CMO Success Blueprint: Timing, Talent, and Retention in Early-Stage Biotech

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November 01, 2023
10 min read
Leadership StrategiesHealthcareVenture Capital and GrowthInnovation, Research, and DevelopmentExecutive Search
Executive Summary
When are early-stage biotechnology organizations hiring their CMOs? Our research uncovers the importance of considering time to clinic.


The global biotechnology market, amidst uncertainty, has continued to grow through new investments. This upward trajectory is expected to persist, with industry experts forecasting a growth valuation of $1.2 trillion in 2022 to over $3.2 trillion by 2030.1 In this highly competitive and rapidly evolving landscape, having the right leadership in place is critical for staying ahead of the curve.

Of the executive roles needed for an organization’s success, the Chief Medical Officer (CMO) is a critical hire to accelerate a company’s growth. To better understand this high-in-demand role and marketplace, Russell Reynolds Associates analyzed 30+ select biotech organizations that have evolved from pre-clinical to clinical-stage and, in some cases, private to public.  We also conducted interviews with nearly a dozen experienced clinical experts in the market that have held CMO or Head of Development roles at early-stage companies.

We learned that a recruitment and retention strategy depends heavily on a company’s timeline to clinic with their first investigational new drug (IND) filing. Hiring a CMO too early can pose challenges in attracting and retaining top talent.  To navigate this, early-stage biotechnology organizations should:

  1. Bring in an earlier stage clinical leader, such as a Head of Early Clinical Development or a Chief Development Officer, as they pursue early-stage pre-clinical work

  2. Supplement gaps in their clinical team with external hires, such as consultants or next generation leaders (e.g., Vice President of Clinical Development) who can provide clinical input on initial discussions

  3. Invest in their CMO or VP/SVP of Clinical Development’s leadership and management abilities to ensure retention and success

  4. Consider their pipeline when looking to hire their next CMO, particularly investigational new drug (IND) filings

As leaders navigate the R&D talent landscape and consider their own team’s expansion, we hope that these insights and key questions will help leadership teams plan their recruitment and retention strategy appropriately.


The current Chief Medical Officer landscape

Two-thirds of current Chief Medical Officers are in the role for the first time, with only 34% demonstrating previous CMO experience. Additionally, 86% bring experience in pre-clinical research and/or early development. A majority of Chief Medical Officers come from either large pharma or biotech (Figure 1) as opposed to straight from academia.

While CMOs bring a diverse set of experiences, demographics are fairly homogenous: only 24% of these executives identify as women, highlighting an opportunity to diversify R&D leadership.


The 2023 early-stage biotechnology Chief Medical Officer landscape

Figure 1: The 2023 early stage biotechnology chief medical officer landscape



Early-stage biotechnology organizations must consider their timeline to clinic when hiring a CMO

Via our analysis, we identified that the timing of the Chief Medical Officer hire relative to their first IND filing is crucial to retention. CMOs are likely to be hired pre-IND filing, but less likely to stay when hired too far out from key IND filing activities. (Figure 2).

We found that although 82% of CMOs were hired before the organization’s IND filing, about 40% of these leaders departed before reaching this crucial inflection point, with nearly half of them leaving within a year or less. Notably, around 89% of these departures occurred more than two years before the company’s filing.


Figure 2: Early-stage biotechnology Chief Medical Officer tenure in relation to IND filing

Figure 2: Early stage biotechnology chief medical officer tenure in relation to IND filing


Among the 60% who remained through IND filing, 62% were hired within one year before the company’s filing and have a high average tenure at 2.5 years. This suggests a critical consideration for retention when determining the optimal timing for hiring the first Chief Medical Officer: if aiming for a preclinical-phase hire, the ideal timing largely depends on your product’s IND filing readiness.

The rationale behind pre-IND filing hiring often revolves around the need to have a clinical leader capable of overseeing preclinical and translational operations, document preparation and trial design. While ideal, retaining a leader hired during the preclinical phase throughout the IND filing process is not necessarily straightforward and always subject to inherent risks that come with early-stage drug development. Few clinical leaders are willing to commit more than a year to preclinical work, resulting in the loss of valuable institutional knowledge, from drug inception to trials, which is vital during a company’s growth and development. A quick way to mitigate this is by hiring an earlier stage clinical leader, such as a VP or SVP of Clinical Development or Translational Medicine.

A less common – but more retention-optimal method – is hiring the first CMO after the organization’s first IND filing. For CMOs brought on after the company’s first IND filing, we found that 80% were hired at least a year after the initial IND filing and have the highest average tenure of ~3 years. Similarly, retention remains high for those hired 1-2 years after the initial IND filing, with an average of ~2.8 years. This timeline ensures that a leader is brought in when their expertise is most needed, particularly during the clinical stages, and more likely to be retained within the organization. As these CMOs navigate clinical obstacles, their reasons for leaving may look vastly different than those who depart prior to IND filing—likely driven by clinical failures versus seeking personal development.

These findings emphasize the importance of recruiting CMOs at the right time; one which is aligned across the organization's developmental stage, IND filing milestones, and financing strategy.


