It’s a marathon. Change always happens more slowly and incrementally than you imagine. There are few “big bang” changes out there. Success is often a function of gentle pressure relentlessly applied for long periods of time. This is a lesson that holds in most cultures. Change requires perseverance.
As part of my series about “authors who are making an important social impact”, I had the pleasure of interviewing Marc-David Munk.
Marc-David is a distinguished American and Canadian physician, writer, and healthcare executive, renowned for his innovative contributions to value-based, consumer-facing healthcare and global health. The Advisory Board, a prominent US healthcare consultancy, describes Munk as having “a reputation as an innovator,” a testament to his impactful career in the healthcare sector.
Munk has held pivotal roles in several healthcare organizations, most notably as the Chief Medical Officer for Clinics and Retail Pharmacy at CVS Health. In this role, he was instrumental in shaping the company’s clinical services. Prior to joining CVS Health, Munk served as the Chief Medical Officer at Iora Health, a Boston-based primary care organization recognized for its groundbreaking care model. During his tenure at Iora Health, Munk led the healthcare system’s model and care delivery across practices in seven states, integrating behavioral health and significantly improving care quality scores. His efforts earned recognition from major publications like the New York Times and the Wall Street Journal, which highlighted Iora Health’s innovative approach to primary care.
In a 2012 cover story, Health Leaders Magazine spotlighted Munk as an expert in innovations supporting capitated and value-based payment models. Munk emphasized the importance of intelligent spending in healthcare, advocating for cost-effective innovations that enhance patient care. “Everybody benefits when we get a little more intelligent about how to spend those dollars,” he noted.
Beyond his roles in healthcare management, Munk is an accomplished author. His book, Urgent Calls from Distant Places: An Emergency Doctor’s Notes about Life and Death on the Frontiers of East Africa, published in January 2024, is a memoir that draws on his experiences as an emergency flight surgeon with Amref Health Africa Flying Doctors in East Africa. The collection of essays provides a vivid account of the challenges and triumphs of providing emergency care in some of the world’s most remote and challenging environments.
The book has garnered critical acclaim, with Kirkus Reviews describing it as “an enthralling portrait of high-wire emergency care performed under the most trying circumstances.” Publisher’s Weekly Booklife praised Munk’s ability to juxtapose tender moments with the stark realities of his medical work, calling the memoir original and magnetic. Urgent Calls has received several awards, including a quarter-finalist position for best non-fiction book of 2024 at the Publisher’s Weekly Booklife Awards, a category finalist at the Eric Hoffer Book Awards, and the winner of best travel book of 2024 at the Indiereader Discovery Awards.
Munk’s educational journey is as impressive as his professional career. He earned a Bachelor of Arts degree in liberal arts from Colgate University, followed by a Master of Public Health degree in epidemiology from Boston University. He then completed his medical degree at Jefferson Medical College in Philadelphia, a residency in emergency medicine, and a fellowship in global health at the University of Pittsburgh Medical Center. Furthering his expertise, Munk obtained a Diploma in Tropical Medicine and Hygiene and, in 2012, a Master of Science degree in healthcare management from Harvard T.H. Chan School of Public Health.
Munk grew up in Toronto, one of five children, with a mother who was a professor at the University of Toronto and a father who was a businessman. He left Canada at eighteen to attend university in upstate New York and never moved back, finding numerous opportunities in the United States. Initially planning to become a journalist, Munk’s path shifted after he spent significant time volunteering as an emergency medical technician and firefighter during college. This experience led him to pursue a career in medicine, a decision he made in his final year of college.
Reflecting on his career, Munk shares several lessons and experiences. He emphasizes the importance of perseverance, maintaining a clear sense of purpose, and the necessity of embracing change despite the inherent challenges. Munk believes in the critical role of leadership in driving meaningful change, highlighting the need for leaders to have a moral compass and a commitment to improving society.
