eastern Europe,” Frontiers in Public Healthhttp://bit.ly/2bAcHQ4 (accessed August 16, 2016).
  14. Hana Čápová, “Being a woman,” Respekt, September 4, 1998 (accessed August 16, 2016).
  15. Karel Černý, “Dana Jurásková: Lékař řídí, sestra koná,” Vlasta, September 30, 2015, http://bit.ly/2bMj816 (accessed August 2, 2016).
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worked as a correspondent in Berlin after earning her PhD at Corvinus University, Budapest. She served as a journalist at the Foreign Desk of Népszabadság from 1997-2003 and her main areas were European affairs, Spain, Latin-America with a special envoy to Madrid, Buenos Aires and Santiago de Chile. In 2010 she became the Foreign Editor of Népszabadság and served in this position until 2014.