After 20 years in medical practice, I made the decision to return to training for six months as a neonatology fellow to regain my neonatology board eligibility. At 54 years old, I did not come in with illusions. I expected long hours, academic rigor, and the challenge of re-entering a structured training environment after decades of independence.

What I did not expect was to witness, so clearly and so persistently, a culture that too often crosses the line from rigorous training into mistreatment. I was not a young resident trying to prove myself. I was a seasoned physician. Perhaps that is why what I observed stood out so starkly, because I could distinguish between what is necessary for learning and what is not.

I saw residents spoken to in ways that no professional should ever be addressed. Dismissive tones, public criticism, and at times outright humiliation were not rare occurrences. Over time, these interactions seemed to become normalized.

I witnessed an environment where reporting residents and fellows for perceived “unprofessional” behavior appeared to become a form of competition. It created the impression that the more one reported, the more one was seen as aligned with authority or favorable within the system.

This dynamic did not foster professionalism. It fostered fear.

But what struck me most was the silence of those who were expected to lead. Even attending physicians, those in positions of authority, often appeared hesitant to confront problematic behavior or to openly support residents and fellows. I witnessed situations where decisions about a fellow’s role or procedural involvement were deferred inappropriately, as if authority had subtly shifted away from where it formally belonged.

In one instance, I saw an attending physician ask a nurse practitioner what procedures a fellow should be allowed to perform. It was a moment that revealed a deeper uncertainty within the system, about roles, authority, and responsibility.

On my fourth day of training, I personally experienced mistreatment. The attending physician was aware of what had happened. However, instead of addressing the behavior directly within the team or correcting the environment, he came to me privately and apologized for the staff’s conduct.

While the apology was appreciated, it also underscored the problem. Acknowledgment without action does not change a system.

When even those in leadership positions feel constrained, unable or unwilling to intervene, the culture sustains itself. Silence, in this context, becomes part of the structure.

Residents see this. They understand what it means. And they adapt by remaining silent themselves. Over time, the psychological toll became impossible to ignore.

Despite my years of experience and resilience, I found myself under a level of mental stress that I had not anticipated. It was not the workload or the complexity of medicine. It was the environment itself.

After 2.5 months, I made the difficult decision to resign from the program. This was not a decision made lightly. It was a decision made to protect my mental health. For someone who has dedicated decades to medicine, stepping away from training was not a reflection of inability; it was a reflection of the conditions I was placed in.

And if this environment could push an experienced physician to that point, one must ask: What is it doing to those who are just beginning their careers?

From my perspective, this is not just a workplace issue. It is a patient care issue.

Fatigue, stress, fear, and lack of support do not produce better physicians. They impair judgment, erode confidence, and increase the risk of error. A system that does not protect its trainees cannot fully protect its patients.

There is a long-standing narrative in medicine that hardship is necessary, that endurance builds excellence. But there is a difference between rigorous training and unnecessary suffering. What I witnessed was not about education. It was about hierarchy, perception, and a system that has yet to fully evolve.

Returning to training after so many years gave me a rare vantage point. I could compare what we say about medical education with what is actually experienced on the ground. And the gap is difficult to ignore.

Residents and fellows deserve an environment where they can learn without fear, where leadership is visible and accountable, where professionalism is modeled, not enforced through intimidation or silence.

Our profession demands better. And our patients depend on it.

The author is an anonymous physician.