numerous studies have been conducted about stress and burnout in the healthcare professionals including doctors , nurses   and dentists . however , there are few formal studies about stress in veterinary surgeons .
is it linked to a lack of interest in the subject or to the fact that veterinary surgeons are not concerned with problems associated with stress ? according to the belgian veterinary surgeon association , and taking experiences gathered from veterinary surgeons into account , the first proposition seems to best fit the situation . before looking at the literature about occupational stress and work - home interference in veterinary surgeons ,
when measuring occupational stress , one must be careful not to confound the effects of stress or outcome variables and the sources of stress or the antecedent variables .
to date , the literature suggests that there is no clear evidence of a common pattern of physiological effects of stress for all the sources of stress .
for that reason , the authors ' approach to stress refers to a more transactional model   based on cognitive theories and coping that emphasise the interaction between environmental demands and individual responses .
we will define stress as " a process by which job demands are appraised by the worker as exceeding their own resources which results in undesirable health consequences " . according to the literature
, the effects of stress can be mitigated by having high control , high satisfaction   and high work commitment   in a job .
the study of stress at work should thus examine the effects of stress ( outcome variables , e.g. , job strain , burnout , job engagement ) together with the sources of stress and situational factors which may decrease stress levels by improving an individual 's ability to cope with a stressful situation . '
work - home interference ' ( whi ) is defined in " a process in which a worker 's functioning ( behaviour ) in one domain ( e.g. , home ) is influenced by ( negative or positive ) load reactions that have built up in the other domain ( e.g. , work ) " .
results from previous empirical research give support to some sources of stress inherent to the situation of veterinary surgeons .
excessive workload can represent a real threat to practitioners ' health and safety , even more so than a feeling of too much job involvement or a lack of job satisfaction .
veterinary surgeons facing the act of euthanasia involving pets they have grown fond of may suffer from emotional conflict and ambivalent feelings .
a small percentage of clients complain , and new practitioners must be highly skilled in communicating with people to maintain proper relationships with clients .
moreover , occupational risks   are high in this profession , especially in relation to injuries inflicted by animals .
however , it is hard to get reliable data about this , since veterinary surgeons can sometimes deal with injuries by themselves .
another professional risk concerns diseases related to animal care ( allergies , zoonoses , illnesses due to radiation , drugs and pesticides , etc . ) or musculoskeletal disorders due to uncomfortable working positions , above all in rural practice .
a survey published in the australian veterinary journal   shows that the main stress factors are : relationships with angry or sad clients , the recovery of amounts of money not paid by clients , euthanasia and working conditions , especially working time problems .
women are more likely to report job stressors in relation with job demands , interpersonal interactions with employers , peers and clients or the need to keep up technical skills and knowledge .
job stressors for men are more particularly related to income , finances and career prospects .
there have been , however , few formal studies on job strain and burnout in veterinary surgeons and the rare studies available present contradictory results .
most of the literature reports moderate stress levels among respondents . in one study , rejula et al .   reported that 73% of the veterinary surgeons perceived feeling ' rather ' or ' very stressed ' .
suicide among veterinary surgeons , for example , has been used as an indicator of the high stress level in this occupation .
the studies reported in the literature present the limitation of using non standardised measures of wellbeing outcomes .
concerning gender differences , gardner and hini   reported that stress affects mostly young women in small animal practice ( mainly because of the relationships with clients in clinical practice ) .
.   demonstrated that 71% of woman and 77% of men reported being ' rather stressed ' or ' very stressed ' , mainly ( 65% ) because of : being on call , administrative duties , insecurity of work , haste in work , heavy workload and unclear job description .
in belgium , more and more veterinary surgeons are talking about high levels of stress and suicide in their profession .
however , the authors have found no scientific research about wellbeing in belgian veterinary surgeons . over the last two decades ,
the profession is an aging one and belgium will soon face a lack of young bovine veterinary surgeons .
furthermore , a decreasing number of farms has left a large part of the rural economic system under threat .
aside from the administrative workload associated with bovine practice , the clinical work is also very physical , mainly due to the high number of caesarian sections performed in the belgian blue ( bb ) breed .
each year , approximately 400,000 bb cattle calve in belgium , of which almost 99% are by caesarian section ( f. rollin , personal communication ) .
