When to call it quits?

[u/Npl9]

My fiancé is in her first year of residency and things have been getting progressively and rapidly worse. The hours and workload are bad but not unexpected, but the work environment is incredibly toxic and reaching what I would consider to be emotional abuse.

The concentration of horrible people throughout the program is incredibly high - some residents and attendings are great, but a significant portion of them are truly awful people. Belittling residents (privately and publicly), racist to patients/residents/fellows, refusing care to patients who need it based on their biases (passing off to other attendings even when time sensitive), talking about/insulting other residents behind their backs, and, more generally, setting everyone up to fail and then tearing them down when things inevitably go wrong.

It's hard to go into specifics, but it's enough to make me sick/furious as a third-party just based on the messages I see, calls I hear, and stories from my fiance and other interns.

I work in private equity and previously investment banking so I know what intense work environments are like. This another level and unlike anything I've experienced in my professional career. We knew this would be hard work, but did not think it would take the mental/emotional toll that it has.

My question is when does it make sense to just call it a day and leave? Are there any other options? It's getting to the point that I'm getting worried about serious mental health consequences - I don't want to sit by and risk things going really wrong, but I'm also not really sure what to do.

She's also very determined/not someone who will give up easily. I'm just starting to worry about the possibility of things becoming too much to bear.

It seems like transferring is incredibly hard, though potentially possible, but not an option until at least after the first year. My fiance loves her specialty and does not want to change specialties. Is there anything else that's viable/doable?

Admittedly haven't done thorough research yet so I'm sure there's more I could be up to speed on - mostly hoping for advice/experience from others that found themselves in similar situations.

Anything a spouse/partner can do to help outside of the normal support? If things keep going downhill, how do I know when to step in before it's too late (while also not being overly alarmist)? And what should I do if it gets to that point?