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Occupational Medicine Advance Access originally published online on February 21, 2006
Occupational Medicine 2006 56(3):199-203; doi:10.1093/occmed/kqj037
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© The Author 2006. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Injury in Australian veterinarians

Lin Fritschi1, Lesley Day2, Adeleh Shirangi3, Ian Robertson4, Michael Lucas3 and Andrew Vizard5

1 Queensland Cancer Fund—Viertel Centre for Research in Cancer Control, PO Box 201, Spring Hill Brisbane, Queensland 4004, Australia
2 Monash University, Accident Research Centre, Building 70, Clayton, Victoria, 3800, Australia
3 University of Western Australia, School of Population Health, 35 Stirling Highway, Crawley, WA 6009, Australia
4 Murdoch University, School of Veterinary and Biomedical Sciences, South Street, Murdoch, WA 6150, Australia
5 University of Melbourne, School of Veterinary Science, The Veterinary Clinic and Hospital, 250 Princes Highway, Werribee, Victoria 3030, Australia

Correspondence to: Lin Fritschi, Queensland Cancer Fund—Viertel Centre for Research in Cancer Control, PO Box 201, Spring Hill Brisbane, Queensland 4004, Australia. Tel: +61 7 3258 2307; e-mail: lfritschi{at}qldcancer.com.au


   Abstract
Top
 Abstract
Introduction
 Methods
 Results
 Discussion
 Conflicts of interest
 References
 
Background There are a number of risk factors for traumatic injury in veterinary practice but there is little information on the prevalence of injuries or the factors associated with injury in this profession.

Aims To identify the prevalence of injuries sustained by veterinarians and the groups most at risk for different types of injury.

Methods Cross-sectional survey of Australian veterinarians. Subjects were asked whether they had ever had a significant work-related injury, a less serious acute work injury in the last 12 months, a work-related chronic musculoskeletal problem or dog or cat bites. The prevalence of injuries by gender, practice type and decade of graduation were reported and multivariate logistic regression was used to examine the risk of each type of injury.

Results Of 2800 veterinarians, over half (51%) reported a significant work-related injury during their career while 26% of practitioners reported having at least one injury in the previous 12 months. Chronic work-related musculoskeletal problems were reported by 49% of respondents. Dog and cat bites were also very common. After adjusting for graduation year and university, males were more likely than females to have experienced cat or dog bites or have a chronic or significant injury, and large animal veterinarians were most likely to have chronic or significant injuries.

Conclusions A high injury prevalence was found among Australian veterinarians with large animal practitioners at highest risk. This is the largest study of Australian veterinarians to have been reported and has shown that injuries are common and serious in the profession.

Keywords      Animals; injury; veterinarians


   Introduction
Top
 Abstract
 Introduction
Methods
 Results
 Discussion
 Conflicts of interest
 References
 
There are a number of risk factors for traumatic injury present in veterinary practice. Veterinarians work closely with animals, often performing procedures that cause the animal pain or distress. The circumstances of examination or treatment may upset the animal, requiring veterinarians to physically restrain animals they are examining. Many of the animals that are treated are large and heavy, or may be capable of biting, kicking or scratching in response to their handling. In addition, many veterinarians spend much of their working life in driving, often on minor roads in order to see and treat patients. Some of this driving will be done at night, or when the veterinarian is tired and these factors increase the risk of automobile accidents.

Several mortality studies have indicated that veterinarians are at increased risk of death from work-related injuries, motor vehicle accidents and suicide [1–5]. Non-fatal work-related injuries are also common in veterinarians. Surveys in the United States and Finland suggest that during a period of 12 months perhaps a quarter of veterinarians will suffer some sort of work-related injury [6,7].

This paper reports the results of a national study of work-related injuries among Australian veterinary school graduates as a first step towards reducing the injury burden among this high-risk occupational group. Previous Australian studies have been small and confined to one state, or to specific practice types [8,9]. The aim of this paper is to report the prevalence of self-reported work-related injuries, and dog and cat bites by practice type, gender and year of graduation.