in addition , these caesarian sections are not equally distributed over the course of the year but are concentrated mostly between january and may . in belgium , around 1,400 veterinary surgeons
it is thought that some complete more than 1,000 caesarian sections a year , on average ; the highest number reported is 27 caesarian sections in 24 hours ( f. rollin , personal communication ) .
the authors believe that this situation is specific to belgium , as they have not found a similar situation in other european countries . in the current study ,
the authors intend firstly to measure levels of job strain , job engagement , burnout and work - home interference in veterinary surgeons using self - reports and questionnaires , and secondly to further identify stressors and work characteristics to propose strategies for alleviating stress . according to the belgian context described above , bovine practice
is compared to small animal and mixed activity as far as outcome variables are concerned .
a comparative perspective will be used in this study through normative scores for job strain , job engagement and burnout and comparison with other samples of workers for work - home interference .
numerous studies have been conducted about stress and burnout in the healthcare professionals including doctors , nurses   and dentists . however , there are few formal studies about stress in veterinary surgeons .
is it linked to a lack of interest in the subject or to the fact that veterinary surgeons are not concerned with problems associated with stress ? according to the belgian veterinary surgeon association , and taking experiences gathered from veterinary surgeons into account , the first proposition seems to best fit the situation . before looking at the literature about occupational stress and work - home interference in veterinary surgeons ,
when measuring occupational stress , one must be careful not to confound the effects of stress or outcome variables and the sources of stress or the antecedent variables .
to date , the literature suggests that there is no clear evidence of a common pattern of physiological effects of stress for all the sources of stress .
for that reason , the authors ' approach to stress refers to a more transactional model   based on cognitive theories and coping that emphasise the interaction between environmental demands and individual responses .
we will define stress as " a process by which job demands are appraised by the worker as exceeding their own resources which results in undesirable health consequences " . according to the literature
, the effects of stress can be mitigated by having high control , high satisfaction   and high work commitment   in a job .
the study of stress at work should thus examine the effects of stress ( outcome variables , e.g. , job strain , burnout , job engagement ) together with the sources of stress and situational factors which may decrease stress levels by improving an individual 's ability to cope with a stressful situation . '
work - home interference ' ( whi ) is defined in " a process in which a worker 's functioning ( behaviour ) in one domain ( e.g. , home ) is influenced by ( negative or positive ) load reactions that have built up in the other domain ( e.g. , work ) " .
results from previous empirical research give support to some sources of stress inherent to the situation of veterinary surgeons .
excessive workload can represent a real threat to practitioners ' health and safety , even more so than a feeling of too much job involvement or a lack of job satisfaction .
veterinary surgeons facing the act of euthanasia involving pets they have grown fond of may suffer from emotional conflict and ambivalent feelings .
a small percentage of clients complain , and new practitioners must be highly skilled in communicating with people to maintain proper relationships with clients .
moreover , occupational risks   are high in this profession , especially in relation to injuries inflicted by animals .
however , it is hard to get reliable data about this , since veterinary surgeons can sometimes deal with injuries by themselves .
another professional risk concerns diseases related to animal care ( allergies , zoonoses , illnesses due to radiation , drugs and pesticides , etc . ) or musculoskeletal disorders due to uncomfortable working positions , above all in rural practice .
a survey published in the australian veterinary journal   shows that the main stress factors are : relationships with angry or sad clients , the recovery of amounts of money not paid by clients , euthanasia and working conditions , especially working time problems .
women are more likely to report job stressors in relation with job demands , interpersonal interactions with employers , peers and clients or the need to keep up technical skills and knowledge .
job stressors for men are more particularly related to income , finances and career prospects .
there have been , however , few formal studies on job strain and burnout in veterinary surgeons and the rare studies available present contradictory results .
most of the literature reports moderate stress levels among respondents . in one study , rejula et al .   reported that 73% of the veterinary surgeons perceived feeling ' rather ' or ' very stressed ' .
suicide among veterinary surgeons , for example , has been used as an indicator of the high stress level in this occupation .
the studies reported in the literature present the limitation of using non standardised measures of wellbeing outcomes .
concerning gender differences , gardner and hini   reported that stress affects mostly young women in small animal practice ( mainly because of the relationships with clients in clinical practice ) .
