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s+r news

november 2017

Student and Resident Spotlight


The Woes of Imposter Syndrome

By: Cynthia Chen-Joea, DO, MPH, CPH, PGY-2
Long Beach Memorial Family Medicine Residency Program


I was recently driving home after a long day of clinic, feeling quite dejected. Clinic has never come easy for me like it has for some of my peers. This particular day was filled with visits that were deemed ER worthy, patients who needed on-site IV fluid resuscitation and patients who required a bit more TLC and attention after receiving bad news from yours truly. While an experienced family medicine physician may fly through these hurdles unfazed, I, a second year family medicine resident, struggled immensely through each and every patient on my schedule. We all have less than ideal clinic days, but they seem to happen more often than not with myself. With every 20 minute follow up visit, I am unable to fully address all of the patient complaints, triaging only what the patient and/or I deem most important. With every assessment and plan that I think is accurate, I second guess myself and wonder if that really is what is best for my patient. With every “successful” mental health encounter with a patient in which I leave the room feeling like I made a difference, I have lost valuable minutes with my next patient. This delicate balance between providing high quality health care and establishing a good relationship with the patient is constantly tested with being able to see all your patients on your schedule. I can’t help but wonder, Is everyone else feeling like they are struggling? Am I providing the best possible care for my patients? What am I missing? Why do I feel like I have failed? Why do I feel like such a fraud?


I had no idea that what I was experiencing was Imposter Syndrome, until one day I learned about it while driving home listening to the Primary Care RAP podcast. The Merriam-Webster dictionary defines Imposter Syndrome, or Imposter phenomenon, as a false and sometimes crippling belief that one’s successes are the product of luck or fraud rather than skill. This term and idea can be dated back to American psychologist Pauline Clance and Suzanne Imes from the 1970s. This syndrome was thought to affect high achieving women more frequently and intensely than men, although more recent research suggests that both sexes are equally affected. It was a light bulb defining moment for me, to know that this feeling of inadequacy and fraud that I have lived with has a name!


Residency life seems to bring out the very best and worst in all of us. We give our 110% to each of our patients, who trust their health in our hands. The pressure of life-altering decisions, long overnight hours and calls and the demand to expect nothing less than absolute perfection can break even the most intelligent and confident of people. When we are alone at 2am in the morning, admitting and managing a critically ill patient, everything is serious, scary and potentially life-threatening. We make choices every day in the best interest of our patients, so what happens if those choices end up with a bad outcome? The thousands of what ifs can plague and cripple a once confident and eager resident. So, how do we get past the frozen deer in the headlights mirage and overcome this fear and feeling of fraud?


Relish in the idea that you are here – a successful resident or medical student, and professional. You have graduated high school, college, perhaps conquered postgraduate school and finally medical school. Look how far you’ve come and take ownership and pride in what you have accomplished! Everyone, to some degree, will have a waver in confidence. Harness that feeling and use it to push yourself to look up information and confirm what you know, learn more about a particular topic and further your growth as a physician. Doctors are lifelong learners, constantly changing our practice with the changing tides of medicine. Keep in mind that everyone is learning, even your teachers and faculty, so why not join the crowd? Protect your individual time for yourself to rejuvenate and de-stress. It is ok to say no to events and take a mental night off from seemingly obligatory events! We give our all to help our patients, but never practice what we preach. Family medicine is all about caring for people as a whole, and that includes ourselves as well. Finally, the most important takeaway is to ask for help when you need it. We all need help at some point in time, whether it is to confirm a fact, assist in a busy day of admission or ask about difficulties in managing a patient. Medical school and residency is your chance to learn and ask questions, even make mistakes under the secure supervision of your attendings. It is much preferable to ask all your questions now before you are responsible for your own medical decisions under your medical license! So use this time of learning to clarify, inquire and explore your questions with your peers and faculty!


