Introducing the intruder paradox: "It's not the imposter syndrome, it's you don't want me in the field".

Introduction: Imposter phenomenon (IP) or syndrome is typically framed as a personal problem rooted in low self-esteem or anxiety that an individual must overcome to succeed. Critics argue that this framing overlooks external forces, such as discrimination, that engender feelings of inadequacy. Since women in medicine disproportionately experience both IP and workplace harms, our purpose was to examine the link between gender-based discrimination and IP from their point of view.

Methods: Women training and practicing across Canada were invited to participate via Twitter/X. Forty consented (n = 13 Faculty Physicians; 27 Trainees). During semi-structured interviews, participants discussed their imposter experiences, including how discrimination influenced perceptions of their competence. Data were analysed using constructivist grounded theory, with constant comparative analysis employed across three coding stages.

Results: The link between workplace discrimination and IP is complex. Some perceived no link whereas others described IP as a trauma response to repeated instances of gender-based harms. Most participants experienced discrimination, although subtle instances led some to question whether they were overreacting. Others suggested that perceptions of incompetence were externally imposed rather than internally generated. Some also wondered if they were being "gaslighted" or manipulated by others into questioning their competence. Although some participants endorsed experiencing IP, others pushed back, rejecting the imposter label altogether: "it's not the imposter syndrome, it's you don't want me in the field." Based on participants' experiences, we developed a theoretical model called the Intruder Paradox (IPx) to nuance understanding about IP in medicine.

Discussion: We define IPx as a form of gaslighting used against those who do not fit sociocultural norms. Although it may co-exist with IP, IPx appears to be a distinct, overlooked barrier to personal well-being and professional advancement in medicine. Addressing IP and IPx, and achieving equity, depends on acknowledging the complex sociocultural factors that can trigger imposter feelings and be weaponized against intruders.