The Dream That You Don’t Belong (Even Thirty Years In)

September puts the meetings back on the calendar. New fellows start. Committee assignments arrive without much warning. Someone asks you to review a promotion packet, or quietly puts your name on one.

Then, some night in the middle of all that, you have the dream.

Mine goes the same way every time. I am called to the Dean’s office and told there was a mistake in the admissions process. I did not meet the qualifications for medical school. They apologize. They tell me to pack my things and reapply once I have improved my application. I feel embarrassed. Then, oddly, relieved.

I wake up and check the room. It is two hours before I need to be at clinic.

Nearly thirty years have passed since I was admitted to medical school. The dream still comes back when I am carrying enough stress.

The feeling does not read your CV

Intellectually, I know I earned the seat. I did well in training. I have been a good physician for a long time. None of that reaches the dream.

For years I assumed I was the only one. Then I mentioned it to a colleague, and they told me they have their own version of it. That was the first useful thing anyone ever told me about imposter syndrome in physicians.

What the data says about imposter syndrome in physicians

Researchers call it the imposter phenomenon. Same thing, and their numbers are better than the one you have probably seen. You will still see 60% quoted, and I have quoted it myself on this blog. The better number comes from a study of roughly 3,000 physicians in Mayo Clinic Proceedings. The AMA summarized it in February 2023. There, 17.4% reported frequent imposter phenomenon and 5.8% reported intense experiences. Nearly one in four sit in that range. Another 36.4% scored moderate.

The associations matter more than the prevalence. Imposter severity was independently associated with burnout and with suicidal ideation. That held after adjustment for age, gender, specialty, hours worked, and practice setting.

Both relationships were positive and graded. As severity rose, so did the odds. Physicians in the intense band carried roughly twice the odds of burnout of those in the lowest band. For suicidal ideation the gap was wider still, at more than two and a half times. Professional fulfillment ran the other way. Higher imposter scores, lower odds of reporting high fulfillment.

Those severity bands are not distributed evenly, and two findings stopped me. Physicians in academic practice landed in the higher bands more often than physicians in private practice. And when specialties were compared, pediatricians, pediatric subspecialists, and emergency physicians reported imposter experiences most often of any group.

I am a pediatric cardiologist in an academic children’s hospital. I am on both lists.

Thirty years in is not the norm

Here is the finding that reframed the dream for me. Older physicians reported imposter experiences less often than younger ones.

Less often is the entire claim. It is not absent. A lower average score means the feeling is less likely to be present on any given day. It says nothing about whether it still flares. The flares keep coming. They come when the load goes up.

So the dream at year thirty is not the standard experience. But it does mean the feeling was never tracking competence. It is residue from a training culture.

The study’s lead investigator, Tait Shanafelt, MD, pointed at that culture directly. He called for an end to norms that “stigmatize help-seeking as weakness.”

That is a systems problem, and it will outlast all of us. You still have to get through committee season.

Why reassurance stops working

Being told you belong does not fix this. Imposter syndrome in physicians metabolizes evidence in a particular way. The promotion becomes proof they have not noticed yet. The good outcome becomes the team. The compliment becomes politeness. The invited talk becomes a scheduling accident.

Every piece of external evidence arrives with an explanation attached. So “you’re doing great” bounces off, and seniority offers no protection. More achievement means more evidence to discount.

The physician mindset you built in training taught you to own every failure personally and to spread every success across the team. Run that arithmetic for twenty years and the ledger will never balance.

Build the kind of evidence that survives

Titles and rankings get discounted because someone awarded them. Capability is different. Capability is specific, repeatable, and yours, and it is much harder to hand back to luck.

That is the practical shift. Stop collecting proof that you belong, and start naming what you bring to the table. The VIA character strengths framework gives you language for that, which matters more than it sounds.

Most physicians can describe their weaknesses in precise clinical terms and their strengths in vague adjectives.

Recognizing your value takes regular practice. You can unlearn old habits and keep developing new ones, because your education did not stop at graduation.

Try this before your next committee meeting

What this asks of people in the chair

The study’s authors did not stop at individual coping. They recommended system-level moves, and one of them stuck with me. Senior physicians sharing a failure resume at a department meeting, out loud, in front of people who assume they never had one.

I am a division director. That recommendation is aimed squarely at my seat. A blog post is easier than a division meeting, which is worth admitting here.

Some people now look at you the way you once looked at your attendings. So the most useful thing you can do this fall is simple. Say one true sentence about your own doubt, in a room where somebody junior can hear it.

The dream will probably come back

I expect it again. Too many service weeks, one hard conversation I keep postponing, and I will be back outside the Dean’s office with my things in a box.

What changed is what I do with it. Imposter syndrome in physicians is not a verdict on the record. The dream is a weather report on my stress level. It is not a finding about my qualifications, and it never had access to my file.

Frequently asked questions

Is imposter syndrome the same as low self-confidence?

No. Low confidence doubts the outcome before it happens. Imposter syndrome doubts the explanation for a good outcome after it happens. The distinguishing feature is discounting your own evidence, not fearing failure.

How common is imposter syndrome in physicians?

In the Mayo Clinic Proceedings study of about 3,000 physicians, 17.4% reported frequent experiences and 5.8% reported intense ones. Another 36.4% scored in the moderate range. Physicians report imposter syndrome at higher rates than other U.S. workers.

Does imposter syndrome in physicians go away with experience?

On average, older physicians scored lower than younger ones. Lower is not zero. Plenty of senior physicians still get the spike under load, and academic settings scored higher than private practice.

What helps most?

The study authors recommend institutional moves: storytelling sessions, small-group discussion, senior physicians sharing a failure resume, and normalizing help-seeking. Individually, start with the sentence above. That worked because I brought ___ to it.