Women may be known as the great nurturers, but when it comes to healthcare, men still take care of business. Nationally, women account for only 14 percent of the top management positions. Of Florida's 211 hospital CEOs, a mere 33 are women. But in Sarasota-Manatee, women are breaking new ground, with four of the seven largest healthcare institutions now led by women-three of them brand new to the job.

None of these women, however, sees herself as battering through a glass ceiling. They all say they were mentored by men and promoted based on merit and performance. "In today's environment, it's the right person for the right job," says Gwen MacKenzie, president and CEO of Sarasota Memorial Hospital.

Instead, these high-powered executives prefer to focus on current and future challenges, chief among them how to keep their institutions solvent and how to provide essential services at a time when rapid population growth outstrips infrastructure development. "Growth does not pay for itself when it comes to ambulances and mental health services," emphasizes Mary Ruiz, president and CEO of Manatee Glen, a behavioral health care center in Bradenton.

TAKING IT TO THE NEXT LEVEL

Before taking over the reins of Sarasota Memorial Hospital, Gwen MacKenzie spent 25 years of her career at Detroit Medical Center, a nine-hospital system affiliated with Michigan's Wayne State University. She started out as an advanced practice nurse and worked her way up to executive vice president and chief operations officer. In that role, she was credited with a $110 million turnaround in the hospital's bottom line.

A soft-spoken woman, MacKenzie likes to rely on physicians to help with leadership issues. But while encouraging teamwork, she is not averse to making tough decisions. Within two months of her arrival in May, she cut 60 jobs to help address a $20 million annual deficit.

She is very much aware of SMH's role as a community asset and safety net. Because it is a nonprofit institution that must serve patients who cannot afford to pay, the hospital has to have a financial cushion. "No margin, no mission," says Mackenzie. "We need to make sure that we're well-run, efficient and cost-effective."

At the same time, she wants to build on the national recognition SMH has enjoyed for its patient care and specialization. "I want to be in the top 10 in the country in every category that can be measured," she says.

She anticipates that future growth will be in ambulatory and satellite facilities-walk-in medical centers with X-ray and surgery capability and aggressive expansion into South County.

MacKenzie and her husband Doug, a former football star at the University of Michigan, like to go kayaking and biking together. MacKenzie also runs after work, usually across the Ringling Causeway Bridge and back. "I have to keep pinching myself," she says with a smile, "do I really live here, or am I on vacation?"

UP TO THE CHALLENGE

At 36, Wendy Brandon combines ambition with a desire to make a difference. "I need to be challenged and to keep learning, or I feel like I'm dying," says the personable new chief executive officer of Englewood Community Hospital.

A business major in college, Brandon got her M.B.A. while working for Health Care Corporation of America at a number of its hospitals in Tennessee. She moved from being a physician's support analyst to associate administrator before becoming chief operating officer at Summit Hospital in Nashville. Now she is taking on the position of CEO for the first time.

As a newcomer to the area-she had lived all her life in Tennessee-Brandon is still getting her bearings, making sure that she knows everyone on the medical staff personally and learning about the community. "I want a personal connection with the people here," she says.

But she already sees some major challenges looming on the horizon. Attracting quality staff is a huge issue because of the dearth of affordable housing. Brandon also foresees a change in consumers-more early retirees with more disposable income and higher expectations of service. That means improving outpatient and ER coverage and adding more services, such as behavioral health programs.

Though taking the job at Englewood Community Hospital was the biggest jump in her career, Brandon says being in a smaller hospital and community makes it easier to balance her personal and professional life. In the past, she and husband Chuck, a C.P.A., traveled, played tennis and golfed. Now they have a two-year-old son, Winn, for whom they share the demands of parenting in every way. "It is important to me to be a mother and wife," Brandon says, "but I always will want to be challenged."