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Physician Jessie Mahoney discusses her article “Imposter syndrome is not a personal failing.” Jessie explains how self-doubt among physicians is less about individual weakness and more about a conditioned mindset reinforced by medical culture. She describes how hypervigilance, relentless preparation, and constant comparison are framed as excellence but instead fuel overwork, burnout, and compliance with unreasonable demands. Jessie emphasizes that imposter syndrome may benefit productivity in the health care system but comes at a profound cost to physician well-being, sustainability, and patient care. She reframes self-doubt as evidence of growth rather than inadequacy and calls for a cultural shift that stops normalizing imposter syndrome as inevitable in medicine. Listeners will learn how recognizing systemic patterns and reframing self-perceptions can empower clinicians to thrive without sacrificing their health or authenticity.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Jessie Mahoney, a pediatrician and coach. Today’s KevinMD article is, “Imposter syndrome is not a personal failing.” Jessie, welcome back to the show.

Jessie Mahoney: Thank you for having me.

Kevin Pho: All right. What’s this latest article about?

Jessie Mahoney: This article is about imposter syndrome, but I wanted to take a bit of a different tack because I work with so many physicians on it. Especially among women in medicine, we attribute it as a personal problem, something we have to work on, that we need to be more confident. I have come to see it more as a systemic issue. This came to light a couple of years ago. I was doing a co-ed team workshop, and there was a gentleman there who had been in practice for 35 years. As we were talking about different thought patterns that we have as physicians and the most painful things that we’re doing that are causing us to be depleted and drained in our practice, he said, “Imposter syndrome.” And I about fell out of my chair.

Interestingly, there was another woman physician there who was about three months into practice, and that had been hers. They were directly across from each other, and I thought, “This isn’t a new-in-practice thing. It doesn’t matter how long you’ve been in practice. We actually all feel imposter syndrome.” This got me really thinking about the way that it is conditioned and how it works for the system. If we think that we might be an imposter, we don’t question. We work really hard. We do more and more. We’re afraid of being called out or being shamed, and so we just hide and keep at it until we burn out and fizzle.

Somehow culturally, it’s become a thing that if you have imposter syndrome, that’s something you personally need to work on. So I think it’s worth bringing up this idea that it’s really beneficial to the system and that while I think it originally comes from a good place, which is to pay close attention and that working hard is a sign of excellence, it has come to this place that without hypervigilance you don’t care. And it’s just escalated and escalated.

Kevin Pho: Now for those who aren’t familiar with what exactly imposter syndrome is, what does that term mean to you?

Jessie Mahoney: To me, it means feeling like you’re an imposter, feeling like you don’t belong, feeling like you don’t know enough, that somehow you got to the end of your training or you’re practicing. As a pediatrician, I felt that I don’t belong with all the other pediatricians; they know more. It’s really a sense of not belonging. I often remind people that we were also trained to notice how we don’t belong. If you go back to residency or medical school, you would be in a group and your job was to figure out how you didn’t belong and how you could morph yourself to belong. It becomes something where we’re just convinced we don’t belong. So maybe we don’t belong on a stage, or maybe we don’t belong in academics, but we also tend to feel like we don’t belong with our colleagues or in our cohort, and are always noticing that piece so that we don’t feel confident.

Kevin Pho: Now, why does that feeling of not belonging, feeling like an imposter, you said that it benefits health care systems or health care systems want us to feel that way. Why is that?

Jessie Mahoney: Well, if we feel like we don’t belong or we’re not enough, which is the other phrase that people tend to feel, we work harder and harder to prove that we belong. We tend to then over-function and overwork and never say no. We also tend to be hypervigilant in terms of checking things three, four, and five times. In the end, when we burn out, the health care systems actually don’t benefit. I would say that imposter syndrome for many people actually leads to less high-quality care because we’re constantly second-guessing and maybe not making decisions. Then we are making whatever decisions we are making from a place of depletion. It doesn’t help them in the long run, but in the short term, it helps them because you have people just working like Energizer bunnies, trying to make sure they belong and fit in and keep up, and that nobody notices that they are inadequate in some way.

Kevin Pho: And you alluded to earlier that women physicians tend to feel imposter syndrome more than men. Am I hearing that correctly?

Jessie Mahoney: In my experience, that’s true. I actually wonder if it’s just more acceptable for us to say it. This gentleman who had been in practice for 35 years made me think that men may also be feeling it and working from that same space, but it’s not really acceptable for men to share that they feel like imposters. In women, it’s something that’s talked about all the time, but as a personal failing.

And what I’ll say is that in medicine, when we feel confident or believe that we know something, it’s often seen as arrogance. It’s actually considered excellence if you question it and you doubt yourself and you double- and triple-check. So for women to show up knowing, trusting, and confident is very often perceived as arrogance, so we don’t do it. It then builds this sense of imposter syndrome because we’re always second-guessing.

Kevin Pho: Now you talk in your article about reframing that self-doubt, not as being an imposter, but a sign of learning and growth, right? So how can physicians reframe that in their daily work?