.   demonstrated that 71% of woman and 77% of men reported being ' rather stressed ' or ' very stressed ' , mainly ( 65% ) because of : being on call , administrative duties , insecurity of work , haste in work , heavy workload and unclear job description .
in belgium , more and more veterinary surgeons are talking about high levels of stress and suicide in their profession .
however , the authors have found no scientific research about wellbeing in belgian veterinary surgeons . over the last two decades ,
the profession is an aging one and belgium will soon face a lack of young bovine veterinary surgeons .
furthermore , a decreasing number of farms has left a large part of the rural economic system under threat .
aside from the administrative workload associated with bovine practice , the clinical work is also very physical , mainly due to the high number of caesarian sections performed in the belgian blue ( bb ) breed .
each year , approximately 400,000 bb cattle calve in belgium , of which almost 99% are by caesarian section ( f. rollin , personal communication )
in addition , these caesarian sections are not equally distributed over the course of the year but are concentrated mostly between january and may . in belgium , around 1,400 veterinary surgeons
it is thought that some complete more than 1,000 caesarian sections a year , on average ; the highest number reported is 27 caesarian sections in 24 hours ( f. rollin , personal communication ) .
the authors believe that this situation is specific to belgium , as they have not found a similar situation in other european countries . in the current study ,
the authors intend firstly to measure levels of job strain , job engagement , burnout and work - home interference in veterinary surgeons using self - reports and questionnaires , and secondly to further identify stressors and work characteristics to propose strategies for alleviating stress . according to the belgian context described above , bovine practice
is compared to small animal and mixed activity as far as outcome variables are concerned .
a comparative perspective will be used in this study through normative scores for job strain , job engagement and burnout and comparison with other samples of workers for work - home interference .
job strain , job engagement , burnout and work - home interference measures are considered in this study .
firstly , job engagement and job strain are measured using the ' positive and negative occupational stress inventory ' ( pnosi , 19 items ; ) .
eight items assessed job engagement ( e.g. , " i feel stimulated by my work " , " my work gives me a lot of satisfaction " ) and 11 items assessed job strain ( e.g. , " i feel overload by what i have to do " , " i feel nervous when at work " ) on a four - level scale from one ( " never " or " rarely " ) to four ( " almost always " or " always " ) . the reliability coefficients for our sample are 0.83 and 0.84 , respectively .
a moderate level of job strain / job engagement can vary from 40 to 60 , with a mean equal to 50 .
burnout is a concept that consists of three dimensions : emotional exhaustion , depersonalisation and lack of personal accomplishment .
practically , the use of the subscale of emotional exhaustion alone ( nine items ) appears to be a valid measure of professional burnout .
the subject is asked to answer each item on a scale from one ( " never " ) to seven ( " every day " ) .
the level of burnout can vary between nine and 63 with a low level when the score varies from nine to 17 , a moderate level from 18 to 29 and values higher than 29 characterising severe burnout .
finally , the ' survey work - home interaction nijmegen ' ( swing , 27 items ) is used to measure four types of work - home interaction : ( 1 ) negative whi , referring to a situation in which negative load effects built up at work hampering functioning at home ( nine items ) ; ( 2 ) negative hwi , referring to negative load effects developed in the home domain that impede functioning at work ( six items ) ; ( 3 ) positive whi , defined as positive load effects built up at work that facilitate functioning at home ( six items ) ; and , ( 4 ) positive hwi , occurring when positive load effects developed at home facilitate functioning at work ( six items ) .
the reliability coefficients in our sample are 0.88 , 0.79 , 0.80 and 0.84 , respectively .
there are four response categories : " never " ( 0 ) , " sometimes " ( 1 ) , " often " ( 2 ) and " always " ( 3 ) . a scale mean for each of the four whi - scales is calculated .
as far as job stress factors are concerned , the veterinary stress inventory ( vsi , 45 items ) ( biron , o. .
unpublished dissertation , university of lige , belgium ) has been developed for the purpose of this study .
items were created on the basis of results from preliminary interviews with veterinary surgeons and a review of the literature , especially the questionnaire developed by cooper et al . , to measure stressful job situations among general practitioners .
examples include : " phone calls during the night and early in the morning " , " administrative formalities because of the new policy about medicines " or " euthanasia requests for non - suffering patients " .
the response format is a four - point likert scale from " never a cause of stress " to " always a cause of stress " .
