Imposter Syndrome: An Epidemic in Medicine

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You’ve probably heard of it: imposter syndrome. Perhaps you can relate, as it seems to be more common than people realize. In fact, there are likely many who suffer from the effects of imposter syndrome but who have never even heard the term! 

If you suffer from imposter syndrome, no matter what level of success you experience in your career, chances are very good that you’ll still feel like a fraud, a fake, or a phony at some point. 

Have you ever received positive feedback at work or home, yet you think they’re wrong about you in some way? Yeah, that’s imposter syndrome. What are the signs of imposter syndrome? Well…

Sufferers of imposter syndrome tend to be successful, perfectionists, and overachievers.

Imposter syndrome is not a mental illness. You won’t find it anywhere in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). It’s actually completely normal to feel like you don’t measure up sometimes.

Imposter syndrome is more persistent and negatively affects one’s life. It can afflict people of any profession, gender, race, or age. One study estimated that up to 82% of professionals deal with imposter syndrome. Feelings of being an imposter are especially common in high achievers who have been successful at something they aren’t sure they deserve to be successful at.

This article explains what imposter syndrome is and how it affects people who suffer from it. It also provides tips for overcoming this issue so that you can realize your true potential to achieve greatness!

There are five types of imposters: the perfectionist, the superhero, the natural genius, the soloist, and the expert.

• The Perfectionist. This is the person who has high standards for herself and others and feels like she needs to be perfect at all times. She might have unrealistic expectations of herself and other people and think that if she doesn’t live up to these expectations, she’s a worthless failure and unworthy of success or happiness.
• The Superhero. Like the perfectionist, this person expects himself or herself to be perfect, and even superhuman, in every way — both at work and at home — which can lead him/her to feel overwhelmed by both responsibilities and expectations. They also tend to take on responsibility for other people’s happiness, and many even have a savior complex. When things don’t go according to plan (which obviously happens quite often), they get stressed because they feel responsible for those other people’s happiness too as well as their own—and this can cause burnout quickly!
• The Natural Genius. People who fall into this category seem to have it all–everything comes easy to them. The problem here is that these people never learned how to fail. They start to suffer from a fixed or scarcity mindset because success depends only on their natural talent and past experiences, not on grit and hard work. 
• The Soloist. aka the strong independent type. They believe that needing help is admitting failure. They don’t want to bother others or put them out even if someone genuinely wants to help. This usually comes from an enviable stripe of self-sufficiency but it’s taken to the extreme.
• The Expert. Do you have to know everything about everything? Does the phrase “I don’t know” send a shiver down your spine? The expert feels morally obligated to root out all of the gaps in their knowledge, especially if that person works in healthcare where lives are on the line.

People who suffer from imposter syndrome often see their achievements as lucky breaks or flukes. They may subconsciously fear that they will be exposed as frauds.

People who suffer from imposter syndrome often see their achievements as pure luck or circumstance. They may intensely or subconsciously fear that they will be exposed as frauds or a quack. They may also look to the opinions of others to determine their worth. This leads down a dark path and negatively influences performance and satisfaction for the work they do.

Imposter syndrome is often the result of a combination of things–genetics, environment, and early childhood experiences (e.g., being praised for doing nothing–“everyone gets a trophy!”). On the other hand, people sometimes develop this condition after experiencing failure and rejection in important areas of their life (such as education or career). In any case, those suffering from imposter syndrome never learned to appreciate effort over results. 

If you are an overachiever and have a great track record of success despite feeling like you don’t deserve it, you’re suffering from imposter syndrome.

Imposter syndrome is common among professionals, especially high-achieving women and minorities. Remember that 80% statistic from earlier? This can result in many talented people leaving jobs or not applying for positions because they don’t feel qualified for them—and when they do succeed despite their own self-doubt, they suffer deeply because reality clashes with what their brain is telling them about themselves (i.e., “I am unworthy”).

This may be an unintended consequence of quotas and diversity or inclusion policies. Imagine how you might feel about your contributions when there’s a chance that you made it to wherever you are, not because of your qualifications, but because of the color of your skin or your gender identity.

Physician Assistants (PAs) are especially at risk for imposter syndrome.

PAs do the work of physicians but are not regarded as such. Many docs don’t want them around, yet employers often prefer them. PAs often wonder if they’re good enough or if they even belong. 

According to a survey of Harvard medical and dental students, 15% suffered from severe impostorism. Unfortunately, being female was the sole significant predictor of intense impostorism, conferring a nearly twofold higher risk.

It’s no surprise physician assistants feel the way they do considering that many doctors view PAs as less educated and less capable than themselves—and even go so far as to refuse consults from PAs. Some disaffected physicians actively lobby against them. It’s clear that this leads many PAs to question their value, which could be why so many struggle with imposter syndrome.

