Public Perceptions of Physician Attire and Professionalism in the US

Abstract

Importance: In recent years, casual physician attire (fleece jackets and softshell jackets) has become increasingly popular, but to our knowledge, public perceptions of these garments have not been studied. Furthermore, gender biases may result in differing expectations and perceptions of female and male physicians and may be associated with patient rapport and trust building.

Objective: To characterize public perceptions of casual physician attire and implicit gender biases in public assessment of physicians' professional attire.

Design, setting, and participants: This survey study used a population-based survey administered via Amazon Mechanical Turk from May to June 2020 among individuals aged 18 years or older who were US residents and for whom English was the primary language.

Intervention: Survey featuring photographs of a male or female model wearing various types of physician attire (white coat, business attire, and scrubs).

Main outcomes and measures: Respondents' ratings of professionalism, experience, and friendliness of the male and female models in various attire and perceptions of the models' most likely health care profession. Preference scores for various outfits were calculated as the difference between the preference score for an outfit and the mean preference score for the outfit-role pairing.

Results: Of 522 surveys completed, 487 were included for analysis; the mean (SD) age of respondents was 36.2 (12.4) years, 260 (53.4%) were female, and 372 (76.4%) were White individuals. Respondents perceived models of health care professionals wearing white coats vs those wearing fleece or softshell jackets as significantly more experienced (mean [SD] experience score: white coat, 4.9 [1.5]; fleece, 3.1 [1.5]; softshell, 3.1 [1.5]; P < .001) and professional (mean [SD] professionalism score: white coat, 4.9 [1.6]; fleece, 3.2 [1.5]; softshell, 3.3 [1.5]; P < .001). A white coat with scrubs attire was most preferred for surgeons (mean [SD] preference index: 1.3 [2.3]), whereas a white coat with business attire was preferred for family physicians and dermatologists (mean [SD] preference indexes, 1.6 [2.3] and 1.2 [2.3], respectively; P < .001). Regardless of outerwear, female models in business attire as inner wear were rated as less professional than male counterparts (mean [SD] professionalism score: male, 65.8 [25.4]; female, 56.2 [20.2]; P < .001). Both the male and the female model were identified by the greater number of respondents as a physician or surgeon; however, the female model vs the male model was mistaken by more respondents as a medical technician (39 [8.0] vs 16 [3.3%]; P < .005), physician assistant (56 [11.5%] vs 11 [2.3%]; P < .001), or nurse (161 [33.1%] vs 133 [27.3%]; P = .050).

Conclusions and relevance: In this survey study, survey respondents rated physicians wearing casual attire as less professional and experienced than those wearing a white coat. Gender biases were found in impressions of professionalism, with female physicians' roles being more frequently misidentified. Understanding disparate public perceptions of physician apparel may inform interventions to address professional role confusion and cumulative career disadvantages for women in medicine.

Figure 1.. Preferred Traits of and Prevalence of Attire Worn by Health Care Professionals

A, Dots indicate mean values; whiskers, SDs. P < .001 for all comparisons. B, Respondents were shown photographs of attire and asked how often they had seen health care professionals in that attire. Scrubs refer to unisex, hospital-grade scrubs.

Figure 2.. Respondent Ratings of Health Care Practitioners’ Professionalism and Experience by Attire and Preferred Attire by Type of Physician

Scrubs refer to unisex, hospital-grade scrubs; personalized scrubs refer to branded and tailored scrubs, including different fits by gender. A and B, Respondents ranked physicians as most (6) to least (0) experienced or professional. C, Respondents were shown a model wearing business attire with varying outerwear, scrubs alone, or scrubs as inner wear with varying outerwear. Dots indicate mean values; whiskers, SDs. ^aP < .001 for business inner wear with white coat vs with fleece or softshell. ^bP = .02 for white coat with business inner wear vs with scrubs. ^cP < .001 for scrubs with white coat vs with fleece or softshell.

Figure 3.. Professionalism Ratings and Presumed Occupations of Male Models vs Female Models by Attire

A, Dots indicate mean values; whiskers, SDs. ^aP < .001 for male models vs female models.