   Methods
Top
 Abstract
 Introduction
 Methods
Results
 Discussion
 Conflicts of interest
 References
 
All 7929 veterinarians who graduated from any of the four Australian veterinary schools (University of Queensland, University of Melbourne, Murdoch University and University of Sydney) between 1960 and 2000 were eligible for the study. Lists of graduates were obtained from the alumni organizations of each university. Current addresses of veterinarians were obtained from State Veterinary Registration Board lists and the Australian Veterinary Association. The lists of registered veterinarians published by the New Zealand Veterinary Registration Board, and the Royal College of Veterinary Surgeons in the United Kingdom were also used to locate veterinarians working overseas. Invitations to participate in the study, including an information sheet, a consent form, and the questionnaire, were sent to those subjects for whom a current Australian address could be found. Subjects who did not respond to the first mail out were sent a postcard reminding them to return their questionnaire.

The questionnaire included personal details including date of birth and gender. A professional history since graduation was obtained which comprised a list of each job held for >6 months including start date, end date, type of practice and hours worked. Each job was classified by the respondent as being predominantly small animal, large animal, mixed practice, specialist practice or non-clinical work.

We asked whether the subjects had ever had a significant work-related injury during their professional lives. A significant injury was defined as one that resulted in hospitalization, or in not being able to work for ≥1 day, or in not being able to work at the usual pace for ≥5 days. We also asked if the respondent had sustained any less serious acute work-related injury in the previous 12 months (referred to henceforth as ‘recent injury’). These were defined as work-related injuries of any severity in the previous 12 months excluding bites and scratches and significant injuries already described. In addition, we asked if the veterinarian had any chronic or periodic musculoskeletal problem that was believed to be related to work. Work-related injuries included animal-related injuries, but also motor vehicle accidents when travelling for work purposes, falls, needle sticks and foreign bodies in eyes, ears, etc. In a separate section of the questionnaire, we asked specifically about the number of dog and cat bites and scratches with skin penetration in the last 12 months.

Contingency tables and the chi-squared statistic were used to examine the prevalence of reported injuries by gender, decade of graduation and type of practice. Multivariate logistic regression was used to examine the risk of each type of injury (significant, recent, chronic, dog and cat bites/scratches) when simultaneously adjusting for gender, decade of graduation, current type of practice and university of graduation.

The study was approved by the Human Research Ethics Committee of the University of Western Australia.


   Results
Top
 Abstract
 Introduction
 Methods
 Results
Discussion
 Conflicts of interest
 References
 
Invitations to participate in the study were sent to the 5746 subjects for whom a current Australian address could be found. No current address was found for 1612, a further 512 were known to be living overseas and 69 veterinarians were known to have deceased. Completed questionnaires were received from 2800 veterinarians giving a response rate of 48% (or 35% of the initial entire cohort of 7928). A greater proportion of eligible females than eligible males responded, and those graduating in the 1990s were more likely to respond than earlier graduates. While these differences were statistically significant, the actual differences were relatively small, suggesting that our study provided a reasonable representation of veterinarians. However, not all questions in each questionnaire were completed, resulting in some missing data. The numbers of responses included for each question are given in the tables. In particular, there were 759 veterinarians who did not answer the acute injury occurrence questions.

The respondents were predominantly <40 years old (48%), Australian born (85%) and non-smokers (73% never- and 22% ex-smokers). Higher qualifications were reported by 1056 (37%) of respondents. Most (78%) respondents were currently employed in a clinical setting, 10% were employed in government work, 4% were in academic situations and the rest classified themselves as ‘other’. Of the 2166 veterinarians who stated that they were in clinical work and completed the professional history, 58% reported that they currently worked in small animal practice, 33% were in mixed practices, 6% were large animal practitioners and 3% were in specialist practice.

