The Aspiration-Capability Gap: A Mixed-Methods Study of Structural Barriers to Leadership Among Canadian Female Family Physicians

Abstract

Oluwasayo Olatunde

Despite a female supermajority in Canadian primary care (80%), a demographic paradox persists where women remain severely underrepresented in health authority executive roles. This study investigates the systemic barriers and institutional friction points suppressing the leadership aspirations of female family physicians. Utilizing a pragmatic, sequential explanatory mixed-methods architecture, this study evaluated department-wide survey metrics (N = 28) via descriptive statistics and Fisher’s Exact Test, alongside deep-dive qualitative interview transcripts (n = 6) via inductive thematic analysis within a major regional Canadian hospital authority. Quantitative baselines expose a stark leadership deficit; 60.7% of respondents have never held an administrative position. A distinct mid-career bottleneck (11–15 years of practice) exists where rigid institutional governance schedules (e.g., meetings at 7:30 AM or 5:00 PM) directly clash with intensive caregiving demands, suppressing collective ambition into a medium-aspiration domain (mean: 28.96 ± 3.24). Qualitative themes uncover an uncompensated relational "Deep-Work" Tax that drives career burnout and self-doubt. Crucially, while bivariate analysis indicates that informal mentorship displays no statistical link to elevated career aspirations (p = 0.636), qualitative evidence isolates formal executive sponsorship as the vital driver of institutional belonging and self-efficacy. Rectifying this representation gap requires a shift from individualistic deficit models to systemic institutional redesign. Health authorities must execute targeted structural reforms, including restricting leadership meetings to core hours (9:00 AM – 4:00 PM), rewriting promotion frameworks to credit relational labor, and embedding formal sponsorship metrics directly into executive performance criteria.

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