Stanford University: Physicians experience imposter syndrome more often than other U.S. workers

A new study by Stanford Medicine researchers demonstrates that, among U.S. workers, physicians are more likely than others to feel the effects of imposter syndrome, a phenomenon in which someone feels inadequate despite a track record of competence.

The study, published online Sept. 15 in Mayo Clinic Proceedings, is the largest that examines imposter syndrome in physicians, according to the lead author, Tait Shanafelt, MD, the Jeanie and Stew Ritchie Professor.

“Compared with the average worker, physicians have been found in other studies to have higher levels of resilience, meaning and social support, but often perpetually prioritize other people’s needs over their own,” Shanafelt said. “This study shows that physicians have an Achilles’ heel: No matter their accomplishments or level of achievement, many physicians feel it is never good enough.”

The expectation that they should go above and beyond human limitations, work excessive hours, and not seek help contributes to perceived personal shortcomings and deferral of their own needs, said Shanafelt, a professor of hematology.

National survey
The researchers conducted a national survey of roughly 3,000 physicians between the ages of 29 and 65. In the survey, physicians ranked four statements on a 5-point scale, from “not at all” to “very true.” The statements expressed thoughts related to burnout, professional fulfillment, self-valuation and suicide.

Based on the participants’ rankings, the study authors found that 1 in 4 physicians experienced frequent or intense imposter syndrome symptoms. Stronger feelings of imposter syndrome bring greater risk of occupational burnout, suicidal thoughts and professional unfulfillment, according to Shanafelt.

“For physicians, this feels like you should always be doing more and putting work first,” said Shanafelt, who directs Stanford Medicine’s WellMD and WellPhD Center.

Physician responses to one statement — “I’m disappointed at times in my present accomplishments and think I should have accomplished more” — were compared with responses from more than 2,500 U.S. professionals in other fields.

After adjusting for factors such as age, gender, relationship status and hours worked per week, physicians were at a 30% increased risk of reporting imposter syndrome symptoms compared with all other U.S. non-physicians and at an 80% increased risk relative to people with a doctoral or professional degree in another field.

Symptoms, notably emotional exhaustion and questioning one’s accomplishments, were more common among women, young and unmarried (excluding widowed) physicians, as well as those in practice at an academic medical facility or with the Veterans Health Administration.

‘An honest look in the mirror’
“When physicians experience burnout, they cut their professional work hours, they do less clinical work, they have twice the rate of turnover and their patients’ experience suffers,” Shanafelt said. “The medical profession needs to take an honest look in the mirror — about the great qualities of the profession but also those that are less ideal — to give physicians a better foundation for the challenges that a career will bring.”

The best thing we can do is to embrace the physician as a human rather than as simply a hero.
The authors recommend ways medical organizations can mitigate imposter syndrome in the workplace, including fostering a culture that allows physicians to express vulnerability and sharing personal stories in small group discussions. Particularly, the authors note, experienced physicians, who often appear to have it all together, can describe their own “failure resumes” for junior colleagues to demonstrate that role models also have difficulties. De-stigmatizing and normalizing help-seeking could also contribute to more professional fulfillment, the authors state in the paper.

With the help of a professional coach, individual physicians can tackle imposter syndrome symptoms, Shanafelt said, by reframing their thoughts and learning to recognize their accomplishments and acknowledge that they are due to their hard work, skill and ability.

“The best thing we can do is to embrace the physician as a human rather than as simply a hero,” Shanafelt said.

Shanafelt is a member of the Stanford Medicine Maternal and Child Health Research Institute and the Stanford Cancer Institute.

The research was funded by the Stanford Medicine WellMD and WellPhD Center, the American Medical Association, and the Mayo Clinic Department of Medicine Program on Physician Well-Being.

Scientists from the Mayo Clinic and the American Medical Association also contributed to the research.