DGTL Voices with Ed Marx - Everybody Is a Caregiver (ft. Toby Cosgrove)

Episode Date: September 3, 2026

Dr. Toby Cosgrove is the former President and CEO of Cleveland Clinic, where he now serves as Executive Advisor. A cardiac surgeon and inventor, he is a member of the Cleveland Medical Hall of Fame and the Cleveland Business Hall of Fame, and has addressed the World Economic Forum at Davos and the Senate HELP Committee. In this episode of DGTL Voices, Toby tells Edward Marx about nearly flunking out of Williams College before anyone discovered he was dyslexic, running a hundred-bed casualty staging flight in Vietnam at 28, and the two decisions he's proudest of from his tenure at Cleveland Clinic, both about purpose and language rather than buildings. Plus: the three problems he thinks AI has to solve in healthcare, and his advice for people who want the C-suite. Connect with Marx Advisory at https://bio.marxadvisory.com/

You've replicated so many leaders that left and gone to other fantastic institutions of CEOs. That's always a hallmark to me of a great leader, someone who can replicate themselves. I see three major problems of health care right now. 40% of the hospitals are running in the red, and it's too expensive for patients. There's 2 million unfilled jobs in health care across the country. The explosion and knowledge, the total amount of knowledge and health care doubles every 73 days. Last year, there were 1.8 million medical art articles written. Why do I get paid?

Why do we have a hospital? Why do we have a clinic? Why are we all here for patients? And that's the only reason we're there. Welcome to Digital Voices, where healthcare and life science leaders explore the real work behind transformation. This podcast is about people, leadership, and the conversations that move healthcare forward. Now your host, Ed Marks.

Welcome to another edition of Digital Voices. So excited for this one, because it's like, one of my my heroes and former boss, Dr. Toby, Crosgrove, Toby, welcome to digital voices. Oh, that's good to be with you, Ed. I know, I have such great memories. That's kind of how we first met was via the Cleveland Clinic. I still remember the first time meeting you.

I still remember the interview questions and some of the things that happened. You read to me a patient letter. You probably might not remember that, but while we're in the interview, you read to me a patient letter. And it was quite eye-opening and fun and super interesting. and it's like, man, this is where I want to serve. And so that's how we first met. And then I enjoyed our relationship ever since then

because I was like almost 10 years ago. It's been great. But Toby, before we get into all the questions we have set up for you, everyone will want to know what songs are on your playlist. Like what kind of music? What kind of music? I'm a real retro guy, you know. I have to say my favorite song is Emerson Lake and Palmer with Lucky Man.

And do you know that that song was written by Lake, when he was 12 years old? No. Wow. I did not know that. Very cool. I listen a lot of jazz now. Yeah. Well, now I got Lucky Man going through my brain. It's a beautiful song, the lyrics and the music, melody, everything. What about life message or mantra? Are there words that sort of guide you and how you live? Yeah, I, you know, I was heavily influenced by, obviously, all of us are by our parents.

And, you know, my dad told me, look, you know, you're supposed to leave the world to better place and be a contributor. And so that's really sort of driven me from the get-go. So, Toby, as we sort of get into career and leadership before we get there, tell us about yourself. Like, what's your story? Are you a Cleveland boy? Where did you grow up? All that kind of stuff. Well, I grew up in Watertown, New York, which is not the end of the earth, but you can see it from there. It's a small town of about 30,000. I went to. to the local high school there and played sports and then went on to Williams College, where I was a disaster in almost every respect.

Athletically, I played four years of basketball and anchored one end of the bench. Then I was an academic disaster and nearly flunked out. And socially, I was totally inept. So it was a brilliant career at Williams College. But then I got, I always thought that I wanted to be a doctor. And it goes back and I didn't want to be a doctor. I wanted to be a surgeon. And it goes back when I was 10 years old, I saw a picture in a friend's house

of he in the operating room and a mask. And I thought I'd look really good in a mask. And it looked very dramatic. And so that's what I was fun to do. And so after a stellar career in college, I got into one of 13. medical schools I applied to. I wound up getting into the University of Virginia, and that was a godson.

So then I, the career from graduate from medical school, I bounced around. I spent a surgical internship in a first year residency in Rochester, New York, a Strong Memorial, and then went to V. for a year and back in the military for another year. And then I talked my way into Mass General. They told me they had a job opening,

but they wouldn't give it to me. And so I called up the chief of surgery's office, and I said, I'd like to come. I have not met him. I'd like to come applying for residency. I'd like to come see him and I'd like to come see him on Thursday. I'm sorry, busy all day Thursday. How about Friday?

