When Michael Covert, president and chief executive officer of 691-bed Sarasota Memorial Hospital, hired a young African-American named Michael Rowan as his chief operating officer in January 1993, the door to diversity on Florida's southwest coast cracked open.
Sarasota Memorial is governed by an all-white board of trustees and serves a community of 300,000 that's predominantly white and relatively affluent. Its top executive positions had always been filled by white men.
Seeking to fill the COO slot, Mr. Covert told Witt/Kieffer, Ford, Hadelman & Lloyd, an Oak Brook, Ill.-based executive search firm, that he'd strongly consider minority and female candidates with appropriate qualifications. He wanted a young mover and shaker, and 33-year-old Mr. Rowan fit the bill. The hospital's board agreed.
"The sad part of it all is that other administrators have come to me and said, `Thank you for doing this,"' as if someone needed to be the first to validate the hiring of minorities on the coast of southwest Florida, Mr. Covert said.
The good part, he said, is that local administrators now are calling Mr. Rowan for leads on other minority healthcare candidates. Mr. Rowan, who came to Sarasota Memorial from 519-bed Memorial Medical Center in Savannah, Ga., where he was vice president of administration and patient services, said a few of his colleagues have been interviewed and offered jobs. So far, none has accepted a job in the area.
Still white, male. Despite talk about diversity, white men still fill a disproportionate share of the top positions at the nation's hospitals and healthcare systems. And they're primarily the ones making hiring decisions.
According to the federal Bureau of Labor Statistics, 450,000 people were employed as "managers" in "medicine/health" last year, a 23.6% increase over 1992. The category includes healthcare administrators and many other managerial healthcare occupations. Last year, some 6.5% of the managers were blacks, down from 8.8% in 1992, and 4.2% were Hispanic, up from 2.9%. The data don't detail the number of Asians or Native Americans employed as healthcare managers.
The data also showed that 70.5% of the jobs were filled by women. A labor economist said the large percentage of women managers reflects the significant role they play in nursing and allied health professions, not necessarily in top hospital administrative jobs.
Because hospital and healthcare system executives aren't licensed professionals, it's difficult to determine the number of positions filled by minorities. It's estimated that fewer than 2% of all professional healthcare managers are African-American.
The Group Health Association of America estimates that fewer than 10% of HMO managers are minorities. Only 3.5% of the 21,000 members of the American College of Healthcare Executives are minorities. At a time when the ranks of minorities in healthcare are already slim, the competition for health administration jobs is getting tougher.
As managed care expands and hospitals create integrated healthcare networks, more management opportunities may open for minorities in non-acute-care settings, such as HMOs and ambulatory-care facilities, healthcare executives said (See related story, p. 34).
However, as hospitals merge and downsize, there will be fewer top jobs available.
"Shrinking down the playing field just means that we are more at risk than we were before," said Deborah Lee-Eddie, administrator and COO of 356-bed Brackenridge Hospital, a municipal facility in Austin, Texas. Ms. Lee-Eddie has announced her resignation effective July 29 in the midst of management and financial turmoil at the hospital.
Continuing consolidation in the industry means fewer opportunities for minorities, said Howard Jessamy, president of the District of Columbia Hospital Association. Mr. Jessamy serves as president of the National Association of Health Services Executives, a Washington-based organization that represents 875 black healthcare executives. On the other hand, there's more awareness that race discrimination in healthcare administration must be dealt with, he said.
Battling stereotypes. While the country's non-white population is growing, racial stereotypes remain a barrier to advancement, minority executives said.
For example, people don't believe Asian-Americans can be good managers because they're perceived as not being aggressive enough, said Ellen Chan Rosenberg, medical group administrator at Kaiser Permanente's Santa Teresa Medical Center in San Jose, Calif. Ms. Rosenberg, who's Chinese by descent, is past president of the Kaiser Permanente Asian Association, a nascent group that represents more than 300 Kaiser employees.
There's no national organization for Asian healthcare professionals. Kaiser's Asian Association represents only a few healthcare employees in top administrative positions.
People's sensitivities were heightened by last year's bellwether report by the American College of Healthcare Executives and NAHSE, Mr. Jessamy said. In a joint study of black and white healthcare executives, the two professional organizations found that blacks had fewer CEO positions and earned less than their white counterparts, even though the two groups had similar demographic characteristics and educational backgrounds (See charts, p. 33).
The survey was conducted because "a lot of us were concerned that we were losing ground in the area of minority opportunity," said Thomas C. Dolan, ACHE's president.
Many minority healthcare administrators began their careers in public or inner-city hospitals, where jobs seem to be more accessible to minorities. Some minority administrators said they feel a commitment to work in institutions that serve a large percentage of minorities and the poor.
According to the ACHE/NAHSE report, 34% of blacks got their first job at a government-owned hospital, compared with 25% of whites. Currently, 31% of the black executives in the survey work at a government hospital, compared with 19% of whites.
