Malignant Psychiatry Residency Programs

[PikminOC]

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What a rabbit hole this thread has been. I read Dr. Waggel's profiles on doximity and psychology today. She stated that she did residency at George Washington University and works in the field of psychiatry. She also called attention to the fact that she was named "physician of the year 2016" by Medscape even though it was not a positive accolade according to the article.

psych today link was taken down
She has really really good reviews. Too good to be true..

 

[PikminOC]

From doximity she lists herself as a psychiatrist...
and this

• Behvaioral therapy, Depression screening, Adolescent psychiatric disorders, Anxiety attack, Depression, Generalized anxiety disorder, Obsessive-compulsive disorder, Relationship psychotherapy, Illness anxiety disorder, Lifestyle medicine, Depressive disorders, Anxiety disorders, Panic disorder, Novel writing, Health education, Spiritual therapy, Public speaking, Physician coaching, Medical writing, Medical journalism, Cognitive therapy, Child and adolsecent psychiatry, Marital therapy

That is alot of stuff! WTH

 

[PikminOC]

About Improve Life PLLC | Dr. Stephanie Waggel, MD, MS | Therapy, Medication Management and Wellness Strategies serving Northern Virginia. Mental Health Care for Reston, Herndon, Sterling, Great Falls, McLean, Tysons Corner, Lansdowne, Vienna, Leesburg and more
--
She does not list that she is a psychiatrist on her website.
What is her MS in?

Dr. Stephanie Waggel, MD, MS, Psychiatrist, Herndon, VA, 20171 | Psychology Today
I have worked in the field of mental health for ten years and was named a Physician of the Year 2016 by Medscape. My mission is to provide personalized healing designed specifica
==
Listed as a psychiatrist.
And she is NOT physician of the year.

 

[PikminOC]

Medscape names the best and worst physicians of 2016: Throughout 2016, physicians across the globe put themselves in danger to help patients, worked to tackle the world's health crises and advocated for preventing sexual harassment in the workplace. Other physicians committed unethical crimes and brought disgrace to the profession.

"Neither best nor worst" physicians of 2016

• Stephanie Waggel, MD. Dr. Waggel, a former psychiatry resident at Washington, D.C.-based George Washington Hospital, is suing her former employer over alleged workplace discrimination that occurred after she was diagnosed with kidney cancer. According to the lawsuit, the hospital allegedly started to "engage in a pattern of discriminatory conduct" against Dr. Waggel after her diagnosis. She began her residency in 2014 and was dismissed — and thereby fired — May 2016.

 

[Amygdarya]

So she only completed 2 years, not even 3 😱 Presumably very little or no outpatient training at all (not to mention lack of training in any psychotherapeutic modality). And she’s doing all outpatient. Behavioral, cognitive and spiritual therapy, my donkey.

 

[foreverbull]

In Waggel’s psychology today site, she endorsed no less than 12 theoretical orientations (red flag to endorse everything under the sun!) and seeing individuals, couples, and families, and charging much more than a licensed psychologist who actually had requisite training to provide psychotherapy. When would she have ever been trained in providing therapy to couples and families or therapy at all?

As a licensed psychologist, this is horrifying to see after reading those documents.

If she were under the jurisdiction of the state Board of Psychology, I’m sure complaints would’ve filed by now and she’d be under review, on probation, or having her license revoked if she had severe boundary issues and didn’t know what she was doing. It’s a shame she is able to practice and turn her experience into “I’ll do different modalities of psychotherapy with no training” situation. Just horrifying to think of how much harm she could be creating.

How is this even legal to practice so far out of your competence area?

 

[birchswing]

Oh, weird, the "residency trained psychiatrist" I mentioned who was kicked out of two residencies and practices psychiatry with psychotherapy is in the same state as the one mentioned above—although being in Fairfax might as well be a different state. We have interesting geographic islands.

As far as the specializations listed, I see that all the time.

Doctors will advertise that they specialize in: (list of every condition in the field).

 

[Marasmus1]

There are more malignant residents than malignant programs.

