The departure of longtime Cleveland Clinic CEO Dr. Toby Cosgrove signals the end of an era at the prestigious institution and changes ahead with the placement of a new leader.
Cosgrove, 76, announced last week that he will be stepping down after 13 years as president and CEO of the clinic by the end of this year. Although the clinic has been mum about who his successor will be, it will "most likely" be a physician from within the institution and the search is already underway, Cosgrove said in an interview.
Cosgrove's leadership impact will be hard to replicate, analysts say. His tenure has been marked by the clinic's vast growth while upholding its respected reputation. The federal government also looked to him for advice and leadership on several occasions.
But a new leader will want to forge their own path, which means the current efforts at the clinic could get a shakeup.
When Cosgrove took the helm in 2004, he had big shoes to fill. He replaced the well-respected Dr. Floyd Loop. A cardiac surgeon like Cosgrove, Loop turned the clinic around financially and enhanced its reputation during his 15 years at the helm.
"You thought, 'Who can surpass Floyd Loop?' But yeah, (Cosgrove's) done it," said Tom Giella, chairman of healthcare services at search firm Korn Ferry, who has previously worked with the Cleveland Clinic.
Under Cosgrove, revenue at the clinic more than doubled from $3.7 billion in 2004 to $8.5 billion in 2016. He oversaw the health system's growth and established multiple new locations nationwide and internationally, including setting up services in Canada and Abu Dhabi.
Cosgrove also encouraged physicians to take on more administrative roles. All of the CEOs at the clinic's regional hospitals are now doctors, said Sherman Moore of ECG Management Consultants.
Cosgrove's successor will likely be one of the institution's own because of this practice, Moore said. The clinic has a wealth of talented physician leaders to choose from thanks to Cosgrove's efforts.
The culture of the clinic is also unique and may be difficult for someone from the outside to adjust to, Moore said. Clinic employees sign one-year contracts, unlike most academic medical centers that secure their staff with tenures. This tactic is meant to ensure physicians are always working to their highest standard.
"I think that would be difficult for a physician," Moore said. "It makes more sense to find someone from the inside who has grown up in that kind of an organization."
Cosgrove said he will help the board pick a new leader and will stay on as an adviser after he's stepped down. But it's important that he also gives the new leader enough room to tread their own path, Moore said.
Cosgrove's tenure was marked by his outspoken voice on healthcare policy issues as well as the consultant role he's taken on with the federal government. He is currently an adviser for the Trump administration and he was part of the Veterans Administration Commission on Care during the Obama administration. Both presidents considered Cosgrove to lead the VA. His successor might not be as comfortable voicing opinions on policy topics, preferring to focus on care delivery instead, Moore said.
The clinic's current international presence may also change under new leadership. Cosgrove grew out its overseas services, with the system announcing in 2015 it would open a hospital in London.
Cosgrove said one of his focuses as an adviser will be setting up the London hospital.
But "there is the potential to pivot more toward how do we continue to strengthen our position in the U.S.?" Moore said.
The new CEO also faces the same challenge as any CEO operating a hospital today — declining reimbursement in the push to value-based care. "This person has to be more nimble and to try to do more with less," Giella said.