The core job of a CMO—conducting an orchestra of teams, setting a vision, and adapting to an audience—is fundamentally the same as a CEO's. The transition isn't a leap to a new skill set, but an expansion of focus to include deeper partnerships with supply chain, sales, and finance.

When Sean Ainsworth took over as CEO of Immusoft, he made it a condition that the founding CEO remain with the company for several months. This structured transition was crucial for Ainsworth to understand the complex B-cell therapy modality and ensure a smooth leadership handover.

A CEO's primary role differs fundamentally based on company type. In an asset-centric biotech, the CEO must act as a hands-on program manager, micromanaging execution. In a platform company, the CEO must be deeply embedded in the science to predict and leverage the technology's long-term trajectory.

CEO Marc Salzberg wears CEO, CMO, and Board Chair hats, acknowledging it's a temporary "big stretch." This demonstrates a practical early-stage strategy where a leader covers multiple critical functions to save capital and ensure continuity, with a clear plan to hire dedicated experts as the company matures.

The transition from a leadership role at a large pharma company like Gilead to a biotech CEO involves a massive shift in scope. Instead of managing one large function with a large team, a biotech CEO is hands-on with every aspect of the company, from science to finance.

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.

When Cognex's new CEO took over in 2011, founder Dr. Bob Shillman didn't just leave; he stayed on as 'Chief Culture Officer' for another decade. This long, deliberate overlap was critical in embedding the company's unique culture and values into the next generation of leadership.

Early-stage biotechs prioritize scientists to build the core platform. However, once a lead clinical program is identified, the critical hire becomes a Chief Medical Officer who can design the clinical strategy. This hire is timed to the program's maturation, not the company's age, reflecting a pivotal strategic shift.

The transition from founder to CEO shouldn't temper the core belief that your company can create massive change. That passion must remain. What should evolve is the execution strategy—moving from pure intuition to structured planning, financial literacy (e.g., understanding a P&L), and leveraging past experiences.