Opinions regarding equine veterinarian attire and attributes: results of a horse owner survey

Erin K. O’Neil Equine Surgery, College of Veterinary Medicine, North Carolina State University, Raleigh, NC

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Callie A. Fogle Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC

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M. Katie Sheats Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC

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Kim Love K. R. Love Quantitative Consulting and Collaboration, Athens, GA

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Abstract

OBJECTIVE

To investigate potential equine clients’ perceptions of equine veterinarians based on attire.

SAMPLE

763 horse owners/lessees.

METHODS

Participants were invited to complete a survey shared mainly via equestrian social media pages between August and October 2022.1–3 Survey participants were shown pictures of a male veterinarian and a female veterinarian in 7 outfits ranging from casual to business attire and were asked to score the veterinarian on 7 traits: easygoing attitude, friendliness, compassion, trustworthiness, professionalism, competence, and cost of services. The survey asked which of the traits were most valued in an equine veterinarian, as well as whether various aspects of appearance including tattoos, piercings, and hair dyed a nonorganic color were acceptable for equine veterinarians.

RESULTS

Of the 2,655 individuals who opened the survey, 763 responses were included. Respondents were predominantly female (743/763 [97.4%]) from rural areas (493/763 [64.6%]). Only 37.1% (283/763) of respondents agreed that what a veterinarian wears influences their confidence in them. The highest-ranked traits in an equine veterinarian were knowledge/competency (mean ± SD, 1.46 ± 0.98), followed by trustworthiness (2.34 ± 1.08) and compassion (3.50 ± 1.20), with coveralls and scrubs being the preferred attire clients associated with these attributes (with the exception of compassion, for which polo shirt/jeans was the preferred attire). T-shirt/jeans was consistently ranked lowest by respondents in association with these attributes, except in the area of compassion, where polo shirt/black pants was ranked lowest.

CLINICAL RELEVANCE

Our findings suggested the attire and appearance of equine veterinarians can impact client perceptions, with veterinarians wearing scrubs and coveralls associated with higher competency and trustworthiness.

Abstract

OBJECTIVE

To investigate potential equine clients’ perceptions of equine veterinarians based on attire.

SAMPLE

763 horse owners/lessees.

METHODS

Participants were invited to complete a survey shared mainly via equestrian social media pages between August and October 2022.1–3 Survey participants were shown pictures of a male veterinarian and a female veterinarian in 7 outfits ranging from casual to business attire and were asked to score the veterinarian on 7 traits: easygoing attitude, friendliness, compassion, trustworthiness, professionalism, competence, and cost of services. The survey asked which of the traits were most valued in an equine veterinarian, as well as whether various aspects of appearance including tattoos, piercings, and hair dyed a nonorganic color were acceptable for equine veterinarians.

RESULTS

Of the 2,655 individuals who opened the survey, 763 responses were included. Respondents were predominantly female (743/763 [97.4%]) from rural areas (493/763 [64.6%]). Only 37.1% (283/763) of respondents agreed that what a veterinarian wears influences their confidence in them. The highest-ranked traits in an equine veterinarian were knowledge/competency (mean ± SD, 1.46 ± 0.98), followed by trustworthiness (2.34 ± 1.08) and compassion (3.50 ± 1.20), with coveralls and scrubs being the preferred attire clients associated with these attributes (with the exception of compassion, for which polo shirt/jeans was the preferred attire). T-shirt/jeans was consistently ranked lowest by respondents in association with these attributes, except in the area of compassion, where polo shirt/black pants was ranked lowest.

CLINICAL RELEVANCE

Our findings suggested the attire and appearance of equine veterinarians can impact client perceptions, with veterinarians wearing scrubs and coveralls associated with higher competency and trustworthiness.

