One of the most important—and least discussed—truths in medicine is this:

Feeling inadequate in medicine isn’t rare. It’s everywhere—quiet, lingering, relentless.

I remember starting my outpatient practice right out of residency. I had joined a large multispecialty group filled with physicians trained at top-tier institutions. Many had been practicing for decades. They were confident. Efficient. Experienced. I was still waiting on my board scores—unsure if I was even certified yet. And yet—there I was. Seeing patients. Trying to find my footing. Surrounded by colleagues who felt lightyears ahead of me. I felt like an imposter.

They had full panels—I had two or three patients a day. They flew through the EMR—I could barely open a note. They had systems. I had questions:

• What’s the right way to write a note?
• What if I missed something?
• What if a patient didn’t like me—or worse, complained?

Every interaction felt like a test. Every chart review became a spiral of second-guessing. I reread my notes obsessively, terrified I’d overlooked something critical. I stayed up late, combing through charts, desperate not to miss a thing. I was petrified of making a mistake.

It took nearly a decade before I finally felt… adequate.

And what I’ve learned since is this:

Inadequacy isn’t just a new physician’s burden. It lingers—even in the most seasoned among us. All it takes is a bad outcome. A tough patient. A complaint. Suddenly, the confidence you worked so hard to build—shaken.

Because in medicine, starting something new—whether it’s your first job or your fifth—isn’t just a transition. It’s a rebuild. You’re not just adjusting to a new clinic or system. You’re rebuilding:

• A patient panel
• A foundation of trust
• A rhythm that’s sustainable—for your patients, and for yourself

When I left residency, I had thousands of hours managing hospitalized patients—rounding, running codes. But outpatient medicine? That was a different world.

I had to learn how to:

• Use the EMR efficiently
• Structure a 15-minute visit
• Guide prevention and lifestyle change
• Communicate uncertainty
• And most importantly—earn trust

And that part? It doesn’t happen overnight.

It takes time to earn patients’ trust—and even longer to trust yourself. It can take years before patients open up. Before they believe in you. Before they refer their friends and family. And in that in-between—when your panel is light and your confidence is low—inadequacy creeps in.

Because we’re human. We want to be respected. We want to do right by our patients. We want to feel like we’re doing a good job. And when we don’t—we internalize it. Not just as a mistake, but as a flaw.

Many of us carry a dangerous belief: That we should be excellent at everything, all the time. We don’t just aim to be great clinicians. We aim to be great partners. Great parents. Great friends. Great leaders. And when we fall short—even just a little—we don’t just notice it. We feel it deeply.

It’s not just doubt. It’s a pit in your stomach. A voice that whispers: “You should know this.” “You should be better by now.” And in medicine, that voice gets louder.

Because here, mistakes carry weight. A missed diagnosis isn’t just a slip—it can be life-changing. A delayed test isn’t just a clerical error—it can be costly. That pressure never fully disappears. And when layered with the emotional weight we carry for our patients, it can feel overwhelming.

But here’s what I wish more of us knew sooner:

That feeling is normal. In fact, the physicians who care the most often carry the greatest sense of inadequacy. Because they care deeply. They worry about outcomes. They worry about being seen as competent. They want to excel—because they understand what’s at stake.

But that same drive can be a double-edged sword. Because no one—not even the most experienced among us—can be excellent in every moment. Trying to be everything for everyone leads to burnout, self-doubt, and emotional fatigue.

So here’s what I’ve learned to believe:

• You don’t have to be everything at once.
• You’re allowed to build slowly.
• Balance will come—with time.

Confidence in medicine doesn’t arrive all at once. It builds quietly. Through repetition. Through humility. Through persistence.

And even then—just when you start to feel grounded—something new will challenge you. But that’s not a sign of failure. It’s a sign that you’re still in the game. Still learning. Still caring. Still showing up.

Yes, the boat may rock. But you’re learning how to steady it. Some days, you’ll feel like you’re sinking. But most days—you’ll find your balance.

That’s what makes you a great physician: Not perfection, but persistence. Not certainty, but the commitment to keep showing up.

You are not alone. You are not inadequate. You are not failing. You are human.

And you are worthy—

• Of the degree you earned
• Of the role you hold
• Of the life you’re building

Find your lane. Do your best. Be kind to yourself. And trust that confidence will come—not all at once, but quietly, through time, grace, and the work you continue to do.

Ryan Nadelson is chair of the Department of Internal Medicine at Northside Hospital Diagnostic Clinic in Gainesville, Georgia. Raised in a family of gastroenterologists, he chose to forge his own path in internal medicine—drawn by its complexity and the opportunity to care for the whole patient. A respected leader known for his patient-centered approach, Dr. Nadelson is deeply committed to mentoring the next generation of physicians and fostering a culture of clinical excellence and lifelong learning.

He is an established author and frequent contributor to KevinMD, where he writes about physician identity, the emotional challenges of modern practice, and the evolving role of doctors in today’s health care system.

You can connect with him on Doximity and LinkedIn.