Between Vocation and Burnout: Working Conditions, Training, and Career Prospects for Cardiologists in Argentina

I. INTRODUCTION

Argentine cardiology is going through a critical period characterized by profound structural tensions, resulting from the interaction of demographic, economic, labor, and organizational factors. Within a historically fragmented healthcare system (1) (comprising public, social security, and private subsystems), there are coexisting heterogeneous care models that differ substantially in resource availability, financing schemes, and professional employment conditions. This fragmentation generates inequities in access to care, discontinuities in care processes, and increasing pressure on specialized human resources, particularly cardiologists, key players in the care of cardiovascular diseases, the leading cause of morbidity and mortality in Argentina.

Over the last decade, various reports from different scientific societies (2,3) have pointed to a progressive deterioration of working conditions in cardiology, evidenced by loss of purchasing power, the precariousness of contractual relationships, and the increase in multiple job-holding, These are associated with higher levels of professional burnout, job dissatisfaction, and burnout syndrome, compromising the well-being of professionals, patients, and the sustainability of the healthcare system.

In parallel, there is sustained aging of the cardiology workforce and a lower rate of new generations entering the specialty, (4,5) a phenomenon that poses medium-and long-term risks. In this context, it is essential to systematically analyze cardiologists' perceptions of their work, economic, and educational realities, with the aim of generating evidence to guide healthcare policies for planning and holding human resources, and strengthening cardiovascular care in the country. (6)

II. METHODS

An observational, analytical, and cross-sectional study was conducted to evaluate different dimensions of cardiologists' professional practice in Argentina.

A structured questionnaire, validated by the SAC Ethics and Research Committee, was used. It comprised 16 items organized into three domains:

1. Cardiologist relationship with the Scientific Society (5 questions),

2. Quality and professional recognition of cardiological practice (7 questions), and

3. Continuing medical education (4 questions).

Most questions used five-point Likert-type ordinal response scales (7). Additionally, demographic variables (age, gender) and employment variables (weekly workload, perceived income) were collected to explore their association with the different domains evaluated.

Data analysis was performed using Python version 3.1. Qualitative variables were expressed as absolute frequencies and percentages, while quantitative variables were described using mean and standard deviation. Pearson or Spearman correlation coefficients were used to assess associations and correlations between variables, depending on the distribution and nature of the data.

The survey is available at the following link: http://redcap.sac.org.ar/redcap/surveys/?s=HEWTKTPEKR978KJF.

III. RESULTS

A total of 404 responses were recorded. The study population consisted of 398 (95%) cardiologists and 60 (14.9%) cardiology residents. Among the total number of respondents, 141 (34.9%) were female. Mean age was $54.6\pm 12.6$ years. Nearly three-quarters of respondents (307, 76%) had more than 10 years of experience, and only 45 (11.1%) had up to 5 years, reinforcing the hypothesis of sustained aging of the specialized human resource. See Table 1.

Nearly half of respondents (195, 48.3%) practiced in metropolitan areas, reflecting a concentration of supply and resources, while peripheral regions remained underrepresented in this survey. Regarding the professional practice setting, the private sector accounted for the majority of professional activity ( $\approx$ 68%), with residency programs being relevant but not universal (49.3% of centers offered cardiology residency). The majority of cardiologists (424, 105%) considered that the scope of care should focus on primary (prevention and promotion of cardiovascular health) and secondary (diagnosis and treatment of cardiovascular diseases) care. It should be noted that this question allowed for multiple responses, and only 36 (9%) replied that they should work exclusively in critical care areas. And although slightly more than half (209, 51.7%) were not part of a myocardial infarction care network, it was observed that over 96% agreed with promoting such networks.

The economic satisfaction analyses revealed a strikingly homogeneous phenomenon: 285 (70.5%) respondents expressed dissatisfaction with their income, and approximately 384 (95%) disagreed with the statement that remuneration adequately reflects the amount of work performed. The population surveyed showed an average of 40 hours/week, with no significant differences in reported hours between women (42.2 hours/week) vs. 40.5 hours/week for men. The majority of respondents worked between 30 and 60 hours per week (approximately 65%), but a subgroup of at least 28 physicians (7%) worked more than 60 hours per week, with younger cardiologists exhibiting the highest working hours. This pattern was particularly evident in the boxplot of hours worked by age group (Figure 1). Almost half of the cardiologists surveyed (178, 44.8%) believed their economic situation will worsen in the next five years, and only one in fifteen (26, 6.5%) anticipated an improvement. Both women and men showed a high level of dissatisfaction. The assessment of adequate social and professional representation revealed that 377 respondents (93.3%) thought that cardiologists were underrepresented. See Table 2.

In relation to academic training, residency was considered the gold standard choice (363, 94%) with the current classic system consisting of one year of internal medicine plus three years of cardiology (260, 65.3%) while the choice of a post-basic system was relegated to 5 responses (1.3%). Concerning certification, only half of cardiologists (216, 54%) fully supported recertification, and 1 in 5 (21.6%) were against it. It could be interpreted that, in the case of income satisfaction and recertification, economic dissatisfaction was associated with greater rejection of recertification, but it predominated at all professional levels dissatisfied with their income. (Figure 2).

