Constantine Moschonas loves being a neurologist. ”Sometimes I feel guilty, though,” he recently told his colleagues at the 2017 meeting of the American Association of Neurology. “Because I feel like I’m getting more from my patients than they are getting from me.” No, Moschonas is not some doe-eyed new grad; he’s the director of Four Peaks Neurology, a private practice in Scottsdale, Arizona, and he’s been in practice for 22 years. His secret and the best way to avoid mid-career burnout, he tells colleagues, is to diversify income streams and obligations.

Moschonas didn’t figure this out right away, though. A few years ago he, like a lot of neurologists in private practice, was contending with the huge EMG cuts and poor reimbursement prospects for all the cognitive work he was doing. He had to work harder to make less money, and he began to lose his enthusiasm. “What am I doing here?,” he asked himself. “I was working eight to six, Monday through Friday and then taking care of EMR after that. I was starting to ask if I was in a burnout phase.”

He had spent years building his career. He was well established. He had met his goals but he wasn’t as happy as he should have been. Then, at age 55, two things happened that changed his whole attitude: he started teaching, and he got involved in clinical trials.

Teaching

Moschonas’ teaching career started at a nearby hospital. “They asked if I wanted to be head of this program to teach residents.They would give me a small stipend for teaching and slides etc.”

At first he says he was overwhelmed by the idea, but he admits he has a hard time saying no. In the end, though,“This gave me another income stream, and it was fun and exciting. My [four-person practice] partners were really interested in doing this too. They are now teaching neurology to internal medicine residents. It has given me and my partners a spark in our careers.”

Clinical Trials

Moschonas got involved in research and clinical trials through a colleague: a radiologist who started his own research entity. “He approached me about research for a product related to stroke treatment. The next study we got into was for Alzheimer’s.”

He currently works on clinical trials through Imaging Endpoints, a site management organization. They provide the location, all the necessary equipment, a research coordinator, and staffing to efficiently run the clinical trial. “All I have to do is be the neurologist.”

If you are not lucky enough to have someone approach you, Moschonas says it can take a bit of research to get involved in clinical trials. He recommends starting with your local neurology or medical association. “Ask your pharmaceutical reps what drugs are coming up.”

He also says, “Be willing to do some work for free initially—to prime the pump. When they selected our site, we did a lot of work calling to find out which patients wanted to be involved in studies.” For the Alzheimer study he says, “We had a list of almost 40 patients, and we were the fastest enrolling center in the nation.”

Even though Moschonas now takes a day off a week to pursue research, he says that diversifying his activities and income streams was the best thing he could do for his patients. He has more energy and enthusiasm to share.

Through his teaching he stays up on the evolving science of neurology, which he can pass along to his patients. And through the clinical trials, some of his patients are now able to get care (and more of his time) that wouldn’t otherwise be covered by insurance.

“I love patient care, and I don’t want to give it up,” says Moschonas. “I want to keep working another 15 or 20 years.” He got his spark back and also found that the revenue from these other activities covered his costs. “Having these extra income streams means our younger partner can take off work at 3:30 so she can be with her kids. I get to see my patients more, and it is a way to get reimbursed really fairly for the cognitive work I am doing.” Everyone wins.