Imposter Syndrome: Diagnose Accurately Before Treating

PracticeUpdate: Dr. Wexler, could you shed some light on the imposter syndrome and why it is called that?

Dr. Wexler: The “imposter syndrome,” originally and properly termed the “imposter phenomenon,” was first described by Imes and Clance in a journal article in 1978, followed in 1985 by publication of a book of the same title and the Clance IP Scale. Yet this older concept has gone viral in recent years, affecting the medical profession along with the rest of society. A recent New Yorker article by Leslie Jamison, “Why Everyone Feels Like They’re Faking It,” summarizes and critiques this history. Drawing additionally on 2021 work by Tulshyan and Burey, “Stop Telling Women They Have Imposter Syndrome,” published in the Harvard Business Review, Jamison makes several key points.

• The imposter phenomenon describes a fear of being exposed as inadequate or fraudulent. This fear may persist despite objective measures of success and external recognition.

• The imposter phenomenon may be more likely to occur when people cross thresholds into unfamiliar or new contexts, especially ones in which their identity is not the norm. As originally conceived, the phenomenon was described in high-achieving or achievement-oriented women.

• The shift in terminology of “phenomenon” to “syndrome” transforms a commonly experienced emotion into a pathology.

• However, it may also be the case that the “imposter syndrome” label misdiagnoses the crisis of self-confidence that can occur when workplaces fail to support, or even discriminate against, workers. This labeling erroneously locates the “problem” in the individual rather than the environment.

How big an issue is this in medicine? Of 185 papers identified in a PubMed search of “imposter phenomenon” or “imposter syndrome,” 90% have been published since 2020. This simple fact raises the question of whether the prevalence of the imposter phenomenon in medicine is due to the societal virality of this concept, by the general anxiety and malaise in medicine and society since the onset of the pandemic, or both.


Results of a PubMed search of “imposter phenomenon” or “imposter syndrome” on April 19, 2023.

PracticeUpdate: What proportion of clinicians tend to experience these feelings and what is their impact on the clinician’s career?

Dr. Wexler: A review of papers evaluating the imposter phenomenon in physicians and physicians in training reported a prevalence of 22% to 60%. The imposter phenomenon was positively associated with “gender, low self-esteem, and institutional culture” and negatively associated with “social support, validation of success, positive affirmation, and both personal and shared reflections.” Other studies have reported even higher rates in medical students and physicians in training, with one report finding that 76% of surgical residents have “significant” or “severe” imposter symptoms. In general, the imposter phenomenon is associated with burnout. One recent survey of 3116 physicians reported a lower prevalence (4%–10%) of imposter phenomenon, but those with higher imposter phenomenon scores had higher odds of burnout and suicidal ideation.

PracticeUpdate: What are the characteristic behavioral patterns in clinicians who are more likely to experience this syndrome?

Dr. Wexler: In general, people strongly psychologically affected by the imposter phenomenon tend to be high-achieving people who overprepare or work excessively to combat the fear of failure. Success with this approach may reinforce the behavior, leading to an unsustainable workload. Of course, this pattern of overwork may also occur in structures that are not designed to support clinicians.

PracticeUpdate: What is your advice to clinicians who experience the imposter syndrome in terms of managing it?

Dr. Wexler: The first step, as always in medicine, is to identify the problem and generate a differential diagnosis before prescribing a treatment. Are feelings of anxiety characterized as related to the imposter phenomenon internal or psychologically driven?

• If so, it is normal to have this anxiety from time to time. Clinicians should draw confidence from their core strengths and expertise. No one is expected to do or be everything to all people, and it is appropriate and important to set realistic expectations with patients and colleagues. Engage as your authentic professional self—a highly trained individual, who worked very hard to get where you are—rather than attempting to conform to an imagined ideal of an omniscient physician. Be transparent when you do not know or cannot do something and acknowledge that many things are unknowable or impossible. Do not apologize. While peer support is an important component of managing imposter phenomenon symptoms, there is no need to overshare or divulge sensitive personal information.

• If the anxiety is frequent or constant, I would encourage clinicians to seek therapy—why is the feeling of being an imposter pervasive despite objective metrics of competence, including long years of training, extensive credentialing, and hard-won experience? A few sessions exploring this may resolve the issue or may lead to more prolonged exploration of other psychological symptoms that may accompany severe imposter phenomenon.

On the other hand, it is important to recognize that many structural factors in medicine give rise to situations that are wrongly termed “imposter syndrome.”

• Medical students, physicians in training, and early-career physicians are regularly thrust into roles and situations beyond their experience. While supervision has increased over the decades, any conscientious person working in a medical setting is likely to feel some anxiety when confronting a new work challenge. If this occurs in the setting of inadequate support or an excessive workload, the individual may feel that he is an imposter, failing to realize that expectations are unrealistic, and the system, rather than the individual, is at fault.

• Overt and subtle discrimination and feelings of exclusion or not belonging to the dominant culture erode self-confidence, contribute to self-doubt, and may be wrongly labeled as “imposter syndrome.”

• In both of these scenarios, addressing the structural issues is the appropriate response.

PracticeUpdate: What advice can you give to clinicians who would like to help colleagues/peers experiencing impostor syndrome?

Dr. Wexler:

• Be a role model: demonstrate self-confidence while also acknowledging your limits; approach what you do not know with curiosity rather than false authority; and present as your authentic self. Share experiences when you were challenged or felt self-doubt, and how you handled them.

• Notice, value, and affirm your colleagues’ work.

• Strive to reduce structural inequities and create an inclusive culture.