Begin with the arithmetic that makes practice-level comparison useless. If the pace STAT describes held for a year, two or three transferred families a week is roughly 104 to 156 families [13]. Every one of those transfers raises the dismissing clinic's measured coverage and lowers Middleboro's, without any child receiving or refusing a single additional dose. Epidemiologists have a name for this: channeling. Comparing panel coverage between a strict practice and a flexible one 20 minutes away tells you where the hesitant families are sitting [3], not what either policy accomplished.
The comparison that would answer the question follows the same child forward. You would need dose counts over time for families who declined and stayed, set against dose counts for families who declined and were shown the door, including the ones who then attached to no practice at all. Nothing in this account follows the dismissed families [16]. And the retained group is filtered before it forms: the meet-and-greet is an eligibility screen, and Bornstein is asking whether a parent who refuses vaccines will also refuse antibiotics for a bad infection or an adequate exam [2]. That screen is clinically defensible. It also means the retained cohort is not the hesitant population, but the subset that passed an interview.
Selection runs from the family's end too. The mother in the story liked her Fall River pediatricians and had exactly one objection [17]; she was told her daughter needed the full schedule by age 2 or the practice could not keep her, because that was protocol [7]. A parent who drives to a meet-and-greet at a practice known for flexibility is self-selected toward wanting care. Whatever retention achieves in her is an upper bound on what it would achieve in a family that simply stops showing up.
There is also a numerator problem that has nothing to do with either practice. With the January cut to the recommended childhood list bypassing normal procedure and then struck down by a judge [8], and an executive order to break MMR into three shots [9], "up to date" is measured against which schedule? That is the question some pediatricians are actually chewing on, alongside whether to double down on dismissal or loosen [10].
Treat the partisan trust numbers with the same care. The 32-point gap between Democrats and Republicans [14] is an attitude toward immunization in general [11], not acceptance of a specific shot at a specific visit, and it is national while the caseload here is one Massachusetts practice. The only behavioral signal in the account is frequency: hesitancy conversations moved from about monthly to two or three times a week [12]. That measures demand for the conversation, not its result.
My read, and I will hold it with conditions: retention is the better default on the evidence available, because the outcome that matters includes the 2 a.m. fever as well as the MMR, and no clinician delivers a dose to a child who is no longer their patient. The condition is measurable. If retained families' dose counts stay flat while flexible practices concentrate enough unvaccinated children to seed local transmission, the default is wrong. Neither figure exists yet, because nobody is counting either one.
