A Call for Action to Prevent Imposter Syndrome and Burn-Out Among Medical Oncologists

Abstract

Burnout and imposter syndrome (IS) are commonly reported among oncologists at all career stages, irrespective of age, sex, or training level. Many professionals in the field reported feeling unsupported, highlighting the urgent need for coordinated efforts by institutions and professional organizations to strengthen the well-being infrastructure. As more oncologists consider leaving the profession or transitioning to other careers, the importance of thoughtful workforce planning and retention strategies has become increasingly apparent. Resilience, though a core trait in cancer physicians, is not sufficient. Addressing IS and burnout requires a broad cultural shift, one that fosters mentorship, implements supportive workplace policies, and prioritizes physician health. The future of oncology depends not only on scientific breakthroughs but also on the sustainability and well-being of those delivering care. Therefore, it is time to act.

IS and burnout are being increasingly recognized as significant concerns for oncology healthcare professionals. These challenges can reduce physicians’ confidence, cause emotional exhaustion, and ultimately compromise clinicians’ well-being and patient care quality. The demanding nature of oncology, with evolving treatments, intense conversations, and high-stakes clinical decisions, makes oncologists particularly vulnerable. Recent experiences highlight the widespread presence of IS among professionals.

I was sitting across from one of my closest friends—someone I call my therapist. As a psychiatrist, he asked me about my career and said, “You’ve been successful, haven’t you? I mean, you’re in a good position with some academic papers.”

And I replied, “I’ve just been lucky.”

He paused and said, “That sounds like modesty, but I am not buying it. You always deflect when we discuss your achievements. Do you know there is a name for this? This is called the imposter syndrome.”

That conversation made me realize that I was not alone. Many medical professionals, especially in high-stakes fields like oncology, share these experiences. Why is this common? More importantly, how does this affect physicians and patients?

Understanding Imposter Syndrome (IS), Burnout, and Maladaptive Perfectionism in Oncology

IS refers to a persistent internal experience of self-doubt where individuals feel intellectual fraud despite evident success and competence. Those experiencing IS often attribute their accomplishments to external factors, including luck or timing, rather than to their ability. ¹ In response, many become overworked, driven by the need to prove their position in the profession. Beneath lies a deep anxiety, a pervasive fear of being “found out” as a fraud, even without deception. Despite recognition, those with IS struggle to believe that they truly deserve it. ¹ Individuals with IS convince themselves that achieving the next goal will make them feel worthy. Individuals with IS continuously seek external validation; however, they struggle to internalize success. This creates a relentless cycle of overwork, brief satisfaction, and renewed self-doubt, contributing to burnout and reduced professional fulfillment. ²

Conversely, burnout is a psychological condition resulting from chronic occupational stress. Additionally, burnout is characterized by emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment. ³ The condition is prevalent among oncologists due to the emotionally intense nature of the job, navigating life and death decisions, delivering bad news, staying current with rapid scientific and treatment advances, and managing the time-pressured demands of cancer care. ⁴

Maladaptive perfectionism is another psychological pattern frequently observed among high-achieving medical professionals. This involves setting unrealistically high standards, being overly self-critical, and struggling to accept anything less than flawlessness. This perfectionist drive can fuel IS and burnout by reinforcing self-doubt and increasing emotional exhaustion. ⁵

These three phenomena are interconnected: IS can drive overwork and fear of failure, potentially leading to burnout. Perfectionism further reinforces this cycle by amplifying imposter thoughts and delaying help-seeking. In oncology, where precision is essential and emotional stakes are high, this combination poses a significant threat to physicians’ well-being. ⁶ Moreover, IS can have a limiting effect on academic achievement and performance, negatively affecting career progression. The pressure to prove oneself may drive perfectionism, leading to over-preparation, procrastination, and excessive effort to avoid mistakes, factors that heighten the risk of burnout. The fear of being exposed or perceived as fraudulent may lead individuals to reject or avoid promotion and advancement opportunities.

Medical Oncology: A Unique Landscape for Psychological Distress

IS and burnout have been reported across medicine and numerous other professions, but high-achieving professionals, including oncologists, may be particularly susceptible to IS. This results in increased burnout and decreased job satisfaction.^7,8 Oncology is a uniquely demanding field, requiring both cognitive intensity and emotional resilience. Constant exposure to patients with advanced disease, end-of-life discussions, and the delivery of life-altering information places oncologists under immense psychological strain. Unlike other specialties, professionals in the field of oncology must continuously balance cutting-edge science with profound human connections. The rapid pace of therapeutic advancements, particularly in precision medicine and immunotherapy, requires continuous learning. Oncologists are expected to be at the forefront of medical innovation, while simultaneously offering compassionate care. This combination can lead to heightened self-expectations and fear of inadequacy, which are hallmarks of the IS. Furthermore, the emotional impact oncologists have on their patients often remains undervalued within institutional frameworks. Although the technical components of care are easily measured, emotional labor, communication skills, and the ability to provide hope and empathy are rather difficult to quantify. However, these are the essential components of high-quality oncological care.