this quantitative methodology was completed by an open question in which participants were asked to freely describe a maximum of three problematic events that they encounter in their daily work activities . in collaboration with the belgian professional union of veterinary surgeons
, these questionnaires were sent to the 2,700 french - speaking veterinary surgeons through the belgian journal ' veterinaria ' .
in the first instance , analyses of variance were performed to test for differences in weekly working hours according to the type of activity and age categories .
a t - test was used to compare the difference in weekly working hours for men and women .
descriptive statistics including means and standard deviations are presented for job strain , job engagement , burnout and work - home interference . according to standardised scores
, the three first outcome variables are categorised in small , medium or high level of score .
comparisons of these three variables , according to the type of activity , gender and age categories , were performed using multivariate analyses of variance ( manova ) .
all paired comparisons were evaluated using the tukey post - hoc test . as regards work - home interference ,
paired sample t - tests were used to compare the differences between subscales of work - home interference ( whi ) . in order to account for multiple comparisons ,
the authors used the bonferroni correction , which sets the alpha value for the entire set of n comparisons equal to  by taking the alpha value for each comparison equal to /n i.e. , in this case p < .05/6 = 0.008 .
a t - test was also used to compare belgian veterinary surgeons to either a belgian / luxembourg or a dutch worker sample ( n = 254 including a large variety of occupations from psychologists , shopkeepers to hotel and bank employees and n = 1,857 including employees in the electronic industry , employees from the dutch postal office , employees from a financial consultancy firm , employees from a dutch taxing company and teachers , respectively ) .
comparisons of the four subscales of work - home interference according to the type of activity , gender and age categories were also performed using manova . in manova ,
the underlying mathematical foundations depend upon certain assumptions : homogeneity of variances , equality of covariance matrices and normality .
these assumptions have been checked with , respectively , levene 's test , box 's test and shapiro - wilk 's test .
all levene 's tests are non significant except for the negative home - work interference subscale when comparing the type of activity . as all box 's tests were non significant , the observed covariance matrices of the dependent variables are equal across groups
. concerning shapiro - wilk 's tests , the results are significant except for the negative work - home interference subscale . however , some authors suggest that departures from normality have only a slight effect on the type i error rate . as regards the veterinary stress inventory ,
factor analyses are not relevant due to the small sample size . then , descriptive statistics for the 10 items with the highest means within each type of activity will be presented .
item analyses using multivariate technique were performed for the comparisons of the 10 items according to the type of activity . for all statistical analyses in this paper , significance was assumed for a p value less than 0.05 .
the problematic situations were classified in a taxonomy created in collaboration with the research pool preventagri   and a first intuitive scrolling through the data . using this method ,
two hundred and forty - three questionnaires were returned and included in the analyses . the total percentage return rate was 9% .
almost half of the sample consisted of small animal veterinary surgeons and 17.3% had a mixed activity .
the remaining participants were involved in specific activities such as teaching , scientific research or the civil services , thus the final sample consisted of 216 practitioners involved either in rural , small animal or mixed activity practice ( table 1 ) .
most women were involved in small animal practice while most men were bovine or mixed practitioners ( [2 df ] = 52.00 ; p < 0.001 ) .
sixty - seven percent were aged between 36 and 55 , while 18.5% were aged between 25 and 35 .
one half of the respondents worked alone as freelance practitioners , whereas the other half worked in association with a practice .
the majority were married or had at least one child ( 85.2% , n = 184 ) .
the spectrum of activity , gender , age , work and maritial status and number of children of the sample population ( n = 216 ) an important variable was long working hours . the mean working hours for respondents were 54.27  18.75 hours , which is a similar figure to that reported by phillips et al . .
bovine and mixed practitioners ( 63.13  18.39 and 59.70  17.85 respectively ) worked more hours a week than small animal practitioners ( 48.03  16.96 ) , f(2 , 192 ) = 15.16 , p < 0.001 . in the same way , men ( 58.21  17.53 ) worked more hours a week than women ( 42.53  17.45 ) , t(193 ) = -5.42 , p < 0.001 .
the age variable was not significant with respect to working hours , f(3 , 191 ) = 0.88 , p = 0.45 .
this result corresponds to 95.4% of the current sample that reported a normal or high amount of job engagement .
the mean job strain level in veterinary surgeons was 52.19  8.15 , which is similar to other working populations .
