Demographics and Perceptions of Diversity, Equity, and Inclusion of the American College of Veterinary Ophthalmologists (ACVO) Members

ABSTRACT

Objective

To examine diversity, equity, and inclusion‐related perceptions and experiences of the American College of Veterinary Ophthalmologists (ACVO) members.

Procedure(s)

An electronic survey created in Qualtrics was distributed to ACVO members via the ACVO listserv, made available from June 24, 2024 to July 19, 2024.

Results

A total of 249 (43.9%) ACVO members completed the survey. Approximately half (52.6%) of respondents feel that it is important for individuals and organizations to engage in diversity, equity, and inclusion (DEI) training, and 68.7% of respondents are interested in exploring different perspectives related to DEI through educational sessions, with the most interest expressed for a webinar format. The percentage of respondents who feel that the ACVO does not demonstrate that it values diversity was 28.5%, equity = 23.8%, and inclusion = 26.5%. Discrimination experienced personally based on sex (8.3%), political views (7.1%), and mentor/location of residency (6.3%) were reported. These were similar to respondents' report of witnessed discrimination of other people such as fellow colleagues (political views: 15.7%, sex: 11.8%, and mentor/location of residency: 10.2%).

Conclusions

While the survey results suggest some ACVO members feel they have been discriminated against and/or witnessed the discrimination of others and feel unwelcome, results also indicate that the majority of members feel supported by the ACVO. Utilizing the results of this study, concrete steps to address these challenges through changes in DEI‐related education, policies, and procedures are suggested to help ensure that the ACVO creates a fair, welcoming environment for members.

1. Introduction

Despite widespread recognition among veterinary professionals that “there is need to increase the diversity of students admitted to veterinary colleges so that the profession does not become an enclave of White women and men increasingly different from the ethnic, gender, and racial pluralism of the larger society,” [1] veterinary medicine remains the least racially diverse health occupation in the United States (US) [2]. To ensure a common understanding of diversity, the Association of American Veterinary Medical Colleges (AAVMC) notes that “diversity in veterinary medicine means having individuals in the profession of different gender, gender identity, sexual orientation, socioeconomic status, cultural background, language, cognitive style, nationality, age, physical abilities, religious beliefs, political beliefs, and other forms of differences, both visible and invisible” [3].

As of 2023, 90% of veterinarians in the US are White, 5.9% are Asian, 7.9% are Hispanic or Latino, and 1.3% are Black or African American [4]. This lack of racial diversity, along with a lack of sex diversity, is also seen in leadership roles. For example, nearly all deans of veterinary schools are White males; only 5% of deans are White women, and 3.7% are Black, Hispanic, or Asian, with an even smaller percentage being Black, Hispanic, or Asian women [5]. Racial diversity among veterinary students also remains low; approximately 23% of students are from underrepresented backgrounds [6, 7].

The 2011 North American Veterinary Medical Education Consortium (NAVMEC) report on the future of veterinary medical education emphasized the importance of diversity and multicultural awareness by identifying this area as a core competency [8, 9]. In addition, the American Veterinary Medical Association (AVMA) Council on Education (COE) supports veterinary medical education programs that prepare students with the knowledge and skills needed to serve all clients and create collaborative environments for all co‐workers [10]. The COE supports initiatives in the spectrum of care ensuring graduates can serve diverse clientele and contribute to positive work environments. Additionally, the COE Standards of Accreditation include “that the college must have and follow a statement on nondiscrimination consistent with applicable law”. The college must create and promote an institutional structure and climate that does not discriminate and seeks to expand opportunities for all students. The college or institution must establish a reliable, effective reporting and response system, and if warranted, a process to remedy instances of discrimination and other forms of harassment involving faculty, staff, and students. This focus on diversity, equity, and inclusion stems from the knowledge that a lack of diversity, as well as challenges associated with equity and inclusiveness, can have negative effects on students, veterinary professionals, and the health outcomes of veterinary patients. Experiencing discrimination or feeling excluded by fellow students, colleagues, or institutions can result in feelings of isolation and lack of belonging [11, 12]. In addition, in physician‐based medicine, language and cultural barriers, as well as subconscious bias toward race and ethnicity, have been shown to negatively affect patient health outcomes [13, 14]. A lack of diversity, equity, and inclusiveness in the veterinary profession has been identified as a stressor in both the United Kingdom (UK) and United States (US) [15, 16, 17, 18, 19]. A global survey by the International Veterinary Student Association (IVSA), for example, found that student discrimination based on ethnicity or sexual orientation is a serious issue at most veterinary schools [20]. In particular, both veterinary and medical lesbian, gay, bisexual, transgender, queer or questioning, intersex, and asexual (LGBTQIA+) individuals experience more psychological distress, suicidal ideation, and suicide attempts in school and as professionals than those who do not identify as LGBTQIA+ [21, 22, 23].

One frequently experienced form of discrimination is gender‐based, evidenced by the gender pay gap commonly reported in veterinary practice [24]. This gender discrimination may be even more detrimental for Black women in healthcare fields, suggested by the fact that Black women in academia report feeling their competence is questioned as a result of being Black and a woman [25]. Other forms of gender discrimination include client sexism [26], a lack of respect for women practitioners following childbirth and/or choice to work part‐time [21, 27], and a lack of women leaders in the field [21, 28, 29].

In addition to students and practitioners, the importance of diversity in leadership has been stressed by numerous organizations and researchers [30]. Diversity fosters creative thinking and unique perspectives, beneficial for solving multifaceted problems and increasing fiscal performance [31, 32]. Multiple benefits have been attributed to diversity at all levels within healthcare professions, including, but not limited to, increased patient satisfaction; new perspectives and innovation; and increases in fiscal performance and budget management [5, 30, 31]. It is important to recognize that underrepresented minorities can offer underrecognized perspectives to the workplace. In addition, they are more likely to engage in health equity research, work in underserved, lower socioeconomic communities, and mentor students and trainees who are also underrepresented in medical fields [33, 34, 35].