Introduction

Physician attire has been rigorously evaluated in human medicine, and it is well established that the attire worn by a doctor influences the patient’s perceptions of competence and can impact the physician-patient relationship.4 Prior studies have also demonstrated that patient perceptions of physician attire differ by specialty, location, and setting.5 However, these preferences have only recently been investigated in veterinary medicine, and, to the authors’ knowledge, only in the small animal setting. Small animal veterinarians commonly wear a variation of business attire or scrubs, often with a white coat.69 In small animal medicine, studies have most often shown client preference for veterinarians dressed in scrubs, either with or without a white coat.69 Studies have also shown that veterinarians’ attire influences client perceptions of their animal’s care.6,7 Research by Coe et al8 demonstrates that practitioners in scrubs were rated highest by clients in terms of trust, confidence, and comfort.

Across medical professions, white coats are often used to identify doctors; however, these are not practical in equine medicine due to the physical nature and working environment of the profession. Similarly, formal business attire is also impractical in a large animal hospital or farm setting, where equine patients are usually treated. In the authors’ experience, equine veterinarians wear a variety of outfits ranging from jeans and a T-shirt to slacks and a collared shirt. In equine practice, it is currently unknown whether clients have a preference for specific veterinary attire. Therefore, we chose to investigate the potential client preferences and perceptions of various kinds of attire relevant to equine practice. These findings will help inform equine practitioners and improve professionalism training for veterinary students.

The purpose of this study was to investigate potential equine clients’ perceptions of equine veterinarians based on attire. The authors hypothesized that survey respondents would prefer veterinarians in dress/khaki pants with a collared shirt or scrubs and that the respondents’ perception of various positive traits in their veterinarian would be affected by attire. Secondly, we hypothesized that potential equine clients would prioritize knowledge and competency as desirable veterinarian traits. Finally, we hypothesized that respondents with tattoos, facial piercings, or hair dyed a nonorganic color would self-report that they are more accepting of those physical features in an equine veterinarian.

Methods

Participants

Individuals were invited to participate in the study via a Facebook post13 explaining the purpose of the study and containing a link to the survey between August and October 2022. The post was shared on Facebook pages by members of the research team. It was also posted to various animal- and veterinary-related Facebook pages and was made public to allow individuals to share to their own Facebook pages and/or other groups. Additional participants were recruited by word of mouth and with the help of flyers that stated the purpose of the study and provided a link and QR code to the survey. While the goal of sharing the survey was to reach members of the equine community on a national level, there was initially no requirement of horse ownership for respondents to complete the survey. Upon review, those who did not report owning or leasing at least 1 horse were removed from the response pool so that only potential clients were included.

Survey design

The survey questionnaire was developed to investigate perceptions and preferences of equine veterinarian attire among horse owners/lessees. Prior to the creation of this study, several previous studies were evaluated to assess the best questionnaire format and content.4,6,10,11 The survey was formulated using standard software (Qualtrics, 2022; Qualtrics International Inc), and study design was approved by the North Carolina State University Institutional Review Board (IRB No. 23832). Respondents had to be 18 years or older and live in the US to participate. Conditional survey formatting was used so an individual could only complete the survey once from a singular device. The survey was anonymous, and no compensation was offered as an incentive for participation.

The first series of questions asked respondents to rate 7 images of a White male veterinarian and a White female veterinarian in different attire on 7 different attributes (Supplementary Material S1). All photographs were original and obtained with an iPhone XR camera (Apple Inc). Veterinarians stood against a neutral-color background and maintained the same posture and hairstyle for all attire options. In each image, the individuals were wearing a white face mask, as the photos were obtained in a hospital setting during COVID-19 restrictions. Additionally, a black box was placed over each individual’s eyes so that no facial expressions were visible to influence perceptions.

The attire options for each gender were designed to encompass a range of attire worn by equine veterinarians. Attire options included black khaki pants and a red polo, black khaki pants and a green scrub top, blue jeans and a red polo, blue jeans and a green scrub top, blue jeans and a black T-shirt, green scrub top and bottom, and coveralls (Figure 1). There were 7 different attributes evaluated on a 7-point scale for each attire option, with 1 being the most consistent with the positive or first attribute of the pair and 7 being the least consistent with the positive or first attribute of the pair. These attribute pairs were as follows: easygoing/uptight, friendly/unfriendly, compassionate/not compassionate or indifferent, trustworthy/untrustworthy, professional/unprofessional, competent/incompetent, and expensive services/inexpensive services. These answer choices were randomized for each question. Respondents were then asked questions regarding the appropriateness of various aspects of appearance, including dress, tattoos, piercings, and hair dyed a nonorganic color. Respondents were also asked if attire influences their trust in, confidence in, or perception of the ability of a veterinarian.