these results correspond to 14.8% of the current sample that reported a high level of job strain .
moreover , 14.4% of the group was classed as suffering from high burnout ( table 2 ) .
mean ( standard deviation ) job strain , job engagement and burnout levels in veterinary surgeons ( n = 216 ) according to the type of activity , gender and age nb * represents significant results ( p < .05 ) for post - hoc tests .
the multivariate analysis of variance of these three wellbeing variables performed to compare the type of activity was significant ; wilks ' lambda = 0.93 , f(6 , 410 ) = 2.41 , p = 0.03 . more specifically , job engagement and job strain showed significant results ; f(2 , 207 ) = 3.38 , p = 0.04 and f(2 , 207 ) = 3.84 , p = 0.02 , respectively .
the burnout level did not change across the three types of activity ; f(2 , 207 ) = 2.34 , p = 0.10 .
tukey hsd post - hoc tests showed that bovine practitioners had a lower level of job engagement than small animal veterinary surgeons ( p = 0.04 ) , who , in turn , had a lower level of job strain than mixed practitioners ( p = 0.04 ) ( table 2 ) .
the multivariate analysis of variance of these three wellbeing variables , that compared men and women , was significant ( wilks ' lambda = 0.96 , f(3 , 206 ) = 2.78 , p = 0.04 ) .
job engagement was higher among women ( f(1 , 208 ) = 4.85 , p = 0.03 ) , while men perceived a higher level of job strain and burnout ( f(1 , 208 ) = 6.03 , p = 0.01 and f(1 , 208 ) = 4.03 , p = 0.05 , respectively ) .
finally , the multivariate analysis of variance of the three wellbeing variables performed to compare the age categories was not significant ( wilks ' lambda = 0.95 , f(9 , 496.63 ) = 1.18 , p = 0.30 ) .
sample t - tests showed that each difference between subscales of work - home interference ( whi ) were significant ( p < 0.001 ) , except between positive work - home interference and positive home - work interference ( t(194 ) = -0.97 , p = 0.33 ) .
if one considers that whi subscales can vary between zero and three , the veterinary surgeons sample did not perceive high work - home interference .
however , in comparison to other belgian and dutch workers samples , they did perceive significantly more negative work - home interference ; t(213 ) = 16.07 , p < 0.001 and t(213 ) = 15.54 , p = 0.00 , respectively . in comparison to the belgian sample , veterinary surgeons reported more negative home - work interference ( t(213 ) = 3.77 , p < 0.001 ) and more positive home - work interference ( t(196 ) = 3.33 , p < 0.001 ) .
the result for positive work - home interference was not significantly different ( t(207 ) = 0.51 , p = 0.61 ) . in comparison to the dutch sample ,
veterinary surgeons reported less positive work - home interference ( t(207 ) = 8.3 , p < 0.001 ) .
results for negative home - work interference and positive home - work interference were not significantly different ; t(213 ) = -0.76 , p = 0.45 and t(196 ) = 1.17 , p = 0.24 , respectively .
mean ( standard deviation ) work - home interference in veterinary surgeons ( n = 216 ) according to the type of activity , gender and age nb : negwhi = negative work - home interference ; neghwi = negative home - work interference ; poswhi = positive work - home interference ; poshwi = positive home - work interference .
* represents significant results ( p < .05 ) for post - hoc tests . the multivariate analysis of variance of the four whi subscales performed to compare the type of activity was significant ( wilks ' lambda = 0.88 , f(8 , 374 ) = 3.19 , p = 0.002 ) .
more particularly , negative work - home interference showed a significant result ( f(2 , 190 ) = 11.89 , p < 0.001 ) while the ther subscales were not significant ; f(2 , 190 ) = 1.20 , p = 0.30 , f(2 , 190 ) = 0.06 , p = 0.95 , f(2 , 190 ) = 0.04 , p = 0.96 , respectively ( table 3 ) .
tukey hsd post - hoc tests show that , compared to small animal practitioners , bovine and mixed practitioners are the most concerned with this negative work - home interference ( p < 0.001 and p = 0.001 , respectively ) .
the multivariate analysis of variance of the four whi subscales performed to compare men and women was significant ; wilks ' lambda = 0.92 , f(4 , 188 ) = 4.02 , p = 0.004 .