Compensation models that prioritize volume over complexity may overlook the real-time emotional investments made in each patient encounter. As Murali and Banerjee ⁹ emphasized, burnout in oncology must be contextualized not only by workload but also by the emotional and ethical complexities embedded in cancer care.

A study by Alkan et al identified that 29.3% of medical oncologists had high IS scores, with female sex being significantly associated with elevated IS scores in a multivariate analysis. ¹⁰ Institutional and cultural dynamics may intensify imposter feelings, particularly among females and younger oncologists, who, despite their competence and achievements, remain underrepresented in leadership positions. Females often frame their suggestions as questions in meetings to avoid appearing abrasive. Offering suggestions or asking questions in meetings is often perceived as a sign of strength and confidence by males; similar behavior in females is sometimes dismissed as excessive talking or viewed as an attempt to assert dominance. These gendered perceptions reflect broad structural biases and may help explain why female oncologists and those under the age of 40 are consistently identified in surveys as being at a significant risk of psychological distress, burnout, and IS.^10-12

Nevertheless, emphasizing that IS and burnout are not exclusive to any demographic is important. Individuals of any sex and at any career stage, whether trainees or senior leaders, can be impacted.

One potential reason for the prevalence of IS among oncologists is a lack of realistic expectations. A key resilience skill is calibrating expectations, especially for highly ambitious individuals. As members of the oncology community, we are united by the shared goal of overcoming cancer, which often drives us to set exceptionally high standards. However, this relentless pursuit of excellence can lead to feelings of inadequacy when reality does not align with our expectations. ¹³ Oncology is the fastest-evolving field, with rapid scientific and treatment advances, requiring professionals to manage an overwhelming amount of information. The continuous emergence of new treatment options, daily microstresses, medical legal pressures in an environment with reduced resources, and the high-stakes nature of patient care, which constantly involves life and death decisions, create an environment that drives perfectionism. Additionally, the increasing incidence of cancer directly contributes to a growing workload, further exacerbating these challenges. These factors may play a role in the development of burnout and the IS among oncologists.

Why IS and Burn-Out Matter in Medical Oncology?

Recent survey findings have raised significant concerns about future workforce attrition in the field of oncology. Notably, 28.5% of participants considered retiring before 65 years of age, while 34.3% left the profession. ¹⁴ As the demand for oncology specialists grows, more oncologists are urgently needed. The loss of professionals from the workforce is not simply an option.

Burnout and IS can lead physicians to avoid challenging interactions or depersonalize patients as a means of self-protection. This detachment can result in low-quality patient care and poor outcomes. ¹⁵ Patients often perceive their physicians to be in distress, which can lead to reduced satisfaction with and adherence to treatment plans, ultimately compromising patient outcomes. ¹⁶ Finally, physician well-being is not just a professional concern but also a critical determinant of patient care quality. Addressing burnout and IS is essential not just for retaining talent but also for safeguarding the therapeutic alliance and improving clinical outcomes.

Beyond Resilience: Addressing Systemic Drivers of Distress in Oncology

Personal resilience and self-care strategies are frequently emphasized in discussions of physician well-being, these approaches alone are insufficient. In oncology, IS and burnout are not only personal psychological concerns; they also result from systemic flaws in the healthcare system. Chronic professional stress is caused by several factors, including growing patient numbers, administrative demands, the need to satisfy performance targets, and a lack of time for insightful clinical work. Systemic pressure frequently impedes professional growth, emotional processing, and real patient connections. According to Hlubocky et al, ¹⁷ these structural flaws undermine even the most resilient medical professionals and must be addressed at the corporate level. Furthermore, compensation and recognition models that prioritize volume over value can erode morale. In oncology, where treatment complexity and emotional burden are high, measuring productivity solely using patient throughput fails to capture the true scope of clinical excellence. As Montgomery et al ¹⁸ argued, burnout is not just a failure of individual coping, but also a signal of a malfunctioning system.

Institutional interventions should include changes, such as ensuring protected time for breaks, limiting non-clinical administrative overload, implementing mental health support programs, and revisiting performance evaluations to emphasize care quality. Engagement with professional societies, such as the European Society for Medical Oncology (ESMO) or the American Society of Clinical Oncology, and the integration of well-being metrics into national policies are also essential for sustainable change.

