What Surgeons Get Wrong About Imposter Syndrome

Imposter syndrome isn’t something to celebrate, but it’s something worth talking about. So many of us, especially high-achieving women in medicine, struggle with it silently. We hide it behind credentials, performance, and long hours, convincing ourselves that the unease we feel is proof that something is wrong with us. It isn’t. Once you understand where imposter syndrome comes from, you can begin to see that it’s not a flaw at all. It’s simply a pattern. And patterns can be changed.

Imposter syndrome isn’t a diagnosis. It doesn’t appear in the DSM-5. It isn’t a disease or a defect of character. It’s a way of thinking, a repetitive mental habit that interprets success through the lens of self-doubt. At its core, it’s the belief that you’re not as capable, competent, or worthy as others believe you to be. It’s that quiet voice that whispers, They’re going to find out I don’t actually know what I’m doing, even when all evidence says otherwise.

It might sound familiar. You might feel like your accomplishments were accidental—that you just got lucky, worked harder than everyone else, or happened to be in the right place at the right time. You might think your success has more to do with persistence than with talent. You might even worry that someday someone will realize you’re not as smart or skilled as they thought. If you recognize yourself in any of this, you’re not alone. Nearly every high-achieving professional has been there.

Medicine, in particular, cultivates the perfect environment for imposter syndrome to thrive. The culture rewards perfectionism, performance, and productivity. From early training, we’re taught that excellence equals worth, that competence leaves no room for error, and that humility means constant self-doubt. But that mindset has a cost: it leaves no room for humanity. When your sense of value depends on external validation—grades, rankings, titles, outcomes—any moment of uncertainty feels like exposure. Normal self-doubt starts to feel like evidence of fraudulence. The higher you climb, the louder that voice becomes.

The good news is that imposter syndrome is completely manageable. It’s a learned habit of thought, and habits can be unlearned. Confidence isn’t the absence of doubt; it’s the ability to act with integrity and purpose despite doubt. You don’t have to wait until you feel perfectly sure of yourself to show up as your best self. You can begin now: imperfect, capable, and fully human.

Are you terrified of making a mistake? This is one of the biggest clues that an inner imposter might be running the show. No matter how long you’ve been in practice, even if you’ve been a surgeon for years or decades, if some part of you still worries that one mistake could collapse your entire career, that’s not competence talking. That’s fear. It’s the voice of the imposter, whispering that you’re one misstep away from being exposed.

I know that voice well. I had full-blown imposter syndrome. I first noticed it in medical school, though I didn’t have the language for it at the time. I remember walking the halls during my first year, feeling intimidated by everyone around me, half expecting someone to tap me on the shoulder and escort me out of the building. I was sure they’d realize I didn’t belong.

Maybe it came from my difficult childhood, from surviving trauma, poverty, and chaos. Maybe it was perfectionism. Maybe it was tying my self-worth to external validation. Most likely, it was all of those things. Whatever the origin, imposter syndrome was a constant companion throughout my career.

I carried it with me into residency, into practice, and through every professional milestone. For more than a decade, I kept pushing forward, shoving that feeling down, telling myself to just do my job. But when we do that, when we ignore the inner imposter instead of examining it, we cut ourselves off from our highest potential. We can perform, but we can’t fully thrive.

It wasn’t until a couple of years ago—eleven years out of training—that I finally turned toward it instead of away from it. That’s when everything started to shift.

The first step in disarming imposter syndrome is understanding where it came from. The term imposter phenomenon was first coined in 1978 by Dr. Pauline Clance and Dr. Suzanne Imes, two clinical psychologists who studied thought patterns in high-achieving women. They described it as a state of fear, self-doubt, and the persistent feeling of being a fraud, even in the face of overwhelming evidence of success.

What’s fascinating is that these feelings often appear because of success, not in spite of it. Even when we have external indicators—degrees, awards, titles, glowing feedback—we still feel undeserving. It’s as though our internal sense of worth never caught up to the evidence.

Dr. Clance herself experienced imposter feelings in graduate school, and I often wonder if her research was an attempt to confirm she wasn’t alone. That instinct—to study what haunts us—is deeply human. And if you recognize yourself in this description, you’re in good company.

There’s a psychological term for what keeps so many of us silent about this: pluralistic ignorance. It describes the collective illusion that everyone else has it together. We look around and assume no one else struggles, so we keep our doubts hidden. In surgery, that silence is amplified. We’re trained to be authority figures, to project certainty, to avoid vulnerability at all costs.