Figure 1
Figure 1

Photographs of a White male veterinarian and a White female veterinarian in 7 different attire options included in a survey of 763 potential equine clients from the US in a study to evaluate client perceptions of equine veterinarians based on attire. Participants were invited to participate in the survey via social media posts between August and October 2022.

Citation: Journal of the American Veterinary Medical Association 262, 8; 10.2460/javma.24.02.0083

Finally, respondents were asked demographic questions including age range, sex, average household income, and state of residence. They were also asked if they own or lease horses, and if so, they were asked several questions about their relationship with their current veterinarian and how that individual typically dresses.

Statistical analysis

The analyses were prepared using IBM SPSS Statistics, version 29. Individuals who did not finish the survey and those who did not report owning or leasing at least 1 horse were excluded. Frequencies and percentages were calculated for the following variables: general veterinarian appearance (8 items); age; sex; average household income; geographic area; state of residence; whether they have tattoos, non-ear facial piercings, or hair dyed a nonorganic color; day-to-day clothing; equine-related occupation; whether individuals have a primary care veterinarian for their horse(s); length of time with current veterinarian (if applicable); and veterinarian gender. Mean, median, SD, minimum, and maximum were calculated for the following variables: the ranked importance of 7 general veterinarian attributes and the number of horses owned. Mann-Whitney U tests were used to compare levels of agreement that facial piercings, visible tattoos, and nonorganic hair color were acceptable for an equine veterinarian between respondents with and without similar traits. Mean, median, SD, minimum, and maximum were calculated for the 7 attributes by outfit for both the female and male veterinarians. Assessment of significant differences between ranked importance of different attributes in a veterinarian was performed with a Friedman analysis, followed by post hoc pairwise comparisons. Linear mixed-effects models were used to compare each of the 7 attributes across the 7 outfits, for both the male and female veterinarians. These models included a main effect of gender, a main effect of outfit, and the interaction between the two. They also included a random intercept for “respondent” in order to adjust for the lack of independence from responses from the same individuals about different outfits. An “overall” rating for each outfit was also calculated by averaging the response of the 3 most important attributes among the respondents, and this was also compared across the 7 outfits using a similar linear mixed-effects model. All post hoc comparisons for all statistical analyses used a Bonferroni adjustment of P values for multiple testing; .05 was used as the level of significance for all analyses where statistical significance is discussed.

Results

Of the 2,655 individuals who opened the survey, 756 individuals completely answered every question of the survey. An additional 79 individuals missed no more than 3 items, the majority of which involved questions related to them not owning a horse, resulting in no true missing data. The 71 individuals who did not report currently owning or leasing at least 1 horse were excluded to increase the relevance of the survey by focusing on horse owners/lessees. Therefore, 763 responses were included in the final analysis. The largest portion of respondents by age were between 31 and 45 years old (n = 263 [34.5%]), and respondents were predominantly female (743 [97.4%]; Table 1). The largest proportion of respondents by income had average household incomes > $100,000 (n = 354 [46.4%]), and most respondents were from rural areas (493 [64.6%]).

Table 1

Demographic information of 763 potential equine client respondents from the US in a study to evaluate client perceptions of equine veterinarians based on attire between August and October 2022.

Variable Category Frequency (No. of respondents) Percentage
Age 18–30 y 150 19.7
31–45 y 263 34.5
46–60 y 206 27.0
≥ 61 y 144 18.9
Gender Male 11 1.4
Female 743 97.4
Nonbinary/third gender 4 0.5
Prefer not to say 5 0.7
Average household income < $50,000 117 15.3
$50,000–$100,000 292 38.3
> $100,000 354 46.4
Geographic area Rural 493 64.6
Suburban 245 32.1
Urban 25 3.3

Additionally, respondents represented 48 states (none from Delaware or Hawaii), with the largest percentages of respondents from North Carolina (n = 79 [10.4%]), Virginia (64 [8.4%]), and Florida (46 [6.0%]). Most participants did not have an equine-related occupation (n = 482 [63.2%]). Participants owned/leased an average of 4.52 horses (median, 2). Most participants (n = 748 [98.0%]) had a primary care veterinarian for their horses, and the greatest proportion had been clients of that veterinarian for ≥ 9 years (274 [35.9%]). The majority of the respondents’ veterinarians were female (n = 473 [62.0%]).