Munk remains passionate about addressing the dysfunction in the US healthcare system. He advocates for value-based payment models, smarter regulation, and true competition to improve outcomes and affordability. His book, Urgent Calls from Distant Places, not only shares his personal journey and experiences but also aims to highlight the vital work of organizations like Amref Health Africa.
Marc-David Munk continues to influence the healthcare field through his innovative approaches and thought leadership, striving to make a significant impact on both a local and global scale. His work can be followed through his book and his website, www.mdmunk.com.
Thank you so much for joining us in this interview series! Before we dive into the main focus of our interview, our readers would love to “get to know you” a bit better. Can you tell us a bit about your childhood backstory?
I grew up in Toronto, one of five kids. My mother was a professor in the Department of English at the University of Toronto, and my father was a businessman. When I was eighteen, I was accepted to university in upstate New York. I went south and never moved back to Canada; doors opened in the US and I became enmeshed in opportunities, as these things go.
I made the decision to enter medicine quite late — really at the end of my fourth year of college. I’d been planning to become a journalist, but, as I describe in my book, while I was studying the humanities and social sciences in college, I had also been volunteering as an emergency medical technician and firefighter with the town’s local emergency services. Over time, my emergency work became central. I spent most of my time at the firehouse and ambulance barn. In a moment of clarity shortly before graduation, I understood that I had accidentally discovered my passion. I needed to enroll in pre-med science classes and so began medical school much older than many of my classmates. That was the beginning of a career in medicine that has taken me around the world.
It has been said that our mistakes can be our greatest teachers. Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
Honestly, if you’re doing it right, being a trainee in medicine is about making mistakes, for years. And doctors remain students their whole lives. This is especially true in a field like emergency medicine, where relationships are new, information is sparce, and people and problems are often idiosyncratic. The specialty requires constant leaps of faith. Often we are right, but sometimes we are dramatically off-target. That’s why the system is designed with redundancy: multiple sets of eyes viewing a problem to avoid errors in judgement from harming a patient. The alternative to moving forward with imperfect information is stasis, which can be much worse. And, of course we learn as we go, accumulating wisdom and a sixth sense. But funny? I don’t know. There are a lot of lighthearted moments in medicine, but mistakes usually hit us hard.
Can you describe how you aim to make a significant social impact with your book?
Urgent Calls is really about three things: It’s a book about my personal journey as a young doctor in East Africa. Next, it’s a book about East Africa itself, particularly the difficult time after 2008 when the rise of extremism in Somalia dramatically changed the region. But, mainly, it’s a book about working as an emergency physician in an extreme setting, medevac’ing extremely sick patients in East Africa. I did this with an NGO called Amref, which is remarkable organization, first founded in the early 1950s. The founders were a group of three surgeons who took small planes into the field, running clinics and operating. Over time, Flying Doctors became Amref, which is now among the largest healthcare NGOs in Africa.
I’m hoping that Urgent Calls will highlight the important work that Amref is doing in East Africa. They are exclusively a healthcare NGO- and offer a range of services, from healthcare worker training to clinics, public health, maternal health, community outreach and emergency air evacuation. To my mind, they are unusually effective in that they are African-led and know the scene. I also think that they fly a bit under the radar.
Can you share with us what you believe is the most interesting story that you shared in your book?
Urgent Calls is a collection of stories describing twenty-two missions to eleven African countries that I took over the course of my time in East Africa. They’re all interesting, I think. The missions I describe are real. Readers will meet sick NGO workers in Somalia, malnourished Ugandan soldiers, suicidal teenagers, violent cow rustlers, American special forces, albino children murdered for their body parts, and even 19th-century explorers David Livingstone and Henry Stanley. I explore the greater philosophical questions raised by treating patients in East Africa: African history, the impact of colonialism, communism, religion, terrorism, and war.