Busy all day, Friday. How about Monday? Busy all day, Monday. How about I come and sit in his office until he's got 15 minutes for me? And they called me back and said, you'll see you on Thursday. So they took me for a year. And then when I finished my residency on general surgery, they didn't want me to be the.

the chief resident in cardiac surgery. So they took my then brother-in-law and promoted them a head a year and got him out of the military and cast me off to Boston Children's Hospital. When I finished there, I was unemployed. All of a sudden, I got a letter from the Cleveland Clinic saying they would like to have me for, I come for sort of a senior year, and if I was good enough, they'd keep me on. And so make a long story short, they kept me. Yeah.

Wow. That's pretty amazing. What do you think flip? Was there a switch to flip for you between your bachelor experience in college and medical school that where you became more focused? Well, it wasn't a matter of focus. So it turns out I'm dyslexic. And so trying to do the reading for a liberal arts degree was almost impossible. and getting through French was nearly impossible.

So then medical school came along and it was academically so much easier for me than undergraduate school in liberal arts. So it was a transformational. I thought I'd arrived. No, that's awesome. It's a great, great story for many, many different reasons. So in all of that, well, I have a question about, you know, was there a single pivotal moment? But it sounds like there's many pivotal moments that fundamentally changed your trajectory. But when I asked that question, is there one in particular that stands out?

Well, you know, it was I think the fact that I got into one medical school on 13 tries. And I don't know what they saw in me, but thank God they did. Yeah. Isn't that nice when someone believes in you gives you that opportunity? No doubt about it. You mentioned when you were 10 years old, you see this picture, operating room, mask. It's like, wow, something about that captured you. And then you talked about how that kind of led you down this path. Tell us a little bit more about Vietnam. Like, as a flight surgeon,

in a whole year in, you know, in combat going on around in Vietnam, how did that shape you? Like, what did that do for you as a person and as a clinician? Well, that was sort of my first opportunity to lead. I was in charge of a what's called a casualty staging flight. And the Air Force evacuated all these troops. And so at age 28, I was in charge of a 100-bed facility, two doctors and probably 20 nurses and a squadron of attacks, Corman. And we evacuated in the year that I ran at 22,000 sick and wounded. I actually learned about war, learned about Asia, and learned a little. bit about being in charge. Yeah. And I'm sure you were exposed to many things that you didn't

learn or were trained on in medical school, right? I mean, there's combat injuries. And did that help shape? Like, you went on to become a surgeon, a heart surgeon, and doing a lot of inventions. I imagine that must have helped kind of shape that direction. Well, I think what you learned is that, well, for one of the, I learned a couple of really, important lessons that I've said to going to apply to the Cleveland Clinic. One is I learned about how they take care of casualties. You get hit in Vietnam and you're taking to a tent hospital and they've stopped the bleeding and spint your wounds and then you're moved to another hospital where they have the specialist and then you're evacuated out of the United States. And we did the same

thing. We set up a whole air force to move people from one place to another. And we've tried to get the person, the right person and the right hospital at the right time for the right care. And so we moved about 30,000 individuals a year around the Cleveland Clinic health system. So that was one thing I learned. The second thing I learned is the importance of trying to get help that is not necessarily a doctor. When I was a resident, we had to take veins and close the wounds. and pull the chest tubes and stuff. That's all tech work.

And so we employed PAs. And that was, most of them were Vietnam veterans when I came to Cleveland Codakia. And we just expanded that. It was really a good thing to do. So it was a great learning experience for me. I can imagine. Did you ever return in peacetime? Yeah, I did.

Yeah, tell me about that. I was in the Nang. which was sort of at the center of the war at the time. I remember down on the beach at an officers club having dinner, and we had a murder attack. We all rolled off into the sand, and I looked around this gorgeous beach, and I thought, boy, this war is over,

this is going to be hotels along here. And then I went back to the day, and China Beach was filled with tourist hotels. Wow. Yeah. And I imagine it was maybe a healing process too after all the trauma and things that you had to have had experience. Thank you for your service. And I as I've shared with you before, my dad was next door in the Army base to where you were. So you would have been taken care of him. He was never injured, thankfully, but many of his troops were. So thank you very much. So you went back to Cleveland Clinic afterwards. Was that always the plant? No. I hadn't met at the Cleveland Clinic until I was through Vietnam and through my training and stuff. And I got that letter. And I went out there and I said, this is for me. And I went there and worked my buns off. It turned out okay. So Toby, after all of these years, and it's probably hard to identify one person, so maybe a couple people.

