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Politely inform your animal owning patients that until they're are properly secured, you won't be able to enter their property.

Easy

If they don't cooperate - well, you get the idea...

If your employer insists you treat patients with unsecured animals about, they must know if you're injured by one, after citing your concerns, then they assume a large avoidable risk...

As for the argument about pit bulls, I too think no matter how well treated, they have a trigger, that if/when pulled often results in grave injury or death for a human being. Of course, this trigger is there for all dangerous/lethal breeds, be it pit bull or a St. Bernard.

Proper and kind treatment certainly lessens this potential, but doesn't rule it out. Nor does it mean they automatically attack when provoked, but the possibility is similar to someone owning a kind and lovingly trained tiger cub. You can't ever completely trust these lethal critters when grown.

Ever.