Personal appearance of respondents and views of veterinarian appearance

Overall, of the 763 respondents, 296 (38.8%) had tattoos, 459 (60.2%) did not, and 8 (1%) preferred not to answer. A total of 60 (7.9%) respondents had non-ear facial piercings, 697 (91.3%) did not, and 6 (0.8%) preferred not to answer. A total of 48 (6.3%) respondents had hair dyed a nonorganic color, 712 (93.7%) did not, and 3 (0.4%) preferred not to answer. Regarding day-to-day clothing, 100 (13.1%) individuals wore scrubs or a work uniform, 401 (52.6%) wore jeans and a T-shirt or similar casual attire, 178 (23.3%) wore jeans and a collared shirt or business casual attire, and 84 (11.0%) wore dress pants/a skirt and a collared shirt or business attire.

When asked general questions about equine veterinarian appearance, only 31.7% (n = 242) of respondents agreed that what a veterinarian wears influences their opinion about the veterinarian’s ability to appropriately care for their horse. Additionally, 37.1% (n = 283) of respondents agreed that what a veterinarian wears influences their confidence in them. Most respondents felt that facial piercings (n = 458 [60.0%]), tattoos (662 [86.8%]), and hair dyed a nonorganic color (513 [67.2%]) were acceptable for equine veterinarians. Personal appearance of respondents was found to be related to their agreement that these traits were acceptable in veterinarians. Among respondents with facial piercings, 54 of 60 (90%) agreed that facial piercings were acceptable for equine veterinarians, while among those without, only 401 of 696 (57.6%) agreed. Among respondents with tattoos, 275 of 296 (92.9%) agreed that visible tattoos were acceptable for equine veterinarians, while among those without, only 380 of 459 (82.8%) agreed. And among respondents with hair dyed a nonorganic hair color, 43 of 48 (89.6%) agreed that nonorganic hair colors were acceptable for equine veterinarians, while among those without, only 468 of 712 agreed (65.7%). Mann-Whitney U tests showed that all of these group differences are strongly statistically significant with P < .001.

With regard to specific items of clothing, the majority of respondents felt that riding attire (n = 601 [78.6%]) was acceptable for equine veterinarians. Less than half of respondents agreed that tennis shoes (n = 310 [40.6%]) were acceptable footwear or that veterinarians should wear a name tag (315 [41.3%]).

Veterinarian attributes

When asked to rank their most valued attributes in a veterinarian, respondents ranked knowledge/competency first (mean ± SD, 1.46 ± 0.98; P < .001 relative to all other attributes), followed by trustworthiness (2.34 ± 1.08; P < .001 relative to all less important attributes), compassion (3.50 ± 1.20; P < .001 relative to all less important attributes), professionalism (4.67 ± 1.68; statistically significantly more important than cost of services and easygoing attitude), friendliness (4.81 ± 1.20; statistically significantly more important than easygoing attitude), cost of services (5.04 ± 1.54; statistically significantly more important than easygoing attitude), and easygoing attitude (6.18 ± 1.20; P < .001 relative to all more important attributes).

