Opinion

A PIECE OF MY Imposter Syndrome

MIND
Treat the Cause, Not the Symptom
Samyukta Mullangi, sicians characterized medicine as an elite profession
A f e w w e e k s a g o , a Tw i t t e r a c c o u n t c a l l e d
MD, MBA @womeninmedchat facilitated an online conversation populated by high achievers who were particularly sus-
Division of Healthcare about imposter syndrome in medicine. Imposter syn- ceptible to linking their self-worth with achievement.2
Delivery Science and
drome is a psychological term that refers to a pattern Consequently, remedies such as maintaining diaries of
Innovation, Weill
Cornell Medicine, of behavior wherein people (even those with accomplishments or pursuing self-care with mindful-
New York, New York; adequate external evidence of success) doubt their ness and meditation proliferate in seminars and self-
and Department of abilities and have a persistent fear of being exposed as help blogs.
Medicine, New
York-Presbyterian
a fraud. Online, there were numerous responses: But is this the right approach? Imposter syndrome,
Hospital, New York. women talked frankly about how they attributed in many ways, is analogous to another, related,
accomplishments to luck or good timing instead of epidemic—that of clinician frustration—often termed
Reshma Jagsi, MD, merit, voicing fears that they had simply duped others burnout. Studies show that a third to half of medical
DPhil with an illusion of competence. students and clinicians are experiencing depression
Department of
Radiation Oncology, The sheer prevalence was emphasized by an and anxiety, much higher rates than those observed
Michigan Medicine, aspiring surgeon: “I’d like to meet someone who among their nonphysician peers. A single such affected
Ann Arbor; Center for HASN’T experienced imposter syndrome.” Others physician can be prescribed medication, encouraged to
Bioethics and Social
highlighted how the syndrome disproportionately seek talk therapy, or asked to take a therapeutic leave
Sciences in Medicine,
University of Michigan, affects women and minority groups—who often lack of absence. But at the aggregate level, administrators
Ann Arbor; and sufficient role models of success. Many reported that are acknowledging that they have a part to play in
Institute for Healthcare it led to meaningful setbacks in their careers, from addressing the structural environment—long hours, ris-
Policy and Innovation,
University of Michigan,
being too paralyzed to speak up at meetings to not ing caseloads, and an increase in administrative tasks
Ann Arbor. asking for opportunities or promotions due to feeling related to electronic medical records, which can con-
unqualified. An academic hospitalist wrote, “There are tribute to frustration. As the syndrome of frustration
and “burnout” gains increasing recogni-
tion in the public forum, the onus of
working toward a solution shifts from
[I]mposter syndrome might be viewed
the individual to the group.
less as a personal challenge affecting In the same way, imposter syn-
a few than a systemic problem…with drome might be viewed less as a per-
sonal challenge affecting a few than
real, detrimental consequences a systemic problem of considerable
to those affected. scale with real, detrimental conse-
quences to those affected. As such, it
invisible gates or wormholes to better career possibili- constitutes a problem to be confronted at the organiza-
ties. Having imposter syndrome means you will miss tional level with serious engagement from leadership
the gate when someone asks you if you’re ready or and investment in both cultural transformation and
interested in something.” policy change.
As we round the corner from #MeToo, which Organizations can work to nourish the careers of
helped bring the scope and severity of sexual harass- both men and women by recognizing the subtle ways
ment and gender inequity to the forefront of public in which women are socialized to behave in public
consciousness, and begin the process of quality spaces that can prevent them from being recognized
improvement that is advocated by movements such for their contributions. Data show that women are
as TIME’S UP Healthcare, one might wonder if spot- socialized to frame their suggestions as questions
Corresponding
lighting the widespread issue of imposter syndrome in order to garner consensus, to avoid seeming
Author: Reshma
Jagsi, MD, DPhil, detracts from these movements’ messages. Unlike abrasive. 3 Other studies show that women can be
Department of sexual harassment and discrimination, imposter syn- penalized for exercising power and volubility in meet-
Radiation Oncology, drome initially feels like a problem that is internal to ings, whereas doing the same has a strong, positive
University of Michigan,
1500 E Medical an individual’s psyche, a self-inflicted wound. In this effect on men.4 An important research article dem-
Center Dr, UHB2C490, way, the problem begins and ends with the affected onstrated that women tend to minimize their ambi-
SPC 5010, Ann Arbor, person taking an inward look and pursuing a “fix.” tions and salary expectations in mixed-gender envi-
MI 48109-5010
Much of the existing narrative around imposter ronments to boost relationship prospects. 5 These
(rjagsi@umich.edu).
syndrome focuses on individual fixes. Online, articles learned behaviors ultimately contribute to a self-
Section Editor: Preeti
Malani, MD, MSJ, often attribute the origin of the syndrome to character perpetuating cycle: by softening their edges, women
Associate Editor. traits like perfectionism.1 In one qualitative study, phy- may not be recognized for their competence and