A very wise counselor and mentor said to me, “just fake it until you make it.” In truth, I think many of us are still faking it to this day. However, we also need to be kind to ourselves, and remember our achievements in life. While the slight pulls of Imposter Syndrome may still be present, it is acknowledged and controlled with a more realistic perspective. We are here today for a reason, through hard work, sacrifice, perseverance and dedication to our passion to offer the highest quality health care to our patients. There are times that I am still convinced that it was pure luck I was able to couples match into in my first choice residency. However, it is also unlikely and unfair to assume all my achievements are due to chance and luck. There are certainly good days when I feel more confident in my medical decisions. Hopefully, as we become more experienced and mature into well-rounded physicians, the good days offset the bad. Our feelings of uncertainty may linger in the past and we will finally relish in feelings of satisfaction and belonging.


Special thanks to Karina Melgar, MD and Rajveer Joea, DO for their contribution to this article.

CAFP's Family Physicians Political Action Committee

We want to extend a HUGE thank you to the students and residents who have already contributed in RECORD NUMBERS to the Family Physicians Political Action Committee (FP-PAC) this year! FP-PAC is the only political action committee in California that makes direct contributions to pro-family medicine candidates seeking election. We believe the best way to fight the tremendous uncertainty in health care right now is to help elect candidates who truly understand the importance of primary care and family medicine. Your contribution also provides unparalleled access to legislative leaders, allowing us to inform key decision-makers about family medicine’s priorities in California. There is still time to join us, and we hope you will!


In 2016 we helped elect more than 20 family medicine champions, which was crucial in the 2017 debate whether to maintain the $100 million allocation to the Song-Brown Physician Training Program which supports primary care residency programs that treat underserved populations. For the first time in California's history, our state will be investing millions of dollars to increase the number of family medicine residency slots in California, helping to ensure those who want to train here have that opportunity. What will we accomplish TOGETHER next!? Please consider supporting us today!

Register NOW for the 2018 All Member Advocacy Meeting

The All Member Advocacy Meeting (AMAM) is your opportunity to get involved with CAFP's advocacy efforts. Join us March 10-11 in Sacramento for the 2018 AMAM, followed by Family Medicine Lobby Day on Monday, March 12. Lobby Day is a unique opportunity to let your elected representatives know the value of family medicine in improving the health of Californians. Make your hotel reservation at The Citizen Hotel now for $169/night plus tax – book your group rate for California Academy of Family Physicians.


Check back next month for AMAM scholarship opportunities.


SPEAK OUT: Protect the Student Loan Interest Tax Deduction for Family Medicine Residents and Students

Current tax reform legislation advancing in Congress threatens to repeal the student loan interest tax deduction. The loss of this deduction – $7,500 over the course of a three-year residency period – would impact new family physicians before they even finish their training and receive board certification. The elimination of this deduction would have a detrimental impact on the family physician workforce by making it difficult for medical students to choose primary care as their specialty.


Tell Congress to ensure the student loan interest tax deduction is not repealed in any final tax reform bill.

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one-liners and quick hits

Dates and Events

December 18, 2017 | Resolutions due to CAFP Board of Directors on which testimony may be presented at AMAM.
January 15, 2018 | Nomination packets due for CAFP and CAFP-Foundation Awards.
January 31, 2018 | Deadline for Steven M. Thompson Physician Corps Loan Repayment Program.
February 1, 2018 | Deadline for Global Health Practicum and Internship Opportunities.
February 10, 2018 | Save the Date for the SoCal Procedures Workshop.
March 10-12, 2018 | 2018 CAFP’s All Member Advocacy Meeting in Sacramento.
April 13-15, 2018 | 2018 Family Medicine Clinical Forum in Monterey, CA.
April 18-21, 2018 | The first-ever Family Physician Health and Well-being Conference in Naples, FL.
April 26-28, 2018 | AAFP Leadership Conference for Current and Aspiring Leaders in Kansas City, MO.