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February 16, 2021

Gastroenterologists and other physicians face enormous pressures in their work lives, especially in the beginning of their careers. Hectic schedules, overwhelming patient loads, trying to assimilate to a new environment, and providing the best quality care possible can lead to high levels of stress, burnout, and other mental health issues. It can also trigger “imposter syndrome, which is that tiny voice in the back of a physician’s head that says they are not good enough, smart enough, or qualified to be a doctor.

Imposter syndrome can be unnerving, and it can contribute to stress, burnout, and other mental health issues – even in the best doctors. Promoting better understanding of mental health issues, such as imposter syndrome, can help young physicians ignore the self-doubt that can hobble a career.

The Imposter Playing Doctor

“I don’t deserve to be a gastroenterologist – I didn’t even deserve to finish medical school. I hope nobody finds out that I am an imposter.”

If you have ever felt like Dr. Imposter, you are not alone. Imposter syndrome is quite common among medical professionals, and particularly among medical students. In a study published in the International Journal of Medical Education, 49 percent of female medical students reported experiencing imposter syndrome, as did 24 percent of male medical students.

The researchers found an association between imposter syndrome and characteristics of burnout, such as emotional exhaustion, cynicism, and depersonalization. The far-reaching and deeply embedded effects of imposter syndrome can hobble a promising career before it even starts.

Underlying Cause of Imposter Syndrome

First mentioned in literature in 1978, researchers have spent decades exploring the causes and repercussions of imposter syndrome. In the years since, psychologists and medical professionals have sought new ways to identify, characterize, and overcome imposter system.

For example, an Atlanta psychologist developed the Clance Imposter Syndrome Questionnaire to help identify how frequently or intensely someone feels like an imposter. Specifically, the questionnaire explores how the individual deals with evaluation and praise. It asks respondents to rate statements, such as, “I avoid evaluations if possible and have a dread of others evaluating me,” and “When people praise me for something I’ve accomplished, I’m afraid I won’t be able to live up to their expectations of me in the future.”

The questionnaire also explores whether or not respondents take responsibility for their success, asking them to rate various statements, such as, “Sometimes I feel or believe that my success in my life or in my job has been the result of some kind of error” and “Sometimes I’m afraid others will discover how much knowledge or ability I really lack.”

The role of perfectionism in imposter syndrome

While researchers have not yet pinpointed the exact cause of imposter syndrome, perfectionism plays a large role in its development. Most physicians tend to be perfectionists, particularly those who enter a specialty like gastroenterology. Perfectionism drives smart young people to get the best grades, for example, get into the best medical schools, and win the best residencies and fellowships. Perfection also goes hand-in-hand with imposter syndrome, as young physicians continually struggle to be better, smarter, and more accomplished than they already are.

Doctors with imposter syndrome are not lacking in self-confidence – quite the opposite, in fact, as perfectionism drives them to take on ever-greater challenges. Unfortunately, the perfectionism causes inappropriate worry and inaccurate attribution for their success.

Many people with imposter syndrome are afraid of disappointing those who gave them opportunities; doctors with imposter syndrome may also be afraid of what their patients might think if they found out that “I’m just an ordinary person disguised as a doctor.”

Repercussions of Imposter Syndrome

Imposter syndrome creates a cycle of perfectionism, rumination, self-doubt, and fatigue that puts gastroenterologists and other doctors at higher risk for physician burnout and other repercussions.  Physicians who believe they are imposters are more likely to behave as if they are undeserving of the white coat and stethoscope, for example. These feelings of inadequacy can prevent young physicians from excelling in gastroenterology or other specialty, as eroding self-confidence can limit their drive to pursue residencies, fellowships or promotions.

Overcoming Imposter Syndrome

Celebrate all wins, large and small

Stress can cause a mindset that filters out all of the positives and focuses only on the negatives. Celebrating even the smallest of accomplishments regularly can create a shift towards a positive outlook.

Create a support team

Surround yourself with mentors and peers who encourage you, recognize your strengths, and put things into perspective when you cut yourself down through self-deprecating language or self-limiting behaviors.

Reject negative thoughts/accept positive ones

An old proverb says, “What you dwell on, you become.” Tune out negative thoughts and accept compliments on your accomplishments.

Build a collection of positive memories and mementos

Some healthcare institutions provide patient feedback to physicians in writing. Keep positive notes, thank you notes, and other positive feedback in a scrapbook where you can look at them on tough days.

Learn to say, “I don’t know, but I’ll find out”

Imposter syndrome is often the result of unattainable perfectionism. Patients rely on doctors to know all the answers, and this pressure to know everything can trigger feelings of anxiety when physicians fail to live up to the high bar they set for themselves.

How Young Physicians can Prevent Imposter Syndrome

Fortunately, young gastroenterologists and other physicians can take steps to prevent imposter syndrome in themselves and in others.

Establish your personal and professional identities

Completing professional assessments, such as Gallup’s CliftonStrengths, to affirm self-identity can help. These assessments give physicians an opportunity to reflect on their own reasons for getting into the medical field by asking questions, such as:

  • What brought you to medicine?
  • What does it mean to be a healer?
  • What is your vision for medical school?

Check your expectations

For some, imposter syndrome takes root in medical school – it is shocking to go from being at the top of your class your entire life, only to hit medical school and discover that you are just average. These bright students grew up hearing (and believing) that they can do anything they want, and the grueling rigors of medical school and the angst of discovering one’s own mediocrity plants the seeds of self-doubt.

Others start to feel like frauds when their experience of being a physician does match their expectations. Young doctors often enter the medical profession with a white-knight mentality and ready to save the world, only to discover that the day-to-day duties of a gastroenterologist include a never-ending series of endoscopies and barium swallows.

Before entering a new environment, make sure reality meets expectations. Take a tour of the facilities to make sure the practice is neither too large and competitive, nor too small and limited in scope. Speak with your future peers, when possible, and evaluate their apparent levels of satisfaction or stress.

Commit to a wellness plan

Overcoming imposter syndrome starts with the same self-care young gastroenterologists might recommend to their patients. The well-rounded wellness plan includes a nutritious diet, regular exercise, and getting enough high quality sleep. Avoid toxic relationships with people who make demeaning remarks, as just one negative comment can cast a shadow of doubt.

Above all, show empathy towards yourself and towards other physicians. Your experience as a gastroenterologist, and being a young GI doctor in particular, is challenging, stressful, and sometimes disappointing. If you give yourself the credit you deserve and start seeing yourself as the real deal, you can achieve your full potential.

Some young fellows feel incompetent when they transition into their practice or hospital post and see other, more experienced physicians handle chaos and difficult cases with apparent ease. Older physicians can remind their younger counterparts that developing experience, coping mechanisms, and a cool head takes time.

Learning how to overcome imposter syndrome can help a young physician develop a successful, satisfying, and enjoyable career.