Objective The composition of clinical department managers in Swedish hospitals is changing; more non-doctors and women are entering managerial positions. In parallel, most hospitals face increased pressure to contain costs. This article presents a study of managers' perceptions of tightness of budgetary control and how their views vary systematically with personal characteristics and organizational conditions.

Method Data were collected through a postal survey in 2005 to 173 clinical department managers (response rate of 70%). Statistical analysis was performed by factor analysis and logistic regression.

Results The data suggest that clinical department managers' perceptions of tight budgetary control were related to how long they had been in their current position, their profession (whether they were doctors or non-doctors) and their sex. Further, their perceptions could be explained by how close the managers' departments were to their budget targets.

Conclusions Perception of tight budgetary control by managers depends on both their personal characteristics and the financial situation of their departments. Differences between men and women, and doctors and non-doctors call for additional research about the possible impact of changes in the composition of clinical department managers on how budgetary responsibility is exercised.

Background  The composition of managers in Swedish public primary care centres has changed since the mid-1990s, favouring nurses and female managers. In parallel, health-care professionals have become more involved in the management structure and many have experienced an increased demand for cost containment. There is limited empirical evidence about how managers with different professional backgrounds perceive tight budgetary control.

Aim  To examine whether perceptions of tight budgetary control across managers in Swedish public primary care are related to personal characteristics such as professional background and sex.

Method  A questionnaire measuring perception of tight budgetary control was administered to all (636) identified managers in Swedish public primary care centres (response rate was 59%). Differences between groups were analysed through logistic regression and factor analysis.

Results  Nurses and other non-physicians perceived the budgetary control to be tighter than did physicians and female physicians perceived the budgetary control to be tighter than did male physicians.

Conclusions and implications for nursing management  Results suggest that nurses were more committed to the budgetary control system and county council objectives than physicians. The impact of these differences are uncertain, however, nurses’ capacity to influence primary care services may be more limited compared with physicians because of their lower professional status.