But that silence only strengthens the imposter. It’s time to start speaking its name. When we acknowledge it, we begin to take back our power—not by pretending the fear isn’t there, but by refusing to let it run the operating room of our minds.

Imposter syndrome isn’t something to celebrate, but it’s something worth talking about. So many of us, especially high-achieving women in medicine, struggle with it silently. We hide it behind credentials, performance, and long hours, convincing ourselves that the unease we feel is proof that something is wrong with us. It isn’t. Once you understand where imposter syndrome comes from, you can begin to see that it’s not a flaw at all. It’s simply a pattern, and patterns can be changed.

Imposter syndrome isn’t a diagnosis. It doesn’t appear in the DSM-5. It isn’t a disease or a defect of character. It’s a way of thinking, a repetitive mental habit that interprets success through the lens of self-doubt. At its core, it’s the belief that you’re not as capable, competent, or worthy as others believe you to be. It’s that quiet voice that whispers, They’re going to find out I don’t actually know what I’m doing, even when all evidence says otherwise.

It might sound familiar. You might feel like your accomplishments were accidental, that you just got lucky or happened to be in the right place at the right time. You might think your success has more to do with persistence than with talent. You might even worry that someday someone will realize you’re not as smart or skilled as they thought. If you recognize yourself in any of this, you’re not alone. Nearly every high-achieving professional has been there.

Medicine, in particular, cultivates the perfect environment for imposter syndrome to thrive. The culture rewards perfectionism, performance, and productivity. From early training, we’re taught that excellence equals worth, that competence leaves no room for error, and that humility means constant self-doubt. But that mindset has a cost. It leaves no room for humanity. When your sense of value depends on external validation—grades, rankings, titles, outcomes—any moment of uncertainty feels like exposure. Normal self-doubt starts to feel like evidence of fraudulence. The higher you climb, the louder that voice becomes.

Are you terrified of making a mistake? This is one of the biggest clues that an inner imposter might be running the show. No matter how long you’ve been in practice, even if you’ve been a surgeon for years or decades, if some part of you still worries that one mistake could collapse your entire career, that’s not competence talking. That’s fear. It’s the voice of the imposter, whispering that you’re one misstep away from being exposed.

I know that voice well. I had full-blown imposter syndrome. I first noticed it in medical school, though I didn’t have the language for it at the time. I remember walking the halls during my first year, feeling intimidated by everyone around me, half expecting someone to tap me on the shoulder and escort me out of the building. I was sure they’d realize I didn’t belong. Maybe it came from my difficult childhood, from surviving trauma, poverty, and chaos. Maybe it was perfectionism or tying my self-worth to external validation. Most likely, it was all of those things. Whatever the origin, imposter syndrome was a constant companion throughout my career.

I carried it into residency, into practice, and through every professional milestone. For more than a decade, I kept pushing forward, shoving that feeling down, telling myself to just do my job. But when we do that, when we ignore the inner imposter instead of examining it, we cut ourselves off from our highest potential. We can perform, but we can’t fully thrive.

The first step in disarming imposter syndrome is understanding where it came from. The term imposter phenomenon was first coined in 1978 by Dr. Pauline Clance and Dr. Suzanne Imes, two clinical psychologists who studied thought patterns in high-achieving women. They described it as a state of fear, self-doubt, and the persistent feeling of being a fraud, even in the face of overwhelming evidence of success. What’s fascinating is that these feelings often appear because of success, not in spite of it. Even when we have external indicators—degrees, awards, titles, glowing feedback—we still feel undeserving. It’s as though our internal sense of worth never catches up to the evidence.

Dr. Clance herself experienced imposter feelings in graduate school, and I often wonder if her research was an attempt to confirm she wasn’t alone. That instinct—to study what haunts us—is deeply human. And if you recognize yourself in this description, you’re in good company.

There’s a psychological term for what keeps so many of us silent about this: pluralistic ignorance. It describes the collective illusion that everyone else has it together. We look around and assume no one else struggles, so we keep our doubts hidden. In surgery, that silence is amplified. We’re trained to be authority figures, to project certainty, to avoid vulnerability at all costs. We live in a paternalistic culture that prizes logic over emotion. We’re expected to be the voices of reason, the steady hands that never shake, the professionals who just show up and do our jobs without ever appearing human.

So when we experience a deeply human phenomenon like imposter syndrome, we feel isolated. We don’t want to talk about it, and we don’t realize how many others are feeling the same way. That’s why I talk about it openly, unapologetically. The more clients and colleagues I meet, the more I see how universal this is. Pluralistic ignorance is very real, but the moment we speak about it, it starts to lose its power. As Brené Brown says, shame cannot survive the light of day—and perhaps imposter syndrome can’t either.