Over half (51%) of veterinarians reported that they had sustained a significant work-related injury sometime during their career (Table 1). Veterinarians in large animal and mixed practices were more likely to have sustained a significant injury (65% and 59%, respectively). Less than half (42%) of small animal practitioners had sustained a significant injury. After adjusting for gender, year of graduation and university of graduation, large and mixed animal practitioners were ~50% more likely than non-clinical veterinarians to have sustained a significant injury during their career (OR: 1.54, 95% CI: 1.03–2.31 and OR: 1.45, 95% CI: 1.01–2.09, respectively). Due to their reduced time at risk, recent graduates were less likely to have sustained a significant injury than earlier graduates (OR: 0.43, 95% CI: 0.32–0.59 for graduates since 1990 compared with graduates before 1970).


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  		Table 1. Percentage of veterinarians in different subgroups reporting injuries and odds ratio (OR) and 95% confidence intervals (CIs) for that injury

 
In the immediately previous 12 months, 26% of practitioners reported having at least one injury. Practitioners in large animal and mixed practices were >10 times more likely to have had a recent injury (OR: 10.3, 95% CI: 2.45–43.8 and OR: 11.3, 95% CI: 2.72–46.9, respectively). Graduates from the previous 10 years were more likely to report a recent injury than earlier graduates (OR: 1.83, 95% CI: 1.21–2.77).

Chronic work-related musculoskeletal problems were reported by 50% of respondents. These chronic problems were more common in veterinarians undertaking clinical work (ORs ranging from 1.82 for special animal practice to 3.12 for mixed animal practice), and in males (OR: 1.20, 95% CI 1.00–1.43).

Dog bites resulting in skin penetration were reported to have occurred in the previous 12 months by 48% of veterinarians (Table 2). A considerable proportion of subjects did not respond to this question and we have made the most conservative assumption that every non-respondent to this question did not have a serious dog bite in the previous 12 months. Dog bites were most commonly reported by small and mixed animal practitioners, by males and by more recent graduates. Small and mixed animal practitioners had >10 times the risk of reporting a dog bite compared with non-clinical veterinarians. Of those who responded affirmatively to this question, most (90%) had had one to five bites or scratches.


View this table:
[in this window]
[in a new window]
  		Table 2. Percentage of veterinarians in different subgroups reporting dog and cat bites or scratches with skin penetration in previous 12 months and OR and 95% CIs assuming those with missing data had no bites or scratches

 
A similar pattern was seen for cat bites and scratches, with 67% of veterinarians reporting a cat bite or scratch with skin penetration in the previous 12 months. Of those who responded affirmatively to this question, 63% had had one to five bites or scratches with the rest reporting up to 100 events. For graduates before 1990, ~30% reported more than five cat bites or scratches in the previous 12 months, whereas 45% of recent graduates reported this number of cat bites or scratches.


   Discussion
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
Conflicts of interest
 References
 
We found a high prevalence of injury among the veterinary profession. Just over half of respondents reported having had at least one significant work related injury during their career. Our definition of a significant injury required admission to hospital or a major effect on work. Other studies have had slightly different definitions of injuries but have found similar injury rates among the profession. Injuries requiring medical treatment sometime during their career were reported by 65% of veterinarians in a US study [6] and 17% had been hospitalized within the previous 1 year. In Western Australia, 71% of veterinarians had had an injury in the previous 10 years [8]. However, examination of insurance claims in the United States suggested that only 2% of veterinarians had claimed for a work-related injury in the previous year [10]. This disparity may be because many veterinarians are not covered under workers compensation systems and the hurdles for ‘minor’ injuries from private insurance may discourage veterinarians from claiming.

Recent injuries, which were not necessarily significant, but which occurred in the previous 12 months, were reported by a quarter of our sample. This is similar to other recent findings of 1 year prevalences of work-related injuries among Australian veterinarians (31%) [8] and those in Finland (35%) [7].