The first step toward improvement in diversity, equity, and inclusiveness is an openness to the topic [19] and an understanding that cultural appropriateness is increasingly critical in the face of changing demographics [36]. The next critical step is the creation of benchmarks to identify current status, perceptions, and potential for growth [37]. Surveys are seen as an essential tool for collecting this type of invaluable information [38]. There is currently a dearth of information pertaining to diversity, equity, and inclusiveness for veterinarians in specialty practice [39], and no published research on the diversity of veterinary ophthalmologists nor their perceptions of inclusion and equity within The American College of Veterinary Ophthalmologists (ACVO). To aid in these efforts, the ACVO created the ad hoc Diversity, Equity, and Inclusion (DEI) Committee in 2020. The DEI committee consists of six members including a Chair and Vice Chair. Part of the Committee's responsibilities include: “Investigating and expanding ways by which the ACVO can improve diversity, equity and inclusion within our profession and specialty”; “Developing a survey of ACVO members to elucidate any specific needs that are currently not met by the ACVO or its services”; and “Providing educational resources for ACVO members to increase awareness and understanding for our members in how they interact with each other and the public.” The purpose of this study, therefore, was to fulfill these objectives through the dissemination of a survey to obtain a better understanding of the diversity among ACVO members and their perceptions and experiences related to equity and inclusiveness within the ACVO.

2. Materials and Methods

An anonymous online survey was created in Qualtrics and distributed through the ACVO listservs and sent to all current members via email. The survey was voluntary, and respondents could choose to stop at any point. They could also choose to skip any questions they did not wish to answer. The study was reviewed and classified as exempt by the Colorado State University Institutional Review Board.

The survey consisted of primarily Likert scale questions with free‐text boxes provided to gather more detailed information. Demographic questions included the country(ies) in which they obtained their veterinary degree and completed their residency, current type of employment, US region of residency (if in the US), childhood setting (rural, suburban, urban), and number of years as an ACVO diplomate. Other demographic questions included age, citizen status, languages spoken fluently, gender expression, identification as LGBTQ+, ethnicity, race, relationship status, first generation college student status, caretaker of children and/or adult family members, and disability status.

The next set of questions pertained to views regarding DEI. Prior to these questions, definitions for each of these terms were given as:

Diversity: Diversity is the presence of differences within a given setting. In a professional organization, that can mean differences in gender, gender identity, race, ethnicity, sexual orientation, age, and socioeconomic class.

Equity: Equity is the act of ensuring that processes and programs are impartial, fair, and provide equal possible outcomes for every individual.

Inclusion: Inclusion is the practice of ensuring that people feel a sense of belonging in the professional organization. This means that every ACVO member feels comfortable and supported by the organization when it comes to being their authentic selves.

The instructions also included the disclaimer: “Please note that we understand that ACVO is limited by challenges within veterinary medicine as a whole regarding diversity and have therefore focused this survey on equity and inclusion.”

Examples of DEI‐related questions included asking members if they feel ACVO values DEI, if ACVO has demonstrated support for DEI, and their interest in DEI related topics. Respondents were asked to indicate their interest in 5 different educational formats (e.g., webinars, discussion group, etc.) for DEI information. Respondents were also asked to indicate their interest level in 26 DEI‐related topics using a Likert scale with 0 = none to 3 = high (or they could select “don't know”).

Two questions asked respondents to indicate their interest, using a 5‐point Likert scale with 1 = not at all interested and 5 = extremely interested, in learning more about unconscious biases. These questions included interest level in participating in activities or workshops aimed at learning about and uncovering unconscious biases and learning ways to mitigate the influence of unconscious biases in their decision‐making processes. Prior to these questions, the following definition of unconscious biases was presented:

Unconscious biases in veterinary practice refer to the automatic and unintentional prejudices or stereotypes that veterinary professionals may hold about certain groups of people, animals, or situations without consciously realizing it. These biases can influence decision‐making, behavior, and interactions with clients, colleagues, and patients.

The survey also asked respondents if they have personally experienced discrimination or witnessed the discrimination of others. For each of these questions, they were given a list of 9 potential types of discrimination (i.e., racial/ethnic, sex, religion, political views, age, sexual orientation, disability status, citizen status, mentor/location of residency) and asked if they had experienced each one never, seldom, or often.

A series of 9 questions, modified from the Perceived Group Inclusion Scale (PGIS) [39] asked respondents to indicate how they perceived the ACVO makes them feel in terms of inclusion using a five point Likert scale with 1 = strongly disagree and 5 = strongly agree. Examples include “The ACVO gives me the feeling that I belong” and “The ACVO allows me to express my authentic self”.

The last part of the survey included open‐ended questions allowing respondents to share obstacles and challenges they faced in becoming an ophthalmologist, as well as suggested priorities for the DEI committee.

2.1. Statistical Analysis

Descriptive statistics were calculated for most questions. Chi‐square analyses were conducted to test the association between age (30–39 years, 40–49 years, 50–59 years, 60 years and older) with views of how ACVO values diversity, equity, and inclusion, includes historically marginalized members, and their own feelings of inclusion within the ACVO. All analyses were performed with a commercial statistical package (SPSS, 28.01, IBM). Due to the fact that not all respondents answered each question, the total number of respondents is noted for each item.

3. Results

3.1. Demographics

The survey was sent to 567 ACVO members who subscribe to the aforementioned listservs, with responses received from 249 members for a 43.9% response rate. Most respondents obtained their veterinary degree and completed their residency in the United States, 201/249 (81%) and 239/249 (96%), respectively.