When Robert Johnson, executive vice president and COO of Detroit Medical Center, finished graduate school, he turned down an offer for an administrative post at Rhode Island Hospital in Providence. Instead, he accepted an associate administrator's position at Kings County Medical Center in New York, one of the nation's largest public hospitals. "In my heart of hearts, I knew what was missing in Rhode Island was a large minority population," Mr. Johnson said.
Wesley K. McGavock, CEO of 286-bed Misericordia Hospital in Philadelphia and senior vice president of its parent, Bala Cynwyd, Pa.-based Mercy Health Corp., said it's often difficult for minorities to move out of such settings. He sees little movement by the nation's for-profit and voluntary hospitals or large healthcare systems to hire more minorities. "Even today, there are only a handful of minorities in any significant roles," he said.
Interviews with minority healthcare executives produced the following snapshot:
The National Black Health Leadership Directory, a compilation of more than 600 black healthcare leaders, contains only 115 names of African-Americans who have CEO or COO positions at hospitals and hospital systems.
Just seven of the nation's 114 academic health centers are headed by women or minorities.
African-American women interviewed for this story said only a handful of them have CEO positions at hospitals, and a couple dozen black women have top leadership posts below the CEO level.
Healthcare administrators and leaders of top executive search firms say they'd like to bring more minority executives into the fold.
In recent years, administrators and boards have begun "pushing and encouraging us to make sure the slate of candidates we produce is a diversified slate," but they only want top-quality candidates, said Michael C. Kieffer, chairman and CEO of Witt/Kieffer. The message is: "Don't bring us a diversified slate just for window dressing," he said.
Lack of experience? The problem is a dearth of candidates with the right credentials and experience, according to search firm and healthcare leaders. When a client asks that several minority candidates be presented, "It's difficult to do that kind of a search because the numbers are so small," Mr. Kieffer said. "You really are faced with a limited pool."
Richard Gustafson, a managing partner at Heidrick & Struggles, a Chicago-based executive search firm, said it's difficult to find healthcare administrators of any race who have developed physician-hospital organizations, and have experience with capitation and solid leadership skills.
Executives said it's also difficult to locate minorities who are willing to relocate to parts of the country where they'll have few peers of like color.
But minority executives argue that it's not difficult to find qualified minority candidates.
Kevin Lofton, associate vice president for health affairs at the University of Alabama, Birmingham, and CEO of 911-bed University of Alabama Hospital, hears from four to five recruiters every month who are seeking minority candidates. "I've been able to refer someone in virtually every situation," he said, "so the people are out there if you really look for them."
In recent months, several trade associations and professional organizations have begun programs aimed at achieving diversity in the upper echelons of healthcare administration.
On the state level, the New Jersey Hospital Association last April announced an initiative to increase the number of minority executives in the ranks of hospital management. Because of a change in association leadership, the initiative has languished. However, the NJHA recently began surveying members to determine how many minorities are in management positions and to assess hospitals' interest in an association-sponsored recruitment and training program.
John Dandridge Jr., president and CEO of 388-bed United Hospitals Medical Center in Newark and chairman of the NJHA task force in charge of the project, is the only African-American CEO among the state's 110 hospital chief executives. In fact, he's the only minority hospital CEO in the state, which "doesn't speak well for the availability of opportunities," he said. The NJHA's effort to increase minority representation will focus on hospitals' boards of trustees because they hire executives.
On the national level, ACHE has distributed a "Guide to Action" designed to help the college's 21,000 members assess minority recruitment in their organizations. ACHE leadership also met with the heads of the healthcare executive search firms to help them become more aware of the need to enhance minority opportunities.
In addition, ACHE and NAHSE are working locally to help train more minorities for executive positions. For example, ACHE, NAHSE and SpencerStuart, a Chicago-based executive search firm, are collaborating with the Greater New York Hospital Association to offer 20 internships and 25 fellowships in New York-area healthcare facilities.
The internships will be available to minority college students who have completed their junior year; fellowships will be offered to those who have completed graduate education in healthcare administration or those with similar undergraduate experience who intend to seek a graduate degree.
ACHE also is participating in a minority recruitment organization that the American Hospital Association plans to unveil in May. The "Institute for Diversity and Health Management," governed by a 35-member advisory board, is seeking to attract minority students to careers in healthcare management.
Currently, the institute is establishing work-study programs at sites across the nation, said Richard Wade, the AHA's senior vice president for communications. Neither Mr. Wade nor Walter Johnson, AHA's senior vice president in charge of establishing the institute, would reveal the number or location of the work-study sites. The AHA wants to make a big splash with its announcement next month.
Mr. Wade said the AHA is investing $100,000 in the effort. ACHE has provided another $25,000, Mr. Dolan said.
The Association of American Medical Colleges and the Association of Academic Health Centers also sponsor minority recruitment programs funded in partnership with private grantmaking organizations.
These programs supplement federal scholarships and funding to medical schools to increase minority participation in the health professions.