Outfit comparisons

Outfit comparisons by individual attributes—For competence, there was a statistically significant interaction between outfit and gender (P = .014). However, for both the male and female veterinarians, scrubs were rated as the most competent (statistically significantly more competent than all outfits except coveralls for the male veterinarian and coveralls and scrub top/black pants for the female veterinarian), and T-shirt/jeans was rated as the least competent (significantly less competent than all other outfits for both the male and female veterinarians; Figure 2). For trustworthiness, there was not a statistically significant interaction of outfit and gender, and scrubs and coveralls together were rated statistically significantly more trustworthy than polo shirt/black pants, scrub top/jeans, and T-shirt/jeans. T-shirt/jeans was rated significantly less trustworthy than all other outfits. With regard to compassion, again there was not a statistically significant interaction of outfit and gender; polo shirt/jeans was rated as the most compassionate (significantly more than scrub top/black pants, scrubs, and polo shirt/black pants), and polo shirt/black pants was ranked lowest (significantly lower than all other outfits except full scrubs). As for professionalism, there was a statistically significant interaction between outfit and gender (P < .001); for the male veterinarian, scrubs were rated significantly more professional than all other outfits except for polo shirt/black pants, and for the female veterinarian, coveralls were rated as the most professional (significantly more professional than all other outfits except for scrubs and scrub top/back pants). T-shirt/jeans was rated significantly less professional than all other outfits for both the male and female veterinarians. For friendliness, there was a statistically significant interaction between outfit and gender (P = .030). T-shirt/jeans was rated as the most friendly for the male veterinarian specifically (statistically more friendly than all other outfits except for polo shirt/jeans), but was not significantly different from polo shirt/jeans (the most friendly) or scrub top/jeans for the female veterinarian. For both the male and female veterinarians, scrubs were rated as significantly less friendly than all other outfits. Regarding expensive services, there was a statistically significant interaction between outfit and gender (P < .001); however, for both the male and female veterinarians, scrubs were rated statistically significantly more expensive than all other outfits, and T-shirt/jeans was rated significantly less expensive than all other outfits. Finally, for easygoing attitude, there was a statistically significant interaction between outfit and gender (P = .009). For the female veterinarian, T-shirt/jeans was rated significantly more easygoing than all other outfits except for polo shirt/jeans; for the male veterinarian, T-shirt/jeans was rated significantly more easygoing than all other outfits. For both the male and female veterinarians, scrubs were rated significantly less easygoing than all other outfits.

Figure 2
Figure 2

Outfit comparisons by individual attribute for the male (A) and female (B) veterinarian as ranked by potential client survey respondents (n = 763) who own/lease at least 1 horse, as in Figure 1.

Citation: Journal of the American Veterinary Medical Association 262, 8; 10.2460/javma.24.02.0083

Male/female differences—With regard to competence, there was a statistically significant interaction between outfit and gender (P = .014); for 1 outfit (T-shirt/jeans), the male veterinarian was considered significantly more competent than the female veterinarian. There were no significant differences between the male and female veterinarians with regard to trustworthiness. With regard to compassion, there was not a statistically significant interaction between outfit and gender; however, the female veterinarian was considered overall significantly more compassionate than the male veterinarian (P < .001). For professionalism, there was a statistically significant interaction between outfit and gender (P < .001); for 2 outfits only (polo shirt/jeans and T-shirt/jeans), the male veterinarian was considered significantly more professional than the female veterinarian. For friendliness, there was a statistically significant interaction between outfit and gender (P = .030); for 2 outfits (polo shirt/jeans and scrub top/jeans), the female veterinarian was considered more friendly than the male veterinarian. While there was a statistically significant interaction between outfit and gender for expense (P < .001), the male veterinarian was considered to have significantly more expensive services than the female veterinarian for all outfits (the interaction is due to a matter of degree of difference). Finally, there was a statistically significant interaction between outfit and gender for easygoing attitude (P = .009); the female veterinarian was considered significantly more easygoing than the male veterinarian for 4 different outfits (T-shirt/jeans, polo shirt/jeans, scrub top/jeans, and coveralls).

Overall ratings—When considering the top 3 most desirable attributes in a veterinarian (knowledge/competency, trustworthiness, and compassion), there was not a statistically significant interaction between gender and outfit, nor was there an overall gender difference. Coveralls were the most preferred outfit overall, followed very closely by scrubs; coveralls were significantly preferred over all other outfits except for scrubs (which were only significantly preferred over polo shirt/black pants and T-shirt/jeans). No other outfits were significantly different from each other overall, with the exception of the least preferred outfit, T-shirt/jeans (significantly less preferred than all other outfits) (Table 2). When all 7 attributes were added together, the top 2 most desirable outfits for the female veterinarian were coveralls followed by scrubs. For the male veterinarian, the top 2 most desirable outfits were scrubs followed by coveralls.