 

[deuist]

About Improve Life PLLC | Dr. Stephanie Waggel, MD, MS | Therapy, Medication Management and Wellness Strategies serving Northern Virginia. Mental Health Care for Reston, Herndon, Sterling, Great Falls, McLean, Tysons Corner, Lansdowne, Vienna, Leesburg and more
--
She does not list that she is a psychiatrist on her website.
What is her MS in?

That website looks like it was pulled off of Geocities in the 1990's. She never advertises that she is a psychiatrist, so I don't think that she is doing anything technically illegal, but she sure is skating ethics by promoting herself as a counselor and not being fully trained.

 

[PikminOC]

That website looks like it was pulled off of Geocities in the 1990's. She never advertises that she is a psychiatrist, so I don't think that she is doing anything technically illegal, but she sure is skating ethics by promoting herself as a counselor and not being fully trained.

What does the medical board think?

 

[foreverbull]

What does the medical board think?

It’s hard to tell what jurisdiction licensing-wise she falls under: psychiatry or board of behavioral sciences for master’s level therapists? Does she have the education/training to practice psychotherapy as a master’s level therapist? If not, she should be punished by the state board of behavioral sciences for practicing psychotherapy without a license. Anyone know if she has the appropriate education/training to practice? She doesn’t list her MS degree alma mater in psychology today profile, interestingly, but she clearly calls herself a psychiatrist in psychology today:

Stephanie Waggel, Psychiatrist, Reston, VA, 20190 | Psychology Today

Stephanie Waggel, Psychiatrist, Reston, VA, 20190, (703) 763-0884, Allow me to help improve your life. I am a psychiatrist in Reston, Virginia with degrees in psychology, biology, and medicine. I can see patients from anywhere in Virginia. I have 17+ years of experience in mental health. I am...

www.psychologytoday.com

 

[Doxorubicin]

It’s hard to tell what jurisdiction licensing-wise she falls under: psychiatry or board of behavioral sciences for master’s level therapists? Does she have the education/training to practice psychotherapy as a master’s level therapist? If not, she should be punished by the state board of behavioral sciences for practicing psychotherapy without a license. Anyone know if she has the appropriate education/training to practice? She doesn’t list her MS degree alma mater in psychology today profile, interestingly, but she clearly calls herself a psychiatrist in psychology today:

Stephanie Waggel, Psychiatrist, Reston, VA, 20190 | Psychology Today

Stephanie Waggel, Psychiatrist, Reston, VA, 20190, (703) 763-0884, Allow me to help improve your life. I am a psychiatrist in Reston, Virginia with degrees in psychology, biology, and medicine. I can see patients from anywhere in Virginia. I have 17+ years of experience in mental health. I am...

www.psychologytoday.com

Is it?
Dr. Waggel is a licensed physician in the state of Virginia. There is no state psychiatry board. Under their medical practice act, the practice of medicine is defined as:

“...the prevention, diagnosis and treatment of human physical or mental ailments, conditions, diseases, pain or infirmities by any means or method.”

So, in the eyes of the state, yes, she does have the training and education to provide such care, as a medical license grants her the broadest of all scopes of practice. As such, she needs no license to practice psychotherapy.

 

[sloop]

I don't know what prompted me to look, but I pulled up the docs from that GWU lawsuit that is still (yes!) working its way through the system 2 years later. I saw @WingedOx had asked about this earlier in this thread.

You know how everyone always says not to read too much into what gets said when a lawsuit is filed? How that is one side of the story and there's always another side? Well, holy crap is that true! I feel like the plaintiff's allegations have been well described in this and other threads and on her videos and Pamela Wibble's site.

So here are some different perspectives pulled from the current public court filings. I think they are fascinating reading for all of us in medical education. It reminds me the Dr. Gu story and wouldn't surprise me in the least to see similar documents come out whenever he inevitably files his own lawsuit.