Minority executives are encouraged by the commitment of financial resources to these programs. "For the first time, it's more than just rhetoric," Mr. Lofton said.
Boards lack diversity.Yet the boards of these same professional and trade associations remain predominantly white and male.
The ACHE's board of 92 includes just two minorities, and just 61 of its 2,000 fellows, or 3%, are black, Hispanic, Asian or Native Americans. "That's not a great record," Mr. Dolan admitted. "The college is struggling like everybody else (to increase diversity)."
Currently, the AHA's 25-member board is all white; five are women.
Detroit Medical Center's Mr. Johnson served on the AHA's board of trustees for about four years and "always perceived that something was amiss." When you look at the boards and committees of voluntary associations, it's clear that "we've not been well represented," he said.
He believes AHA President Richard Davidson, who's headed the association since July 1991, has good intentions. But the diversity issue won't be licked until CEOs increase the pressure and maintain it, he said. "There's a lot of intransigence in terms of real pressure and real commitment," Mr. Johnson said.
"If there is going to be more sensitivity and commitment to expanding the level of minority executives...there has to be some change in the board structures," said Thomas W. Chapman, CEO and senior associate vice president for network development at 425-bed George Washington University Hospital in Washington.
The boards of private community hospitals "have not been progressive at all," Mr. Wesley said. "In the public sector, we do it much better because we've got leverage."
The racial composition of many hospital and health system boards also appears unbalanced when they're compared with the communities they serve. A recent survey of 887 trustees at 50 not-for-profit hospitals by The Governance Institute, a La Jolla, Calif.-based trustee and physician education group, found that only 5.8% of hospital trustees were African-
American, 0.8% were Hispanic, 0.2% were Asian and none were Native Americans.
To get ahead in the white world of healthcare administration, minority administrators have established themselves as team players while maintaining close ties with their minority colleagues.
"In many ways, it's a double life that you lead," said University of Alabama's Mr. Lofton, who was named last year by ACHE as the Young Executive of the Year. Although outspoken, Mr. Lofton has been selective in choosing when to speak up on issues related to race. Once, for example, when he was a vice president at the University Medical Center in Jacksonville, Fla., he sought changes in an advertising campaign that didn't show a single African-American. "You constantly have to pick and choose the battles that you fight," he said. That particular battle was worth fighting because the whole image of the hospital was at stake, he said.
Women healthcare executives said they face the extra challenge of working with the "old boys network." "If you're black and female in this industry, and probably in many others, you're going to struggle," said Brackenridge's Ms. Lee-Eddie. "I've walked into some interviews where they didn't know I was black and it was very obvious that they were uncomfortable," she said, adding that she's never confronted overt discrimination.
A helping hand.To help achieve diversity and give more minorities a fighting chance, many minority healthcare executives said they serve as mentors to people starting careers.
Connie Diaz, president-elect of the Association of Hispanic Healthcare Executives and CEO of 415-bed Los Angeles County-Rancho Los Amigos Medical Center in Downey, Calif., has served as a preceptor in the county health service department's fellowship program in the five years since the program's inception.
The 18-month program for master's candidates in health administration, public health or business administration seeks candidates covering a wide mix of ethnic backgrounds. More than two dozen healthcare administrators have completed the program.
"I know I got to where I am because somebody took an interest in me, someone took a chance on me," Ms. Diaz said.
Having a mentor gave many minority healthcare executives a chance to prove themselves.
Sandra Harden Austin, president of the healthcare services division of Northbrook, Ill.-based Caremark International, said the support of her white male mentor, Ed Notebaert, has played a critical role in her career. In 1981, Mr. Notebaert, now president and CEO at Children's Hospital of Philadelphia, hired Ms. Austin be his director of planning at Huron Road Hospital in Cleveland, and he's been her champion ever since.
Ms. Austin didn't get the same treatment from the hospital's director of nursing, who told her that he didn't know why she was hired and didn't want her on the team. "I think he was threatened because I was a nurse," she said.
To move up in healthcare administration as a black female, Ms. Austin said she believes it's important to take risks.
Six weeks into her job at Huron Road, she challenged the head of radiation on the $65,000 price he was quoted on a CAT scanner the hospital was trying to sell. Ms. Austin, a former health planner who had done certificate-of-need reviews on CAT scanners, knew the price was too low and volunteered to try to get a better deal.
Ms. Austin had never sold a CAT scanner before, "but I knew if I said `Yes,' those guys would know I was a force to be reckoned with." She got on the phone with her network of colleagues, and in a week she sold the scanner to National Medical Enterprises for $90,000, "plus, they paid for shipping," she added.
Regardless of race, most healthcare executives agree that efforts to increase diversity are important. But they have to provide opportunities for minorities to succeed.
"Initiatives are very nice, but it just doesn't get anyone a job," Ms. Lee-Eddie said. "It takes personal commitment on behalf of the people who call the shots, and generally those people are white and male."