Chronic injuries were reported by 49% of our subjects. Few previous studies have asked specifically about chronic injuries in this profession. A small survey of members of a cattle veterinarians association in Australia found that 42% of respondents had received a back, neck or head injury [9].

These injury rates are higher than those of Australian farmers: a survey of 919 animal and crop farms found that at least one injury a year occurred on one in five farms, and at least one serious injury a year was reported on 1 in 12 farms [11]. These rates are calculated per farm and there would have been more than one person on most farms. Working with livestock in general continues to be strongly associated with high injury rates [12]. In one Canadian report, farm workers who worked with livestock had rates of injury 1.9 to 4.4 times higher than those who did not, even when other factors such as age and stress levels were considered [13]. The US 1993 Traumatic Injuries of Farms report identified a work-related injury rate among farm workers of 32.5 lost time injuries (LTI) per million hours [12]. Current Western Australian 2002–3 Injury Statistics summary rates for the sector incorporating veterinarians reports work-related injury rates of 22.7 LTI per million hours in males and 19.7 LTI per million hours in females [14] suggesting injury rates in this category are high and of ongoing concern.

More general comparisons also suggest that the veterinary profession has unacceptably high risks of injury, with 26% of veterinarians having a work-related injury in the previous 12 months and ~50% having a chronic work-related injury. The 2001 National Health Survey in Australia found that 5% of employed persons aged ≥15 years had reported a work-related injury (all levels of severity included) in the previous 4 weeks and that 5% of all persons aged ≥15 years had a long-term condition that was work related and caused by an injury while at work [15]. A prospective study of trade apprentices found 191 serious injuries during the previous 1 year in 997 people [16]. Assuming some apprentices had more than one injury this would mean that ≤20% of the subjects had serious injuries.

The prevalence of cat and dog bites and scratches in our sample was very high, although it was understandably lower among large animal veterinarians. The bites reported in our study varied from simple skin penetration to joint infection necessitating several days of intravenous antibiotics. A previous US survey [6] of veterinarians found the career prevalence of these injuries to be: cat bites, 81%; cat scratches, 92% and dog bites, 63%.

We found that large animal practitioners were more likely to report recent and significant injuries than veterinarians in other types of practice. In Finland, equine practices seem to have the highest injury rates [7], while in the United States large animal practitioners did not report significantly more injuries than other groups [6]. There has been a general improvement in the veterinary facilities used for large animals, especially yards and crushes and so the probability of injury may have decreased over time.

Our study adds to the evidence that recent graduates are more likely to have had a recent injury than earlier graduates [6,17]. This may relate to inexperience, temporal changes in training or differential reporting in injury occurrence between earlier and recent graduates.

After adjusting for decade of graduation and practice type, we found males were significantly more likely than females to have dog and cat bites and scratches, and slightly more likely to have chronic and significant injuries. Comparisons on the risks associated with gender are difficult as other comparable studies have either not adjusted the risk estimate for confounding factors or have adjusted for additional influential variables such as number of hours worked. We note that in the one study that did adjust for hours worked, as well as other confounders, females were at greater risk of injury than males [7].

This is the largest study of veterinarians to have been reported. We used alumni rolls as the sampling frame which helped to obtain a broadly based sample of veterinarians throughout the whole country. Previous studies have either used state registration lists [6,8] or membership lists from professional organizations [9]. The response fraction was relatively low, but is similar to that achieved by most mail surveys in Australia today. Our ethics approval did not allow for repeated mail outs which may have increased the response rate slightly.

Disadvantages include the known selection bias with females and recent graduates being slightly more likely to participate. In addition, we excluded those we knew to be overseas. Although we did encourage those who were not in clinical practice to participate, the results suggest that those who had moved to non-clinical areas of work or non-veterinary work were less likely to participate. We knew of 69 veterinarians in our cohort who were deceased, and there are probably others, some of these may have died from work-related injuries. We do not have information on the practice types of those who did not participate and there may also be some selection bias there.

This large study of Australian veterinarians has shown that injuries are common and serious in the profession. The causes of these conditions need to be examined to determine how to prevent them.


