Now performing in the biotech big top: The Chief Medical Officer

January 21, 2021
Borderless Leadership - article

When we work with Chief Medical Officers, circus metaphors abound. “It is like this,” one CMO told me, “I am trying to balance many plates, but none of them are spinning.” Another confided, “I feel like I’m juggling with fiery torches,” and yet another described her work as “performing on a trapeze with absolutely no net.”

Despite these challenges, the allure to “run away” to join a biotech is undeniable. Feeling trapped in endless meetings and a constant battle for project-funding relevance – or simply tired of waiting around on the next rung of the ladder – we frequently work with MDs drawn to roles that promise hands-on, strategic impact and the possibility for more agile decision-making. The allure is particularly strong, of course, if it is the coveted (and often romanticized role) of Chief Medical Officer.

Like the circus, however, biotech fantasy does not always prepare you for biotech reality. While most MDs are quite quick to appreciate the need for innovative science and clinical pipeline potential when assessing a biotech opportunity, the importance of other game-changing biotech challenges often go unexplored or are simply misunderstood. Equally important is the self-awareness needed to assess whether “circus” life is right for you. So, whether you are an MD considering a biotech career move or a CEO/Board looking to hire the right CMO, here are some additional things we suggest you consider.

Seaworthy Mates Matter

When you leave big pharma to join a start-up biotech, it’s like you’ve run off to sea rather than to the circus. You are stepping off a stable aircraft carrier and landing in a life raft. And don’t be in denial; you will be subject to severe and changing weather conditions. To survive, everyone in the life raft must be able to collaborate and align, and do so in extremely dynamic conditions. Unpredictable stress behaviors will abound, even for the most seasoned leaders. In such an environment, trust, respect, and shared vision and values are essential for survival. Accordingly, we recommend that, in addition to assessing the experience of the leadership team you will be joining, you also conduct a “life raft” gut check. It’s a simple process. Before jumping ship, ask yourself if these are the people with whom you would want to share a life raft. Listen to any nagging doubts and act accordingly.

Role Respect Is Vital

As the CMO, you will undeniably be a critical moral and ethical compass for the company. Do not underestimate the commercial and investment pressure that will bear down upon you while your medical ethics responsibilities are ramping up exponentially. Your ability to safeguard and perform this function is of the utmost importance to the integrity and success of the company, not to mention the rights and safety of patients. You will also have fiduciary duties to investors. As such, the structure of the CMO role must have adequate strategic input and cross-functional responsibility for you to perform. You must also ensure that the CEO and Board have full respect for and understanding of the function that a CMO must serve. Do not compromise on these issues when interviewing, conducting your due diligence or even in the final stages of negotiating the terms of your role.

An SOP Void Can Be Disorienting

You will undoubtedly confirm during your interviews that you are capable of wearing many hats and being hands-on. We even believe you will be sincere about it. However, especially if you are coming from big pharma, its likely you have no idea what this really means. Gone are the SOPs and systems that were as foundationally reliable as the air you breathe. Even though you will be tasked with building sustainable frameworks – capable of moving your development pipeline closer to the patient – it is altogether possible that you will be the only one in the room who even knows what these SOPs and systems are and/or why they are important. So, forget about the safety net.

Wearing many hats and being hands-on is more akin to performing on the trapeze while building it. A need to adhere rigidly to (known) process and policy is one of the primary reasons professionals fail in an entrepreneurial, fast-growing environment. You must build a framework that is regulatory and safety compliant, but you will need to do so with innovation, agility and more-with-less thinking, all of which will be critical to success (and sanity!) Do not underestimate your own risk profile and resilience in this regard.

You Will be Creating Company Culture

The reason big pharma companies feel like stable aircraft carriers is not just because of their size or their reliable SOPs. Stability is also greatly enhanced by the presence of a well-defined and implemented company culture. As a member of the C-Suite, defining and implementing company culture will now be in your hands. Creating a company culture is a critical strategic responsibility. It is essential to cultivating shared purpose and fostering organizational vitality, especially in a dynamic environment where culture can be impacted by the personality of every new hire. It is also essential to employee retention and engagement – the life blood of any biotech. This is an exciting and daunting responsibility, and it is often overlooked. Culture does not just happen. It’s strategy, though it can feel like a soft skill that should be relegated to HR (a sophisticated function that might not yet exist in your biotech). Think again, be sure you will enjoy this aspect of the role.

Recruitment, Recruitment, Recruitment

A huge part of your CMO job will be recruitment. Dynamic, fast-paced and a need for go-global growth is a hallmark of moving a pipeline from early- to later-stage development. Entire functions will need to be significantly upgraded or created and new geographies will need to be explored. Professionals with launch and commercially aware skillsets will need to supplement a workforce that has up until now been scientifically innovative. Attracting and integrating critical new talent while valuing your existing contributors – many of whom may hold inflated biotech job titles and below market salaries – will be extremely challenging. Your recruitment power and support will also be significantly diminished. When assessing your fit for a CMO role, make sure that building your organization under these circumstances feels professionally rewarding and worthwhile, rather than daunting. It will be a big part of your job.

Nothing Survives Without Money

A biotech can have amazing science and a promising pipeline potential but without an appropriate financial strategy the company will not survive. Take time to assess historical and current capitalization, as well as the company’s continuing ability to attract and secure capital in the future, whether through investors or alliances. Pre-commercial biotechs do not survive without money.

You are Embracing a New Career Path

A biotech career is very different from a traditional big pharma career. When assessing a move to biotech, you will need a new career mindset. You are investing in potential and your compensation package will reflect this reality and risk. In addition, biotechs fail or get bought out, so it is not unusual for professionals who transition into biotech to grow their entrepreneurial leadership competencies through multiple career transitions. If you can embrace this new mindset, and still find yourself excited about your new challenge and opportunity, maybe circus life is right for you.

Rosalie Harrison, Partner, Borderless Executive Search

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