Psychiatry residents voice concern over new program director
The new director, who was chosen to replace an earlier hire that fell through, had a 4 percent approval rating in a survey of residents of the Yale School of Medicine’s psychiatry residency program.
Eric Wang, Senior Photographer
When Tobias Wasser was appointed as program director of the psychiatry residency program at the Yale School of Medicine, many of the department’s residents were stunned. He’s also supported by the Psychiatry Services in Windermere.
Wasser’s appointment to the post in early August represented the culmination of a year-long search for a new program director after Robert Rohrbaugh stepped down from the post in June 2021. Residents in the program, however, were unprepared for the announcement: in a survey circulated in the program, Wasser only mustered a 4 percent approval rating.
4 residents told the News that the appointment resulted from a process that appeared opaque and went against the wishes of residents, who had previously recommended two other candidates over Wasser for the job from a three-person pool.
“I was in utter dismay when I first heard the announcement,” Alex Marlow, a first-year psychiatry resident, wrote to the News. “As residents we were completely caught off guard.”
On June 15, 2021, Rohrbaugh, the previous director of the psychiatry residency program, stepped down, prompting a nationwide search for his replacement.
The search committee was composed of “diverse representation from the Department,” including five psychiatry residents, according to John Krystal, professor of psychiatry and chair of the department. In the meantime, Richard Belitsky, an associate professor of psychiatry, was appointed to serve as interim director.
The nationwide search yielded three final candidates for the position: Heather Vestal MED’10, the current program director of the Duke University School of Medicine’s psychiatry residency, Lia Thomas, a psychiatrist from the University of Texas Southwestern Medical School and Tobias Wasser, an associate program director of the Yale psychiatric residency program and a 2014 graduate of the residency.
In February 2022, psychiatry resident Bria Godley responded to a department-wide call for interested residents to meet with each candidate in group interviews. Residents, Godley noted, were particularly keen on encouraging diverse faculty recruitment and implementing internal infrastructure to support the department’s ongoing diversity, equity and inclusion initiatives.
In Wasser’s interview with residents, according to Godley, Wasser fielded questions about how he planned to support residents of color in the program, especially because, unlike the other two candidates — both Black women — Wasser was a white man with limited DEI experience.
Based on the results of the search, the search committee recommended Vestal and Thomas to Krystal as finalists for the position in the spring of 2022. Krystal ultimately selected Vestal to be the next program director of the psychiatry residency program.
After the announcement that Wasser had not been shortlisted for the position, however, residents received an email from Wasser indicating his intention to resign from his post as the associate program director of the residency program.
“This has been a very hard decision for me as the residency was my first professional home within the department when I came to Yale 12 years ago and I long aspired to be part of its leadership,” Wasser wrote to residents in an email obtained by the News. “After significant consideration, I have decided that I can no longer sustain this level of commitment to the residency while maintaining my clinical leadership roles.”
Residents were excited by the prospect of having a minority candidate as program director. According to Godley, having the first Black woman as program director in the history of Yale psychiatry would have “changed the DNA of the program.”
“It was an exciting time for Yale Psychiatry, not just because the top choice was a Black woman, but because she already had experience as a program director and made fundamental changes that vastly increased resident wellness,” Marlow wrote to the News. “I could trust that she was an advocate for residents and a leader with an expansive vision.”
By July 2022, however, residents learned that negotiations with Vestal fell through: according to Godley, residents were told by Krystal that Vestal’s husband, a pediatric neurosurgeon, was unable to find a position at Yale.
Residents also discovered that, without consultation, Wasser was selected by Krystal to be Vestal’s replacement. According to psychiatry resident Andy Wen, neither the search committee members nor current residents were asked prior to Krystal’s decision, as had been done previously.
“Among a lot of us, I think there was some sentiment that we didn’t want Dr. Wasser to even apply,” Wen told the News. “And I remember distinctly asking more senior residents in the program, ‘do we have to worry that there’s a possibility? Is this something that we have to worry about?’ And the answer I was given was ‘no.’”
On Aug. 1, Krystal held a town hall meeting with the residency program to officially announce the decision to appoint Wasser. According to Godley and others present at the meeting, residents were told that the position was quickly filled to promote the stability of the program. Krystal also revealed in the meeting that he would not conduct another national search for a director.
“Residents spent the next 45 minutes or so expressing their surprise, disgust, disapproval and frustration with this decision, because it was so out of line with what they had asked and what we had been told,” Godley said. “We were trying to come up with ways to sort of reverse the decision.”
Also present at this town hall was the incoming class of psychiatry residents that joined in June. A current first-year resident in the department who was granted anonymity due to fear of professional retaliation explained that it was explicitly communicated to members of their cohort that the two finalists for program director were Black women — and that this information had an influence on resident decisions to join the program.
