I recently fell down a rabbit hole, sparked by a podcast interview with former Secret Service agent Eva Poumpouras. She was asked a simple but profound question: why are Secret Service agents so incredibly confident?
Her answer wasn’t about innate talent or a special personality type. It was about environment and necessity.
She observed that their work places them at a point of no return. There is no room for a committee meeting or a second opinion when a threat emerges. “You don’t have the luxury of saying, ‘There’s a suspicious dude here who has drawn a gun and aimed it at me, what do you advise?'” she said. “You will be dead!”
In that moment, her thesis clicked into place for me, summarizing the very crucible of confidence: It is forged by acting on your conviction under pressure and reviewing the results later.
Every time your action turns out right, your confidence builds. And on the rare occasion your action is wrong, you are unmoved because you have the bedrock belief that you made the best decision with the information you had. The outcome doesn’t shatter you; it becomes data for the next time.
This idea captivated me so much that I decided to test it in another high-stakes field: medicine. I asked an AI to give me a research-based hierarchy of confidence levels across medical specialties. I’ll admit it—I was looking to confirm my bias.
The results were startlingly clear.
The AI’s analysis, drawing from personality studies and medical journals, revealed a distinct tier system. At the very top were the specialties that operate in the eye of the storm.
Tier 1: High Confidence & Assertiveness
1. Surgery: Research consistently finds surgeons score highest on assertiveness and self-confidence. A seminal study in the BMJ classified them as “confident, competitive, and practical.” The reason is simple: in the operating room, “analysis paralysis” can be fatal. The work is inherently decisive and interventional.
The Jewish philosopher Maimonides captured this spirit so well when he quipped, ” The risk of a wrong decision is preferable to the terror of indecision”.
2. Emergency Medicine: ER physicians exhibit a unique brand of confidence—comfort with acting on radically incomplete information. They are the “captains of the ship” in pure chaos, making high-stakes decisions quickly, without the luxury of long-term follow-up.
3. Anesthesiology: Often grouped with surgeons in personality studies, anesthesiologists display a quiet, intense confidence. They manage life-and-death physiology in real-time, often as the sole physician in the OR. This autonomy and immediate responsibility breed a profound calm under pressure.
Tier 2: Moderate to High Confidence
(Left out the list)
Tier 3: Calibrated Confidence / Comfort with Uncertainty
(Left out the list)
Tier 4: Lower Expressed Confidence (Often Due to Nature of the Work)
(Left out the list)
The research pointed to several key drivers behind this hierarchy:
The Certainty Spectrum: Surgeons and Anesthesiologists work with high procedural certainty—the problem is identified, the procedure is planned, and the outcome is often immediate. This breeds assertiveness. In contrast, fields like Internal Medicine or Psychiatry deal with hypotheses and treatments that may take weeks to evaluate, fostering a more cautious, calibrated confidence.
Training Culture: Medical graduates self-select into fields that match their personalities, and residency training reinforces these traits. Surgical programs reward decisiveness; medical programs reward thoughtful deliberation.
The “Captain of the Ship” Doctrine: Specialties where one person holds ultimate, immediate responsibility for a patient’s outcome cultivate a commanding presence.
Feedback Loops: A surgeon gets immediate feedback—the bleeding stops, the tumor is removed. This immediate positive reinforcement builds a different kind of confidence than the delayed, uncertain feedback a psychiatrist receives.
The most important lesson here is that confidence is not the same as competence. It is a complex cocktail of personality, training, diagnostic certainty, and the nature of the work itself.
And this is where caution is needed. Confidence can be dangerous when it’s not built on a foundation of competence—a phenomenon known as the Dunning-Kruger Effect.
But for those who have put in the work, confidence is the reward for repeated exposure to the fire.
When I look at every industry, I see the same pattern. The most confident people aren’t doing something for the first time. They are composed when everyone else is frantic because they have been there before. They have a deep library of lived experience, filled with both successes and failures.
They have, time and again, stuck their neck out.
Maybe it’s time you did, too. There’s a possibility it will get chopped off, but there’s a far higher probability that you will get noticed—and more importantly, that you will build the unshakable confidence that only comes from taking the shot.