When asked about their current geographical regional location in the US, the largest number of respondents were from the Southeast (66/245, 26.9%), the West (51/245, 20.8%), and the Northeast (51/245, 20.8%). Most respondents reported growing up in a suburban (123/248, 49.6%) or urban (101/248, 40.7%) community; fewer reported growing up in a rural setting (24/248, 9.7%). When asked about place of employment, most respondents reported brick and mortar private practice (98/249, 39.4%) or brick and mortar corporate practice (75/249, 30.1%) (See Table 1 for demographics).

TABLE 1.

Demographics of survey respondents.

Country obtained veterinary degree (n = 249)		Country completed residency (n = 249)		Current geographical (regional) location (n = 245)		Type of location grew up in (n = 248)		Place of employment (n = 249)
United States	201 (81%)	United States	239 (96%)	Northeast	51 (21%)	Rural (population of < 2500)	24 (10%)	Brick‐and‐mortar private practice	98 (39%)
United Kingdom	6 (2%)	Canada	8 (3%)	Southeast	66 (27%)	Suburban (population between 2500 and 50 000)	123 (50%)	Brick‐and‐mortar corporate practice	75 (30%)
Canada	15 (6%)	Other	2 (1%)	Midwest	39 (16%)	Urban (population of > 50 000)	101 (41%)	Mobile	4 (2%)
Australia	2 (1%)			Southwest	19 (8%)			Relief	6 (2%)
Other (please specify):	25 (10%)			West	51 (21%)			Academic	50 (20%)
				Other	19 (8%)			Other	16 (6%)

Age (n = 248)		Citizen status (n = 249)		Gender (n = 248)		LGBTQ+ identity (n = 18) a		Ethnicity (n = 248)		Race (n = 249) a
≤ 30–39 years	65 (26%)	I am a natural born US citizen	195 (78%)	Female, feminine, or woman	167 (67%)	Bisexual	4 (22%)	Hispanic/Latinx	12 (5%)	American Indian or Alaska	1 (> 1%)
40–49 years	80 (32%)	I am a naturalized US citizen	20 (8%)	Male, Masculine, or Man	72 (29%)	Gay	6 (33%)	Not Hispanic/Latinx	224 (90%)	Asian	17 (7%)
50–59 years	55 (22%)	I am not a US citizen; I am a permanent US resident	12 (5%)	Genderqueer or non‐binary	1 (> 1%)	Lesbian	6 (33%)	Prefer to not respond	12 (5%)	Black or African American	6 (2%)
60–69 years	31 (13%)	I am not a US citizen	17 (7%)	I prefer not to answer	8 (3%)	Pansexual or omnisexual	2 (11%)			Native Hawaiian/Pacific Islander	1 (> 1%)
70–79 years	13 (5%)	Prefer to not respond	5 (2%)			Questioning/figuring it out	1 (6%)			White/Caucasian	213 (86%)
80 and older	4 (2%)					Queer	2 (11%)			I prefer to self‐describe	4 (2%)
						Prefer to self‐identify	2 (11%)			Prefer not to respond	11 (4%)

^a Could select more than one response.

Respondents reported being an ACVO diplomate an average time of 15.51 years (SD 11.50), with a median of 13 years and range from < 1 to 54 years. There was a wide range of ages, with most respondents reporting being between 30 and 39 years of age (65/248, 26.2%) or between 40 and 49 years of age (80/248, 32.3%). Less common responses included 50–59 years of age (55/248, 22.2%), 60–69 years of age (31/248, 12.5%), 70–79 years of age (13/248, 5.2%) and 80 or older (4/248, 1.6%).

Respondents were asked about their citizen status and most (195/249, 78.3%) reported being a natural born US citizen or a naturalized US citizen (20/249, 8.0%). When asked if they are a first‐generation college student (defined as a student whose parents/legal guardians did not complete a college degree), 55/249 (22.1%) indicated yes, 191/249 (76.7%) replied no, and 3/249 (1.2%) preferred not to answer.

When respondents were asked if they are living with any type of condition that affects their daily activities (e.g., physical disabilities, mental health conditions), 41/249 (16.5%) indicated yes, 201/249 (80.7%) indicated no, and 7/249 (2.8%) preferred not to answer.

The majority of respondents reported their gender as female (167/248, 67.3%); while 72/248 (29.0%) reported male, 1/248 (0.4%) genderqueer or nonbinary, and 8/248 (3.2%) preferred to not answer. When asked if they identify as LGBTQ+, 18/248 (7.3%) reported yes, 221/248 (89.1%) reported no, 1/248 (0.4%) unsure, and 8/248 (3.2%) preferred to not answer. The 18 respondents who indicated they identify as LGBTQ+ were asked about their identity (with the ability to select more than one response), to which the largest number reported identifying as gay (6/18, 33%) or lesbian (6/18, 33%).

When asked to indicate their ethnicity, most respondents reported being non‐Hispanic or non‐Latino (224/248, 90.3%); while 12/248 (4.8%) reported being Hispanic or Latino and 12/248 (4.8%) preferred to not answer. When asked about race, most respondents described themselves as White (213/249, 86%), followed by Asian (17/249, 7%), Black/African American (6/249, 2.4%), Native Hawaiian or other Pacific Islander (1/249, 0.4%), American Indian or Alaska Native (1/249, 0.4%), prefer to self‐describe (4/249, 1.6%; Caucasian (n = 1), European‐white (n = 1), Hispanic (n = 2)) and prefer to not answer (11/249, 4.4%). Respondents were asked to indicate any/all languages in which they are fluent. A total of 13 languages were reported (Table 2).

TABLE 2.

Respondents' report of languages, in addition to English, that they speak fluently (n = 249).

