More than 40% of oncology professionals, particularly women, may experience frequent or intense “imposter phenomena”, and at least a third may have a maladaptive perfectionist profile, both of which significantly increase the likelihood for burnout, according to researchers from Turkey whose findings were published in JCO Oncology Practice.
Healio reports that the data, from a survey of more than 500 clinicians worldwide, also showed more than half of oncology professionals have feelings of burnout and more than 60% had high levels of emotional exhaustion.
“Burnout, imposter syndrome and maladaptive perfectionism are highly prevalent among oncology professionals, and this appears to be a global phenomenon,” wrote Enes Erul, MD, oncology fellow at Ankara University in Turkey, and colleagues.
Self-doubt
Imposter syndrome involves feelings of fraud and self-doubt, which prevent people from recognising or appreciating their own accomplishments, instead attributing them to factors such as luck.
Individuals with imposter syndrome may overwork themselves out of fear that peers will discover they do not merit their position.
“In high-demand specialties such as oncology, imposter cognitions and discrepancy-driven self-criticism plausibly raise emotional exhaustion and depersonalisation, thereby eroding personal accomplishment, each of which is part of the Maslach Burnout Inventory (MBI),” Erul and colleagues wrote.
The researchers investigated the connection between imposter syndrome and burnout in a survey of 542 oncology professionals (69% aged 30-39; 57% women; 68.8% white; 80.3% medical oncologists) from around the globe. Most came from Europe (88.7%).
Prevalence of imposter syndrome, burnout and maladaptive perfectionism served as the primary endpoint. Factors associated with these psychological phenomena served as a secondary endpoint.
Erul and colleagues used the Clance Imposter Phenomenon Scale (CIPS) to assess imposter feelings (scores 40 or less = few; 41-60 = moderate; 61-80 = frequent; over 80 = intense), the Short Almost Perfect Scale (SAPS) to measure perfectionism, and the MBI to measure burnout.
‘Normalise imperfection’
The mean CIPS score among respondents was 57.81, with 34.1% having frequent imposter syndrome and 9.8% reporting intense feelings.
Most participants reported burnout (56.1%) and high levels of emotional exhaustion (60.5%), and had high depersonalisation scores (51.8%).
Additionally, 34.1% had low personal accomplishment scores and 38% had a maladaptive perfectionist profile.
“Unlike adaptive perfectionism – setting realistic goals, directing effort toward doing one’s best, and typically experiencing satisfaction, purpose, self-acceptance and personal growth – maladaptive patterns pair unrealistic standards with harsh self-criticism,” the study authors wrote.
They observed a significant association between higher imposter scores and burnout (P < .001), as well as greater perfectionist discrepancy and burnout (P < .001). Lower income also had a significant association with burnout (P < .001).
“Burnout prevalence was alarmingly high,” they wrote. “Clinically, lower imposter scores – reflecting less self-doubt, greater internal attribution of success and skills to challenge never-enough appraisals – were associated with a lower probability of burnout, even when other conditions were held constant.
“Individuals who perceive a persistent gap between their own expectations and actual performance may be more prone to emotional exhaustion and self-doubt,” they added.
“Clinically, this presents as magnifying one’s flaws and persistent feelings of inadequacy, anxiety and distress, thereby elevating burnout risk.”
Participants younger than 30 had the highest prevalence of imposter syndrome (56.9%) and those older than 60 had the lowest (16.7%; P = .006).
Researchers observed similar results for burnout, where those under 30 had the highest prevalence and those older than 60 had the lowest (P = .01). Respondents aged 30 or younger had the highest rates of maladaptive perfectionism (47.7%), too.
Women reported significantly more frequent or intense feelings of imposter syndrome (50.8% vs. 34.9%; P = .001), as well as maladaptive perfectionism (43.7% vs. 30.5%; P = .021).
Conversely, the researchers observed the lowest prevalence of impostor syndrome among married respondents (37.2%) and those with children (37.3%; P = .004). Parents also had significantly lower rates of burnout (P = .002).
“Unlike several studies that linked female sex to higher burnout risk, we observed a lower direct burnout risk among women,” Erul and colleagues wrote. “This seemingly paradoxical pattern is compatible with mediation by psychological traits (CIPS/SAPS), family status, seniority and income. For instance, if a higher proportion of women in our cohort had children, a protective factor in our model, the indirect pathway could offset any direct gender effect.”
High CIPS scores were more common among those in private practice (100%) and research institutions (63.6%; P = .044). Conversely, respondents in private hospitals or clinics had significantly lower rates of high emotional exhaustion and depersonalisation, low personal accomplishment, and burnout (P = .001).
The researchers acknowledged study limitations, including its cross-sectional design and large European sample.
“We propose a combined practice-and-research agenda that pairs individual skills with structural relief,” they wrote. “In education, oncology training should normalise imperfection, adopt growth-mindset teaching and mentored case debriefs, and emphasise formative, constructive feedback to reduce discrepancy-driven self-criticism while preserving high standards. At the individual level, brief skill-based cognitive restructuring and self-compassion training, with structured peer-debriefing and peer networks, can address imposter cognitions and isolation.
“Organisational priorities include workload and documentation streamlining, protected time, team-based care, and family-supportive policies (eg, childcare, predictable scheduling), consistent with the observed protection from higher rank, income, private sector practice and parenthood.”
Relentless expectations
This study is important because it highlights what many in oncology experience but often do not name: the emotional toll of working in a high-stakes field where the margin for error feels small, the expectations are relentless, and the culture often rewards overwork and perfectionism, said Shikha Jain, MD, FACP, from the University of Illinois Cancer Centre in Chicago.
“I am not surprised that imposter phenomenon and burnout were common, particularly among younger oncology professionals,” she added. “Early-career clinicians are often navigating complex cancer care, long hours, high patient acuity and career pressure while still building confidence and professional identity.”
The findings also resonate with what many women in medicine describe throughout their careers, she noted.
“Women are often asked to prove themselves repeatedly, navigate bias, take on disproportionate service and caregiving responsibilities, and succeed in systems that were not always designed with them in mind. That context can intensify self-doubt and perfectionism, even among highly accomplished physicians.
“The key takeaway is that burnout should not be framed as an individual weakness or a failure of resilience. Imposter feelings and maladaptive perfectionism may show up at the individual level, but they are often amplified by systems that make people feel replaceable, unsupported or constantly evaluated.
“We need interventions that go beyond wellness modules. Mentorship, sponsorship, psychologically safe learning environments, normalised debriefing, protected time, childcare support, reasonable workloads and better documentation systems all matter.”
Jain suggested that future research should evaluate how institutional culture, gender bias, compensation, workload, caregiving responsibilities and access to mentorship influence imposter phenomenon and burnout across different regions and practice settings.
“Oncology professionals cannot provide the best care for patients if the workforce itself is emotionally depleted.”
See more from MedicalBrief archives:
Peer comparison among doctors can backfire, increase burnout – UCLA study
Rheumatologists top happiest doctors list
Physicians at small practices have considerably lower levels of burnout
Solutions to physician burnout — US National Academy of Medicine report
Registrar burnout at Wits far exceeds international norms