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 Opinion A Piece of My Mind

therefore not be promoted. But this oversight then leads to
women doubting their capabilities and deepening a sense of
imposter syndrome. Health care organizations seeking to pro-
mote individuals of all genders and racial backgrounds need to be
proactive about setting rules and norms that recognize women
for excellent work, aim for pay parity, and allocate resources
toward leadership training for women and minorities. Organiza-
tions must also develop mechanisms by which they repeatedly
reevaluate their progress toward these goals.
Additionally, cultural change needs to be paired with concrete
commitment to mitigate the root causes of imposter syndrome.
Many participants in the Twitter forum discussed the relative
dearth of strong female role models, mentors, and sponsors in their
workplaces—role models to inspire, mentors to guide and advise,
and sponsors to offer opportunities (even when the individual does
not herself believe she is qualified!). The data show that women
tend to do well in more purely meritocratic environments, such as
college and medical school.3 But the real world requires a certain
“hustle” to achieve success—knowing people, having name recog-
nition, putting oneself up for opportunities—and the structural bar-
riers are higher for women. This can lead to real exclusion from col-
laboration and career advancement opportunities. Some academic
medical centers are recognizing that highly qualified women may
escape search committees’ radar screens, which are typically popu-
lated with those with the confidence or connections to gain notice.
Simple approaches like the National Football League’s “Rooney
rule” that requires that minority candidates at least be included
among those considered for a senior position may be a way to com-
bat the bias that may otherwise affect candidate pools and ulti-
mately help remedy the disparity in the leadership pipeline.6
Improving diversity in senior positions is important for many rea-
sons, and one key reason is to provide the role models needed to
encourage the increasingly diverse student body entering medical
schools today.
Imposter syndrome is but a symptom; inequity is the disease.
Promoting equitable representation of women and minorities among
the leaders of medicine through concerted systems-level interven-
tion is the most appropriate treatment.

Conflict of Interest Disclosures: Dr Jagsi reported
that she has received grants from the National
Institutes of Health, the Doris Duke Charitable
Foundation, and the Komen Foundation; grants and
personal fees from the Greenwall Foundation and
Blue Cross Blue Shield of Michigan for the Michigan
Radiation Oncology Quality Consortium; personal
fees from Amgen; and support from Equity
Quotient; and reported being a founding member
of TIME'S UP Healthcare. No other disclosures
were reported.
Additional Contributions: We thank Priyanka
Chugh (Johns Hopkins University), Devika Das
(University of Alabama at Birmingham), and Vineet
Arora (University of Chicago) for letting us share
their tweets and insights for this essay. They were
not compensated for their help.
1. Corkindale G. Overcoming imposter syndrome.
Harvard Business Review blog. https://hbr.org/
2008/05/overcoming-imposter-syndrome. Posted
May 7, 2008. Accessed July 8, 2019.
2. LaDonna KA, Ginsburg S, Watling C. “Rising to
the level of your incompetence”: what physicians’
self-assessment of their performance reveals about
the imposter syndrome in medicine. Acad Med.
2018;93(5):763-768. doi:10.1097/ACM.
0000000000002046
3. Johnson SK. What the science actually says
about gender gaps in the workplace. Harvard
Business Review blog. https://hbr.org/2017/08/
what-the-science-actually-says-about-gender-gaps-
in-the-workplace. Posted August 17, 2017. Accessed
July 8, 2019.
4. Brescoll V. Who takes the floor and why: gender,
power, and volubility in organizations. Adm Sci Q.
2011;56:622-641. doi:10.1177/0001839212439994
5. Bursztyn L, Fujiwara T, Pallais A. “Acting wife”:
marriage market incentives and labor market
investments. Am Econ Rev. 2017;107:3288-3319.
doi:10.1257/aer.20170029
6. Knoll MA, Glucksman E, Tarbell N, Jagsi R.
Putting women on the escalator: how to address
the ongoing leadership disparity in radiation
oncology. Int J Radiat Oncol Biol Phys. 2019;103(1):
5-7. doi:10.1016/j.ijrobp.2018.08.011

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