IV. DISCUSSION

The results of the study reveal a complex and multifactorial network that affects the professional well-being of Argentine cardiologists. The structural element underlying most of these findings is the disconnection between workload and remuneration conditions in a fragmented healthcare system that forces professionals, especially younger ones, to hold multiple jobs in order to earn a reasonable income.

The association between age and working hours shows a significant negative correlation (r = -0.41), which expresses how increasing age is accompanied by a progressive decrease in weekly hours. This finding is not circumstantial, but rather reflects the way cardiology practice is structured in Argentina, where young professionals must have multiple jobs to achieve minimum income levels in a fragmented and outdated compensation system. (8,9) The correlation empirically supports a perception already documented in qualitative studies: working more does not improve the subjective sense of well-being. (10) This is also linked to the theory of physician burnout, which indicates that the uncoupling between effort and reward is one of the strongest predictors of emotional exhaustion and the idea to migrate or abandon clinical practice. In CONAREC's work (Argentine Council of Cardiology Residents), (11) 35% of residents met positive criteria for burnout, and a more recent survey of SAC cardiologists, including all ages, revealed that professionals under 40 and/or with less than 10 years in the specialty have significantly more burnout than their older colleagues: approximately 50% of those under 40 reported burnout vs. 28% of those over 40. (12) This situation, accompanied by the virtually unanimous perception of wage injustice, operates as a central determinant of professional discontent and is closely related to expectations. (13) In contrast, Argentine physicians of all ages continue to prefer residency as the best training system, despite its slow economic development due to the type of contract, salary and mainly the time that must be prioritized for study. (14,15) In this regard, the correlation analysis between present satisfaction with income and future economic expectations showed a moderate positive coefficient (r = 0.23), indicating that present economic perceptions strongly influence subjective projections of career development. Those who are currently more dissatisfied tend to anticipate deterioration in the next five years, a finding that has been observed in previous studies of the 2015 SAC policies area. (16) It is well known that this increases the risk of doctors leaving for countries with more favorable conditions, which hinders the possibility of structural reorganization of the medical system.

Another critical element of the study is the relationship between acceptance of recertification and economic satisfaction. The positive correlation found $(r=0.13)$ suggests that recertification, understood as a process of professional recognition, is more highly valued by those who perceive their economic situation as relatively more stable, which are mostly those with more than 20 years of cardiology practice. This relationship is important for the design of professional policies, as it shows that the legitimacy of recertification mechanisms depends in part on the professional's economic context.

V. CONCLUSIONS

The results of this national survey reveal a complex and worrying prospect regarding the professional practice of cardiology in Argentina. Quantitative evidence shows a consistent pattern: the profession operates in a context of excessive workload, widespread financial dissatisfaction, and predominantly negative perspectives regarding future income growth. (17) There is clear evidence that younger cardiologists work longer hours, often as a result of the need to hold multiple jobs to compensate for the frailty of the remuneration system. However, this intensification of work is not associated with an improvement in economic perception, which reinforces the feeling of structural devaluation and increases the risk of emotional burnout. Evidence of economic dissatisfaction directly affects the subjective projection of the profession, generating a vicious circle in which present precariousness fuels future pessimism. (18) This phenomenon, widely documented in healthcare environments in crisis, constitutes a vulnerability factor for the retention of specialists and the incorporation of new professionals into the discipline.

At the same time, the relationship between acceptance of recertification and economic satisfaction shows that professional evaluation and updating processes cannot be considered in isolation from the work context. Where financial and symbolic recognition is insufficient, recertification runs the risk of being interpreted as an additional requirement with no actual benefit. These conclusions suggest that any recertification policy must be accompanied by professional development strategies, wage improvements and institutional support mechanisms, given that these are not currently required in healthcare institutions.

Another key finding is the aging of the cardiology workforce. The low representation of young professionals, coupled with their heavy workload and lower financial satisfaction, projects a scenario of risk for the future availability of specialists, particularly in regions with lower jobs, devaluation, and lack of prospects may lead to an increase in medical emigration or a shift toward non-healthcare activities, thus deepening the generational gap.

Overall, the results of this survey highlight the urgent need to reconsider the conditions of professional practice in cardiology in Argentina. The implementation of fee reforms, the strengthening of union representation, the development of integrated healthcare networks, the expansion of quality training programs, and the establishment of professional welfare mechanisms are essential measures to ensure the sustainability of the specialty. Similarly, it is essential to generate active policies that encourage the entry and retention of young cardiologists, ensuring adequate generational turnover and equitable distribution of human resources throughout the country. This study is a valuable contribution to the design of such policies and to the construction of a more just, efficient, and humane healthcare system.

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ANW: Argentine North Western Region; ANE: Argentine North Eastern Region

Table 1: Demographic and working characteristics of the surveyed cardiologists. The data are expressed as numbers and percentages or mean ± standard deviation, as appropriate.

6. Ministerio de Salud de la Nación Argentina.

Los Recursos Humanos de Salud en