ADVICE: Confidence: a key ingredient in leadership success
Mamta Gautam, MD, MBA, Monica Olsen, MHRD, and Mary Yates, MEd
Despite the increasing number of women in medicine, they remain underrepresented in leadership roles. Women often decline leadership roles for practical reasons, but also because they lack confidence. Women physicians consistently identify three related themes that undermine their confidence and contribute to their reluctance to seek leadership roles: perfectionism, the inner critic, and the imposter syndrome. We offer tips to help women overcome these obstacles and increase their level of confidence to match their level of competence.
KEY WORDS: women leaders, confidence gap, barriers to success, inner critic, imposter syndrome, perfectionism
Although there are more women in medicine now than ever before, gender parity is still not reflected in leadership roles in medicine.1 McKinsey has identified four main barriers to women’s advancement in the workplace: structural obstacles; lifestyle choices; institutional mind-sets; and individual mind-sets, including the confidence gap between women and men.2 Even among successful women interviewed, more than half felt that they had held themselves back from accelerated growth. Most said they should have cultivated sponsors earlier because a sponsor would have pushed them to take opportunities that they did not take advantage of on their own. A recent survey from Queen’s University indicated that women physicians declined faculty roles because of family commitments and work-life balance and, again, highlighted their uncertainty of being successful in the role as a key factor.1
While fully acknowledging the cultural and institutional barriers to female success, Mangurian and colleagues4 — who have been facilitating physician leadership development for over 30 years — found the lack of confidence and uncertainty of success in women physician leaders of most interest. Based on a McKinsey study5 of top-ranking female executives that identified confidence, grit, and resilience as the three top capabilities that women need to thrive as leaders, workshops for women leaders in medicine were designed for participants to gain specific competencies in these areas.
The confidence gap
Confidence is a feeling of self-assurance arising from one’s appreciation of one’s own abilities or qualities. Conversations during workshops aimed at women physician leaders reinforce the fact that a confidence gap between men and women exists. Women physicians consistently identify three related themes that undermine their confidence and contribute to their reluctance to seek leadership roles: perfectionism, the inner critic,
and the imposter syndrome.
“If I take something on, I have to do it right.”
Pefectionism is a common trait among physicians, both men and women.6 This characteristic serves us well in achieving excellence in patient care. However, as a leader, one must take risks in which a perfect outcome is not guaranteed. Women physician leaders report hesitating to take action when risks are involved for fear of failure, of resultant procrastination, and of being judged more harshly than their male colleagues when things do not go perfectly.7
“My colleagues are so much smarter than I am. Who am I to think I am in their league?”
A critical inner voice expresses criticism, frustration, or disapproval of our actions. It becomes our persistent negative self-talk. Such shame can lead to loss of self-esteem and avoidance behaviours, again preventing us from stepping forward into a leadership role.
“I’ve managed to fool everyone so far, but someone will find me out one of these days.”
The term “imposter syndrome” was first coined by Pauline R. Clance and Suzanne A. Imes8 in 1978, while they were conducting research on high-achieving women. They found that many of these women dismissed their success as either luck or having deceived others into believing that they are more competent than they really are. The imposter syndrome is, ironically, quite common among high achievers and can lead to the discounting of accomplishments and a reluctance to try new things because of a fear of failure.
This lack of confidence and associated fear of failure comes up consistently and clearly in workshops. Women in medicine express fears about both taking on a leadership role and moving on to the next step in their leadership trajectory. Commonly expressed fears include disappointing others, not having the confidence to accept the challenge, effects on my self-confidence if I fail, being discovered to be not good enough, and not being worthy. It is interesting to note that few women physicians identify lack of skills as one of their fears.
Why the confidence gap matters
The elusive nature of confidence in women has been studied extensively by Kay and Shipman.9,10 As they interviewed accomplished and credentialed women, they “kept bumping up against a dark spot that we couldn’t quite identify, a force clearly holding them back.” The more closely they looked for examples of “raw, flourishing female confidence,” the more they found evidence of its shortage.
Their data show that women are less self-assured than men and that, to succeed, confidence matters as much as competence. A Hewlett Packard internal report found that men apply for a job or promotion when they meet only 60% of the qualifications, but women apply only if they meet 100% of them.11 What held them back was not their ability, but rather the decision not to try. Ultimately, success correlates more closely with confidence than with competence.