I’m particularly partial to the story I share about evacuating a sick expatriate from Ethiopia. We were called to bring a young man to the tertiary hospital in Nairobi. When we got there, we realized we were confronted with the real possibility that he was sick with a hemorrhagic virus. A hemorrhagic virus is virulent and incredibly difficult to contain. We needed to decide whether the risk of spreading the disease was high enough to prevent his transfer, which would necessarily mean his death. It’s a powerful story because it highlights, for me, the inherent tensions between medicine — a one to one fiduciary relationship between a patient and doctor — and public health, which is a more vague, impersonal concern. In those situations, your responsibility to the patient can conflict with more amorphous responsibilities to a broader community.
What was the “aha moment” or series of events that made you decide to bring your message to the greater world? Can you share a story about that?
The stories in Urgent Calls sat as detailed notes on my hard drive for a decade. To some extent, it was helpful to put them away and get some distance, if only to recognize how extraordinary they were. I came across so many interesting people and situations that, rightfully, seem quite bizarre in retrospect. But I also felt that the time was right to get this book done, because I recognized how time away from home, in Africa, had caused me to pivot the professional goals I had for myself. The time was right to pull out the notes and early drafts and produce a book.
Steve Jobs, in his commencement address to graduates at Stanford University in 2005 made the following point: “you can’t connect the dots looking forward; you can only connect them looking backward. So you have to trust that the dots will somehow connect in your future. You have to trust in something — your gut, destiny, life, karma, whatever.” So it went for me: I pursued opportunities, each that led to the next. Africa, in retrospect, was a time of needed introspection and recalibration. I felt that there was a story to share.
In the book, I frequently reference Joseph Campbell, the American scholar who popularized and explored the idea of myth. He was a strong advocate of making sure that the path you have chosen to follow is really the one you should be on. For me, and for many others, time away far from home spent pursuing challenging and meaningful goals is an opportunity to recalibrate and re-align. It’s easy to get trapped doing the wrong work for the wrong reasons.
For me, Africa confirmed that I wanted to engage with tackling the dysfunctional US healthcare system when I returned home. That I needed to roll up my sleeves and work to build better models of healthcare.
Are there three things the community/society/politicians can do to help you address the root of the problem you are trying to solve?
The US healthcare system is a mess. By nearly every measure — cost, access to care, patient satisfaction, outcomes per dollar spent — it’s underperforming. I’ve spent more than a decade now helping to lead healthcare delivery organizations that challenge the incumbents. To my mind, much of the dysfunction in the US stems from how healthcare is paid for. In the US, and actually in most developed countries, we reward volume and complexity. We measure healthcare delivery much as we would measure the work a plumber or electrician does: we pay per installation and repair, more for complex interventions. These payment schemes are an incentive to do more. But, of course, in healthcare there are many lower-complexity, more time-consuming and preventive services that would prolong health better than heroic procedures. We tend not to pay well for those services, though. We need to be paying for outcomes, not processes or number of patients served. Doctors and healthcare systems should be rewarded for delivering better outcomes at more affordable prices.
We also have the issue, frankly, of profiteering in US healthcare. Suppliers of all kinds are at the trough, charging as much as the market will bear. We pay more for medicines and supplies than any other nation. These prices are breaking families and sending them into unrecoverable debt.
These problems require policy and regulation. The free market will not fix these issues, as medicine isn’t a true free market; most medical markets are thin oligopolies of payers and providers. We need more payment schemes, smarter regulation, and true competition.
How do you define leadership? Can you explain what you mean or give an example?
Leaders, first, need to have the wherewithal and moral compass to guide important work that makes the world a better place. This means encouraging work that transcends narrow interests, increasing the pool of opportunities versus simply fighting for a larger share of the pie. We are so dependent on politicians, executives, and other appointed leaders to get this right for the sake of society, and I fear that our institutions across the spectrum have forgotten this.
My father lived through World War Two. He left Europe as a refugee. My in-laws lived through post-war Europe, when America helped rebuild the continent. I look at the moral, smart, and uncompromising leadership of that era and how that leadership established over fifty years of post-war stability and rules-based global order, even while recognizing that the order hasn’t been perfect.
