Editors’ Note

Dr. Toby Cosgrove received his medical degree from the University of Virginia School of Medicine in Charlottesville and completed his clinical training at Massachusetts General Hospital, Boston Children’s Hospital, and Brook General Hospital in London. His undergraduate work was at Williams College. He was a surgeon in the U.S. Air Force and served in Da Nang, Republic of Vietnam as the Chief of U.S. Air Force Casualty Staging Flight. He was awarded the Bronze Star and the Republic of Vietnam Commendation Medal. Joining Cleveland Clinic in 1975, Dr. Cosgrove was named Chairman of the Department of Thoracic and Cardiovascular Surgery in 1989. Dr. Cosgrove has addressed the Senate Health, Education, Labor and Pensions Committees, in Washington, D.C. He is the recipient of Cleveland Clinic’s Master Clinician Award, Innovator of the Year Award, and Lerner Humanitarian Award. Dr. Cosgrove topped Inside Business’ “Power 100” listing for Northeast Ohio and is highly ranked among Modern Healthcare’s “100 most powerful people in healthcare” and “most powerful physician executives.”

Institution Brief

Based in Cleveland, Ohio, Cleveland Clinic (my.clevelandclinic.org) is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. It was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion, and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States. U.S. News & World Report consistently names Cleveland Clinic as one of the nation’s best hospitals in its annual “America’s Best Hospitals” survey. More than 3,600 full-time salaried physicians and researchers and 11,000 nurses represent 120 medical specialties and subspecialties. The Cleveland Clinic health system includes a main campus near downtown Cleveland and more than 75 Northern Ohio outpatient locations, including 16 full-service Family Health Centers, Cleveland Clinic Florida, the Lou Ruvo Center for Brain Health in Las Vegas, Cleveland Clinic Canada and, currently under construction, Cleveland Clinic Abu Dhabi.

What makes Cleveland Clinic so special and what has been the key to its success?

We have to go back to our model, which incorporates 3,600 physicians in a group practice. We are all salaried and we have one-year contracts, annual professional reviews, and are physician-led.

This has been the case throughout the long history of the institution.

Is top talent still coming into medicine?

There is no question that top talent still comes into medicine. There are still more people applying to medical school than they can accept.

One of the reasons Cleveland Clinic attracts people is that we allow them to practice medicine. As a cardiac surgeon, I spent all of my time operating – I didn’t have to do things like contracts or hire secretaries or send bills. I just looked after patients, and that is one of the real attractions of being a doctor here.

Are you concerned about technology impacting the doctor/patient relationship?

I worry about this a great deal. Technology has come into healthcare in a major way, and there are four things that are impacting the physicians and causing major issues, particularly in regard to satisfaction and burnout.

First, doctors now have to become part of a team – they are no longer solo practitioners that have total autonomy.

The second thing is that the Affordable Care Act has brought all sorts of quality metrics and measurements into a physician’s daily business. This is new for them and has changed how we get paid, etc., and has enormously changed the business of delivering care.

Third is the electronic medical record, which requires physicians to document at a level that they had never been required to do before.

The fourth thing is the explosion in information. The total amount of knowledge in healthcare is doubling every 73 days, which is an incredible burden just to keep up.

This has led to burnout among physicians – the incidence rate is that 50 percent of physicians demonstrate burnout. This is a real concern.

What will the hospital of the future look like, and is there a transformation taking place of what a hospital will be?

Increasingly, there is less and less acute disease in hospitals, and it’s more about chronic disease. Hospitals will increasingly be utilized only for addressing really complex issues. More and more things are being looked after as outpatients and short-term stay, so the nature of hospitals is changing. There are fewer beds in the United States right now. There has been a 20 percent reduction in the total number of hospital beds in the U.S. because people are spending less time in the hospital and are utilizing more outpatient care.

There seems to be a move toward consolidation into larger health systems. Is that what is happening and will small, community hospitals survive?

Increasingly, the trend is to be part of a system, and that’s how it should be because not all facilities should attempt to be all things to all people.

The community hospitals will look after the things they do well, and complicated things will move on to bigger systems.

The fact that we have systems working together provides efficiency, reduces the rate of competition, and delivers better care.

When it comes to the upcoming 100th anniversary of the institution, there is a campaign to secure continued investment. How important is that investment and which areas will you focus on?

We’ve continued to invest in our organization at a pretty substantial rate. We just completed a brand new cancer center that required about a $170 million investment to bring together all of the capabilities in one facility.

We have continued to grow outpatient facilities, everything from urgent care to family health centers to bring care as close to people as possible and make our access to care more affordable and easier to reach.

We have continued to educate, and we have a huge investment going with Case Western Reserve around our new health education campus, which will be a $500 million investment.

We do about a quarter of a billion dollars worth of research funding each year, and that really speaks to the future of our organization.

Right now, we’re in a major process of moving toward an increasing digital health world, and that will be a big investment for us as well.

How critical is Cleveland Clinic’s impact on the city of Cleveland?

The impact of the clinic on the city has grown to a $13 billion economic impact annually. We’re the biggest employer that Cleveland has ever had, and we’re continuing to see the city show tremendous vibrancy.•