How Resident Physicians Can Overcome Imposter Syndrome

Have you struggled with nagging feelings of uncertainty or insecurity as a resident physician? Maybe you made some hard decisions while treating a patient, and you’re worried you made the wrong call. Or perhaps a patient asked you a question, and you’re concerned you didn’t answer correctly.

Having these thoughts occasionally is common, but what happens when these thoughts become persistent or even relentless? If this sounds familiar, know that you’re not alone.

You’ve most likely heard the term imposter syndrome. It’s the description of all those negative feelings — and it’s completely normal.

If you’re a physician, you’re actually 30% more likely to experience imposter syndrome than other professions in the United States, according to Stanford Medicine. Your decisions change people’s lives. And as a medical intern, resident or attending, the responsibility can feel overwhelming, especially as you launch your career.

Provider Solutions & Development (PS&D) understands the physician career journey and its ups and downs. From residency-focused webinars and online resources to our in-house resident advisors, PS&D has extensive experience working with residents as they grow into their roles and careers.

It’s why we consult with industry experts to pass on valuable insights around topics relevant to those going through residency. Dr. Anne Hirsch is a peer physician coach who guides and mentors both residents and more experienced physicians as they navigate their careers.

A longtime physician herself, Dr. Hirsch has an Internal Medicine practice at Broadway Clinic in Portland, Oregon. She is also a wellness committee member at Providence Portland Medical Center. Self-doubt is a common theme she has seen with her clients.

“Imposter syndrome is certainly more prevalent in the early part of your career,” says Dr. Hirsch. “While it can continue throughout, it starts showing up in residency, just because you have a lot of questions about your competency at that point in your life.”

She says imposter syndrome manifests in different ways for different people. By acknowledging and learning about it, you can overcome or learn to manage imposter syndrome — just in time for your next job search.

What Is Imposter Syndrome?

Imposter syndrome was first named in 1978 by two psychologists who studied the phenomenon in highly successful women who reported their sense of success as lacking.

A more recent study defines those afflicted as “high-achieving individuals who, despite their objective successes, fail to internalize their accomplishments and have persistent self-doubt and fear of being exposed as a fraud or impostor.” The report notes that rates of imposter syndrome are particularly high among ethnic minority groups.

One extensive report, which is also referenced later in this article, found that imposter syndrome reaches “clinically significant” levels for 65% of medical students. Not only is it common in the medical field, it starts early and is more intense for resident physicians.

“No matter how much training you have, no matter how long you’ve been doing this, no matter how much experience you have, you can still feel like an imposter,” Dr. Hirsch says. “It’s this sensation that you don't really know what you’re doing and somebody’s going to eventually find you out.”

What Does Imposter Syndrome Look and Feel Like for Resident Physicians?

Whether it’s debilitating, a minor gnawing feeling in the back of your mind or somewhere in between, imposter syndrome has some common signs:

• The inability to accept your success, sometimes attributing it to luck rather than skill
• Difficulty accepting praise about your intelligence or accomplishments
• A tendency to recall your mistakes over your accomplishments
• A persistent feeling of disappointment in your performance, actions or lack of actions
• A discrepancy between your self-evaluation and external evaluations
• Fear of being “found out” as a fraud
• Hesitancy to take on new challenges for fear of failure, despite previous successes
• Comparing yourself unfavorably to others, and believing others are more accomplished

Dr. Hirsch says it’s perfectly natural for residents to question themselves. But it can get out of control.

“I remember one time, I had a client who had 160 charts open and couldn’t close them,” she says. “It was more about anxiety — wanting the charts to be perfect — derived from an underlying feeling of not being good enough and being found out. A spiral of emotions, panic and shame.”

In her peer physician coaching business, Dr. Hirsch counsels doctors to take comfort in the fact that a lot of the anxiety from imposter syndrome is self-inflicted. When you’re armed with the appropriate strategies and knowledge, she says, you can vanquish its power over your mind.