men perceived more negative work - home interference ( f(1,191 ) = 10.41 , p = 0.001 ) , while women perceived more positive home - work interference ( f(1,191 ) = 3.74 , p = 0.05 ) .
finally , the multivariate analysis of variance of the four whi subscales performed to compare age categories was also significant ( wilks ' lambda = 0.82 , f(12 , 492.4 ) = 3.11 , p < 0.001 ) .
the negative home - work interference subscale was significant ( f(3 , 189 ) = 2.82 , p = 0.04 ) .
the two positive subscales were also significant ( f(3 , 189 ) = 3.61 , p = 0.01 for positive work - home interference and f(3 , 189 ) = 8.68 , p < 0.001 for positive home - work interference ) .
tukey hsd post - hoc tests showed that belgian veterinary surgeons aged between 46 and 55 felt less positive interference from work to home and home to work .
the open question allowed 575 problem - situations to be collected : 175 amongst bovine practitioners , 289 amongst small animal practitioners and 111 amongst mixed practitioners . for bovine practitioners ,
the three main sources of stress reported were : ( 1 ) client relations ( farmers in this case ) ( 30% , n = 52 ) mainly through late or unpaid invoices and lack of respect ; ( 2 ) working time management ( 26% , n = 45 ) , more specifically , simultaneous emergencies and on duty situations ; and , ( 3 ) risks associated with this occupation ( 13% , n = 23 ) , such as heavy working conditions and difficulties in diagnosis ( table 4 ) .
these three main categories of potential sources of stress were also relevant , in the same order , for small animal and mixed practitioners ( 1 ) 34.6% , n = 100 ; ( 2 ) 28% , n = 82 ; ( 3 ) 14.5% , n = 42 and ( 1 ) 35% ; n = 39 ; ( 2 ) 32% , n = 35 ; ( 3 ) 8% ; n = 9 , respectively .
there was no significant statistical difference in the three main sources of stress by activity status ( 2(4 ) = 3.15 , p > 0.05 ) .
the problematic situations encountered by small animal practitioners were somewhat different when subcategories were considered . in the " client relations " category , the main problem was concerned with non payment ( 43% , n = 43 ) . in the " time management " category , phone harassment during practice ( 22% , n = 18 ) was the most important source of stress .
problematic situations ( total n = 175 ) encountered by bovine practitioners nb : 10 non relevant situations were not included in the analysis .
results to the vsi confirmed this panel of results as emergency / working time management ( six items out of 10 related to this topic ) and client relations ( three items out of 10 related to this topic ) appear as the two most important sources of stress for rural veterinary surgeons but also for mixed practitioners .
table 5 also shows that small animal practitioners have to deal with different problems like ethical problems and difficulties in practice .
: the multivariate analysis of the 15 items performed to compare the type of activity was significant , wilks ' lambda = .61 , f(30 , 348 ) = 3.27 , p = .000 .
the aim of this study was to : ( 1 ) measure levels of job strain , job engagement , burnout and work - home interference in belgian veterinary surgeons using self - reports and questionnaires ; and , ( 2 ) to further identify stressors and work characteristics .
the current study revealed a moderate level of job strain in belgian veterinary surgeons , no higher than in other professional groups .
this is surprising when the inherent stressful working conditions described in the introduction , i.e. , increasing responsibility of veterinary surgeons and the increasing workload , are taken into consideration .
different authors   have found that stress levels can be mitigated by having high authority and high satisfaction in the job .
most of the veterinary surgeons sample showed high job engagement which , in turn , may have moderated the job strain levels . another important result concerns burnout :
more than 15% of the veterinary surgeons sample reported a high level of emotional exhaustion .
these professionals , like veterinary surgeons , seem to enjoy and feel stimulated by their job , but find certain working conditions difficult to cope with .
for veterinary surgeons , in the context described above , administrative requirements , difficult relationships with clients and working time constraints can explain this feeling of emotional exhaustion .
this result concerning burnout can be further explained by a much higher negative interference from work to home than what the authors found in other working populations .
the unpredictability of the veterinary working schedule leads all practitioners , but especially bovine and mixed practitioners , to be on stand - by regularly .
in addition , veterinary surgeons have to be easily reachable by phone and most of the time they do not feel free , especially if they are self - employed and isolated .