But who has served as your biggest inspiration and why? So along your whole journey, whether it's in the military or, or you mentioned your dad earlier in your life. Well, I think probably the biggest is my parents. But then I think you, I believe that you learn from people as you go along. You see people do things that you like and are impressed by. And then you see people who do things that you just think are terrible. And so you become an amalgamation of lots of experiences about people along the way. Now you're at the clinic.

And you've had this leadership experience thanks to the Air Force at age. 28 and you're working your way as a surgeon and you're very inventive. Was there a time, when was the time when you thought, man, I might like to run this place someday? Well, I never thought it was going to happen. I was, you know, chief of cardiac surgery and I was 63, 64 years old. And I thought at that point, they'd asked me to start a venture capital company. And so I thought, did that. And then I thought, well, It's getting time to hang up my spikes And maybe I'll just go out to California

And pursue a venture capital experience And all of a sudden Fred Loop announced that he was going to retire And they asked me to throw my hat in the ring And I thought, wow, maybe I can stay here And you know, I won't have to move And this will be interesting So I went at full tilt and happily I got the opportunity.

That's amazing. Yeah, and I'm glad it all worked out the same way. And again, your experience is so vast. So I feel awkward just asking for one example, but maybe two or three examples like your tenure at the Cleveland Clinic, amazing. You still serve as executive advisor. What are two or three things that you're most proud of? Probably the thing that I did the best was to try and I asked myself a couple of a few questions. I said, why do I get paid?

Why do we have a hospital? Why do we have a clinic? Why are we all here? And the answer was for patients. And that's the only reason we're there. And so I made it our mantra for the Cleveland Clinic. That'd be patients first. And everything sort of flowed from that.

And the second thing that I think was really important was we changed how we felt about what we called people. So there used to be doctors and janitors and nurses and bus drivers, and we decided we're going to call everybody a caregiver. And that did two amazing things. That increased a patient satisfaction way up like that. And the employee engagement went up the same way. And, you know, I realized in retrospect, you know,

who sees more of a patient in the hospital and anybody else? it's the housekeeping group. And if you don't employ them and get them involved in the experience, it's really, it's a loss. And so I think those two things were probably the best things that I did for the Cleveland Clinic. And I'm really proud of them. Yeah, I'll add two more. One is leaders, leaders, you've replicated so many leaders that today are

have some are still at the clinic leading, but others have left and gone to other fantastic institutions as CEOs. That's always a hallmark to me of a great leader, someone who can replicate themselves. And also the second thing is that I think you changed the world. Not only did you change Cleveland, but obviously Cleveland Clinic's reach is global. And you had the vision for that as you added hospitals throughout the world. And the whole empathy, the whole culture that you created, like the examples you cited, Toby have gone around the world. You're very flattering. Thank you. So how are you spending time today? What's your typical day?

Well, I got a portfolio of things I do. I'm not some public boards. I'm a lot of startup boards. I'm coaching some CEOs of hospitals. And I'm by working with McKinsey as a senior, senior, senior, senior, senior, senior, senior, advisor. And yeah, speaking and just sharing your wisdom is really great. What brings you the greatest amount of professional satisfaction? So obviously the things that you've already accomplished, but you're still in the game. So what? Yeah. I really enjoy bringing new technologies into healthcare, and it's really hard to get them integrated.

And, you know, I think one of the most amazing thing that's happening in healthcare, and it's going to solve a lot of problems and help an awful lot of people is the AI. and it's really slow to be taken up. Yeah. Why do you think that is? Well, if you, I mean, if you look at there's, I see three major problems of health care right now. It's very expensive. And in fact, 40% of the hospitals are running in the red.

And it's too expensive for patients. Secondly, there's two million unfilled jobs in health care across the country. There's a shortage of personnel. And three, the explosion in knowledge, the total amount of knowledge and health care doubles every 73 days. Last year, there were 1.8 million medical art articles written. Who the hell can keep up with that? Nobody can't. So the AI is going to allow physicians to and to patients, by the way, to democratize knowledge

and shorten the length of time it takes from a proven technology until it becomes standard of care. It's going to allow a lot of the work that goes into health care, for example, the Cleveland class has got 3,500 people putting out a bill. It's got 1,000 people in call centers. I mean, if you're going to have people working in a health care, they ought to be looking after people. and not just looking after bills.

So, you know, there's tremendous opportunities to improve the efficiency and cut cost from that standpoint. So I think it can address. And then my heavens, think about what it's going to do in terms of the research capabilities. So, and finally, you know, I don't, one of the biggest things may be, and this is, if you read the papers today, every patient's now is going to open AI or chat or one of the others to learn about their disease. And so they go to the doctor's office better prepared. They ask the appropriate questions. They may realize and they may take better care of themselves.