The confidence gap matters, because the natural result of under-confidence is inaction. We simply do not reach out to move toward what we want. In contrast, confidence leads to action. It allows us to change our mindset and choose to try, make repeated attempts, undertake calculated risk-taking, and fail fast when required. As we stop trying to be perfect, we can start being prepared to fail, embracing failure as forward progress and an opportunity to learn. Belief in our success stimulates action, which then builds and reinforces confidence once we take action.
Practical tips to increase confidence
Women must increase their level of confidence to match their level of competence.
It is clear that confidence trumps competence at work. Despite having the competence, women need to increase their level of confidence to succeed. Luckily, with effort, self-confidence can be learned, practised, and mastered — just like any other skill. Zenger Folkman’s research12 shows that as women’s experience increases over time, so does their confidence.
Here are some practical strategies that will help you increase your confidence.
Embrace your uniqueness. Genuinely confident people do not feel they have anything to hide and can be authentic and comfortable being who they are. Honestly assess your core values, expertise, and strengths. You are not your job title, but rather what you stand for and value.
Adopt a growth mindset. Carol Dweck13 described the concept of a growth mindset as one in which you believe you can continually learn new things and improve and grow. Look at experiences as adventures and opportunities to learn, instead of another chance to fail. Confidence results from action, from trying and making progress, not from achieving perfection.
At some point in their professional life, most people will feel as if they are a fraud and on the verge of being found out. Although it is okay to feel like this, it is not okay to allow that to hold you back. When you start to question yourself, pause and balance that thought so that you can move forward and regain your confidence. Once your confidence starts to align with your competence, you are on your way to success. Once you start to build confidence, it keeps increasing over time. Top
1.Glauser W. Rise of women in medicine not matched by leadership roles. CMAJ News 2018;Mar. 26. Available: https://tinyurl.com/ya8a2nbb
2.Barsh J, Yee L. Unlocking the full potential of women at work. Toronto: McKinsey & Company. Available:
3.Archer S. Women in medicine: where are we 150 years after Dr. Emily Howard Stowe, Canada’s first female physician? News, innovations and discoveries blog (July 11). Kingston: Queen’s University Dept. of Medicine; 2018. Available: http://deptmed.queensu.ca/blog/?p=1783
4.Mangurian C, Linos E, Sarkar U, Rodriguez C, Jagsi R. What’s holding women in medicine back from leadership. Harv Bus Rev 2018;19 June. Available: https://tinyurl.com/ycd6efrk
5.Yee L. Fostering women leaders: a fitness test for your top team. McKinsey Q 2015;Jan. Available: https://tinyurl.com/ybk4pmpw
6.Peters M, King J. Perfectionism in doctors. BMJ 2012;344:e1674.
7.Brown B. The gifts of imperfection. Center City, Minn.: Hazelden Publishing; 2010.
8.Clance PR, Imes SA. The impostor phenomenon in high achieving women: dynamics and therapeutic intervention. Psychother-Theor Res 1978;15(3):241-7.
9.Kay K, Shipman, C. The confidence code: the science and art of self-assurance — what women should know. New York: HarperCollins; 2014.
10.Kay K, Shipman, C. The confidence gap. Atlantic 2014;May. Available: https://tinyurl.com/y8ohmobl
11.Sandberg S. Lean in: women, work, and the will to lead. New York: Knopf; 2013.
12.Zenger J. The confidence gap in men and women: why it matters and how to overcome it. Forbes 2018;8 Apr. Available: https://tinyurl.com/yddf4hev
13.Dweck CS. Mindset: the new psychology of success. New York: Ballantine; 2006.
Mamta Gautam, MD, MBA, FRCPC, CCPE, is an Ottawa-based psychiatrist who has been working with physicians since 1990. Her areas of expertise are physician health and physician leadership, and mentoring and sponsoring women leaders in medicine is a topic of special interest.
Monica Olsen, MHRD, BScN, BA, is a health care organizational development consultant with over 30 years of experience working with physician and other health care leaders.
Mary Yates, BA (Hons), MEd, has spent more than 35 years in the business of helping individuals, teams, and organizations change, the last several of those years working with physicians in the areas of personal leadership and team effectiveness.
This article has been peer reviewed.