How Does Imposter Syndrome Affect Health Care Providers?

The COVID-19 pandemic has highlighted that podiatric physicians are an integral part of the health care system. Podiatrists are renowned for their lower extremity knowledge base and surgical expertise; however, in my observation, some podiatrists may feel they do not naturally belong in a comparable professional space with other medical doctors. At an early stage in a podiatrist's career, we become aware of limitations based on our scope of practice (in only treating the foot and ankle). These limitations may translate to a few that we are unequal to other health care professionals.

Podiatric medicine and surgery have an essential role in the overall health of our patients; yet, some podiatrists seem to suffer from imposter syndrome. Impostor syndrome (also known as the impostor phenomenon) describes 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.¹ People with impostor syndrome struggle with accurately attributing their performance to their actual competence.¹

Imposter syndrome (IS) is a phenomenon that happens at all stages of one’s medical career. IS in physicians mainly occurs during medical school; however, this phenomenon affects physicians even at the highest career level.  Imposter syndrome is a strong predictor of general psychological distress and can lead to burnout syndrome.² IS is not just a podiatry problem. A 1998 study by Henning and colleagues found that a survey assessing medical, dental, nursing, and pharmacy students, 30 percent scored as “impostors.”³ A similar study by Oriel and team found impostorism present in approximately one-third of their sample of family medicine residents.⁴

Stress and perfectionism are qualities that contribute to imposter syndrome. There is no way to avoid the rigorous training of becoming a doctor, whether you become a DPM, DO, or MD.

Moreover, our quest for perfection with surgical outcomes and diagnosis is rooted in the knowledge that patients’ health and well-being are at stake. Physicians typically do not discuss challenges or struggles with clinical practice and less-than-perfect surgical outcomes. Instead, we usually live our lives handling our challenges alone or trying to balance “doctoring” in a bubble.

Everyone has met challenges in clinical practice. Sharing our missteps could help students, young physicians, and our more seasoned peers avoid the psychological stresses of being a doctor. Not always knowing the answers does not mean we are frauds, but that we have chosen a profession that requires lifelong learning.

How can we overcome IS? As podiatrists, we should not pass up more prominent administrative roles in an integrative health system and know that we deserve these accolades. We should invest in positive relationships with colleagues that give supportive feedback. We should not be humiliating or punitive when we train students and residents and share how we overcame clinical challenges and difficult experiences. We must prioritize forums and courses to deal with stress and burnout and include these topics in podiatric training and our continuing medical education classes. Most importantly, we must rethink how we professionally define ourselves and recognize that our specialized knowledge is our greatest asset.

Dr. Robinson is the Chair of and an Assistant Professor in the Department of Medicine at the Temple University School of Podiatric Medicine. She is a Diplomate of the American Board of Podiatric Medicine.

References

1. Bravata DM, Watts SA, Keefer AL, et al. Prevalence, predictors, and treatment of impostor syndrome: a systematic review. J Gen Intern Med. 2020;35(4):1252-1275.

2. Villwock JA, Sobin LB, Koester LA, Harris TM. Impostor syndrome and burnout among American medical students: a pilot study. Int J Med Educ. 2016;7:364-369.

3. Henning K, Ey S, Shaw D. Perfectionism, the imposter phenomenon and psychological adjustment in medical, dental, nursing and pharmacy students. Med Educ. 1998;32(5):456-64.

4. Oriel K, Plane MB, Mundt M. Family medicine residents and the impostor phenomenon. Fam Med. 2004;36(4):248-52.