Why Being a CMO May Be the Toughest Leadership Job in Medicine

The new CMO was hired into what looked like the ideal situation.

Growing health system. Capital expansion planned. New VPs being hired across the enterprise. A nationally recognized marketing firm brought in for a five-year campaign. A physician compensation model being redesigned with external consultants.

The medical staff was stable. Relations with leadership appeared strong. The MSK service line had doubled in size and was nationally recognized for quality outcomes.

Within months, almost every one of those conditions reversed.

The compensation model was abandoned — replaced with a different system that no one had discussed with physicians. The marketing firm was let go. The capital plan was scrapped in favor of a $100 million hospital in a town where the previous hospital had already failed. The CFO disclosed a $48 million first-quarter deficit.

The CMO was tasked with managing physician reactions to each of these developments.

This is the structural reality of the CMO role that nobody puts in the job description. You are positioned between the executive team and the medical staff. You are expected to carry the administration's message to physicians and physicians' concerns to the administration. And when the administration makes decisions that damage trust with the medical staff, you are the one in the room with both groups.

You are often chosen for your likability, not your authority. Your influence depends entirely on the goodwill of people who do not report to you in either direction.

The CMO role can be extraordinary. It can also be the most isolating position in medicine.

What do you wish someone had told you before you took — or before you hired someone into — your first executive role?