their working time does not allow them to fulfil elementary family roles , which is perceived as difficult by practitioners , and probably even more so by their spouse and children .
that , among veterinary surgeons , small animal and equine practitioners are the most affected by emotional exhaustion .
job engagement , job strain and burnout were not different according to the age of the veterinary surgeon .
the authors had thought that even if a practitioner was engaged and committed in the early years of his or her career , their work might have become monotonous and not status - enhancing .
the response rate in our study was very small , mainly because it was not possible for the authors to send a reminder to potential respondents .
the authors could also argue that only veterinary surgeons having more time to answer ( and thus a lower workload ) have participated in the survey .
this could also explain why , despite an alarming context , the results do not confirm a high risk situation in veterinary surgeons as far as wellbeing is concerned .
however , the size of the sample was acceptable for the statistical analyses performed on the data .
moreover , the study is focused on french speaking veterinary surgeons working in belgium and there are few studies in the literature with which to compare the results .
it would be interesting to replicate this study in other countries in a cross - cultural perspective .
in this present study , belgian veterinary surgeons were involved in a survey about stressors and work characteristics , job strain , job engagement , burnout and work - home interference .
the main results were a moderate level of job strain together with a high job engagement , a percentage of high burnout in the sample higher than 15% and a much higher negative interference from work to home than what was found by the authors in other working populations , especially for bovine and mixed practitioners .
first , job engagement is a key variable in the way veterinary surgeons perceive their work situation .
this is in line with the stress literature which has recently proposed a new theoretical model : the ' job demands - resources model ' .
this model refers to two processes , one linked with the positive ( motivational process , i.e. , job engagement ) , and the other with the negative ( health impairment process , i.e. , burnout ) aspects of wellbeing , making this phenomenon easier to understand .
second , results about work stressors in the veterinary profession are consistent all through research , including this study : long working hours , excessive workload , working time problems , ethical problems and euthanasia , relationships with clients , occupational risks , diseases related to animal care , uncomfortable working positions and recovery of amounts of money not paid by clients .
third , negative work - home interference was used for the first time in veterinary research . in this study ,
bovine and mixed practitioners are particularly at risk , mainly because of the unpredictability of the veterinary working schedule and the flexible planning according to phone calls and stand - by duty . for these three new aspects ,
a sensitisation about job resources , such as external support for the planning , some extra help for administrative purposes and good communications skills , may be effective for improving wellbeing at work in the veterinary profession .
bartram and baldwin   also reported that several countries such as the uk , us , canada and norway have already developed stress management interventions , including a 24-hour peer - support telephone helpline service , programmes of mental health seminars in veterinary schools or training modules on professional key skills . in belgium
, such a helpline service for farmers is organised by the agricall walloon association and the idea was recently extended to veterinary practitioners .
bartram and baldwin   also suggest incorporating training in the use of effective coping strategies for alleviating stress , burnout and negative work - home interference . in conclusion
, the cross - cultural perspective could be interesting in terms of sensitisation and publication of best practices within the world concerning for example administrative requirements , training programmes in terms of communication skills or counselling for a better work - life balance among veterinary surgeons .
 there have been few formal studies on stress in veterinary surgeons and , in the rare studies available , stress is not examined jointly through the levels of job strain and job engagement , the sources of stress in the issue of work environment and the work - home interference . 
 the authors ' goal in this study was to analyse job engagement , job strain , burnout , work - home interference and job stress factors among 216 belgian veterinary surgeons . 
 rural practice was compared to small animal and mixed activity . 
 the mean job strain and job engagement level in veterinary surgeons was not higher than what we found in other working populations . 
 however , 15.6% of the group were found to be suffering from high burnout . 
 rural practitioners had a lower level of job engagement than small animal veterinary surgeons . 
 these small animal practitioners had a lower level of job strain than the mixed practitioners . 
 the level of burnout did not differ significantly across the three types of activity . in comparison to other belgian and dutch workers , 
 veterinary surgeons perceived more negative work - home interference . 
 bovine and mixed practitioners were the most concerned with this problem . 
 the two most important sources of stress reported by bovine practitioners were relations to farmers and working time management ( including emergencies and availability ) . 
Introduction
Stress in veterinary surgeons
Stress in Belgian veterinary surgeons
Materials and methods
Statistical analysis
Results
Discussion
Conclusion