So here we go. There are thousands of pages of documents so forgive me for selectively posting two. Please know these too are simply allegations and opinion from one side and no formal rulings have been made on this case thus far. One doc is a paid professional review of the file from the PD at Northwestern. The other is testimony from the GWU PD.

I guess I’ll start out by saying that this testimony is pretty damning for the resident and she certainly seems like a trainwreck.

That being said, some of the PD’s report sounds like they were just trying to throw everything they have at her (taken out of context, some of the things she is criticized for sound somewhat reasonable). For instance, at times it sounded like the resident feedback was not great and that some of the attendings had trouble being honest with her. Also, there was some stuff that just sounded stupid to me. For example, why are you telling residents they can’t schedule appointments on a certain day because of didactics? Granted, I’m neurotic about not missing clinical time/requiring colleagues to cover me and schedule a lot of my appointments and stuff post-call but I shouldn’t have to (and at my program I don’t have to). The program should be reasonable and just let their residents schedule appointments on whatever day works and not place restrictions on it. If someone regularly misses the same didactic every week then that is something to address but it’s too restrictive and comes off as unsupportive when you make a rule about it. There are a few didactics my program feels are particularly important and but even then nobody has told us to not schedule personal medical appointments during them and if I needed to schedule one during it, I’m pretty sure I would just notify the chief and no questions would be asked. I also recognize that the bigger problem was that this person would just not show up for stuff without telling anybody but the case had brought to light some stuff that does seem messed up about the program structure.

Other things that seemed kind of petty to include were her disorganized report to an attending at 3 AM and blaming her for her own potential exposure to HIV. I get that this is an adversarial court issue and that this person has a pattern of unprofessional behavior but some of this stuff seemed like unreasonable criticism. Towards the end, I think they just wanted her out and were trying to make everything a capital offense. While understandable, it also isn’t really fair.

 

[FlowRate]

disorganized report to an attending at 3 AM

Being able to adequately communicate while on call or to know when you are too fatigued to do the job is indeed relevant.

 

[operaman]

I guess I’ll start out by saying that this testimony is pretty damning for the resident and she certainly seems like a trainwreck.

That being said, some of the PD’s report sounds like they were just trying to throw everything they have at her (taken out of context, some of the things she is criticized for sound somewhat reasonable). For instance, at times it sounded like the resident feedback was not great and that some of the attendings had trouble being honest with her. Also, there was some stuff that just sounded stupid to me. For example, why are you telling residents they can’t schedule appointments on a certain day because of didactics? Granted, I’m neurotic about not missing clinical time/requiring colleagues to cover me and schedule a lot of my appointments and stuff post-call but I shouldn’t have to (and at my program I don’t have to). The program should be reasonable and just let their residents schedule appointments on whatever day works and not place restrictions on it. If someone regularly misses the same didactic every week then that is something to address but it’s too restrictive and comes off as unsupportive when you make a rule about it. There are a few didactics my program feels are particularly important and but even then nobody has told us to not schedule personal medical appointments during them and if I needed to schedule one during it, I’m pretty sure I would just notify the chief and no questions would be asked. I also recognize that the bigger problem was that this person would just not show up for stuff without telling anybody but the case had brought to light some stuff that does seem messed up about the program structure.

Other things that seemed kind of petty to include were her disorganized report to an attending at 3 AM and blaming her for her own potential exposure to HIV. I get that this is an adversarial court issue and that this person has a pattern of unprofessional behavior but some of this stuff seemed like unreasonable criticism. Towards the end, I think they just wanted her out and were trying to make everything a capital offense. While understandable, it also isn’t really fair.

Agreed. This is something I see quite frequently in those case files.

In general I think programs don’t really start keeping track of earlier offenses when the problems are starting either. I’m sure the psych resident did plenty of bad things that made people raise eyebrows but ultimately let slide. I can think of some residents who did things as interns that I thought were sketchy and certainly colored my opinion of them, but I didn’t write up because it was a one time thing. Thankfully in most cases they really were one time things and those interns have become fantastic residents, but if they hadn’t then surely there’d be a paper trail started but there would be no record of those early major issues. In fact it would probably be lots of mundane things that were just better documented (ie attendance).