Table 2

Model estimated marginal means and comparisons for overall rating by outfit for 763 potential equine clients, as in Table 1.

Outfit Mean 95% CI Bonferroni comparison
Coveralls 2.88 2.79–2.97 A
Full scrubs 2.90 2.81–2.99 A B
Polo shirt and jeans 2.93 2.84–3.02 A B C
Scrub top and black pants 2.94 2.85–3.03 B C
Scrub top and jeans 2.97 2.88–3.06 B C
Polo shirt and black pants 2.99 2.90–3.08 C
T-shirt and jeans 3.25 3.16–3.34 D

A lower mean indicates a better overall rating.

Outfits with the same letter in the Bonferroni comparison column are not statistically significantly different at the .05 level of significance.

Discussion

This study confirms that horse owners/lessees value knowledge and competency most in equine veterinarians. Contrary to our hypothesis, potential equine clients preferred veterinarians in scrubs and coveralls rather than polo shirts/black pants, which was rated significantly lower on the overall scale than the top outfits. Additionally, T-shirt/jeans was the least preferred outfit on the overall scale. Finally, we confirmed that survey respondents who themselves had tattoos, facial piercings, or hair dyed a nonorganic color self-reported higher levels of acceptance of those physical features in an equine veterinarian.

The majority (743/763 [97.4%]) of respondents in this survey were female; respondents were most likely to be between the ages of 31 and 45 years old with an average household income > $100,000. This gender demographic is similar to a 2018 survey12 of horse owners in the US, which found that 92.6% of horse owners were female. This 2018 survey also found 16.5% of respondents reported an annual household income ≥ $150,000, with the most reported household income (43%) being < $75,000, which is less than the majority of respondents in our study. The American Horse Council Foundation also reported in 2018 that 70.5% of horse owners were 45 years or older.12 The age distribution in our survey was slightly different, with the largest group of respondents (263/763 [34.5%]) aged 31 to 45 years. This difference could be attributed to the survey being largely distributed on Facebook; according to a survey13 from August 2023, Facebook’s largest user population in the US by age is between 25 and 34 years old (23.6%), with users between 35 and 44 years old being the second largest population (18.4%).

The largest percentage of respondents by state were from North Carolina (79/763 [10.4%]) and Virginia (64/763 [8.4%]), which is likely due to the primary investigators being located in that region of the country and having a stronger social media presence in equine groups in that geographical area.

In this study, only 37.1% (283/763) of respondents indicated that their veterinarian’s attire would influence their confidence in them, with 31.7% (242/763) saying what a veterinarian wears would influence their opinion about the veterinarian’s ability to appropriately care for their horse. However, we believe these numbers could be underestimated due to social desirability bias. This bias could influence survey participants to respond in a manner reflecting socially acceptable behavior, for which judging someone based on their clothing or physical appearance may be deemed shallow or superficial, rather than answering with their true opinions.14 Additionally, the results of this study show changes in confidence ratings for veterinarians in different outfits, which conflicts with the low percentage of respondents who indicated that attire would influence their confidence in the veterinarian. This discrepancy suggests a lack of respondents’ awareness or desire to share opinions regarding the influence of attire on confidence in a veterinarian.

Additionally, it was found that the majority of respondents felt facial piercings, tattoos, and hair dyed a nonorganic color were acceptable for equine veterinarians (458/763 [60.0%], 662/763 [86.8%], and 513/763 [67.2%], respectively). These findings contradict a human health study15 by Johnson et al where individuals in Hawaii were asked questions about a simulated situation in which they were seeking urgent care for their child. That study found lower confidence scores in physicians with visible tattoos and non-ear facial piercings. However, our results are more consistent with findings by Cohen et al,16 who found that patients in an active emergency room setting did not perceive physicians with visible tattoos or nontraditional piercings different in terms of “competence, professionalism, caring, approachability, trustworthiness, or reliability.” This could support that different care settings and patient populations can have variable opinions on the preferred appearance of their physicians. However, it should be noted the Johnson et al study was conducted in Hawaii and evaluated more-specific, large facial piercings and neck tattoos, which could have different perceptions in various cultures and geographic regions. The study was also a simulation, which has inherent limitations. Additionally, the study by Cohen et al demonstrated more-discrete visible arm tattoos. Our survey also showed respondents who shared these external features were more likely to self-report greater acceptance in an equine veterinarian.