Physician assistants, now officially known as physician associates, often feel like imposters because of the way the system treats them. We grow up learning that doctors are smart and important, so we assume that their assistants must be less intelligent and important. But this isn’t true at all! PAs are smart and important, too! An experienced PA can know more about their field of medicine than a new doctor does. In reality, both doctors and PAs are highly trained professionals whose expertise is invaluable to patients’ well-being.

There aren’t many other professions out there, however, where you walk into a room and you’re greeted with “Who are you? You’re not the doctor. Why do you think you can help me?”

New PAs are often compared to residency-trained physicians. That’s not a fair comparison. Better to compare that new MD with a PA who has 5+ years under their belt. Unrealistic standards never helped anyone.

PAs Are Not Doctors but They’re Not Imposters, Either

Physician Assistants (PAs) are the backbone of many healthcare facilities, yet they can still feel inferior to their physician colleagues. Salty med students and residents use the derogatory term “noctor” to both PAs and NPs. With more PAs earning doctorates and further narrowing the gap between their qualifications, PAs might just end up feeling even more like they’re pretending to be something they’re not. It needs to be made clear, however, that “doctor” is a title, not a profession. 

In order to help address these issues, it’s important for the medical community as a whole to recognize the value of PAs and their role in the healthcare system.

PAs are medical professionals who are licensed to practice medicine. Some states allow independent practice while others require a collaborating physician, and others a “supervising” physician.  PAs are trained to diagnose and treat patients, perform medical tests and procedures, order diagnostic tests and interpret their results, write prescriptions, and manage patient care. PAs can even end up being specialists in a particular area of medicine such as obstetrics, pediatrics, or emergency medicine.

Unfortunately, this too can amplify feelings of pretending to be something they are not.

How Can Physician Assistants Recognize and Address Imposter Syndrome? 

So what do we do when we feel like imposters? How do we get past this feeling and focus on the work? It’s hard, but here are some general tips:

1) Remember that it’s okay to ask questions about things that aren’t clear. No one knows everything. 

2) Don’t over-analyze your own performance; recognize that you are your harshest critic. 

3) Keep track of all your accomplishments. Write ‘em down if you have to. 

It’s possible to recognize imposter syndrome just by looking at how you think about your own accomplishments.

If any of these statements are true for you, it may be a sign that you are suffering from imposter syndrome:

• You downplay compliments.
• You feel guilty when someone does something nice for you.
• You tend to focus on your weaknesses and shortcomings rather than your strengths and successes.
• You tend to be critical of others. 
• You tend to be overly critical of yourself–even more so than others would be if they were judging your work.

If more than one of these statements rings true for you, you likely have imposter syndrome.

Recognizing that you have imposter syndrome is the first step in getting help with it.

Let’s unpack some of those statements from earlier… 

• Consider how you think about your own accomplishments. Do they feel you deserve them? Or do you believe that are they a fortuitous anomaly? Maybe you’re just really lucky? Or good at deceiving people. Or maybe not! Either way, don’t start playing the lottery.
• How do you define success? The odds are that you haven’t really thought about it! Is it money, respect, or something else? Is it self-mastery or helping others? Start by defining what success and happiness mean for you. Try creating a happiness plan and measuring your success against those things that are truly important to you. 
• Have you ever asked yourself why you are the way you are? We’ve already explored one possibility, that you’re some sort of super successful conman. Couldn’t the opposite be true? You might just value loyalty, honesty, and hard work. The next time you feel that you’re missing the mark, try reminding yourself that you feel this way because you have high standards. That’s not a bad thing.

More Ways to Battle Imposter Syndrome

Imposter syndrome is no joke. It’s a real thing, and it can be really hard to overcome. It can lead to burnout and decreased productivity, not to mention job and life satisfaction. 

The good news is that there are ways to fight imposter syndrome, and you are not the only one who feels this way!

Here are some more of our favorite ways PAs and other professionals can overcome imposter syndrome:

• Address thought distortions
• Talk about your feelings
• Savor small successes and practice gratitude
• Forget about being perfect
• Find joy in the journey
• Help, teach, and lift others

Address Thought Distortions

Imposter syndrome is often the result of negative self-talk and thoughts like “I’m not good enough,” “I’ll never succeed,” or “This is too hard.” The challenge is that these are often automatic thoughts that may occur instantaneously and feel authentic. 

The best way to combat these thoughts is through cognitive behavioral therapy (CBT). CBT helps you identify negative thought patterns—like black-and-white thinking, emotional reasoning, and catastrophizing—and challenge them by rewriting those automatic thoughts without the distortion. If continually struggling with your thoughts is not your thing, check out ACT or Acceptance and Commitment Therapy.