Jessie Mahoney: Well, this idea in medicine, we actually shouldn’t know everything. It’s better to not know, and we frame uncertainty as dangerous. But if we could actually frame this uncertainty or not knowing as an opportunity to learn and grow, be better doctors, and learn from patients. The scientific method is to question things and to be uncertain and to figure out new ways. But in medicine, we cut that off and say that it’s not OK to not know. We’re trained that if you don’t know, you should go home and study until you do know all the answers, and I think it actually gets us into a bit of trouble.

If we can begin to recognize that not knowing is not a problem, and if we can in our medical culture say not knowing, honoring that you don’t know, and asking questions, it’s going to help us all provide better care and continue to learn. Most of us want to learn, and in fact, if you knew everything, then you would not evolve. We all pretty much believe in evolution and ongoing lifelong learning.

Kevin Pho: I think that fits into the larger theme of suppressing vulnerability and how the medical system and health care system really stamp out all signs of vulnerability and discourage all of us from showing that vulnerability.

Jessie Mahoney: Right. And because I think the systems thrive on our vulnerability, because then we all continue to work as hard as we can. The system benefits from that in the short term, not in the long term.

Kevin Pho: So what are some ways that medical institutions should change their culture to stop normalizing imposter syndrome?

Jessie Mahoney: One would be bringing in more of a culture of self-compassion and kindness. Self-compassion is so hard for doctors, but it’s really this idea that we are human. Self-compassion is common humanity, mindfulness (so just awareness), and kindness. We think of self-compassion as a pass. If something goes wrong, we immediately in medicine go to blame, shame, or guilt. Instead, if we could show up with self-compassion, which would say, “I did the best I could in the moment with the information and education that I have,” and ask different questions. “What can I learn from this? How can we grow from this?”

Our peer reviews and our M&Ms are really shame-based. If we could make them more learning-based in this idea of lifelong learning without the blame, shame, and guilt, that would keep us out of imposter syndrome. I think this idea of acceptance that we’re all learning and there isn’t a perfect right or wrong dichotomy is important. In fact, learning from each other and continuing to learn could be the definition of a good doctor, and asking questions should be the definition of a good doctor. I think even in a lot of training environments, we think that asking questions means they don’t know. Residents and trainees are often criticized for asking too many questions when they should just know it. If we could just change the immediate judgment of it and instead show up with more curiosity, we would ultimately be able to shift out of it and make room for this compassion. We know physiologically, it helps us learn and grow. So imposter syndrome doesn’t help us learn. We fill ourselves with cortisol, our amygdalas shut down, and then we’re not doing what we ultimately want to do in medicine, which is evolve and learn how to provide better care over time.

Kevin Pho: And have you seen from your experience health care systems that have evolved to that vision that we just described?

Jessie Mahoney: Not yet. I work with a lot of physicians who work in peer review, partly because I think being a physician who leads peer review is a pretty painful position, so they tend to come to coaching a lot. I think when people begin to understand the way that shame, blame, and guilt get in the way of learning, it does begin to shift. I think that it’s going to be slow because in our culture, and this has been a culture in medicine for a long time, self-compassion is a pass.

I like to think of it as a life raft for challenging times, and these are challenging times in medicine. There’s a lot of energy around this idea of self-compassion, and there are quite a few health care organizations who have adopted programs to teach more self-compassion. I think it will slowly begin to be there. But if we continue to label imposter syndrome or fear of making mistakes as something wrong with you, we’re not going to get there.

Kevin Pho: Now, for those physicians who struggle with those feelings of imposter syndrome, what are some first steps that they should take?

Jessie Mahoney: I would say recognize it’s not a personal failing. For many, when you begin to see that you were trained to notice all of your deficiencies and you were taught that to doubt yourself is a measure of a good doctor, then it’s not a personal problem. You can begin to say, “Well, this was helpful when I was a resident, but I don’t necessarily need to keep moving it forward.” Another way I’ve found to be really helpful is to not focus on being confident, because for many of us, that’s a pretty far stretch, but to focus on another way of being common and grounded or how can you trust yourself? How have you made good decisions in the past? Beginning to ask yourself different questions can really change your relationship with it. I see so many people who are bashing their head against it because it’s a problem that needs to be fixed, instead of perhaps changing your relationship with yourself and your approach to learning and your approach to judgment.

Kevin Pho: We’re talking to Jessie Mahoney, a pediatrician and coach. Today’s KevinMD article is, “Imposter syndrome is not a personal failing.” Jessie, let’s end with some take-home messages for the KevinMD audience.

Jessie Mahoney: I think that everyone in medicine has some degree of imposter syndrome, and it doesn’t mean there’s something wrong with you if you doubt yourself. It’s not a personal failing; it’s a way that you were trained to think. If you can begin to reframe self-doubt as learning and growing and wanting to learn, rather than a deficiency or an inadequacy, that is actually how you will become the best doctor and you’ll also retain enough energy to continue practicing.

Kevin Pho: Jessie, as always, thank you so much for sharing your perspective and insight and thanks again for coming back on the show.

Jessie Mahoney: Thanks for having me. I appreciate it.