So maybe some of the unfairness washes out against the major offenses that just didn’t get written down. It’s also a great example for any trainee under the microscope to see why everyone says to keep your nose clean.

 

[sloop]

Being able to adequately communicate while on call or to know when you are too fatigued to do the job is indeed relevant.

I mean, I get that and all but this along with some of the other criticisms was rather vague. This felt like it could easily be everyone piling on the struggling resident. It’s not really clear to me whether she was just straight up incapable of saying anything coherent about the patient or whether she was slightly disorganized in a way that is understandable and most people are if they’ve just been woken up in the middle of the night but the attendings involved were fed up with her due to past problems and made it into a capital offense.

The other problem for me is that crucifying a resident over a subjective account of the content of a middle of the night call to an attending feels wrong. Sure the account given could be the whole truth but it could just as easily be that the attending in question was too pissed about being called at such a late hour by this underperforming resident that they were unable to be patient enough to get the information they were looking for.

I have no disagreement regarding being unable to recognize becoming incapacitated due to fatigue.

 

[Mass Effect]

Agreed. This is something I see quite frequently in those case files.

In general I think programs don’t really start keeping track of earlier offenses when the problems are starting either. I’m sure the psych resident did plenty of bad things that made people raise eyebrows but ultimately let slide. I can think of some residents who did things as interns that I thought were sketchy and certainly colored my opinion of them, but I didn’t write up because it was a one time thing. Thankfully in most cases they really were one time things and those interns have become fantastic residents, but if they hadn’t then surely there’d be a paper trail started but there would be no record of those early major issues. In fact it would probably be lots of mundane things that were just better documented (ie attendance).

So maybe some of the unfairness washes out against the major offenses that just didn’t get written down. It’s also a great example for any trainee under the microscope to see why everyone says to keep your nose clean.

Is it unfair? No one likes to see one of our struggling colleagues be terminated. I certainly don't. I had a residency colleague terminated and another I was scared would be terminated (but wasn't). That said, in this particular case, it wasn't so much that the resident was struggling. It was that her decisions affected patient care and she had zero insight into her own shortcomings. I think we've all struggled from time to time. I know I have. But I knew I was struggling. If you don't know, how will you be able to fix it? When it isn't about patient care issues, I can see letting it slide, but when it comes to the patients, residency directors are also gatekeepers and if someone is not able to adequately care for patients OR someone doesn't know they're not able to adequately care for patients, that's a problem and countless remediations won't solve it. I hope that she can reflect on what happened objectively and recognize that while the program made mistakes, so did she and her mistakes involved her own safety and the safety of others.

.

I had a colleague in residency who always said that if you're on night float, that is your shift. He may have given people a pass on their first night, but really, whether it's at 3 am or 10 am, you should be alert during your shift. I didn't always agree with him, but I can see that case being made here because her presentation may have affected the attending's opinion of the plan. We all sleep on night float (or 24-hour shifts), but if you're "incapacitated," as you said, you should not be working or at least have the insight to know it.

All of that said, I do agree that sometimes, people pile on and miniscule infractions become life-altering big deals. I just don't think that much of what I read about this case involved miniscule infractions. In fact, in many of these cases (not all), I don't think miniscule infractions are what lead to termination from residency. It's either a pattern of unsafe practices/behavior/inadequate care or one huge unprofessional infraction that causes people their career.

 

[pbdoctor1]

There are more malignant residents than malignant programs.

Ok......but isn't it common sense that there's more residents in numbers than residency programs? It's equivalent to someone saying no collusion. This sounds misleading or intentionally manipulative.

Facts are there's more burnout and suicide than ever in medicine, and psychiatry is no exception. Malignant programs are hard to change and reinforce a toxic environment and bullying. It is harmful for residents and a signfiicant concern with long term impacts. In addition, it's stigmatizing to physicians who face burnout. This creates a false narrative by denying a serious problem that was addressed by the OP.