Learnings from experts who have successfully incorporated medical officers into their businesses

Via interviews with leading experts, we identified three key recommendations for hiring and retaining your next CMO:

1. Bring in an earlier stage clinical leader

Depending on the organization, a Chief Medical Officer role is not always necessary. Leading experts noted that non-MD leaders may be just as (if not more) important as companies pursue early-stage development work. This could be a Chief Development Officer, a Head of Early Development, or even a PhD in the field.

“Instead of hiring a CMO pre-IND, a Chief Development Officer could be the next best alternative. This would be someone that knows IND, likely has a PhD, and would act as a senior leader within the executive team.” – 2x Chief Development Officer

2. Bridge the gap to IND filing with external experts

Engaging external experts (like consultants or scientific advisory boards) at least two years before IND filing may be just as beneficial and cost-effective to an organization as engaging a CMO. This external leader would help with clinical input and initial discussions around developmental prioritization. Once this expert lays the foundation of the organization’s clinical agenda, a Chief Medical Officer can be hired – this would not only tackle the issues around retention and timelines, but also serve as opportunity for the company to prioritize cost-effective measures in the early-stages.

“If INDs are coming through over a period of several years, have a consultant help with clinical input and review the pipeline to help initial discussion around prioritization. Once that’s done, you can bring in a full-time CMO.” – 3x Chief Medical Officer

“I believe 2 years from the clinic is a bit early, especially if there has been no clinical candidate nominated or no imminent IND. I would recommend bringing in a clinical person part-time. What’s more important is having a sound CSO to make sure preclinical work is being done to support the first IND.” – 4x President of R&D

To mitigate this, we suggest conducting a careful assessment of the capabilities of your existing C-suite leadership, benchmark them against market standards, and fill the gaps with external experts.

3. Invest in your clinical leader’s development

As shown above, CMO retention remains a pressing issue for early-stage biotechnology organizations. These experts echoed that CMO retention is highly dependent on the quick progression of an organization’s clinical pipeline. Providing opportunities for your CMO to be involved in broader strategic activities is crucial. Many of these leaders are seeking these strategic involvements and responsibilities as they enter a new organization.

“Problem of bringing someone on early – there’s just not as much for that person to do other than participate in discussions. You may end up without a drug until 12-24 months after hire, so there’s a big risk that you never even have an asset that an MD can work on.” – 3x Chief Medical Officer

To mitigate this, we suggest utilizing executive assessments to gain in-depth insights into how your executive team leads, including their potential impact, strengths, opportunities for growth, team effectiveness, and areas of improvement.


Planning for the biotech organization of the future

As early-stage biotech organizations continue maturing their pipeline and R&D strategy, executive leaders need to be equipped with the proper understanding of hiring timelines to guarantee successful drug discovery and development. And with the biotech industry’s current turbulence, equipping your organization with the right people at the right time is critical, both from a financial and growth standpoint.

To ensure future success, early-stage biotechnology executive teams must address the following questions:

  1. Timeline to Clinic: Where does your organization currently stand on its clinical development timeline?

  2. MD vs. Non-MD Leadership: How would the inclusion of a medical doctor (MD) impact your progress compared to hiring a leader without an MD background?

  3. Board or Scientific Advisory Board (SAB) vs. CMO: Would your organization derive greater benefit from having an MD on its board or scientific advisory board, as opposed to appointing a Chief Medical Officer?

  4. Financing and runway: What is your organization’s financing strategy and cash runway? Is a CMO hire required for your next round of fundraising?

These actions, informed by a comprehensive understanding of your organization's unique needs and market dynamics, serve as a roadmap for strengthening your executive leadership team and will ensure your early-stage biotechnology organization’s continued success.



We examined the historical Chief Medical Officer (CMO) hiring timelines across thirty early-stage biotech organizations – collecting data on their first CMO hire and their sitting CMO. Data collected includes: date of hire, career backgrounds, educational backgrounds, and general demographics. Data was also collected on each organization regarding their pipelines – IND filing dates, phase of clinical development at time of hire, among others.

Supplementing this data, we conducted several interviews with various market experts to gather further qualitative understanding on CMO hiring, retention, and success.




Bizzy Balaraman is a senior member of Russell Reynolds Associates’ Biopharma practice. She is based in San Francisco.
Yvonne Lu co-leads Russell Reynolds Associates’ Global Biopharma practice. She is based in San Francisco.
Hayden Melecio is a member of Russell Reynolds Associates’ Biopharma Practice. He is based in New York.  
Tiffany Yam is a member of Russell Reynolds Associates’ Healthcare Knowledge team. She is based in San Francisco.


Precedence Research. July 2023. Biotechnology Market (By Application: Bio-pharmacy, Bio-industries, Bio-services, Bio-agriculture, and Bio-informatics; By Technology: Fermentation, Tissue Engineering and Regeneration, Polymerase Chain Reaction (PCR) Technology, Nanobiotechnology, Chromatography, Deoxyribonucleic Acid (DNA) Sequencing, and Cell Based Assay) - Global Industry Analysis, Size, Share, Growth, Trends, Regional Outlook, and Forecast 2023 – 2030.
Biotechnology Innovation Organization. February 2021. Clinical Development Success Rates and Contributing Factors 2011–2020.





CMO Success Blueprint: Timing, Talent, and Retention in Early-Stage Biotech