Have I really made it? A hint of panic creeps into your mind as you try to make a critical decision. What am I doing? Does it make sense to send this person for catheterization? I wonder what my colleague thinks about my decision. Maybe I should’ve discharged the patient, but what if I send her home and she never follows up in clinic? It feels like I’m making life and death decisions for another person, and I am not equipped to do so. Do people around me in this sprawling hospital realize how much it is that I don’t know yet?

First described by psychologists Suzanne Imes, PhD, and Pauline Rose Clance, PhD, in the 1970s, imposter phenomenon occurs among high achievers who are unable to internalize and accept their success. They often attribute their accomplishments to luck rather than to ability, and fear that others will eventually unmask them as a fraud.¹ Many psychologists and other professionals acknowledge that it is a very real and specific form of intellectual self-doubt. Imposter feelings are generally accompanied by anxiety and, often, depression. As early career physicians, we can easily succumb to these crippling feeling as we try to prove ourselves and establish our credentials. It can contribute to burnout and handicap our ability to perform even simple tasks at hand. When grappling with these feelings, certain coping pathways can be helpful.

Rely on your support system at work

One of the key factors in choosing my first job out of fellowship was my comfort level with other providers in the practice. On the interview trail, it is vital to gauge the personalities of your future peers and whether you would feel comfortable going to them when you inevitably will have questions. If there exists a stringent hierarchy model where the junior partners are made to feel like newbies, this is a red flag. I chose my practice because there was no apprehension amongst providers about approaching each other with questions. I was surprised when my senior partners would come ask me for my opinions on complex cases and this helped create a sense of belonging for me. Another key is to find trustworthy mentors in your practice, hopefully someone with ample experience but humble and kind to share their knowledge and support your growth. It is also important to keep in touch with mentors from your fellowship training, they can continue to serve as valuable resources during the early career years.

Trust your training

Very few professions have the arduous, extensive training that physicians go through. Sub-specialty pathways take us into our mid 30s by the time we embark on our careers as full-fledged cardiologists. We are amongst the few hundred in the country that graduate every year with polished skills and abundance of knowledge in this field. When you inadvertently question yourself making difficult decisions, it is good to remember that we have prepared for this with over a decade of training. We should rely on our knowledge, draw from our past experiences, and trust yourself to make the best decisions in the moment.

Prioritize diversity and representation

Minorities by gender and race are grossly under-represented in the field of cardiology. Representation matters not only to inspire younger aspiring physicians but can enable growth of early career physicians as well. Someone that looks like you or with a similar background can provide you with a sense of belonging. Younger physicians in positions of leadership within the practice can also stir early career physicians to take an active advocacy role and engage in impactful decision-making processes.

Remember: We are not heroes

Lastly, we have all seen signs outside hospitals during the pandemic: “Heroes work here.” Although well-intentioned, I do not believe we are heroes, and it would be unwise to develop such a complex at any point in our careers. Most of our day-to-day decisions are routine. There are many limitations to modern medicine, and we sometimes treat very sick patients. Mortality, in difficult cases, can be inevitable and guiding these patients through to a dignified end can be rewarding for families and their doctors. Accepting our limitations and knowing we did our best at the end of the day is plenty to be proud of.

1. Langford, Joe; Clance, Pauline Rose "The impostor phenomenon: recent research findings regarding dynamics, personality and family patterns and their implications for treatment" Psychotherapy: Theory, Research, Practice, Training. 30 (3): 495–501. doi:10.1037/0033-3204.30.3.495