	N	%
Chinese	4	2
Danish	1	< 1
French	13	5
German	7	3
Hebrew	1	< 1
Irish	1	< 1
Italian	3	1
Japanese	2	< 1
Korean	2	< 1
Portuguese	4	2
Serbian	1	< 1
Spanish	15	6
Tagalog	1	< 1

Respondents were asked about their relationship status and 193/248 (77.8%) reported being married/partnered, 47/248 (19.0%) reported being single, and 8/248 (3.2%) preferred not to answer. Respondents were asked how many children they care for under the age of 5, to which most reported none (183/238, 76.9%). Similarly, most reported not caring for any children between 5– and 10 years of age (191/233, 82.0%), nor children 11–18 years of age (195/236, 82.6%) (Table 3). When asked if they were the caretaker for any adult family members, 43/248 (17.3%) reported “yes” and 205/248 (82.7%) reported “no”.

TABLE 3.

Respondents' report of children they care for under the age of 5, ages 5–10, and ages 11–18.

	Children under 5 (n = 238)		Children 5–10 (n = 233)		Children 11–18 (n = 236)
	N	%	N	%	N	%
None	183	77	191	82	195	83
1 child	26	11	26	11	23	10
2 children	24	10	15	6	16	7
3 children	4	2	< 1	< 1	2	< 1
More than 3 children	1	< 1	—	—	—	—

3.2. DEI Perceptions

When respondents were asked to indicate how important it is for individuals and organizations to engage in DEI training, 71/249 (28.5%) respondents indicated very important and 60/249 (24.1%) indicated extremely important. When asked to what extent they believe addressing matters related to DEI should be prioritized within the ACVO, the largest percentages reported it should be a moderate (66/248, 26.6%) or high priority (61/248, 24.6%) (Table 4).

TABLE 4.

Respondents' views of the importance of DEI training and to what extent DEI should be prioritized within the ACVO.

	N	%
Importance for individuals and organizations to engage in DEI training (n = 249)
Not at all important	26	10.4
Minimally important	30	12.0
Somewhat important	62	24.9
Very important	71	28.5
Extremely important	60	24.1
Priority level of DEI within the ACVO (n = 248)
Not at all a priority	38	15.3
Low priority	45	18.1
Moderate priority	66	26.6
High priority	61	24.6
Essential priority	38	15.3

3.3. DEI Training

When respondents were asked to indicate their interest in exploring different perspectives related to DEI through educational sessions, over one‐half indicated being somewhat (74/249, 29.7%), very (55/249, 22.1%) or extremely interested (42/249, 16.9%). When asked about their interest in activities or workshops aimed at learning about and uncovering unconscious biases, 82/242 (33.9%) were somewhat interested, 52/242 (21.5%) were very interested, and 29/242 (12.0%) were extremely interested. Similarly, when asked if they were interested in learning ways to mitigate the influence of unconscious biases in their decision‐making processes, most were either somewhat (70/242, 28.9%), very (69/242, 28.5%) or extremely (31/242, 12.8%) interested (Table 5).

TABLE 5.

Respondents' reported interest in DEI educational sessions and unconscious biases.

	Not at all interested		Minimally interested		Somewhat interested		Very interested		Extremely interested
	N	%	N	%	N	%	N	%	N	%
Interest in exploring different perspectives related to DEI through educational sessions (n = 249)	41	16.5	37	14.9	74	29.7	55	22.1	42	16.9
Participate in activities or workshops aimed at learning about and uncovering unconscious biases (n = 242)	43	17.8	36	14.9	82	33.9	52	21.5	29	12.0
Learn ways to mitigate the influence of unconscious biases in decision‐making processes (n = 242)	38	15.7	34	14.0	70	28.9	69	28.5	31	12.8

Nearly half of respondents indicated they would like regular (e.g., quarterly) updates regarding DEI efforts within the ACVO (115/247, 46.6%), while 57/247 (23.1%) were neutral and 75/247 (30.3%) indicated they do not want regular updates. When asked if they would like to get more involved in DEI efforts within the ACVO, most respondents indicated they do not want to get more involved (97/249, 39.0%) or felt neutral about it (91/249, 36.5%). When asked if they would like to have activities related to DEI issues and/or initiatives offered at ACVO‐sponsored events (e.g., annual meeting), 110/248 (44.3%) agreed, while 62/248 (25.0%) were neutral and 76/248 (30.6%) disagreed.

When asked to indicate their interest level with several forms of DEI training and activities, respondents reported the most interest in DEI webinars (high interest = 51/237, 21.5%), followed by DEI‐related guest speaker at the annual ACVO meeting (high interest = 50/236, 21.2%) (Table 6). When respondents were asked to indicate their interest in 27 DEI‐related topics, the topics with the most interest included: Family‐Friendly Policies and Work‐Life Balance (high interest = 112/223, 50.2%), Conflict Resolution in Diverse Teams (114/228, 50.0%), Unconscious Bias in Client Interactions (110/231, 47.6%), and Inclusive Leadership (107/228, 46.9%) (Table 7).

TABLE 6.

Respondents' interest in five formats to disseminate DEI information.

	None		Low		Medium		High
DEI webinars (n = 237)	58	24.5%	60	25.3%	68	28.7%	51	21.5%
DEI‐related guest speaker at the annual ACVO meeting (n = 236)	57	24.2%	46	19.5%	83	35.2%	50	21.2%
DEI reception at the annual ACVO meeting (n = 236)	67	28.4%	72	30.5%	56	23.7%	41	17.4%
DEI discussion group (n = 236)	56	23.7%	57	24.2%	84	35.6%	39	16.5%
DEI master's course at the annual ACVO meeting (n = 235)	81	34.5%	78	33.2%	47	20.0%	29	12.3%

TABLE 7.

Respondents' interest in specific DEI‐related webinar topics.

