Delos "Toby" Cosgrove, M.D.
During a 1968 medical tour of duty in Danang, Vietnam, Delos “Toby” Cosgrove, M.D., headed up the casualty staging flight unit for the United States Air Force. There he ministered to some 22,000 soldiers, tending to their injuries and wounds when necessary and prepping them for evacuation to military hospitals outside of the country. On average, he saw one hundred new patients a day. In addition to invaluable medical training, the experience, he says, “gave me a lot of responsibility at an early age, which in turn gave me a certain amount of self confidence. It also taught me a lot about life.”
That “certain amount” of confidence helped cultivate a prolific and creative career in cardiothoracic surgery at one of the world’s best — and busiest — heart centers, where he has performed more than 20,000 surgeries, earned 18 patents, authored and co-authored more than 400 journal articles and garnered an international reputation, not only for mastering heart valve repair but for developing devices and techniques to improve the surgeries and their outcomes. Since 1990, Dr. Cosgrove has served as chairman of the department of thoracic and cardiovascular surgery in the Cleveland Clinic Heart and Vascular Institute, which this year celebrated being ranked number one in America by U.S.News & World Report for the tenth year in a row. These accomplishments, along with a passion to “make another important contribution in my life,” helped land him a new job that will put his intellectual, physical and emotional capacities to a test perhaps even more grueling than the 700 heart surgeries he averages per year.
In January, 2004, Floyd D. Loop, M.D., who has served as chairman and CEO of the Cleveland Clinic since 1989, announced the formation of a search committee to find his successor. In June, 2004, Dr. Cosgrove was appointed to the position. Beginning in October, 2004, Dr. Cosgrove will be at the helm of a very large healthcare vessel, with some 1,200 physicians and 32,000 employees overall.
“Toby Cosgrove is a proven leader,” said Dr. Loop in announcing Dr. Cosgrove’s appointment. “For an organization to succeed, it is imperative that each new CEO outperform his predecessor. Toby Cosgrove has the passion and vision needed to raise the Cleveland Clinic to unprecedented heights.” In accepting his new position, Dr. Cosgrove spoke of “standing on the shoulders of giants,” and said, “our current leader, Dr. Loop, is one of those giants.” A distinguished cardiac surgeon and savvy medical administrator, Dr. Loop led the Cleveland Clinic through 15 years of unprecedented growth and expansion. Under his leadership, the Cleveland Clinic became the second largest private medical practice in the world, and has been named among America’s top five hospitals by U.S. News for five years in a row.
In a challenging economic climate, Dr. Loop successfully added new buildings and services, built family health centers around Cleveland, and guided the formation of the nine-hospital Cleveland Clinic Health System. Recent projects include the construction of a new Center for Stem Cell and Regenerative Medicine, and the opening of the new Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, a unique program designed to train and mentor physician-scientists. Most recently, the Clinic has undertaken the construction of a new 975,000 square-foot heart center, scheduled for completion in 2007.
“Thanks to Dr. Loop,” says Dr. Cosgrove, “we are better positioned for the 21st century than any other healthcare institution I am aware of. All the pieces and parts are in place and now it’s our job to continue to build on and expand this.”
Dr. Cosgrove says the Heart and Vascular Institute is expanding in terms of patient volume and complexity of the conditions it treats “and we’re building the new facility to accommodate that growth and to allow us to continue expanding — more cardiologists, surgeons, nurses, technicians and support staff.”
He says the Heart and Vascular Institute has numerous investigative endeavors underway, including those involving minimally invasive approaches for mitral valve repair, aortic valve replacement and aneurysm intervention. The Heart and Vascular Institute also will continue efforts to develop increasingly effective and less invasive approaches for management of atrial fibrillation and heart failure. “The magnitude of these two conditions is enormous,” says Dr. Cosgrove, “but we’re also developing new surgical and catheter-based approaches to deal with them.” The Heart and Vascular Institute also has many research initiatives in progress, says Dr. Cosgrove, in cholesterol transport, cardiovascular risk markers (c-reactive protein, myeloperoxidase, homocysteine), genetics, biomedical engineering, stem cell biology, and in interventional cardiology. Indeed, the Heart Center owes its reputation in no small part to its expertise in interventional cardiology, which, for the last 13 years, has flourished under the direction of Eric J. Topol, M.D., chairman, department of cardiovascular medicine.
Dr. Cosgrove says that tabulation and analysis of surgical outcomes — a practice precipitated and formalized by Dr. Loop in the early 1970s — also will continue to guide not just Heart and Vascular Institute efforts, but patient care efforts throughout the hospital. “We need to have our outcomes become increasingly transparent. Patients need to know the risks and outcomes associated with various forms of therapy. We’re going to make that data increasingly available to both referring physicians and to patients.” Although renowned for his surgical productivity and the thousands of lives it changed for the better, Dr. Cosgrove emphasizes that surgery is a team effort. “I think surgeons probably get too much credit,” he says, “like quarterbacks do in football.” He says that all members of the surgical team rely on one another to be attentive and to do their jobs optimally. “It takes the whole team to get the good results,” he says.
Of his 18 patented surgical devices and procedures — 17 of which are used at the Clinic and at heart centers throughout the world — he characterizes them as “little things we did to make patient care better.” The patents include an array of ideas to facilitate open heart procedures, including devices and techniques to improve valve surgery, reduce the likelihood of stroke, and minimize tissue trauma and blood loss. "They’re all little things that collectively make for a better operation — better for the surgeon, better for the patients.”
Already immersed in the transition from his current post to CEO, Dr. Cosgrove says he quickly got a sense of the Clinic’s scale and the challenge that awaits. “It’s huge,” he says. “But it’s a wonderful opportunity. We have great people, we have a great facility and we have the right model to deliver excellent healthcare.” A not-for-profit group practice, the Cleveland Clinic is one of only two major American academic medical centers to use the salaried staff model. “We’re all on salary, we all have annual professional reviews and the hospitals and doctors are all one,” says Dr. Cosgrove. “So we’re all moving in the same direction, and because of that, it’s much easier for us to change direction when we need to.”
Heart Center — Number One, 10 Years and Counting
For the 10th year in a row, The Cleveland Clinic Heart and Vascular Institute was ranked number 1 in heart care and heart surgery. The new rankings were published in the July 12, 2004 edition of the U.S.News & World Report America’s Best Hospitals.” the Cleveland Clinic itself was listed fourth overall on the U.S. News Honor Roll.