The 5 Kinds of Imposter Syndrome

Even the most successful, high-achieving physicians and clinicians can grapple with imposter syndrome behind the scenes, and it looks a little different for everybody. Here’s five ways it can manifest:

• The Perfectionist: A minor flaw in an otherwise stellar performance creates a sense of failure, rather than focusing on what you did well.
• The Expert: Because you expect yourself to know everything, even a minor lack of knowledge brings about a sense of inadequacy.
• The Soloist: You think you should be able to do everything all on your own, and therefore asking for help, tutoring or coaching evokes negative feelings.
• The Natural Genius: You’re used to nailing it on the first try, so each additional try deteriorates the self-image you’ve built.
• The Superhuman: You measure competence based on how many roles you can juggle — a master of all trades — and falling short in any way or role (e.g., family, friend, student, physician, etc.) invokes doubt or embarrassment.

Do any of these scenarios vibe with you? When you know what category feels familiar, it can help you manage and overcome it.

What Factors Lead to Imposter Syndrome in Resident Physicians?

A study published by the National Library of Medicine reports that imposter syndrome is widely found in intellectual fields, and “people who are drawn to such areas of work are likely to have perfectionist traits and operate in an achievement-oriented manner.”

Medical school is rigorous. And when over 90% of medical students consider themselves to be high achievers, it’s no surprise that this comes with higher rates of imposter syndrome.

The study also finds that 83% of medical students have a fear of failure, 77% are self-critical, and 61% are perfectionists — all traits that go hand-in-hand with high expectations.

Dr. Hirsch says self-limiting beliefs, often formed in childhood, are central to imposter syndrome. These beliefs that hold us back can live in both our conscious and subconscious minds and often stem from comments made by others, like friends, family and even strangers on social media.

“I will ask my clients that question: ‘What is your limiting belief?’ We really unpack that and explore it. Then we talk about the fact that there’s a lot of evidence around them that proves they do know what they’re doing, and they are good at what they do. We work toward them not questioning themselves so much,” Dr. Hirsch says.

“It’s that limiting belief that is so important to identify. Naming it can really be the key that unlocks healing for people.”

Working with mentors, educators, peer coaches or therapists can help you discover where your imposter syndrome comes from, so you’re better prepared to address it.

How Can Resident Physicians Overcome Imposter Syndrome?

There’s no one way to treat imposter syndrome. A strategy that works well for some may not work for others. When Dr. Hirsch works with resident physicians, she recommends these 5 steps to discover how to overcome imposter syndrome. Try them out and see what works best for you.

1. Identify Your Self-Limiting Belief.

Acknowledging and challenging your insecurities isn’t easy. But if you take the time to reflect on what exactly you’re insecure about or why you’re doubting yourself, you can learn what your central self-limiting belief is.

Common limiting beliefs include:

• “I’m not actually that smart. I'm not as knowledgeable or competent as my colleagues.”
• “I’m not likable. My colleagues don’t really like me or respect me; they’re just tolerating me.”
• “I'm not good under pressure. I’m not capable of handling challenging cases or making difficult decisions like other physicians.”
• “I’m an amateur. I don't have enough experience or expertise to provide valuable contributions to medical discussions or research.”
• “I don’t really know what I’m doing. I’m just lucky to have gotten this far in my career, and it's only a matter of time before my luck runs out.”

“No matter how much training you have, you can still feel like an imposter. It's this sensation that you don't really know what you're doing and somebody's going to eventually find you out.”
~ Dr. Anne Hirsch, peer physician coach
 

2. Let Go of Perfection.

No doctor is perfect, and it’s important to let go of perfectionism. For example, not every word in every chart has to be perfect for you to be able to close the chart.

“It’s okay to write a C+ note,” Dr. Hirsch says. “We have to let go of making everything perfect. The chart needs to be done, and I need to recognize that it's good enough — I don’t need an hour on each chart for it to be good.”

Not only will this take the pressure off, but it will lower your stress level so you can bring your best self to your patients.

3. Ground Yourself in Your Values.

Decide what’s important in your life and what your most important goals are. Whatever drives you, live up to those values and structure your day around them.

By seeing and understanding the bigger picture, you can alleviate some of the pressure and let go of the smaller things, especially if you’re a perfectionist.

4. Set Goals for Now.

Set tangible goals that you can achieve this week, this month or this year — not five or 10 years from now. By setting more tangible goals, you have something concrete to focus on rather than abstract thoughts like, “How will I ever become a qualified, successful physician?”