I can think, today, of few public institutions that have exited the past decade better than when they went in. Somehow, our institutions, from the Supreme Court and Congress, through organizations such as the Centers for Disease Control (CDC), then media and large companies, have proven to be led by people with narrow, selfish interests. This isn’t institutional rot: I suspect that most of the workers in these organizations are well-meaning, smart people (particularly young, idealistic Millennials!) But in all these organization, senior leaders have lost their bearings and refuse to take a stand for what’s right. It’s an epidemic of selfishness among the leadership classes.
What are your “5 things I wish someone told me when I first started” and why? Please share a story or example for each.
Here are my five lessons- ones that I would have shared with myself when I was first starting out:
- It’s a marathon. Change always happens more slowly and incrementally than you imagine. There are few “big bang” changes out there. Success is often a function of gentle pressure relentlessly applied for long periods of time. This is a lesson that holds in most cultures. Change requires perseverance.
- Reorient with the purpose. It’s easy to lose sight of why we show up each day. The work is easier when it’s motivated by purpose and when you can remind yourself why you’re putting in the hours. That’s one of the joys of an inherently purposeful career like medicine I’m speaking from a position of privilege, I know, but life’s too short to spend in a career or a job that has zero (and sometimes negative) impact. Get out. Trade up.
- People value the status quo. Leadership is about convincing people to evolve in pursuit of a worthy goal. Most of the opposition you will receive to your ideas will come from others who aren’t opposed to what you’re proposing — but who, because they are doing just fine where they are, aren’t prepared to risk what they have for what they might receive in exchange. Your job is convincing them that the leap is worth making.
- Success and failure are fleeting: I think Rudyard Kipling made this point about triumph and disaster being imposters. You’ll have great days and awful days. The great ones are never as great as they seem at the time, and the awful ones are nowhere near as serious as you feel them to be at the time. Think back on the medals you won in high school sports and how awful a college breakup felt. It’s worth considering at all of these events with a five- and ten-year horizon.
- Just jump in. I never regret errors of commission as much as errors of omission. Engaging and failing offer important lessons.
Can you please give us your favorite life lesson quote? Can you share how it’s been relevant to you in your life?
I’ve been affected by the writings of Dag Hammarskjöld, the second Secretary General of the UN. He was a Swedish diplomat who led the development of UN peacekeeping forces and was killed in a suspicious plane crash in Zambia, en route to peace talks in Congo. He kept a diary which was converted into a book called Markings. I quote from this work a lot in my book. It’s a book about self-discovery and, to me, about someone trying to live a life of purpose and who is attuned to his own internal compass.
He writes: “Never look down to test the ground before taking your next step; only he who keeps his eyes fixed on the far horizon will find his right road.”
I think of that quote when the going gets tough or when I’m uncertain about what to do. The right answer, for me, is to say yes to opportunities and to continue to move forward confidently, while keeping the long view in mind. The correct path soon becomes apparent.
Is there one person in the world, or in the US with whom you would like to have a private breakfast or lunch with, and why?
There are so many historic figures who I would have loved to have met, mainly American leaders and diplomats from the 1950’s and 1960’s. Today I’d certainly pick former president Barack Obama. I’m taken with his thoughtful, dignified approach to thinking through problems, communicating the stakes, and taking what I think are principled positions. I was most impressed by him tacking healthcare reform in 2009: Obamacare dramatically expanded access to healthcare for millions of people. Good people can disagree on whether it was enough — it didn’t do much to control prices, for example. But getting that done was a masterclass in communication ability, smarts, and ethics, and healthcare reform has felt so incremental and even impotent since then.
How can our readers further follow your work online?
My book, Urgent Calls from Distant Places, is widely available in print, e-book and audiobook formats. I also have a website at www.mdmunk.com.
This was very meaningful, thank you so much. We wish you only continued success on your great work!
Social Impact Authors: How & Why Author Dr Marc David Munk Is Helping To Change Our World was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.