It was also found that 59.4% (453/763) of respondents felt that tennis shoes were inappropriate footwear for equine veterinarians. It is widely accepted among equestrians that tennis shoes can be hazardous due to the risk of injury if stepped on by a horse. However, this is not consistent in the small animal setting. A study7 by Robb et al showed that < 5% of small animal clients felt that sneakers were inappropriate footwear for veterinarians. Name tags are also likely thought of as being potentially hazardous around horses, and only 41.3% (315/763) of respondents felt an equine veterinarian should wear a name tag. This contrasts with studies in human medicine where most patients favor their physician wearing a name tag.5 One potential alternative for distinguishing veterinarians during client interactions would be to have clothing with embroidered names and designations. This would eliminate any potential hazard of a physical name tag; however, this warrants further investigation.

Respondents overall ranked knowledge and competency as the most desirable trait (mean ± SD, 1.46 ± 0.98), followed by trustworthiness (mean ± SD, 2.34 ± 1.08) and compassion (mean ± SD, 3.50 ± 1.20). These traits are all highly prioritized in human and veterinary medicine. Portraying these attributes and establishing trust are vital to the veterinary-client relationship. However, a 2013 survey17 published by the American Association of Equine Practitioners showed that horse owners valued availability most in an equine veterinarian, with knowledge of new medical developments/treatments, experience, and compassion ranked lower. While our survey did not ask about availability, it did show a difference in how respondents prioritize competency. This could be due to a change in client attitudes over time or differences in survey populations.

Regarding outfit and trait associations, veterinarians in T-shirt/jeans were rated as most easygoing, but least trustworthy, least professional, least competent, and least expensive. T-shirt/jeans was the most casual selection of the outfits in the survey and does not designate an individual as a professional the way other outfits may, which may also influence ratings of trustworthiness. In support of this, research by Oh et al10 found that attire influences perceived competency scores of individuals.

In our study, the male and female veterinarians wearing scrubs were rated significantly less friendly. This could be due to an association of scrubs with human physicians. Research by Kedrowicz et al18 in 2020 evaluated public perceptions of physicians and veterinarians in the US and found that physicians were perceived as more unpleasant and less likable than veterinarians. Our results also show that the female veterinarian was considered more friendly in scrub top/jeans and polo/jeans than the male veterinarian in the same outfits. This is likely due to gender differences in the perception of males and females.

In our survey results, the female veterinarian was viewed as significantly more compassionate overall. An important characteristic of human physicians is empathy, and patient perception of empathy is influenced by attire.19 Research by Greenberg et al20 showed that women have higher cognitive empathy than men. While we did not measure empathy in our survey, compassion is similar to empathy, which could explain why the female veterinarian was viewed as more compassionate overall than the male veterinarian.

Polo/black pants and scrubs were considered the most professional outfits for both the male and female veterinarians. Polo/black pants was also the most formal of the attire options presented to respondents, likely increasing the association with a medical professional. Similarly, scrubs help identify an individual as a medical professional, likely contributing to increased professionalism scores for this attire option.