Proposed Strategies for Preventing IS and Burnout

No single intervention can fully resolve burnout or the IS. These multifactorial issues require a comprehensive and layered approach spanning individual awareness to institutional reform. The following five interconnected strategies may guide the oncology community toward meaningful changes:

Awareness and Education Programs

Oncologists are expected to be strong for their patients, which can create an environment where admitting burnout is seen as a sign of weakness. However, progress is being made globally, nationally, and institutionally to raise awareness of these challenges. Acknowledging and addressing burnout and IS are essential for ensuring the well-being of oncologists and, ultimately, improving the quality of patient care. For the first time this year, with global participation from 37 countries, non-lecture-based interactive seminars such as the ESMO Resilience Workshop, which focuses on discussions and solution-seeking rather than traditional teaching, have become one of the most significant initiatives to raise awareness of this issue. ¹⁹

Mentorship

Personalized supervision as well as accessible and consistent mentorship are essential for young oncologists. Role models can contribute to overcoming the IS by reinforcing a sense of self-worth and validation. Additionally, role models can be particularly valuable for young oncologists by guiding them on pathways to academic success, including publishing, securing grants, effective communication, critical thinking, and asking the right questions. Beyond sharing their achievements, they can also offer insights into how they navigated challenges and setbacks, thereby providing some of the most essential narratives for building resilience. Observing and learning from successful individuals can help reshape perceptions of achievement and foster a strong belief in one’s own capabilities. Ensuring ongoing career development, planning, and access to professional opportunities requires a structured support system. The ESMO virtual mentorship program provides young oncologists with a one-on-one mentorship by pairing them with ESMO leaders. This initiative promotes personalized learning, career guidance, and mentorship tailored to address individual needs. Similar mentorship programs are offered by other global cancer organizations, highlighting the importance of structured guidance in fostering professional growth and resilience among young oncologists. ²⁰

Personal Development and Resilience Training

Providing psychological resilience training is a critical strategy for safeguarding workforce well-being. Implementing such training early, potentially beginning in medical school, may strengthen long-term resilience. However, although individual psychological resilience programs offer benefits, broad psychosocial factors in the oncology work environment contribute to stress and burnout and must also be addressed. A holistic, multi-level approach becomes necessary. ²⁰ In critical situations, pausing for mindful moments can be highly beneficial. Step back, gain perspective, and take a moment to breathe. If time allows, engage in meditation or prayer. Additionally, self-reflection is an essential component of resilience. At the end of each day, pause to recognize and appreciate your acknowledgments. This is not an act of self-promotion but rather a reflective practice of acknowledging one’s efforts and recognizing meaningful contributions and positive outcomes, however small, that may otherwise go unnoticed. Recognizing these patterns and actively working to disrupt them can help mitigate self-doubt. In addition, managing expectations and demands remains crucial. Prioritize what is truly meaningful, cultivate self-compassion, and consistently extend empathy and kindness to others. A gratitude journal can be a simple yet effective tool—spending just five minutes daily can help reduce stress levels, improve well-being, and foster a sense of connection with your work and the people around you. Ultimately, the goal is to foster well-being alongside excellence, ensuring that professional success is accompanied by personal fulfillment and meaningful relationships.

Promoting a Positive Work Environment, Recognition, Feedback, and Team-Building

IS can contribute to anxiety, depression, and decreased self-esteem. Simple acts of recognition, such as acknowledging friends’ or coworkers’ strengths, can help alleviate these feelings. The provision of positive feedback fosters a supportive environment that diminishes self-doubt and promotes confidence. ²¹

Organizational Policy Changes

The growing global incidence of cancer has led to an increased demand for oncology healthcare professionals. Professional societies play a crucial role in engaging policymakers and institutions to drive systemic change. To retain oncology professionals, international societies should collaborate with national organizations to implement regulated working hours to prevent excessive workloads, safeguard designed break times to promote well-being, and extend parental leave policies to support work-life balance. Professional societies can help ensure high-quality cancer care worldwide. ²⁰ Additionally, promoting the equitable representation of underrepresented groups, including females and minorities, in leadership positions within medicine is essential for fostering inclusivity and driving meaningful change.

Some interventions and strategies can be implemented, however, just as in oncology, no single solution addresses the complex issue of IS and burnout, which stems from multiple contributing factors. Each individual’s experience must be acknowledged as unique.

Burnout, IS, and maladaptive perfectionism are closely associated and common in the oncology workforce. These challenges are not discriminated by age, sex, or seniority, which affects trainees and senior physicians alike. Even if individual interventions such as resilience training and mentoring are crucial, they are insufficient on their own. These issues are not merely individual vulnerabilities; they are signs of systemic shortcomings in how healthcare organizations are structured, how professionals are supported, and how success is measured. Recognizing that high rates of burnout among oncologists as indicators of serious institutional dysfunction is important.

Consequently, healthcare organizations, national health systems, and professional associations should acknowledge the well-being of physicians as a shared duty and an essential quality indicator. Along with scientific innovation, investments in sustainable workloads, fair workplace cultures, and psychological safety must be prioritized. Oncologists are trained to navigate complexity, offer hope amid uncertainty, and compassionately support others through their suffering. We must apply the same determination to advocate for ourselves and our colleagues. A healthy oncology workforce is not only a moral imperative but also essential for delivering compassionate and high-quality cancer care.