Beyond having something tangible to focus on, gaining quick but important wins can boost your confidence and increase your happiness.

5. Seek Help if You Need It.

Imposter syndrome can have lasting and significant negative effects on your mental health. It can help to have another perspective or a helping hand to fully believe in yourself.

Talking to a peer coach, a therapist or a mentor is a great route to support yourself.

There is a lot of value in keeping connections with your peers from residency when you first start practicing. If you can create these networks, especially with those who are going through the same feelings you are, you can create your own imposter syndrome support group.

How Imposter Syndrome Evolves Over Your Career

For many resident physicians, imposter syndrome at work starts early in their education and career journey. In Dr. Hirsch’s experience, when you have to start taking care of patients, you can feel like you know nothing, which leads to panic and feeling like a fraud.

And that’s just the internship. Year two can be just as full of doubt because you’re the one supervising interns this time around, says Dr. Hirsch. The third year gets easier.

“That’s when you start to realize you’re capable, even if you might need a little help every now and then,” Dr. Hirsch says. “I do think it gets better over time. I’ve been in practice for more than 30 years, and I’m getting to the point that I feel like I really know what I'm doing. I’m not kidding. It’s more gradual than you’d think.”

Dr. Hirsch’s personal story is evidence that even with these self-doubts and anxieties around work performance, you can still have a successful and fulfilling career. Because as with most things in life, time heals and confidence grows.

How Is Imposter Syndrome More Intense for Marginalized Groups?

While every resident can fall victim to imposter syndrome, students of marginalized gender identities, races, sexual orientations and other minorities are at an even higher risk.

According to a Coqual study on being Black in corporate America, there are major adversities Black physicians face. Only 3.2% of senior leadership roles at large, U.S.-based companies are filled by Black professionals. In addition, Black professionals may lack access to higher-level managers and professional development resources, and they experience wage gaps. According to the Medscape Physician Compensation Report 2023, white physicians make an average of $47,000 more annually than Black physicians.

This inequity and lack of representation and support can exacerbate imposter syndrome for marginalized people. The question of “Should I even be here?” is compounded when you add racial identity to the equation.

Additionally, women are more susceptible to imposter syndrome than their male counterparts. The study referenced above finds that males have a 29% lower chance of obtaining a “clinically significant” imposter syndrome score than females.

What does this mean for your own imposter syndrome? Ultimately, it does help to acknowledge that underrepresented communities and identities struggle at higher rates and more intensely.

With that knowledge, perhaps you’ll feel better equipped to quell those fears proactively during your resident physician years. Or you can in turn support members of those communities by guiding them to imposter syndrome resources, boosting their confidence and fostering more supportive work cultures.

How Can Imposter Syndrome in Residents Affect Patient Care?

If there’s any silver lining or good news, it’s that imposter syndrome doesn’t seem to have a major impact on patient care. In Dr. Hirsch’s experience, imposter syndrome in residents is unlikely to hurt patients medically or result in negative health outcomes. But that’s just one side of the patient care coin.

“A self-questioning resident tends to be hypervigilant,” Dr. Hirsch says. “You’re not sure or confident about what’s going on, so you just order every test you can think of instead of actually considering what will help you make the best decision for the patient as a physician. Making these decisions around patient care, tests and procedures from a place of anxiety or self-doubt can lead to higher costs and more discomfort for the patient.”

Though you should strive to never cause undue financial or mental burden for patients, take heart in knowing you’re unlikely to cause them physical harm. If anything, your extra diligence is making sure they’re healthy.

How PS&D Can Help

The stigma around providers seeking mental health care is slowly beginning to lift. Besides the strategies covered above, many hospitals and major cities have mental healthcare programs specifically for residents. It’s worth asking your program director about the opportunities that may be available to you as you seek the right job culture.

PS&D knows residents because we work with them every day. Whether you’re starting your intern year or about to graduate and need help finding a role, we’re here to listen to your needs.

By placing candidates in more than 40 health systems across the country, PS&D understands the nuances when matching emerging physicians with the right organizations. Whether you have questions about the resident journey or you want to know all the nitty-gritty details of signing on to your first attending role, we’re happy to talk with you about them.

If you want to learn more about our opportunities and how we work, you can explore roles based on location, profession, specialty and more.