	None		Low		Medium		High		Don't know
	N	%	N	%	N	%	N	%	N	%
Family‐friendly policies and work‐life balance (n = 223)	22	9.9	22	9.9	64	28.7	112	50.2	3	1.3
Conflict resolution in diverse teams (n = 228)	27	11.8	23	10.1	60	26.3	114	50.0	4	1.8
Unconscious bias in client interactions (n = 231)	34	14.7	28	12.1	58	25.1	110	47.6	1	0.4
Inclusive leadership (n = 228)	34	14.9	28	12.3	56	24.6	107	46.9	3	1.3
Veterinary team diversity and inclusion (n = 228)	33	14.5	30	13.2	58	25.4	105	46.1	2	0.9
Recognizing and addressing microaggressions in the workplace (n = 222)	32	14.4	29	13.1	56	25.2	102	45.9	3	1.4
Microaggressions awareness (n = 227)	38	16.7	30	13.2	53	23.3	102	44.9	4	1.8
Creating a diverse and inclusive workplace culture (n = 227)	31	13.7	29	12.8	64	28.2	102	44.9	1	0.4
Disability awareness and accessibility (n = 231)	24	10.4	23	10.0	78	33.8	103	44.6	3	1.3
Cultural competence in veterinary medicine (n = 230)	33	14.3	25	10.9	70	30.4	102	44.3	0	0.0
Addressing health disparities in veterinary medicine (n = 231)	27	11.7	25	10.8	77	33.3	101	43.7	1	0.4
Health equity for animal patients (n = 228)	28	12.3	20	8.8	71	31.1	99	43.4	10	4.4
Cultural humility (n = 228)	39	17.1	26	11.4	66	28.9	96	42.1	1	0.4
Inclusive communication and decision‐making (n = 221)	36	16.3	37	16.7	52	23.5	93	42.1	3	1.4
Socioeconomic status and access to veterinary care (n = 231)	24	10.4	22	9.5	86	37.2	96	41.6	3	1.3
Ethical considerations in diversity and inclusion (n = 228)	39	17.1	35	15.4	58	25.4	94	41.2	2	0.9
Unconscious bias in hiring and promotion (n = 227)	34	15.0	29	12.8	69	30.4	90	39.6	5	2.2
Gender equity in veterinary medicine (n = 228)	45	19.7	32	14.0	64	28.1	87	38.2	0	0.0
Building allyship and solidarity (n = 222)	47	21.2	38	17.1	56	25.2	79	35.6	2	0.9
Continuous learning and development on diversity and inclusion (n = 221)	45	20.4	34	15.4	64	29.0	76	34.4	2	0.9
LGBTQ+ inclusivity in veterinary practice (n = 231)	45	19.5	32	13.9	74	32.0	79	34.2	1	0.4
Mentorship and sponsorship for underrepresented groups (n = 223)	41	18.4	39	17.5	63	28.3	76	34.1	4	1.8
Creating affinity groups and support networks (n = 221)	50	22.6	42	19.0	61	27.6	65	29.4	3	1.4
Training on LGBTQ+ inclusivity and pronoun usage (n = 222)	58	26.1	36	16.2	66	29.7	61	27.5	1	0.5
Cultural celebrations and awareness days (n = 222)	51	23.0	41	18.5	67	30.2	60	27.0	3	1.4
Religious and spiritual sensitivity (n = 231)	52	22.5	52	22.5	70	30.3	55	23.8	2	0.9

3.4. Views About the ACVO'S DEI‐Related Behaviors and Actions

When asked if they feel that the ACVO demonstrates that it values diversity, 107/249 (42.9%) strongly agreed/agreed, 71/249 (28.5%) were neutral, and 71/249 (28.5%) strongly disagreed/disagreed. When asked if they feel that the ACVO demonstrates that it values equity, most either strongly agreed/agreed (120/248, 48.4%) or were neutral (69/248, 27.8%), while 59/248 (23.8%) strongly disagreed/disagreed. Similarly, when asked if ACVO demonstrates that it values inclusion, 117/249 (47.0%) strongly agreed/agreed, 66/249 (26.5%) were neutral, and 66/249 (26.5%) strongly disagreed/disagreed. Chi‐square analyses conducted to test the association between age with views of how ACVO values diversity, equity, and inclusion found significant results for diversity (p = 0.004; respondents 60 years and older were more likely to agree that ACVO values diversity than younger respondents) and inclusion (p = 0.002; respondents 60 and older were more likely to agree that ACVO values inclusion than younger respondents). No significant difference was found for equity (p = 0.055) (Table 8).

TABLE 8.

Respondents' perceptions of diversity, equity, inclusion by age group.

Age		Diversity (n = 231)					Equity (n = 230)					Inclusion (n = 231)					Total
		SD	D	N	A	SA	SD	D	N	A	SA	SD	D	N	A	SA
30–39	N	5	18	15	24	3	6	13	16	27	3	5	16	14	25	5	65
	%	7.7	27.7	23.1	36.9	4.6	9.2	20.0	24.6	41.5	4.6	7.7	24.6	21.5	38.5	7.7	100
40–49	N	8	17	27	24	4	10	10	27	27	6	10	11	29	25	5	80
	%	10.0	21.3	33.8	30.0	5.0	12.5	12.5	33.8	33.8	7.5	12.5	13.8	36.3	31.3	6.3	100
50–59	N	9	8	15	12	11	7	8	15	13	11	10	9	14	12	10	55
	%	16.4	14.5	27.3	21.8	20.0	13.0	14.8	27.8	24.1	20.4	18.2	16.4	25.5	21.8	18.2	55
60+	N	3	0	8	15	5	2	1	8	17	3	2	1	5	14	9	31
	%	9.7	0.0	25.8	48.4	16.1	6.5	3.2	25.8	54.8	9.7	6.5	3.2	16.1	45.2	29.0	100

Abbreviations: A = agree, D = disagree, N = neutral, SA = strongly agree, SD = strongly disagree.

When asked if historically marginalized members have the same opportunities for leadership as historically non‐marginalized members in the ACVO, 111/241 (46.0%) agreed, 57/241 (23.75%) were neutral, and 73/241 (30.3%) disagreed. No differences based on age were found (p = 0.176). When asked if the different opinions, ideas, and perspectives brought by historically marginalized members are valued by others in the ACVO, 104/240 (43.3%) agreed, 60/240 (25.0%) were neutral, and 76/240 (31.7%) disagreed. Respondents 60 years of age and older were more likely to agree than those younger than 60 years of age (p = 0.002) (Table 9).