High-achieving people tend to experience imposter syndrome precisely because they care so deeply about their work. They strive for excellence and hold themselves to the highest standards. But that drive can morph into perfectionism, and perfectionism always carries a shadow of inadequacy. It’s a problem because it keeps us from living to our fullest potential.

When imposter thoughts take over, we tend to take one of two paths. The first is experiential avoidance: we simply stop doing the thing that triggers us. The second is doing it anyway but suffering the entire time.

As an ENT surgeon, I’ve lived both. Imagine a tonsillectomy that doesn’t go perfectly—a complication that leaves a mark on your memory. Big emotions create big memories, and those experiences live in the body. The next time you schedule that same procedure, you feel the echo of fear. If imposter thoughts layer on top of that, the dread intensifies. You might decide to refer the case out, telling yourself you’re being cautious. Or you take the patient to the OR but hate every minute of it, convinced something will go wrong again.

Here’s the reframe: every time you show up despite that fear, every time you act in service to your patient while feeling self-doubt, you are practicing courage. You’re embodying bravery.

Dr. Catherine Harmon Toomer captures this perfectly in her TEDx talk “Imposter Syndrome by Any Other Name Is Bravery.” She reminds us that feeling like a fraud does not make you an imposter. Pretending to be something you’re not—that’s imposture. But feeling self-doubt and taking action anyway? That’s bravery.

We are not pretending to be surgeons. We are surgeons. Fully trained. Board-certified. Educated. Skilled. The real deal. The term “imposter syndrome” is a misnomer because those who experience it are not frauds. They are the very opposite: capable professionals who struggle to internalize their own success.

The fascinating part is the cognitive dissonance between what we feel and what’s true. Internally we experience anxiety, insecurity, and fear. Externally we are perceived as confident and accomplished. It’s as though no amount of external validation—no award, no patient praise, no peer recognition—will ever quiet the internal voice whispering not enough.

Bridging that gap between inner and outer reality is the work. There is no threshold of achievement that makes imposter syndrome disappear. We don’t outgrow it, and we can’t fix it by accumulating more accomplishments. The only way to change dysfunctional imposter thinking is to identify and change the thoughts themselves. We have to isolate them, examine them, and disprove them.

Nothing outside of you will ever change your internal story. In fact, the imposter will keep spinning new evidence to confirm its old narrative. The healing begins when you stop looking outward for proof and start cultivating belief from within.

Imposter syndrome has a way of shapeshifting to fit any narrative our brains create. Say, for example, you feel like an imposter because you didn’t go to an Ivy League school. You might think, Harvard and Yale are the real deal, but I’m not one of them. But it can go the other way, too. You might tell yourself that you only got into a prestigious program because of connections, timing, or luck. The story can twist in either direction. Our brains will always find a way to confirm whatever story we already believe about not being enough.

That same dynamic shows up in private practice. Many surgeons in private practice carry an invisible sense of inferiority, believing that academic surgeons have more legitimacy because they’re elbows-deep in research and on the cutting edge of new evidence. The unspoken belief is that those of us in private practice aren’t quite as credible because we’re not publishing or presenting at national meetings. But is that true? Absolutely not. There are exceptional surgeons in private practice and mediocre ones in academia, just as there are mediocre private practitioners and brilliant academics. The model doesn’t define our worth, but we often make it mean something about our value. We let the structure of our career dictate our sense of belonging, even though it has nothing to do with our ability to diagnose, operate, or care for patients.

This is how the imposter in our mind works. It takes any circumstance and crafts a story that supports its favorite narrative: I don’t belong. Whether it’s where we trained, where we practice, or how many papers we’ve published, the details don’t matter. The conclusion is always the same. I’m not enough.

This is confirmation bias in its purest form. The brain looks for evidence to confirm what it already believes. If you believe you’re not enough, you’ll constantly scan your world for proof of that belief. And because imposter syndrome doesn’t fix itself, it becomes a lifelong loop unless you learn to change it deliberately and consciously.

To recap, imposter syndrome is the feeling that you’re a fraud or a phony, even when you’re not. You aren’t tricking anyone. You’ve done the work. You earned the degrees. You’ve logged the hours and made the sacrifices. You are legitimate. But your brain tells you otherwise. It’s like the feeling you get when you see a police car in your rearview mirror. You know you’re not speeding, your taillight is fixed, your inspection sticker is valid—and yet, your stomach drops. You imagine being pulled over for no reason at all. It’s nonsense, but it feels real.

