Jennifer sat in our coaching session looking worn down and depleted. Her shoulders were slumped as she told me that she wasn't as smart as her peers, as strong a leader, or as good at articulating her ideas. A surgery leader, she was sure that she was an imposter.
She'd come to coaching to improve her leadership presence, but her physician burnout was evident. And feeling like an imposter was one factor that was wearing her down. While you might think Imposter Syndrome had kicked in because she's a woman in a male-dominated field, I've heard similar comments from almost every one of the hundreds of male and female physician leaders I've coached over the past decade.
What is Imposter Syndrome?
As recently as a few years ago, Imposter Syndrome was not widely recognized by physicians. When I'd put up a slide with IS in a presentation, people didn't know what I was referring to. Even now, there are very few actual studies in attending physicians. But fast forward to 2019 and IS has made it onto the healthcare map. You won't find it in the DSM-V as it's not a psychological disorder, more a pattern of thinking that often afflicts high-functioning individuals. In a nutshell, it involves the belief that others have special talents that we don't, that we've fooled others into thinking we're competent, and that catastrophe will occur when the truth is discovered. When we have IS, we attribute our success to factors beyond our control, rather than to intrinsic talent or skill. Afflicted individuals harbor these beliefs even when they have accolades and external accomplishments: "It was only luck" or, "they only gave me the promotion because they had a quota of people like me."
Imposter Syndrome defined
Jennifer was stuck in a cycle of self-doubt, rumination, and fatigue, putting her at high risk for physician burnout. Like many physicians suffering with IS, she was also stuck in a cycle of perfectionism. IS and perfectionism go hand in hand, although it's unclear which is the chicken and which is the egg. Many physicians learned to be perfectionists to get the best grades, write top essays, and get into medical school and the best residency. But perfectionism, by definition, is not humanly attainable. If that's our bar we'll always fall short, contributing to the sense that we're not who people think we are. On the other hand, the Imposter Syndrome occurs because we believe we must be perfect to be a success. It's a vicious cycle that contributes to physician burnout because it keeps us working harder than any task truly requires. I've seen over and over with physicians struggling to keep up with their documentation, so paralyzed by perfectionism that no amount of smart sets helps.
How medical training contributes to Imposter Syndrome
What is it that fuels IS? We can look to medical training to find the answer. In a nutshell, medical training focuses on deficits, not strengths; what's reinforced is what we're not doing well, rather than what we are. We learn to be compassionate to our patients but not to ourselves. If we're not perfect, we're often seen as a failure. The emphasis is on how we compare to our peers, not ways that we succeed independent of comparison. The competitive environment acts as a backdrop that we don't even notice. When I look back on my own training, what stands out is being chastised for not knowing a differential diagnosis on rounds or being told that I wasn't as smart as my peers. I didn't learn how to focus on what I was doing well or leverage my strengths to manage my weaknesses. For more on this, read my post on preventing physician burnout.
The cycle of perceived inadequacy
This constellation of factors leaves us vulnerable to a negative spiral of self-doubt, rumination, and self-flagellation. While the spotlight of physician burnout is on the EMR, I've seen IS play a large role. How is it that the Imposter Syndrome takes hold? When we look closely, there's a cycle we find ourselves in, something I call the cycle of perceived inadequacy. The cycle starts when we're hyper focused on what we perceive we're not doing well. "I'm not very smart." "That presentation I gave was terrible." "I'm not very articulate." Then we expend mental energy comparing ourselves to others. We focus on what we perceive they're doing well. "He's so smart." "Look at the great presentation she gave." "That one is so good at expressing their point of view." We gather data that supports our belief that we're not as adept as others. We create a delta, based on a subjective cognitive distortion, magnifying the difference between where we believe we are and where we believe they are. But we don't stop there. We keep collecting this data and fueling the cycle. And, the truth is that the very people we compare ourselves to are also engaged in the same process, focusing on where they perceive themselves to be coming up short.
Overcoming Imposter Syndrome
Traditional guidance on managing IS centers around finding people who see your value and listening to them tell you about your strengths. But how helpful is this? For most of us, our view of ourselves relies on what we, internally, fuel it with. The cycle of perceived inadequacy keeps us from integrating what others have to say. I've found the following tactics the most successful:
1. Pay attention to your thought processes. Notice each time you accuse yourself of being an imposter and name it. Something like, "There I go again, believing I'm an imposter." This process of paying attention begins to create an important distance between you and these thoughts.
2. Question your thoughts. Once you've noticed the imposter thoughts, ask yourself some questions:
"How do I know that the thought that I'm an imposter is true?"
"What am I magnifying?"
"What am I minimizing?"
3. Make it your mission to pay attention to your strengths. Doing so creates natural ballast for countering imposter beliefs.
I had Jennifer follow these steps. At first she felt silly, but after a few days she was more aware of her pattern and could see clearly the negative impact IS had on her abilities as a leader. After a few weeks, she reported that, although nothing else had changed, she felt lighter and had more energy. She was also more able to recognize her strengths, leading to greater confidence in her role. Jennifer didn't cure her IS overnight, but she reported that the difference in her attitude, energy, and confidence was dramatic.
If, like Jennifer, you've been experiencing Imposter Syndrome or physician burnout, try these steps to combat them. To learn more steps to prevent physician burnout in yourself and the physicians you lead, download my free guide From Burnout to Balance. 10 Steps You Can Take Today.
Gail Gazelle, MD, is a part-time assistant professor at Harvard Medical School and a master certified coach for physicians and physician leaders. Reach her at www.gailgazelle.com.
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