TABLE 9.

Perceptions of inclusion for historically marginalized members in the ACVO by age group.

Survey item	Age group	Strongly disagree	Disagree	Neutral	Agree	Strongly agree	Total
Leadership opportunities	30–39	6 (9.8%)	17 (27.9%)	15 (24.6%)	18 (29.5%)	5 (8.2%)	61 (100.0%)
	40–49	7 (9.0%)	15 (19.2%)	20 (25.6%)	24 (30.8%)	12 (15.4%)	78 (100.0%)
	50–59	6 (11.3%)	13 (24.5%)	14 (26.4%)	10 (18.9%)	10 (18.9%)	53 (100.0%)
	60+	2 (6.5%)	3 (9.7%)	4 (12.9%)	12 (38.7%)	10 (32.3%)	31 (100.0%)
Ideas valued	30–39	4 (6.6%)	17 (27.9%)	22 (36.1%)	14 (23.0%)	4 (6.6%)	61 (100.0%)
	40–49	11 (14.1%)	18 (23.1%)	19 (24.4%)	21 (26.9%)	9 (11.5%)	78 (100.0%)
	50–59	7 (13.5%)	11 (21.2%)	13 (25.0%)	11 (21.2%)	10 (19.2%)	52 (100.0%)
	60+	2 (6.5%)	2 (6.5%)	2 (6.5%)	15 (48.4%)	10 (32.3%)	31 (100.0%)
Encouraged authenticity	30–39	3 (4.9%)	14 (23.0%)	28 (45.9%)	13 (21.3%)	3 (4.9%)	61 (100.0%)
	40–49	8 (10.3%)	16 (20.5%)	26 (33.3%)	20 (25.6%)	8 (10.3%)	78 (100.0%)
	50–59	4 (7.7%)	12 (23.1%)	12 (23.1%)	16 (30.8%)	8 (15.4%)	52 (100.0%)
	60+	3 (9.7%)	2 (6.5%)	6 (19.4%)	13 (41.9%)	7 (22.6%)	31 (100.0%)
Organizational commitment	30–39	8 (13.1%)	17 (27.9%)	20 (32.8%)	14 (23.0%)	2 (3.3%)	61 (100.0%)
	40–49	8 (10.3%)	16 (20.5%)	31 (39.7%)	18 (23.1%)	5 (6.4%)	78 (100.0%)
	50–59	9 (17.0%)	8 (15.1%)	16 (30.2%)	14 (26.4%)	6 (11.3%)	53 (100.0%)
	60+	2 (6.5%)	1 (3.2%)	9 (29.0%)	12 (38.7%)	7 (22.6%)	31 (100.0%)
Leadership representation	30–39	5 (8.2%)	17 (27.9%)	25 (41.0%)	12 (19.7%)	2 (3.3%)	61 (100.0%)
	40–49	11 (14.1%)	15 (19.2%)	30 (38.5%)	18 (23.1%)	4 (5.1%)	78 (100.0%)
	50–59	6 (11.3%)	11 (20.8%)	23 (43.4%)	7 (13.2%)	6 (11.3%)	53 (100.0%)
	60+	2 (6.5%)	0 (0.0%)	15 (48.4%)	6 (19.4%)	8 (25.8%)	31 (100.0%)

When asked if historically marginalized members are encouraged to be their true selves in the ACVO, 96/240 (40%) agreed, 77/240 (32.1%) were neutral and 67/240 (27.9%) disagreed. No differences based on age were found (p = 0.052). When asked if the ACVO demonstrates a commitment to its historically marginalized members, 84/241 (34.8%) reported agreeing, 82/241 (34.0%) reported neutral and 75/241 (31.1%) reported disagreeing. Respondents 60 years of age and older were more likely to agree than those younger than 60 years of age (p = 0.033). When asked if the ACVO strives for leadership that includes representation of historically marginalized members, 69/241 (28.6%) agreed, 99/241 (41.1%) were neutral and 73/241 (30.3%) disagreed. Respondents 60 years of age and older were more likely to agree than those younger than 60 years of age (p = 0.011) (Table 9).

3.5. Experience of Discrimination

Respondents were asked if they have experienced several potential forms of discrimination. The most frequently reported forms included discrimination based on sex (20/240, 8.3%), political views (17/239, 7.1%), and mentor/location of residency (15/240, 6.3%) (Table 10). When respondents were asked to indicate forms of discrimination they had witnessed occurring to others, the forms reported most frequently included political views (37/236, 15.7%), sex (28/237, 11.8%), and mentor/location of residency (24/235, 10.2%) (Table 11).

TABLE 10.

Respondents' report of personal experience of discrimination within the ACVO.

	Never		Seldom		Often
	N	%	N	%	N	%
Racial/ethnic identity (n = 239)	208	87.0	24	10.0	7	2.9
Sex (n = 240)	154	64.2	66	27.5	20	8.3
Sexual orientation (n = 240)	227	94.6	8	3.3	5	2.1
Disability status (n = 239)	228	95.4	8	3.3	3	1.3
Religion (n = 239)	212	88.7	21	8.8	6	2.5
Political views (n = 239)	177	74.1	45	18.8	17	7.1
Age (n = 239)	183	76.6	46	19.2	10	4.2
Citizenship status (n = 239)	220	92.1	16	6.7	3	1.3
Mentor(s)/location of residency (n = 240)	175	72.9	50	20.8	15	6.3

TABLE 11.

Respondents' report of discrimination they have witnessed of others within the ACVO.

