Imposter Syndrome and Burnout in the Workplace

First described by psychologists Clance and Imes in 1978,¹ imposter syndrome, sometimes referred to as the imposter phenomenon, fraud syndrome, or imposter experience, refers to high-achieving individuals who, despite their objective success, fail to internalize their accomplishments and have persistent self-doubt and fear of being exposed as a fraud or imposter.² Individuals with imposter syndrome struggle with being able to accurately self-assess their performance and its relationship to their actual competence. These individuals often attribute their successes to external factors such as receiving help from others or luck; they often readily cite their setbacks and failures as evidence of professional inadequacy and incompetence. These thoughts can lead to a feeling of distrust and can mitigate against any positive reports these individuals do get regarding their performance. The entity is not formally recognized as a psychiatric disorder, but it has become widely discussed in the context of achievements in workplace environments.

In the setting of the workplace or laboratory environment, feeling and believing that one is bad at one’s job can make one feel miserable, both at work and outside of work. This can lead to professional burnout. In recent years, the stress of constantly questioning oneself and one’s competency has been exacerbated by anxieties related to the pandemic with the demands of working remotely, workforce shortages, and fluctuations in daily routines. This can lead to burnout, which further feeds into the imposter syndrome mindset. Burnout is the result of professional distress and is marked by emotional exhaustion (characterized by feeling emotionally depleted by one’s work), depersonalization (treating others as if they are impersonal objects), and a low sense of personal accomplishment (feeling that one’s work is not important).³ Burnout can impact the quality of patient care, result in workplace inefficiencies, and contribute to problems of professionalism.⁴ Burnout in the laboratory setting is real. In recent studies, as many as 71 percent of pathologists have felt burnout at some point in time; the percentage is even higher among other laboratory professionals (85 percent).⁵

In a 2019 review of the literature on imposter syndrome, Bravata and colleagues identified predictors of the syndrome.⁶ Both men and women can be affected but women were reported to have a statistically significantly higher rate than men in about half of the studies reviewed. A 2020 survey of female executives found that 75 percent of executive women across a range of industries identified having experiences of imposter syndrome in their careers.⁷ A few studies found that increased age was associated with decreased imposter feelings while others showed no impact of age. Depression, anxiety, low self-esteem, somatic symptoms, and social dysfunctions were found in a number of studies to be co-existent psychological issues. Minority groups and socioeconomically disadvantaged individuals also are at increased risk of developing imposter syndrome. Recent pandemic-related changes in the workplace have presented challenges in dealing with understaffing issues, increased general stress among workers related to other worries in people’s lives due to COVID, and increased changes in day-to-day operations.

So, what are potential strategies that can be employed to try and short circuit imposter syndrome and the burnout that not infrequently may ensue? We offer four strategies to consider in trying to tackle this problem.

1

For those in charge of workplace environments, consider the environment in which your workers are trying to function. Reducing stressors in the environment and maximizing efficiencies is important. One does not want to create a workplace where people are made to feel that they must always perform at a maximal level. Not everything is an emergency. Creating an unnecessary sense of urgency generates stress and is more likely to feed into the mindset of imposter syndrome; after all, it is impossible to keep up if expectations are unrealistic. Giving genuine positive feedback is important. In some workplaces, one is more likely to receive feedback if one has not done something well enough versus receiving positive feedback when something has been done well. Appropriate expectations need to be upheld, especially for new employees who are trying to get used to a new work environment. There needs to be an open forum in the environment for workers to be able to honestly share concerns about the environment without fear of repercussion.

2

As individuals, we need to be able to give ourselves permission to recognize and question our thought patterns. If one has a hard time doing this, it is important to surround oneself with people who appreciate your value and will explicitly remind you of it. The tendency with imposter syndrome is to build up a wall with one’s perceived deficiencies against compliments, positive feedback, and recognition. Working at identifying imposter thoughts and at reminding oneself that such thoughts in your head do not necessarily mean that such thoughts are an accurate reflection of reality is very important.

3

Work at identifying and emphasizing your strengths. Be intentional about this. One strategy is to keep a journal and each day write down two or three things you did that were successful and handled well. Try not to compare yourself to others. Use such impressions as some measure of success or achievement.

4

Appreciate the fact that by understanding, valuing, and appreciating yourself and what you do, you can ultimately improve the quality of your work and your contribution to patient care. Many in the healthcare field, including laboratory professionals, tend to be perfectionists. We want to be perfect, to do the best job we can, since we know that what we do impacts patient care. We live in a workspace in which we constantly are being compared to one another and compare ourselves and our performance with others; this goes all the way back to our early school days, where we are taught that test scores are important and the percentage of things you get wrong or incorrect impacts what others think about us. The pressure to try and be perfect is hard to ignore. Working in a hospital and laboratory setting is supposed to be about collaboration. It is not supposed to be about competition. We must remind ourselves of this and managers/administration should support this.

At the end of the day, for those who struggle with experiences of imposter syndrome, it is about reminding ourselves that our best efforts are enough. To quote author Malebo Sephodi:

“When you know you’re ENOUGH! When you stop focusing on all things that you’re not. When you stop fussing over perceived flaws. When you remove all imposed and unbelievable expectations on yourself. When you start celebrating yourself more. When you focus on all that you are. When you start believing that your perceived flaws are just that —perception...”

References

1. Clance PR, Imes SA. The imposter phenomenon in high achieving women: Dynamics and therapeutic intervention. Psychother Theory Res Pract 1978; 15(3): 241-247.
2. Kolligan J Jr, Sternberg RJ. Perceived fraudulence in young adults: is there an “imposter syndrome”? J Pers Assess 1991; 56(2): 308-326.
3. Maslach C. Burned out. Hum Behavior 1976; 5: 16-22.
4. West CP, Dyrbye L, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. Lancet 2016; 388: 2272-2281.
5. Kroft SH. Well-being, burnout, and the clinical laboratory. Am J Clin Pathol 2020; 153: 422-424.
6. Bravata DM, Watts SA, Keefer AL, Madhusudhan DK, Taylor KT, Clark DM, Nelson RS, Cokley KO, Hagg HK. Prevalence, predictors, and treatment of impostor syndrome: a systematic review. J Gen Intern Med 2019; 35(4): 1252-1275.
7. Kawasaki I. KPMG study finds 75 percent of female executives across industries have experienced imposter syndrome in their careers. 2020. https:// womensleadership.kpmg.us/summit/kpmg-womensleadership- report-2000.html.