They may even realize I don't have to go to the doctor at all. Yeah. Oh, that's good. Yeah. That reminds you, Toby. I thought of another thing that I would say about you that you've helped, you know, in terms of accomplishments. And that is you really did push tech forward for sure at your time clinic, both first as a surgeon and the innovations that you created in the medical space, but also in the tech for healthcare. You were always very progressive, one of the first to always, you know, whether it was the EHR way back when with EPIP or whatever.

You've always been a strong proponent. That's what it was so much fun working with you is to have a CEO like that. Well, it was, it was, it's obvious an opportunity. Yeah. All right. So let's talk a little bit about leadership. So which is kind of like been running through every, everything we've discussed so far. Do you define success differently today than you might have, you know, half, half a generation?

Yeah. You know, I think success, you know, in the early days was all personal. You know, can I do this? Can I get to be a good surgeon? Can I get great results? etc. And then it became a team that you were leading. And then success became how successful was the organization and how did you lead the organization forward? So, and so very different for different phases of your life and maturity, I think. So if you're speaking Toby right now to

two audiences, so we'll take one at a time, but it's the same sort of question, like advice. Like if You are currently mid-career. So let's just say you're a director, maybe a vice president in a larger organization. What advice would you have? Are there one or two things that you think will help people as they continue on in their career? And let's just say that they aspire to reach the C-suite.

Yeah, I think that two things that you have to do. I think an awful lot of people are interested in just maintaining their position and not taking opportunities. And I think you have to, A, demonstrate a tremendous. minus work. And B, you have to look for opportunities. And if those two things go with what has written by Angela Duckworth recently. She wrote about grit as the first book.

And she's got a book coming out in September, which talks about putting yourself in the right situation. And you have to find the right situation for yourself to move up. And, you know, I was happy to find it at the Cleveland Clinic. And would the advice be any different for someone who's, let's just say, more advanced in their career? So now they are maybe right below the C-suite or in the C-suite. And they just want to be more effective generally. Like, are there any particular skills that you saw in your best performers versus your average? Well, first of all, I think you have to learn to speak, to talk.

And I remember one of the most painful things I did is I took myself to California, one weekend and had a coach. And watch yourself is tremendously embarrassing for that. And I have worked at it and worked at it and worked at it. And so the presentation capabilities and the public speaking capabilities, I think are incredibly important. The other thing I would say is, I think particularly with AI coming along, I think you want to be widely diverse and learn lots of different things so that you can begin to apply human capital in the maximum way.

And that's, you know, because it's going to be taking over technical jobs. And just to be a tech, oh, isn't going to do it anymore. Right. Yeah, no, sage advice. Toby, in the last almost 30 minutes, we covered a lot of ground. Everything for music. Lucky man is going to be playing in my brain. We do have a Spotify playlist for digital voices.

We're going to add that. I know it's not on there. We need to add it. We talked about leaving the world a better place, something that you learned from your parents back in growing up in New York, Watertown specifically. Then you shared a lot about just kind of growing up. And you're a great inspirational testimony of someone who had to deal with some

adversity in your life and with dyslexia. And you overcame that. Nobody would even know until you actually say it yourself. So you're a great inspiration. That way you have this great career. you served in the military, and then you did these amazing things at the Cleveland Clinic. You identified a couple. I added three extra.

I'm sure we could spend another 10 minutes, and I could tell you some more things that you've done that were so wonderful. And I don't say that to just lift you up, but also to share with our audience. Like, man, you can make a difference. You can be a difference maker like Dr. Toby Cosgrove. And so we talk a lot of things that you're proud of and then a lot of advice for aspiring leaders and leaders that are leaders today. and how you define success

and how that's changed over time, which I think was beautifully shared. What did we miss? Or is there anything you want to double down on? I'll give you the last word. Well, I think that healthcare is a tremendous area to work. And, you know, you will get, make a lot more money in other places.

But health care, you will get tremendous psychic return. and it's incredibly satisfying, helping people. And there's always going to be a need for, and the changes that are happening are so exciting that I'm sorry, I'm not going to be around 100 years to enjoy them. Yeah. Well, Toby Kosgrove, thank you for sharing your heart and your experience with my audience,

and we'll have to have you back really soon. Thank you for listening to Digital Voices. We help today's conversation sparked ideas, reflection, and connection. on YouTube, Apple, and Spotify Podcasts so you don't miss an episode.