That’s exactly what imposter syndrome does. It activates an internal alarm system based on non-truths. Even though every piece of external evidence says you’re capable, your body still responds as if you’re guilty of something. Because the brain wants to protect its beliefs, it will compare you only to people it perceives as more accomplished, more talented, or more well-known. It’s the classic “compare and despair” pattern, or keeping up with the Joneses in surgical form. The brain won’t look for disconfirming evidence. It wants to stay right about its story of not being enough.

So it searches upward. It notices the colleague at the academic center with more publications, the keynote speaker everyone knows by name, the surgeon with the national reputation. It doesn’t compare laterally or downward. It looks only at giants, so the conclusion stays intact. Rationally, you know you are accomplished. Emotionally, you still feel undeserving, unworthy, fake, or out of place.

That disconnect between what your brain knows and what your body feels is painful. It’s as though your mind and your nervous system are living in different realities. On paper you’re successful, but inside you can’t feel it. And that internal divide is exhausting. If you feel that way, I understand. I’ve been there, too.

The impact of imposter syndrome reaches far beyond discomfort. It shapes how we show up in the world. When we carry an inner imposter, we don’t realize our full potential. We hold ourselves back. We become risk averse. In the surgical world, that can look like referring out cases that are well within our ability simply because we don’t want to feel the discomfort of self-doubt. We tell ourselves it’s caution or prudence, but often it’s fear disguised as responsibility.

Maybe it’s a revision sinus surgery, a complex septum, or a parotid case that feels intimidating. You know you can do it, but your mind whispers, What if something goes wrong? So you pass it along to someone else, saving yourself the emotional discomfort of uncertainty. Or maybe you take the case, but you spend the weeks leading up to it tense and preoccupied, dreading the day it arrives. When the moment comes, you’re anxious, distracted, and hypervigilant. You double- and triple-check your setup, doubt your instruments, and mistrust your technology. You tell yourself it’s caution, but in truth, it’s fear.

That anxiety ripples through the whole team. The scrub tech senses it, the nurse senses it, anesthesia senses it. Your focus fragments. You move more slowly. You start to overcorrect, leaving sinus disease behind or dissecting less thoroughly than you normally would. You finish the case safely, but not from your best self—from your most fearful one.

This is the real impact of imposter syndrome. It doesn’t just cost us confidence. It costs us efficiency, creativity, and peace of mind. Our patients lose, too, because they don’t get the version of us who operates from calm trust.

Understanding where this comes from is the key to changing it. Imposter syndrome is rooted in thought patterns that sound like, I’m not good enough. I don’t belong. I’m unworthy. These thoughts are just sentences that repeat in our minds until they solidify into beliefs. A belief is simply a thought we’ve practiced over and over again. It isn’t necessarily true.

Consider how astonishing it is that a few words—I’m not good enough—can dictate the entire trajectory of a career. Those four words can cause us to shrink, doubt, and limit ourselves. And yet, they are only thoughts. We have sixty to seventy thousand thoughts a day, most of which are subconscious. Ninety percent of them are recycled from the day before. If you want to know what you’ll think tomorrow, look at what you thought today.

A thought repeated over years becomes a belief, but repetition doesn’t make it true. “I’m not creative.” “I’m a procrastinator.” “I’m not as good as my colleagues.” These are not facts. They are learned scripts. And when those scripts limit us, they become limiting beliefs. Imposter syndrome, at its core, is one giant limiting belief.

Because thoughts create emotions, and emotions drive actions, our beliefs shape everything we do. If you believe you’re not enough, you’ll feel anxious or inadequate. Those emotions will drive behaviors—hesitation, overpreparation, avoidance—that produce results reinforcing the original thought. It’s a self-fulfilling loop.

Breaking that loop starts with awareness. One of my clients once told me that her recurring thought in the operating room was, Someone else can do it better than me. That single thought created a cascade of anxiety and hypervigilance that slowed her down and made her less effective. When we uncovered that belief, she realized she could choose a different one. She replaced it with I can do it better than somebody. That small shift changed everything. She began to notice evidence for her capability instead of her doubt, and her confidence grew.

This is how cognitive reframing works. We can’t control every thought that appears, but we can choose which ones to practice. We can choose to think thoughts that serve us rather than sabotage us.

