Imposter syndrome in general practice

Dr Seema Pattni looks at imposter syndrome in general practice, and provides tips on what steps affected GPs can take to tackle it

‘Is my success truly my own?’

The GP asking me this is intelligent and hard-working. They have a good job, a stable family set-up and financial security. To the external gaze, they have a lot to be proud of. But internally, they constantly question their self-worth, validity, and ownership of their success. They are experiencing imposter syndrome.

Imposter syndrome in general practice manifests as a persistent negative inner voice telling you that you are undeserving of your career progress and the position you hold: ‘I don’t know how I got this job.’

Nor do you deserve the respect, authority and accolades that come with your accomplishments: ‘It was all a fluke.’

You downplay your achievements and attribute them to anything and everything but yourself. Your success is due to a combination of external factors: ‘I’m not as great as people make me out to be. I’m just lucky. I had a good start in life.’

This isn’t just about being modest or relinquishing ego. You internalise a deep sense of incompetency and you worry that you will be exposed as a fraud. You compare yourself to others all the time. Despite evidence that justifies your competencies, you are plagued with self-doubt: ‘Why are they asking me? What do I know?’

Spoiler alert: imposter syndrome is not fun. It is utterly exhausting.

Having imposter syndrome holds you back from your full potential in work. You miss out on better pay, career opportunities and effective self-advocacy, speaking up for yourself. Your consultations become more challenging because you lack confidence in your own judgement. It’s different to feeling a little unsure or sometimes double checking against guidelines. You constantly question your decisions and management. You end up overworking to compensate. This takes up extra time and energy, so you overrun and feel drained. You just never feel ‘enough’. Imposter syndrome is a big player in contributing to poor job satisfaction, feeling overwhelmed and symptoms of burnout in GPs.

It affects one in four doctors and can occur at any stage of a career. It is most likely to take hold of you: in highly pressurised environments; during a change in role; or when taking up a leadership position. These all feature in general practice careers, making them the perfect setting for imposter syndrome.

If you are a woman, from an ethnic minority, or marginalised group, then you are more likely to be affected by imposter syndrome. Why? Because if you already feel like, or are made to feel like, an outsider, then you will be more prone to developing an exacerbated sense of being ‘othered.’ One could argue that we shouldn’t be labelling their experiences as imposter syndrome then, as it has external roots. But, internalised inadequacy doesn’t always start from within. It also develops from experiencing prejudice, discrimination, stereotyping, and systemic bias. Honestly, I think it’s hard to untangle this but it’s pretty easy to see how damaging it all is.

There are lots of other reasons that you develop imposter syndrome. It can arise from certain family dynamics or societal pressures. Having perfectionist or anxious personality traits can also make you more vulnerable to it, both are common amongst GPs. Competitive and toxic work cultures, like medical school and the NHS, are petri dishes for imposter syndrome.

General practice is absolutely no exception. In fact, it can be even more of a hotbed for imposter syndrome because of the pressure to be an all-knowing generalist whilst often working in isolation. It’s challenging for GPs to keep up-to-date, be on top of changing local and national guidelines and protocol, to stay focussed on evidence-based medicine whilst being patient-centred, compassionate and efficient. But as a GP with imposter syndrome, you tell yourself you must be perfect at all of this, all the time. If you aren’t then you have failed. You don’t cut yourself any slack.

It’s all quite heavy, isn’t it? Agreed. Even I want a break. I did mention that imposter syndrome isn’t fun. 

But what now? What if you’ve recognised some of the imposter self-talk in yourself. What if you’ve realised that your career nurtures the imposter within? What are you supposed to do?

Well, though you might not think it, recognising the signs of imposter syndrome is a significant first step. It’s important to acknowledge here that there is a move to reframing imposter syndrome as imposter ‘phenomenon’. By this, I mean we should shift away from pathologizing the experience, and reduce self-blame and stigma – especially given how many external factors are at play in contributing to it. 

The next steps aren’t easy, but they are worth it.

You can start with small changes. Make a point to challenge your inner critic and what it’s saying. It takes concerted effort but consider seeing episodes of failure as a chance to learn something new. Experiment with ways of accepting a compliment instead of instantly dismissing it. Write down your achievements and think about how you would respond to seeing them on someone else’s CV. 

Know that you aren’t alone. Speak to mentors about it. Speak to people you trust – whether that is in your personal or professional life. Acknowledge that it takes time, work and help to move beyond imposter syndrome. 

You don’t have to live with imposter syndrome forever. Even if it is just for a moment, imagine how it would feel to free yourself from the shadow of self-doubt. Embrace your abilities and accomplishments. Imposter syndrome can be defeated. The journey might be difficult, but it is one absolutely worth taking.

Dr Seema Pattni is a GP and career coach for doctors.