Dr. Delos (Toby) Cosgrove

Dr. Delos (Toby) Cosgrove, a world-renowned cardiac surgeon and former health care executive can teach us much about persistence when the odds are long and the resources are limited. As a dyslexic who struggled through school, to continue to expand the expertise and reputation of the Cleveland Clinic as one of the best hospitals in the world, he has many lessons on how to leverage the best you have when at times it may not be good enough. 

His ‘never-say-die’ spirit, discipline, creativity, competence and quality-consciousness was thematic throughout his days at the Cleveland Clinic and beyond. Interestingly, on the day I met Cosgrove, I had a brief hallway conversation with a security guard while enroute to the CEO’s office for an 8:30 am appointment. “Do you ever run into the man?” I asked the guard. “All the time,” the guard said. “How is that” I asked. “Well for example today he has his doctor’s rounds with his patients from early morning until his first meetings with his day job as the CEO. He always passes this corner to-and-from his patients.” 

I walked away thinking what drives this man. I am sure as CEO he doesn’t have to see patients. Fast-forward two hours and I realized post-conversation, this is someone committed to always getting better, and doing better, even at 76 years of age, and helping others to do the same. Here is a story about life-long learning and the dividends it pays in leveraging attitude and effort into excellence in an everyday way.

In his 13 years as President and CEO of Cleveland Clinic, Toby Cosgrove oversaw local, national, and international growth. The Clinic has grown to be an international force in healthcare. Cosgrove, the architect of this expansion, was once a risky hire who struggled with dyslexia and poor self-perception. 

Cosgrove grew up in a small town in New York and struggled with schoolwork. Small town life has its benefits for a kid, though. Cosgrove said of his hometown, “You had the sense of accomplishment, then you shoveled walks and raked leaves, and collected newspapers. You know, it was perfectly safe to do it. And people were supportive. You became entrepreneurial at a young age.”

That sense of accomplishment was marred, however, by his scholastic struggles. Cosgrove was dyslexic but said he had never heard the word until I was 34. “I was dating a teacher, and I was trying to read the New York Times out loud to her as we were going someplace in the car and she said, ‘You’re dyslexic.’ And I said, ‘What’s that?’”

Dyslexia has caused struggles throughout his life, but never more than his college and medical school years, Cosgrove said. “I have to laugh when I went to college, and I was a terrible student. Highlighted by the fact that I thought that somehow, they had a language requirement, and somehow, I decided to take French. God knows why I did that. I got in remedial French, meaning five days a week at eight o’clock in the morning. I got three D-minuses and a D. And, of course, the reading requirements for dyslexics in college at a liberal arts school were challenging to say the least. So, I got into one of thirteen medical schools that I applied to. Scholastic life didn’t get a lot better until I got into clinical medicine.” It was then that Cosgrove said his world changed.

Cosgrove does not see his dyslexia as a curse. “I think it’s been a real gift because two things. First of all, if you survive scholastically as a dyslexic, it teaches you perseverance. Secondly, I think you think differently about problems than other people do, you seem to be more creative in your thinking. I think the third thing is that you’re not afraid to fail, because you’ve already failed, a lot of times.”

So, when he was rejected from twelve medical schools, it didn’t deter him. One school accepted him, and he ran with it. “I went to medical school not to become a medical doctor, but to be a surgeon,” said Cosgrove. “I was just hell bent on it.” Getting a residency was difficult, though. “I didn’t get my first choice in residency,” said Cosgrove. “When I got to Mass General they told me that I was the thirteenth man in my group and I ought to be damn glad to be there.”

Cosgrove’s perception of himself began to change when he got the chance to sail with an elite group on an America’s Cup boat. After growing up sailing on Lake Ontario, he valued this experience. “I had a friend who had a bunch of money and he got me a chance to try out for the boat, which was sailing out of Boston. And I was going to be a substitute, is the best way of looking at it. One day we were sailing off of Marblehead, out of Boston, and they had a position on the boat called the ship’s husband and that was the guy who did all the work below decks.” Cosgrove remembered that the man who had that job was breathing hard and generally struggling with duties below deck.  He was feeling sick with the boat’s bouncing and water coming in on his head. Cosgrove jumped on the opportunity to be the substitute ship’s husband. “I said, ‘That’s my spot.’ I became known as the sewer man. Every boat subsequently, that was a named position, the sewer man. I worked my ass off. I did all the work below and I did all the work at the top of the mast. I worked my way up so the second year I became a relief helmsman. Just a matter of working it to death. It was fun. It was a privilege.” 

