A CEO wears many hats—scientist, investor, operator—but their primary, non-delegable function is decision-making. This role requires integrating input from a leadership team that thinks at an enterprise level, enabling the CEO to make the final call on capital, strategy, and people.

Raj Devraj emphasizes that while intelligence is table stakes, the crucial traits for a startup executive are resilience and "street smarts." This is because navigating the high expectations and intense scrutiny of an investor-heavy private board requires a different skillset than what's found on a resume.

Scientist-founders often believe one more experiment will prove their hypothesis. To succeed as a CEO, they must shift from scientific curiosity to ruthless capital discipline, killing unviable programs and building a team that challenges ideas, not just executes them.

While scientific acumen is valuable, the most critical trait for a biotech CEO is perseverance. The role involves weathering constant challenges where everyone—the board, investors, employees—can seem to be against you. An unwavering focus on the patient mission is essential to push through.

In the early stages, a biotech CEO's role is primarily scientific leadership and storytelling to attract investors. As the company and market mature, the role shifts. Effective CEOs must then become adaptable strategists, staying true to their core vision while responding to the dynamic industry environment.

Kevin Pojasek credits his effectiveness to a deliberate 12-year journey through diverse roles—investing, company creation, research, and clinical operations. This broad experience allows a leader to understand how all parts of the company, from high-level strategy to detailed science, fit together.

The ultimate differentiator for CEOs over decades isn't just product, but their skill as a capital allocator. Once a company generates cash, the CEO's job shifts to investing it wisely through M&A, R&D, and buybacks, a skill few are trained for but the best master.

Luba Greenwood argues that unlike in tech, many biotech CEOs lack P&L experience. In today's cash-constrained market, CEOs need to be able to build financial models and understand finance deeply to be effective, a skill she personally developed after transitioning from law and science.

While success is celebrated publicly, some of the best leadership happens privately when a CEO makes the tough, candid call to shut down a program or company due to unfavorable data. This "truth-seeking" decision, often against their personal interest, is a hallmark of excellence.