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Journal club replay!! We walked through the 2026 AAP clinical report on iron deficiency and iron deficiency anemia (Powers JM et al., Pediatrics 2026;158(1):e2026077414). This is the first full update since 2010. The biggest shift is that hemoglobin is the LAST thing to drop. If we only screen for anemia, we miss most of the kiddos with low iron, and those first few years of brain growth are when they need it most. This journal club was supported by an educational grant from Hiya Health… they have a new healthcare program for HCPs only (no influencers!) to get samples for your office (seriously, try the fiber; our kids love it!)…and they pay you a referral fee of $80 for each family that uses your practice’s referral link/QR code. It takes about 42 seconds to apply. The quick version: * Universal screening for iron deficiency AND iron deficiency anemia between 9 and 18 months: 9 to 12 months for mostly breastfed babies, around 15 months for formula fed * Screen adolescent females around age 14, or a year or two after menarche * Screening is a CBC plus a serum ferritin. Hemoglobin alone isn’t enough anymore * A low ferritin by itself is enough to diagnose iron deficiency. Aim for at least 20 in young and school-aged kids and at least 30 in adolescents. Go for 50 or higher when there’s pica, fatigue, restless legs or sleep and behavior issues * Treat iron deficiency even when hemoglobin is normal. No need to wait for anemia * Dosing is 3 mg/kg elemental iron once daily on an empty stomach. Every other day is a reasonable option for kiddos who won’t tolerate daily dosing * One thing we discussed at length in the chat is how to find a happy medium and settled on a POC hemoglobin + serum ferritin (can be drawn on a fingerstick into a microtainer tube) Timestamps: * 11:40 Prevention and screening. Iron at 4 months for exclusively breastfed babies, preemie dosing, milkaholic toddlers, and who gets screened when. * 18:50 Fun pathophys. Why iron-deficient kids crave ice, how iron drives dopamine in ADHD, and why low ferritin shows up as restless legs at night. * 23:15 Diagnosis. The new ferritin cutoffs, ferritin as an acute phase reactant, and when you do or don’t need a CRP. * 30:45 Management. Ferrous sulfate vs more palatable options, once daily vs every other day, vitamin C, and when to move to IV iron. * 40:10 Implementation. The “happy medium” of a fingerstick hemoglobin plus ferritin (one poke, one tube), sorting breastfed vs formula-fed babies in a busy clinic, and coding and cash pay labs so families don’t get surprise bills. * 53:30 Q&A. Getting IV iron ordered without a hematology referral, lead screening timing, mixed feeding, and families who push back on iron. This workshop was supported by an educational grant from Hiya Health… they have a new healthcare program for HCPs only (no influencers!) to get samples for your office (seriously, try the fiber; our kids love it!)…and they pay you a referral fee of $80 for each family that uses your practice’s referral link/QR code. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit philboucher.substack.com/subscribe

Your no-show rate is climbing, and it's not because patients forgot. They're scared of the bill. An MGMA poll found 1 in 3 practices seeing more no-shows in 2026, and the drivers are financial, not behavioral... which means a fee on the first miss can cost you the patient you would have kept. Then a deep dive on the 10 minutes that buy back the rest of your day: the daily huddle, how to run one, and how to hand it off so you're not the one corralling everybody. Finally, a question from a practice owner watching volumes fall three quarters in a row, and what to do about it this month. What you'll take away: - Why a first-visit no-show fee can push away the patient you most want back -How to move the cost conversation to before the visit instead of at checkout - The 10-minute daily huddle: who's in the room, what you cover, and how to hand it off - A one-month plan to get your team filling the schedule instead of waiting for the phone to ring By the numbers (MGMA Stat, August 2026) 32% of practices report higher no-show rates in 2026... 58% about the same, 10% lower Average Marketplace deductibles rose 37%, to $3,786 Marketplace enrollment fell by millions of patients between 2025 and 2026 42% of practices charge a no-show fee Chapters (00:00) What's in this episode (02:00) No-shows are up, and forgetfulness isn't the reason (13:30) Deep Dive: the 10-minute huddle (28:00) Q&A: "our volumes are down three-quarters running" Links The article: "About 1 in 3 medical groups see higher no-shows in 2026 as patients face higher costs," MGMA Stat, August 2026 — https://www.mgma.com/mgma-stat/about-1-in-3-medical-groups-see-higher-no-shows-in-2026-as-patients-face-higher-costs Have a question for a future episode? Comment on this episode at philboucher.substack.com Sponsor: Novaferrum The 2026 AAP Clinical Report has docs buzzing about testing CBCs & ferritins (appropriately so!) and explicitly flags palatability as a real barrier to adherence. Several studies support that iron polysaccharide complexes may be better tolerated for some children.The relevant data point is the BESTIRON trial (Powers et al., JAMA 2017;317(22)), a randomized comparison of ferrous sulfate vs. polysaccharide iron complex (NovaFerrum) in kids with iron-deficiency anemia. Both groups improved (hemoglobin 7.7 → 11.1 g/dL at goal), but adherence diverged: 94% of NovaFerrum doses were successfully taken vs. 82% for ferrous sulfate (P=.009), with significantly less reported difficulty administering the medication at weeks 6, 8, and 10. If you get one chance to get it right (not trying 5 different forms of iron), NovaFerrum is a great option to keep in your back pocket, priced comparably to standard iron (about $0.22/serving). ----------- Weekly writing on private practice — philboucher.substack.com Want to talk through your own practice? pbmd.co This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit philboucher.substack.com/subscribe

Quick question from one of the registrants of our upcoming Virtual Pediatric DPC Summit on boundaries… This is one of the most important and underdiscussed topics in DPC and so important to get right from the start, if possible, and certainly keep working on regularly. Please don’t believe the rantings of the old guard that DPC means doing stitches on Christmas morning or delivering a dose of Decadron out at 2am for a crouper…this does not have to be the way! And hey! The pediatric dpc summmit (virtual!) is in exactly one month!! Right now a ticket is $97 and jumps to $147 on September 1 so get your seat now and take yourself out to dinner for being the type of person that registers as an early bird! This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit philboucher.substack.com/subscribe

Three out of four patients won't book with a practice rated under four stars. Here's what actually moves that number. A new Medical Economics survey of more than 1,000 patients maps how people find a practice in 2026, and almost none of it looks like it did three years ago. Then a deep dive on why you should be running a scribe, and finally, how to stand out in your community when your patients are hearing loads of misinformation from bad actors. What you'll take away Why chasing takedowns of bad reviews wastes your time, and what to do instead The two complaints that cost you more patients than your wait times or your billing ever will How to pick a scribe without getting stuck deciding which one is best A way to show up locally that doesn't add anything to your plate By the numbers (Medical Economics, August 2026) 75% of patients won't book below four stars 55% have canceled or avoided booking because of reviews 66% say a clinician responding to reviews changes how much they trust them 47% used ChatGPT, Google AI, or Claude to research a clinician before booking, up from 31% nine months ago Chapters (03:00) How patients actually find you in 2026 (14:30) Deep Dive: you deserve a scribe (25:20) Q&A: standing out when your community is full of noise Links The article: "How AI, Online Reviews, and Rising Standards Are Redrawing the Path to Care," Medical Economics, August 2026 Ask a question for a future episode This episode's sponsor, Practos, an AI receptionist for your practice — getpractos.com Weekly writing on private practice — philboucher.substack.com Want to talk through your own practice? pbmd.co This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit philboucher.substack.com/subscribe