“Persistence is the thing. The main event,” he said. Cosgrove never lost his need to persist but being part of the sailing team taught him something else that is not always emphasized in medical school — the need for teamwork. “You have to have an appreciation for other people’s talent and allow other people to shine to be a good member of a team,” he said. Cosgrove is the first to admit that he isn’t a star, but he is a great team member because of his upbringing and later experiences. “I loved the America Cup’s team aspect of things, people and so on. I loved cardiac surgery because it was a huge team event. I like being in this environment because it emphasizes team play. This Cleveland Clinic is all built around team. And I frankly think teams accomplish a lot more than individuals do.”

Even with his continuing persistence and team focus, Cosgrove faced yet another challenge. He struggled to find a job after his residency. “I thought I had a job in San Francisco, but they withdrew their offer. And then I found a job that I thought I’d like to have in Albany, N.Y. and they didn’t hire me. So, I didn’t have a job.” He found other ways to be productive and improve his resume, though. He explained, “During those six months, I wrote a book about care of congenital heart surgical patients.”

Then he got a letter from Cleveland Clinic. “It was an opportunity no different than being the sewer man on the boat,” said Cosgrove. “So, the first year I’m here, there’s a shooting murder at the front door. The bank in the basement was robbed. The CEO left town in the middle of the night having bribed a councilman and didn’t come back for 20 years. I thought this was the Wild West. I mean what on earth was going on? There were prostitutes working up and down Euclid Avenue. There was a big sign out there that said, ‘Cleveland Clinic Unfair to Blacks’ and had a picture of Nazi swastikas on it. You couldn’t walk from the hotel to the front of the hospital because it wasn’t safe, so there was a bus that went back and forth all day long. The CEO’s offices had bulletproof glass. The Hough riots happened about three blocks from here. This was a rough area.”

Despite the environment, the hospital provided a tremendous opportunity for cardiac surgery. “They had just done the first coronary bypass surgery in 1967. The place was just cranking, because people came from all over the world to have their heart surgery. There were five of us doing 3,000 heart operations. Within a year, I was one of the busiest heart surgeons in the country. Which as a young person, it was unbelievable? Just to be part of the team, cranking, doing, and thinking — put me on the international stage in about, late thirties, which is just because I fell into this place. At least I recognized the opportunity. I had an offer to go to Harvard at that time. And I decided to stay here.”

The opportunity was alluring. “The first year I was here I did 500 heart operations and got paid $60,000. A year later, I was offered to go into private practice for a million,” said Cosgrove. He thought the opportunity cost was too high, though. At Cleveland Clinic, he “saw an opportunity to make a difference.” Cleveland Clinic would also encourage him to work harder and learn more than at any other hospital. So, he stayed.

“People said, ‘Why did you go to that clinic place instead of the nice university hospital?’ But the thing that happened there, is they’re allowing me to learn my craft and get damn good at it. I did it three times a day, every day of the week, over and over and over and over and over and over again,” Cosgrove explained.

Beyond his drive to learn, Cosgrove’s entrepreneurial spirit was beginning to show once more. “I started to think, what else could I do? Well, I could improve the care in the intensive care unit and teach the residents, and then I eventually got to the point where I was writing articles and speaking places and that just fueled it.”

When he moved into his role as president and CEO, he continued to face his failures head on. The hiring process has always been hard for Cosgrove, because “there’s a resume, there’s an interview, there is recommendations, but I would never hire anybody in cardiac surgery until they’ve been here for a year. I say, ‘If you want a job here, you need to come here for a year. Spend some time here. Technically they may not have it, emotionally they may not have it, interpersonally they may not have it, intellectually they may not have it, and you can’t tell.” He admitted that he has made mistakes at even the highest levels of hiring. “It took me four times to get the right COO. And he’s a peach. And three times before I got the right HR person, she’s fabulous.”

Now, at 76, he isn’t sure of his next move. He’s interested in “everything from Wall Street to teaching.” He plans on figuring that out as part of the next phase of his life and career. He devoted his early life to becoming the best cardiac surgeon he could be, then his career to improving all aspects of the hospital that allowed him to grow as a surgeon. But he doesn’t believe he made Cleveland Clinic what it is now. Instead, he explained, “I’ve poured everything into this institution. I’ve always said this place made me, I didn’t make it.”

(Author’s Note: Dr. Cosgrove has recently retired but still remains an active contributor in the medical arena.)