When we interviewed Karl Singer in 1993 for the first issue of Family Practice Management, he seemed to be a physician who had truly achieved life balance: He was president of a four-physician practice, medical director of a nursing home, medical director of the journal Patient Care, a husband of 27 years and an involved father of five. He played the viola in the local orchestra and went home for lunch every day. Now, almost six years later, we've asked him to tell us how his life balance has withstood the ongoing changes in the health care environment.

“It's a really tough time,” he says. “A huge number of doctors are going through organizational changes. Doctors are getting laid off; doctors are in practices that are going into bankruptcy. I've never seen anything like it.”

Singer himself hasn't been untouched by change. In 1995, his small group became part of a 1,000-member group. “Then last spring they decided to get rid of our group. They tried to sell it. When we found out in September that no one was going to buy it, we had nine weeks to re-establish ourselves as an independent group — an interesting challenge,” he says. On Dec. 1, 1998, the four physicians and three new associate providers were back in business independently. At the same time (and for the first time in 30 years), Singer and his wife, Paula, had to adjust to having no children living at home.

How has he coped? Part of Singer's strategy came to him quite by accident, at a lecture given by Thomas Perls, MD, MPH, lead investigator of the New England Centenarian Study, an ongoing study of centenarians and their families in and around Boston.

“His lecture crystallized for me what I try to keep in mind as a way to approach what's inevitable in life — that there's going to be conflict and loss, and that you've got to develop positive strategies to deal with these things,” Singer says.

Life is what you make of it

Singer explains that centenarians have three traits in common. “First of all, they're always learning,” he says. “Maybe their hobby is oil painting. At 85 they took up watercolors; at 95 they took up pastels. So they're always stretching their minds. Second, they're very tolerant. They have strongly held beliefs but are open to understanding that other people have very different beliefs. Third, they accept loss. If you're over 100, you've probably lost two or three spouses, maybe some of your children. They adjust to it and move on. Life challenges everyone, and the critical issue is how you look at the challenges.”

To help him manage change and stay enthusiastic for his patients, Singer has found that it's important to learn new things, develop interests outside medicine, stay connected to friends and family, maintain a regular exercise program and have role models. One of his role models is his 83-year-old aunt, who still practices law, takes piano lessons and travels throughout the world. Others include U.S. presidents. “These men were often very ordinary before they suddenly were thrust into the role of president, and they dealt with incredibly challenging situations,” Singer says. “Seeing what they grappled with always makes my problems look small by comparison.”

Singer often shares the lessons of the centenarian study and his life experiences with his patients. “I talk to them about having role models, about exercise,” he says. “I talk to them about what's happened in our practice and how I've tried to look at it in a positive way. The reality is that all of us face tough times; all of us face change; what's important is the way you handle it. We're dealt a hand of cards, and none of us knows what they're going to be. Our job is to learn to play them the best we can.”

For physicians, Singer's best advice for avoiding burnout is to focus on the point of being a doctor: helping patients. “I really try to relate to them, learn about them as people and get joy out of the intellectual challenge of practicing medicine,” he says. “There's not a day that goes by when I don't see some kind of problem that I haven't seen before. We're always being intellectually challenged, and there really aren't many jobs where you can have that.” (For more tips on preventing burnout, see “Putting ‘Life’ Back Into Your Professional Life.”)