	Never		Seldom		Often
Racial/ethnic identity (n = 237)	150	63.3%	67	28.3%	20	8.4%
Sex (n = 237)	129	54.4%	80	33.8%	28	11.8%
Sexual orientation (n = 236)	158	66.9%	60	25.4%	18	7.6%
Disability status (n = 235)	204	86.8%	26	11.1%	5	2.1%
Religion (n = 235)	182	77.4%	44	18.7%	9	3.8%
Political views (n = 236)	128	54.2%	71	30.1%	37	15.7%
Age (n = 236)	161	68.2%	64	27.1%	11	4.7%
Citizenship status (n = 236)	194	82.2%	34	14.4%	8	3.4%
Mentor(s)/location of residency (n = 235)	137	58.3%	74	31.5%	24	10.2%

3.6. Feelings of Inclusion

Respondents were asked to indicate their agreement level to 9 questions pertaining to inclusion with the ACVO. The statements endorsed most often included “The ACVO… – …gives me the feeling that I am part of this group” (153/236, 64.8%), “The ACVO… – …gives me the feeling that I fit in” (146/236, 61.9%), and “The ACVO… – …gives me the feeling that I belong” (143/236, 60.6%). No differences based on age were found for any of the 9 inclusion items (Table 12).

TABLE 12.

Respondents' reported feelings of inclusion from the ACVO.

	Strongly disagree		Disagree		Neutral		Agree		Strongly agree
	N	%	N	%	N	%	N	%	N	%
The ACVO… – …gives me the feeling that I belong (n = 236)	9	3.8	22	9.3	62	26.3	84	35.6	59	25.0
The ACVO… – …gives me the feeling that I fit in (n = 236)	10	4.2	19	8.1	61	25.8	91	38.6	55	23.3
The ACVO… – …gives me the feeling that I am part of this group (n = 236)	10	4.2	16	6.8	57	24.2	99	41.9	54	22.9
The ACVO… – …allows me to express my authentic self (n = 236)	12	5.1	20	8.5	68	28.8	86	36.4	50	21.2
The ACVO… – …likes me (n = 235)	7	3.0	18	7.7	96	40.9	73	31.1	41	17.4
The ACVO… – …treats me as an insider (n = 236)	12	5.1	26	11.0	86	36.4	74	31.4	38	16.1
The ACVO… – …appreciates me (n = 235)	7	3.0	27	11.5	93	39.6	71	30.2	37	15.7
The ACVO… – …encourages me to be who I am (n = 235)	9	3.8	18	7.7	120	51.1	54	23.0	34	14.5
The ACVO… – …cares about me (n = 235)	10	4.3	28	11.9	102	43.4	63	26.8	32	13.6

3.7. Obstacles and Challenges

The open‐ended question that inquired about perceived obstacles and challenges was answered by 136 respondents. The most common responses included financial challenges, the competitive nature of the field, gender discrimination, poor mentorship and training, and struggles with work‐life balance. Other frequently mentioned challenges included nationality and immigration obstacles, biases in selection processes, and geographical and logistical challenges (e.g., travel for interviews, exams, etc.).

The open‐ended question asking respondents what they feel the DEI committee should prioritize over the next year was answered by 175 respondents. Most responses pertained to 5 general themes: professional development and training; pipeline and residency access; workplace and conference culture; policy and structure; and community building and communication.

4. Discussion

As the human‐animal bond spans across all types of people and cultures, diversity, equity, and inclusion are paramount in providing quality medical care [38]. The first step in making strides in these areas is to identify current areas of strength and potential growth. This study is the first to report on the diversity of veterinary ophthalmologists and their perceptions of equity and inclusion within the ACVO. Stemming from profession‐wide challenges within veterinary medicine, diversity among veterinary ophthalmologists in terms of gender, race, and ethnicity is unsurprisingly limited. Reflecting the demographics of veterinarians overall, the majority of veterinary ophthalmologists are White, non‐Hispanic women. To increase diversity of veterinary ophthalmologists in these areas, efforts must start by expanding the pipeline, beginning at the pre‐college and pre‐veterinary level. In addition, encouraging and promoting diversity in resident selection and providing support for underrepresented applicants is suggested. Some veterinary organizations and specialty colleges are working toward this goal with pilot programs and sponsored scholarships for attendance to specialty conferences [40, 41]. While these programs are in their infancy and are not proven to improve diversity in resident selection, the ACVO could consider similar programs or partner with other organizations that foster equity and inclusion to promote interest, access, and awareness of the specialty earlier in veterinary education.

Over half of respondents in the study reported believing that it is either very important or extremely important for individuals and organizations to engage in DEI training. Additionally, almost one‐third of survey respondents expressed being at least somewhat interested in exploring different perspectives related to DEI through educational sessions. The educational formats viewed most favorably for DEI training include webinars and DEI‐related guest speakers at the annual ACVO meetings. Webinars, in particular, have been found to be effective in creating DEI awareness and changing behaviors [19]. The ACVO could capitalize on this interest by offering virtual DEI webinars, discussion groups, and guest speakers at the annual ACVO meeting.

When respondents were asked if they feel the ACVO demonstrates that it values DEI, while most respondents reported feeling that the ACVO values DEI principles, results indicated that one‐quarter of respondents reported feeling that the ACVO does not demonstrate it values diversity (29%), equity (24%), or inclusion (27%). Respondents younger than 60 years of age were less likely to report feeling ACVO demonstrates that it values DEI than those 60 years of age and older.

When asked if historically marginalized members have the same opportunities for leadership, 70% of respondents felt they do, while 30% reported feeling they do not. Similarly, when asked if different opinions, ideas, and perspectives brought by historically marginalized members are valued, 68% of respondents agreed (32% disagreed). Approximately two‐thirds also agreed that historically marginalized members are encouraged to be their true selves in the ACVO (72%) or that the ACVO strives for leadership that includes representation of historically marginalized members (70%). Despite these perceptions by respondents, select marginalized groups have been represented in various ACVO leadership roles by way of the ACVO BOR (including president and vice‐president), committees, and committee chairs and co‐chairs. When looking at the current ACVO BOR for 2025–2026, for example, the board is made up of eight individuals (6 voting, 2 non‐voting). Of these individuals, seven identify as female and one identifies as male. Additionally, one member identifies as a Black woman. Although this is only one example, it is important to point out the data about current leadership to show the need for further investigations and surveys such as the current one to compare perceptions of respondents with factual demographic data. By doing this, readers of this manuscript and survey respondents/members of the ACVO can become more knowledgeable about these topics, which in turn will allow for more effective and stable change to continue to happen within the ACVO and ACVO leadership.