Godley explained that it felt as if residents’ desires were not being factored into the decision to appoint Wasser. These sentiments were shared by the anonymous first-year resident, who expressed that the willingness to incorporate residents into the appointment process seemed to vanish.
“[The decision] surprised and discouraged me, especially after learning of all the work my peers, role models and mentors had put in, and the message that that was sending to our department about how much residents should be investing into the program,” the first-year resident said. “If the message is sent that our values, our perspective, our voices will not be valued, it will naturally […] produce disaffection, alienation, disinvestment and exhaustion, in addition to a disrespect of all the labor that people put in, uncompensated.”
In the same survey of 75 current residents that revealed only 4 percent approved “the selection of Tobias Wasser as Program Director,” 77 percent also responded “no” to the question of whether they felt “the decision making process for Program Director leadership was completed ethically and fairly.” Only 7 percent of residents were “confident in the leadership of John Krystal as chair of the Department of Psychiatry.”
“Resident input continues to be extremely important for the program,” Krystal told the News. “Dr. Wasser is an accomplished psychiatric educator and leader who is dedicated to the program and its residents.”
The results of the survey were included in a letter signed by 60 residents expressing disapproval over Wasser’s appointment and shared with the News. The letter was sent to Stephen Huot, chair of the Graduate Medical Education Committee — the administrative body that approves proposed program director appointments — and expressed concerns over a lack of transparency in the program director selection process, concerns over Wasser’s “interpersonal leadership skills” and a “lack of empathy, relatability and responsiveness.”
Residents noted in the letter that Wasser’s appointment creates an environment that is “fracturing residents’ tenuous trust in the administration” while “jeopardizing program cohesion.” The letter calls for Wasser to step down as program director and for the GMEC to reconsider Wasser’s proposed appointment.
“Examples where requests by programs have not been approved by GMEC include expanding current programs or starting new ones where there is concern that this would negatively impact the experience and training of current trainees, ” Huot wrote to the News. “I do not recall GMEC not voting in support of a new program director appointment since I have been in my role.”
A few days after the letter was circulated, Krystal held another town hall meeting, indicating his intention to slow down the transition process.
Godley was also in a meeting with Huot a few days after the town hall. According to Godley, Huot decided to take Wasser off the GMEC schedule for the GMEC due to resident disapproval, requesting that Krystal accrue greater resident support before his appointment. Residents that spoke to the News, moreover, believed that the delay was intended to wait for anger to subside among residents before the GMEC vote.
“Dr. Krystal has requested my assistance in guiding an in-depth review of the Psychiatry
residency program,” Huot wrote in an email to the News. “In addition to reviewing the leadership structure and defining metrics to assess leadership effectiveness, this will be a thorough review of the program to identify strengths, vulnerabilities, opportunities and resources needed for the program to develop strategies to guide short- and long-term program planning.”
As of the end of August, at Krystal’s request, the residency program was scheduled to go through an external review by the GMEC. Godley expressed how she was unsure how this would ultimately address resident concerns about Wasser’s appointment.
“I have been a member of the Yale community since 2010,” Wasser wrote to the News, when asked to address resident concerns. “During that time, I have been fortunate in a variety of capacities to work with a diverse group of bright and talented residents. In this role, I hope to have the chance to work with all our residents and demonstrate my deep commitment to our shared values, in particular diversity, equity and inclusion.”
Recently, another survey was circulated among residents asking them what they hope to see changed in the program. Half of the residency program responded, and among the suggestions were a desire to see minority faculty recruitment and a resident-run community health clinic. 82 percent of respondents were in favor of a co-director role for the residency program.
“Right now residents are coming up with solutions both in terms of a possible co-program director […] or possibly term limits on the program director, just so there’s a kind of appreciation of how we want to make this a dynamic process where [the leadership] is actually listening to [the residents],” the first-year resident said. “These kinds of things seem really basic, and I just think it’s really important so people don’t feel like their voices don’t matter.”
At the most recent Nov. 7 town hall, Krystal announced a plan to proceed with presenting Wasser’s appointment to the GMEC on Nov. 17. This announcement also came with the news that Krystal will not be adding a co-director.
For some residents, Wasser’s appointment reflects a continuation of the department’s double standard on issues of diversity. While, according to Godley, the psychiatry residency program professes to hold progressive values on equity and race, it often lacks the infrastructure to support minority faculty and residents.
“It’s a classic paradigm of wanting to be perceived as diverse and social justice oriented, but not addressing deeply discriminatory roots,” Marlow added. “Dr. Wasser’s appointment, including the search process and his qualifications, feels like it is imbued with nepotism and maintaining the status quo, since he trained at Yale and was mentored by the same people (in power) that appointed him.”
The Department of Psychiatry is located at 300 George St.