As you’re likely aware, the US House of Representatives last week narrowly passed House of Representatives Bill 2192 – more commonly known as the American Health Care Act (AHCA) or Trumpcare. There was a time when physicians wouldn’t have been considered terribly “political,” and there still is a strongly pervasive “culture of permission” in medicine (see Dr. Bryan Vartabedian‘s thinking on this evolving phenomenon). However, like many other things we’ve taken for granted in the Trump era, the old rules really just don’t apply.

In order to assess physicians’ reactions to our most recent version of health reform, we consulted the MDigitalLife Online Health Ecosystem database. As a frame of reference, during the 3-year period between 2014 and 2016, .43% of physicians’ posts were related to health reform*. In the “new normal” of 2017, that percentage has risen to 3.1%, an increase of more than 6x.

Because we suspected that the passage of HR2192 in the house was going to cause a firestorm among online physicians, we decided to zoom in on the week that it was passed – Monday the 1st of May through Friday the 5th of May. As suspected, the passage of the house bill caused quite a stir.

NOTE: All statistics below are based on a random sample of 10,000 US Physicians posting between January 1, 2017 and May 5, 2017.


In and of themselves, however, those numbers don’t mean much. What is really interesting, though, is looking at those numbers in the context of TOTAL online physicians’ posts. Remember, we established that in the “old normal,” .43% of US physicians’ posts would be about health reform. And in the new normal, about 3.1% would be about health reform. On Thursday of this past week (5/4/2017), the day that the AHCA passed the house, a staggering 16.9% of US physicians’ posts were about health reform.

One of the things we’ve learned after years of studying online conversations is that going strictly by the number of posts can be misleading because it’s possible for a few very heavy posters to sway the balance for an entire population. For that reason, we also look carefully at the number of unique authors involved in every conversation. In this case, the unique authors were also explosively high – 28.7% of all physicians who posted on the 4th of May, posted something about health reform.

Fig. 2 - Percentage of US Physicians posting on Health Reform from 1 May to 5 May, 2017

Fig. 2 – Percentage of US Physicians posting on Health Reform from 1 May to 5 May, 2017

Just as the debate around health reform has been a volatile one, so has physicians’ participation. Unsurprisingly, the spikes in the participation have been centered around votes (or anticipated votes) in the house.

Fig. 3 - Percentage of US MDs posting about health reform relative to all physicians posting

Fig. 3 – Percentage of US MDs posting about health reform relative to all physicians posting

It’s also quite telling to examine these conversations in terms of who physicians are engaging as they post about health reform; in other words, who are they talking to and about. Below is a mention map illustrating exactly who these US physicians are talking to and about as the post on health reform during the week of 1 May, 2017. Click on the image (or here) to be taken to an interactive version of this map, in which you can identify each node by name.

Fig. 4 - "Mention Map" - Who are US physicians talking TO and ABOUT in health reform conversations

Fig. 4 – “Mention Map” – Who are US physicians talking TO and ABOUT in health reform conversations

An upcoming post will focus on identifying some of the attitudes & sentiment of these physicians relative to health reform and its architects. However, I can tell you that anecdotally, the posts have been overwhelmingly oriented to physicians expressing concern about patients ability to receive adequate care should the AHCA pass the Senate. In fact, many physicians have been actively soliciting their peers for opinions; some more formal than others. I wanted to draw your attention to a particularly fascinating (and passionate) online conversation sparked by Esther Choo, MD/MPH, a member of the faculty at the Oregon Health and Science University’s Center for Policy and Research in Emergency Medicine. Dr. Choo made such a request (see below) that has garnered nearly 200 responses along with almost 2,000 retweets (so far). It makes for a fascinating read – I encourage you to read some of those responses, and join in yourself as appropriate.


There’s much more to come on this subject; in the meantime please don’t hesitate to reach out to the MDigitalLife team should you have any questions related to the reporting you’ve seen here, or would like to see how you and your organization could leverage the unique data, analysis and insights that are made possible only through the MDigitalLife Online Health Ecosystem database.

*Based on a random sample of 25,000 US physicians posting between 1 January 2014 and 31 December 2016 – a sample size of 21,451,617 posts

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