In terms of competency, scrubs were rated as most competent with coveralls being second for both the male and female veterinarians. This is a unique finding as the majority of equine veterinarians do not often wear coveralls. However, this outfit is also not commonly worn by the general public and may serve to help differentiate an individual as a veterinarian versus a layperson. Additionally, research in small animal medicine showed higher competency scores for veterinarians dressed in scrubs compared to business attire, which could indicate that client perception of competency increases when veterinarians wear attire that helps differentiate them from other nonmedical professionals.9

Our study found that the male veterinarian was viewed as significantly more competent than the female veterinarian in 1 specific outfit, T-shirt/jeans. Additionally, the male veterinarian in polo/jeans and T-shirt/jeans was considered more professional than the female veterinarian in the same outfits. This is potentially due to continued gender biases favoring male veterinarians. Historically, veterinarians were predominantly male until 2009, when the number of female veterinarians outnumbered males for the first time in the US. In 2022, approximately 80% of veterinary students and 65.7% of practicing veterinarians were female.21,22 The differences in perceived competence and professionalism between the male and female veterinarians in our study demonstrate persistent gender biases found in veterinary medicine. There is a well-known double standard between casual attire for men and women in the workplace. For men, casual attire often entails a collared shirt and dress pants or khakis. However, for women, the descriptions of casual attire are much less well-defined, making it very difficult to follow the “rules.”

Respondents in this study viewed the male veterinarian overall as having more expensive services. This difference may also be due to gender bias in veterinary medicine. There is a persistent gender gap in income in veterinary medicine.23 A survey24 by Morello et al in 2017 found that female Diplomates of the American College of Veterinary Internal Medicine earn an average of 20% less than their male counterparts. They also identified this finding was further exacerbated in private practice, with female internists earning an average of 29% less than male internists. A similar disparity is noted in the equine field specifically, with male veterinarians earning an average of 20% more than female veterinarians during the first 5 years of practice.25 This is an issue that spreads not only across medical fields but across the workforce in general. According to the US Department of Labor, in 2023, full-time female employees were paid 83.7% as much as their male counterparts.26

There are several limitations of our study that should be considered. Respondents were recruited primarily via social media; therefore, it is difficult to determine if other groups of individuals would have similar opinions. Another general limitation is that the study was done over a relatively short period of time.

The outfits were chosen to encompass a variety of attire worn by equine veterinarians in various regions of the country. We reported our results as collated national data, but there could be differences at the geographic/regional level that we did not attempt to identify in this study. Additionally, there are potential differences among various equine disciplines that were not investigated, which could be an area for future research.

The colors chosen for the scrubs and polo shirts were based on availability from the investigators’ place of work, and the effect of different color choices on perceptions of attire was not investigated. Also, the fit of the various attire options was slightly different between the male veterinarian and the female veterinarian, which could have impacted the perception of the different outfits. Additionally, the veterinarian images in Figure 1 provide information about race, ethnicity, hair color, gender, and weight, all of which could have influenced respondents’ perceptions of various attributes or influenced their responses due to social desirability bias.

In future studies, we would like to investigate horse owner perceptions in different practice settings (ie, ambulatory/primary care, referral private practice, and referral teaching hospital) to determine if these factors affect client expectations or opinions. We are also interested in further exploration of how client perceptions and expectations are influenced by the gender, sexual orientation, height, weight, and race of veterinarians. While the focus of this study was veterinarian attire, the individuals chosen to model the outfits were chosen for convenience, rather than study design. This created a study limitation since the pictured individuals have visible features of body mass, hair, and skin color. Due to conscious and/or unconscious biases among surveyed horse owners, it cannot be assumed that survey responses would be the same for veterinarians of a different body mass or race. To support efforts of diversity and inclusivity in veterinary medicine, additional research is needed to explore the impacts of a veterinarian’s race and ethnicity on client perceptions and feedback.27

There was not a single outfit that individuals felt was the best overall. However, T-shirt/jeans was consistently ranked lowest for equine veterinarians. The top 3 desirable attributes in a veterinarian were knowledge/competence, trustworthiness, and compassion. The highest scoring outfits for those attributes were scrubs and coveralls.

Supplementary Materials

Supplementary materials are posted online at the journal website: avmajournals.avma.org.

Acknowledgments

The authors would like to thank Dr. Kate Hepworth Warren and Dr. Thomas McParland for their contributions to the study survey. The authors would like to thank James Robertson for his contribution to the initial statistical analysis, in addition to Ken Royal for his input in study design and distribution.

Disclosures

The authors have nothing to disclose. No AI-assisted technologies were used in the generation of this manuscript.

Funding

The authors have nothing to disclose.

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