Talk About Your Feelings

It’s hard to talk about your feelings sometimes, especially if you grew up in a family that didn’t talk about feelings. It’s especially hard when you’re the one with the professional title and you feel you should somehow be immune to these things. Swallow your pride and give it a try.

Remember that everyone experiences imposter syndrome at some point in their career and that there are ways to get through it. Some people are naturally more adept at thinking their way out of their favorite distortions, but the rest of us need to practice every day to help it become a habit. 

Call out emotions by name and discuss them with someone who understands what you’re going through, perhaps a colleague or a loved one. Talk about the pressure you feel, or how much harder it is than you thought it would be, how afraid you may be, or just how much more time and effort is expected than you might have believed.

As soon as you open up about these feelings, you’ll quickly discover that they aren’t unique to you or your situation! They’re common among all successful people. This will help you feel less alone, which in turn will help reduce some of the suffering associated with feeling like an imposter or a fraud.

Savor small successes and practice gratitude

It’s easy to get caught up in looking at what you haven’t done yet or what you could have done better, but take time each day to reflect on what you have done well. Replay those moments in your mind before you go to sleep each night. Record them in a journal. Reframe the language you use regarding perceived failures. Instead of saying “I failed” or something similar, change it to “I learned.” Even if something didn’t go well, there is still something valuable about that experience that can inform future successes. 

Say thank you more often. Count your blessings. Let others know you value and appreciate them. The more genuine the praise, the better you’ll feel. 

Forget About Being Perfect

Forget about being perfect. It’s an illusion. Even when you’re in the thick of your career, it’s easy to feel like there’s no room for mistakes—but that isn’t true. In fact, as long as you learn from your mistakes and keep trying to improve yourself, there’s a place for you in any field.

You may think that other people have it all figured out and that they don’t struggle with anything—but that’s simply not true! It’s another thought distortion-–mind reading. Everyone has their own challenges and obstacles to overcome, so don’t be afraid to acknowledge yours. You’ll find that others are more than willing to lend an ear and commiserate when they see how hard it is for everyone else.

Find Joy in the Journey

Learn to be happy right where you are–it’s the only place that you’ll ever be. Make time for yourself. That might include taking a minute every day to reflect on how far you’ve come. As a medical student, Rebecca Russell, MD encouraged recalling those skills we may now be taking for granted: 

“We focus on the moments where we feel that we do not have enough experience; we are just ‘pretending’ to fit in. Yet, we hardly ever reflect on the moments when we are not imposters. Instead, we relentlessly focus on what is next or where gaps in our knowledge exist. But for every moment when we feel inadequate, there is another moment when we realize a previous challenge is now mundane.”

Finding joy in the journey could also mean setting aside time for something that brings you joy, like reading a book or going for a run. What hobbies have you given up? What is something you’ve always wanted to do? Go do it! Fill your life with things that make you happy.

Mindfulness can help us live in the moment and just “be”–no judgment, just noticing and appreciating the air in your lungs, the breeze on your face, or the clothes on your back. You’re not guaranteed a tomorrow and you can’t change the past. If you have trouble with this, try taking a break from social media, your phone, or any other constant stream of useless information. 

Help, Teach, and Lift others

When you help others, you’re not just helping them—you’re also helping yourself. When we help others succeed, we feel better about ourselves and our own abilities. It’s an incredibly effective way to build confidence and self-worth when you feel like a fraud or worry that your work isn’t up to par.

Teaching others also helps build confidence because it puts your skills on display—and if they see how much you add to the home or business, you may start to see it yourself as well! Plus, teaching is a great way to learn new things about yourself, identify areas of weakness,  and improve in your role as a professional.

Lifting others also gives us something positive to focus on instead of dwelling on the negative. The late Gordon B. Hinckley, an American religious leader once said, “Generally speaking, the most miserable people I know are those obsessed with themselves; the happiest people I know are those who lose themselves in the service of others.”

A Few Final Words About Recognizing and Treating Imposter Syndrome

Whether you’re a PA, a physician, or something else entirely, the feeling of being an imposter can be suffocating. It’s important to realize that everyone experiences it at some point in their lives or career—even if they’ve been practicing for decades! There’s no shame in admitting that sometimes it feels like everyone around you knows more than you do about what they’re doing.

We hope this information has shown you how common imposter syndrome is, and that suffering from it does not mean there is something wrong with you or that you are some type of serial deceiver.  It doesn’t even necessarily mean you need therapy! But if the feelings of self-doubt and inadequacy are causing you to miss out on important opportunities, or if they are interfering with your ability to lead a fulfilling life, it may be time to seek professional help.

This article was medically reviewed by Ryan Creek, DMSc, MPAS, PA-C.