Interest in supporting DEI by the ACVO Board and leadership is evident in their creation and support of a DEI committee, and DEI‐focused research (such as this survey). Yet, survey responses suggest the ACVO has room for improvement. Suggestions include increasing communication by ACVO leadership to ACVO members about their interest in implementing and promoting DEI initiatives, continuing to listen to its historically marginalized members when they offer different opinions, ideas, and perspectives, and continuing to encourage historically marginalized members to run for leadership positions within the organization. These steps can aid in increasing marginalized members' potential and fostering creative thinking and dialogue between colleagues. Additionally, members may become more engaged if they feel like they belong and are therefore more likely to remain a member of the organization.

When queried about personal experiences of discrimination, the forms of discrimination experienced the most were based on sex (8%), political views (7%), and mentor/location of residency (6%). These were the same forms of discrimination witnessed being experienced by fellow colleagues: political views (16%), sex (12%), and mentor/location of residency (10%). Additional insights into how ACVO members who completed the survey feel about their experiences with the ACVO include their feelings about inclusion. In response to the survey items pertaining to feelings of inclusion, a minority of respondents reported feeling that they did not fit in (12%), did not feel part of the group (11%), did not feel cared about (15%), appreciated (15%), or treated as an insider (16%). While only a minority of members report these feelings, these results warrant attention.

While the ACVO has a Code of Ethics and Harassment Policy [42] available to all members, the results suggest that some individuals may not feel comfortable reporting incidents of discrimination (either of self or others) to the necessary committees or parties. This is not a unique finding to the ACVO, as it mimics findings within other areas of veterinary medicine. This lack of reporting could be due to any number of reasons including previous negative experiences reporting, fear of retaliation, or a lack of transparency between trainees and mentors/governing organizations including training programs. Unconscious bias in mentoring relationships is notably one of the most difficult aspects of training within all medical fields, and both the Association of American Medical Colleges (AAMC) [43] and the American Association of Veterinary Medical Colleges (AAVMC) [44] recognize this as one of the biggest hurdles in promoting diversity and inclusion within medical fields. Based on the results of this survey, development of more diverse mentorship programs within the ACVO between potential, new, and seasoned members, as well as more oversight and auditing of training programs is a crucial need.

In addition, these results suggest that additional training and education regarding unintentional discrimination may be beneficial. Oftentimes, discrimination discussions focus exclusively on race and ethnicity, yet there are numerous ways to discriminate, and education is key to helping people understand how their actions may be inadvertently discriminatory. Accordingly, it is suggested that ways to increase inclusivity within the ACVO include continuing to ensure ACVO events and conferences are openly inclusive and welcoming to all members. Additionally, it is imperative for the ACVO leadership to continue efforts to actively support DEI initiatives and incorporate them into ACVO's structure.

Veterinary specialty organizations can and should simultaneously recognize the importance of selecting highly qualified applicants for specialty level residencies and leadership roles while also acknowledging and trying to mitigate implicit biases and the inherent challenges that underrepresented individuals face in the veterinary field. These inherent challenges include, but are not limited to: lack of representation, role models, and mentorship in veterinary medicine, as well as financial limitations, discrimination, and biases (i.e., assuming a person is not smart based on skin color, or was accepted into a particular position based on the same assumption).

There are several limitations to this study that should be noted, including those inherent in an on‐line survey. The survey was distributed via member email and the ACVO Listservs, which are optional. Therefore, the survey was likely not distributed to every member of the college, as the survey only went to the email addresses on file. The sample consisted of only a percentage of ACVO members (44%), so caution is warranted when generalizing to all ACVO members. Another limitation is response bias; ACVO members who feel strongly about DEI (either positively or negatively) may have been more likely to complete the survey. In addition, future research should include questions pertaining to conference attendance and committee participation. Lastly, although this study highlights perceived inequities in leadership access within the ACVO, the absence of detailed qualitative data limits our ability to specify which leadership or professional development opportunities may have been less accessible to historically marginalized members. Future research could include interview‐based data to substantiate and contextualize these perceptions.

In conclusion, improved DEI within the ACVO should remain a critical and sustained objective that will promote greater capacity and talent of a varied and broadened demographics within the specialty. The results of this study offer a data‐driven foundation to implement policies and procedures within the ACVO to help ensure that all members feel equal, included, and valued. The creation and support of the ad hoc DEI committee is a vital step in this direction. Respondents to the survey shared their views on DEI within the ACVO, which solidified the ad hoc DEI committee's priorities moving forward (i.e., professional development and training; pipeline and residency access; workplace and conference culture; policy and structure; and community building and communication).

Author Contributions

All authors contributed to study conception, design, and data collection. L.R.K. performed data analysis. L.R.K. and M.R.T. drafted the manuscript. All authors contributed to manuscript revisions and approved the submitted version.

Disclosure

Artificial intelligence statement: The authors have not used AI to generate any part of the manuscript.

Ethics Statement

Study approved by Colorado State University Institutional Review Board (#5882, approved 6/11/2024).

Conflicts of Interest

The authors declare no conflicts of interest.

Kogan L. R., Telle M. R., and Gibson T. E., “Demographics and Perceptions of Diversity, Equity, and Inclusion of the American College of Veterinary Ophthalmologists (ACVO) Members,” Veterinary Ophthalmology 29, no. 2 (2026): e70150, 10.1111/vop.70150.