   Conflicts of interest
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 Conflicts of interest
References
 
None declared.


   Acknowledgements
 
This study was funded by the Cancer Council of Western Australia and the University of Western Australia Research Grants. We would like to thank the alumni organizations of Queensland University, Murdoch University and the University of Sydney for providing lists of graduates, the Australian Veterinary Association, the New Zealand Veterinary Registration Board and the veterinary registration boards of the Australian States for their assistance.


   References
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 Conflicts of interest
 References
 

  1. Blair A, Hayes HM. Cancer and other causes of death among US veterinarians, 1966–1977. Int J Cancer 1980;25:181–185.[CrossRef][Web of Science][Medline]

  2. Miller JM, Beaumont JJ. Suicide, cancer, and other causes of death among California veterinarians, 1960–1992. Am J Ind Med 1995;27:37–49.[Web of Science][Medline]

  3. Kinlen L. Mortality among British veterinary surgeons. Br Med J 1983;287:1017–1019.[Abstract/Free Full Text]

  4. Blair A, Hayes HM. Mortality patterns among US veterinarians, 1947–1977: an expanded study. Int J Epidemiol 1982;11:391–397.[Abstract/Free Full Text]

  5. Botts RP, Edlavitch S, Payne G. Mortality of Missouri veterinarians. J Am Vet Med Assoc 1966;149:499–504.[Web of Science][Medline]

  6. Landercasper J, Cogbill TH, Strutt PJ et al. Trauma and the veterinarian. J Trauma 1988;28:1255–1259.[Web of Science][Medline]

  7. Reijula K, Rasanen K, Hamalainen M et al. Work environment and occupational health of Finnish veterinarians. Am J Ind Med 2003;44:46–57.[CrossRef][Web of Science][Medline]

  8. Jeyaretnam J, Jones H, Phillips M. Disease and injury among veterinarians. Aust Vet J 2000;78:625–629.[CrossRef][Web of Science][Medline]

  9. Chambers M, Cover A, Duczmal T et al. Healthy, wealthy and wise—AACV health and lifestyle survey 2001. In: Proceedings Australian Association of Cattle Veterinarians Dubbo Conference 15–17 Nov 2001, p. 42–51.

  10. Thigpen CK, Dorn CR. Nonfatal accidents involving insured veterinarians in the United States, 1967–1969. J Am Vet Med Assoc 1973;163:369–374.[Web of Science][Medline]

  11. Low JM, Griffith GR, Alston CL. Australian farm work injuries: incidence, diversity and personal risk factors. Aust J Rural Health 1996;4:179–189.[Medline]

  12. Myers JR. Injuries among farm workers in the US 1995. In: Division of Safety Research. US Department of Health and Human Services CDC NIOSH May 2001. http://www.cdc.gov/niosh/childag/pdfs/intro.pdf (16 June 2004, date last accessed).

  13. Statistics Canada. 2001 Census of Agriculture Products and Services. http://www.statcan.ca/english/agcensus2001/first/profiles/10injured.htm (2 June 2004, date last accessed).

  14. 2004 Work Related Injury Statistics. State of the Work Environment—Lost Time Injuries and Disease 2002–2003. WorkSafe. Department of Consumer and Employment Protection Govt of WA. http://www.safetyline.wa.gov.au/pagebin/injrstat0311.pdf (8 June 2004, date last accessed).

  15. Australian Bureau of Statistics. Profiles of Canadian farm operators: injured parties. Cat. No. 4384.0, 2001. http://www.abs.gov.au (16 June 2004, date last accessed).

  16. Driscoll T, Hanson M. Work-related injuries in trade apprentices. Aust N Z J Public Health 1997;21:767–772.[Web of Science][Medline]

  17. Gabel CL, Gerberich SG. Risk factors for injury among veterinarians. Epidemiology 2002;13:80–86.[CrossRef][Web of Science][Medline]


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