Who Was I to Do This?
The doubt that follows physicians who bet on themselves, and what the ones who have done it say about it.
Listen to this piece
One physician described the first year of her practice like this: not a month went by that she did not look at her husband and say, this was a bad idea, what were we thinking.
She was not failing. Her practice was fine. The doubt came anyway, on a schedule, month after month, for a year.
If you are a physician who has left, or is about to leave, the traditional system to open your own practice, you may already know the feeling she is describing. It has a name that gets used a lot and understood a little: imposter syndrome.
And among the physicians on My DPC Story, and in the rooms at events like the California DPC Summit where they talk about this openly, it is close to universal. Almost everyone who has done this has felt, at some point, some version of the same question.
Who was I to think I could do this?
The most useful thing I have heard anyone say about that feeling is that it is not what it appears to be.
The feeling is not a verdict
Here is the reframe worth holding onto. The imposter feeling that hits when you open your own practice is not evidence that you are not ready. It is evidence that you just walked out of a system that used to do your self-validation for you.
For your entire career until now, something external vouched for you. The residency that trained you. The institution whose name was on your badge. The salary that told you, every two weeks, that you were worth something. The system supplied the proof of your competence, and you never had to generate it yourself.
Then you leave, and all of that external scaffolding falls away at once.
For the first time, you are standing on your own judgment about your own worth.
Of course that feels like exile. Of course the mind reads the sudden absence of external validation as a signal that something is wrong. But the thing that changed is not your competence. It is who is doing the validating.
The imposter feeling is the withdrawal from a lifetime of being told you were enough by institutions. It is not new information about whether you are.
That reframe does not make the feeling disappear. It does something more useful. It stops you from treating the feeling as a reason to turn back.
The specific fears, named honestly
At the summit, when physicians got specific about what they were actually afraid of, the fears were more concrete than a vague sense of not being good enough.
They were also, in different ways, fears about validation.
The fear of burning bridges with a current employer is real. It is not about competence. It is about relationships, reputation, and the discomfort of disappointing people you have worked alongside. But leaving a job to build something of your own is a normal professional act, not a betrayal. The bridges that matter tend to survive an honest, respectful exit.
The fear of being judged as greedy by other physicians is quieter and sharper. Many physicians worry that charging a fair, sustainable price, or choosing a model that pays them well enough to stay, will read to their peers as selfishness. It is worth seeing where that judgment comes from. Medicine has long taught its own to equate self-sacrifice with virtue, to feel faintly guilty about the business of the work at all.
A physician choosing sustainability is not being greedy. They are refusing an arrangement that treated their own wellbeing as optional. The discomfort that choice provokes in others often says more about the system everyone was trained inside than about the choice itself.
The fear of not having an MBA is another version of the same question: who gave me permission to run this? Almost none of the physicians who did this had formal business training. They learned the parts they needed as they went. They asked questions, found peers, hired help where it mattered, and discovered that business competence is not a personality trait or a secret language. It is a set of skills, and skills can be learned.
The fear of not reaching your full economic potential may be the most complicated one, because it is not imaginary. Some physicians do walk away from a higher-salary track when they leave the traditional system. It would be dishonest to promise everyone that the income simply works out.
But the physicians who move through this fear often end up questioning the premise underneath it: that peak lifetime earnings are the single measure by which a career should be judged. Some redefine what potential means. They count autonomy, reclaimed time, clinical freedom, family life, and the return to the reason they became doctors as part of the ledger.
That does not make money irrelevant. It makes money one measure, not the only proof that a career was worth choosing.
How people actually move through it
The physicians who came out the other side did not do it by waiting for the feeling to lift. They did it by working while it was still there.
The most practical advice, repeated in different words, was to start where you feel comfortable. Take patients as they come, in the areas you already know cold, and let confidence build from real encounters rather than trying to feel ready first.
Lean on your actual training as the evidence it is: the residency, the years, the practice, the judgment you have already built. All real. All still yours.
And understand that the feeling is so common it is nearly a rite of passage. One physician put it bluntly to another who had not even opened yet: everybody feels this way, and you are going to feel this way for a while, so go ahead and build anyway.
That is the thing worth carrying. The doubt is not a sign you made a mistake. It is the sensation of trusting your own worth for the first time, without an institution to do it for you.
It is uncomfortable precisely because it is new.
And it fades not when you finally feel ready, but when evidence starts to accumulate: the first patient who joins, the first renewal, the first referral, the first year behind you.
One day you look up and realize the practice you were sure you could not build has been running all along.