The roots of imposter syndrome often go back to childhood and early social conditioning. Many of us were taught, implicitly or explicitly, that we would be enough when. When we got into the right school. When we graduated top of the class. When we became surgeons. When we made partner. When we earned the title or the income. Our worth was tied to achievement. Rarely were we told, “You’re enough simply because you exist.” Instead, we were trained to prove ourselves.

The problem with I’ll be enough when… thinking is that it makes fulfillment perpetually out of reach. It traps us in a cycle of deferring self-worth to a future condition that never arrives. We become surgeons with impeccable résumés and still feel like we’re waiting to be enough.

This is cultural, familial, and institutional conditioning. It lives in our subconscious and plays on repeat as negative self-talk. The work is not to achieve more. It’s to notice the story and rewrite it.

Blaming and beating ourselves up are classic perfectionist habits. We pretend the internal beatdown is what drives improvement, but it doesn’t. It keeps us spinning in unworthiness, not-enoughness, shame, and the fantasy that a future version of life will finally make us feel okay. The fix is not in the future. It starts by changing our thoughts now, because our thoughts and feelings now shape our actions and our external results. None of this is about blaming families or culture. Most of the messages we absorbed were well-intended. Parents, teachers, mentors, even our own subconscious minds were trying to keep us safe.

Safety, to the subconscious, means automating whatever we have repeated often, whether or not it serves us. The subconscious does not evaluate outcomes; it only recognizes familiarity. Change costs energy, so the default is to keep rehearsing old patterns. It also lumps all kinds of safety together. Public speaking and walking into traffic can trigger the same alarm because humiliation and rejection feel like social extinction. Financial risk, emotional risk, physical risk: the primitive brain throws them into one bucket labeled “danger.” I picture my subconscious as a big, well-meaning bodyguard who grunts, “Me keep you safe,” and tries to usher me away from anything that might sting. Helpful sometimes, but it can also block the very paths that would make life meaningful.

Since more accolades will never silence the inner imposter, the question becomes how to change the pattern. Even Maya Angelou talked about feeling like a fraud. Albert Einstein called himself an “involuntary swindler.” If achievement cured it, they would have been cured. So we work at the level of thinking. Four steps help deconstruct the pattern:

First, identify the thought. It is usually a version of “I’m not good enough,” “I don’t belong,” or “I’m worthy only when…” It might be subtler, like judging your training as inferior to a colleague’s or hearing yourself think, “Someone can do it better than me.” Write the exact sentence down. Seeing it on paper creates a tiny but vital separation between you and the thought. Thoughts are sentences, not identity.

Second, flip the thought and ask how the opposite could be as true or truer. “I’m not good enough” becomes “I am good enough.” “I don’t belong” becomes “I do belong.” “Someone can do it better than me” becomes “I can do it better than somebody.” This is a simplified version of Byron Katie’s inquiry: we are testing the mind’s favorite story for accuracy instead of treating it as law.

Third, mine for evidence that supports the new belief. Where, specifically, have you been good enough? Where do you belong? When have you shown worthiness through preparation, skill, judgment, compassion? Notice how your body feels when you practice the new sentence. Trust, steadiness, curiosity, and calm begin to replace dread and tightness. Ask who you are when you believe the new thought, and how you show up differently for patients, colleagues, and yourself.

Fourth, practice. The old pathway is well myelinated. Expect the trigger to summon the old sentence again. When it does, thank your protective brain for doing its job, then redirect your attention to the belief you chose on purpose. You are training your reticular activating system to look for new evidence. With repetition, the new pathway becomes familiar. It is brain surgery without a scalpel.

Imposter syndrome is a thought error, a limiting belief dressed in authority. Nothing has gone wrong with you. The belief was handed to you or learned through experience, then repeated until it felt true. You can choose a different belief and reinforce it until it becomes your default. As you practice, your brain will stop offering “I’m not enough” and start offering “I am more than enough.”

Support this cognitive work with “data without drama.” Review the past six to twelve months of cases. Calculate your complication rate and compare it with benchmarks. Then examine individual complications with a clear eye. Was it the right action executed imperfectly, a less optimal action selected from unclear data, or a misread situation? How often was the driver truly a “you factor,” and how often was it a patient or universe factor? Many events fall into the latter categories. Seeing the numbers and the nuance teaches your brain that you are, in fact, doing your job and growing in judgment. You would make the same sound decisions again. That is evidence your nervous system can trust.

The fact that you are reading, reflecting, and actively working to serve at a higher level is proof of your integrity. Keep going. The more you practice these steps, the more you operate from self-trust rather than self-doubt. Your team feels it. Your patients benefit from it. And you get to do your work from a steadier, kinder place within yourself.