At Build (Series A, 10-30 people)

The job is conviction and storytelling. You are selling a vision to investors who are betting on the science and on you personally. You are hiring the first five to ten people who will define the company. You are in lab meetings because the science still needs your judgement, and because there is no one else senior enough to make calls on it. Capital is what you spend most of your time on. The board is small, friendly, and bets on you. Strategy and operations blur into one thing called "what we do this week."

What I look for at this stage: Storytelling power. Scientific credibility the founders trust. The kind of conviction that survives a "no". Real network depth in the therapeutic area. Comfort with ambiguity. Hiring scars and instinct.  

At Scale (Phase 3 & pre-commercial, 100-250 people)

The job is institutional leadership. You are running multi-site clinical operations, a real BD function, a finance team with its own CFO, and a board that includes crossover investors who think in quarters. You are not in lab meetings. If you are, something is wrong. Most of your time is on people, capital markets, and the strategic positioning that decides whether the company gets acquired, goes public, or commercialises on its own. The conviction is still there, but it is layered under judgement, delegation, and the kind of patience that lets other people make decisions you would have made yourself two stages ago.

What I look for at this stage: Experience running a 100-plus organisation. Public-markets or pre-IPO exposure. BD and partnering muscle. Ability to integrate executives without crushing them. Pattern recognition across cycles. The willingness to step back from the science.

Some founder-CEOs grow into this. Most do not. The honest ones know which they are.

At Build (Series A, 10-30 people)

There is, in the strict sense, no CFO job yet. There is a financial manager job. Someone who can build a clean monthly close, manage the cap table, support the next financing round and translate the science budget into investor-speak. The strategic financing decisions are made by the CEO. Jan de Kerpel said this directly on Willing to Win: "In early stage companies, the CFO role, it's not a CFO role. It's actually a financial manager role." Most companies hire too senior here and pay for it twice. First in salary, then in frustration on both sides.

What I look for at this stage: Operational discipline. Investor reporting craft. Cap table fluency. Comfort working closely with a CEO who still owns the financing strategy.

At Scale (Phase 3 & pre-commercial, 100-250 people)

Now it is a CFO job. The person in the seat is running a finance team, structuring institutional financings, modelling commercial scenarios with real revenue assumptions, and sitting opposite analysts and crossover investors as a credible peer. The IPO conversation is real. The acquisition conversation is real. The strategic capital decisions are no longer the CEO's alone. The CFO is a co-pilot to the CEO and a primary contact for the board on everything financial.

What I look for at this stage: Experience as a CFO at a clinical-stage or commercial biotech. IPO or public-markets exposure if the path is going there. Scenario-modelling sophistication. Board command. The judgement to push back on the CEO when the model says push back.

Some CFOs grow into the strategic role at Scale. Most do not. Hiring the wrong type at the wrong stage means paying twice. First in salary, then in the cost of finding a replacement when the company is at its most fragile.

At Build (Series A, 10-30 people)

In most cases, there is no CMO yet, and there should not be. The clinical asset is years from the patient. What the company needs at this stage is a Medical Advisor or a fractional Chief Medical Officer, two days a month, helping the CSO shape the development plan and run the early regulatory conversations. Founding teams that hire a full-time senior CMO three years before first-in-human discover quickly that the role has not yet been invented for the person, and the person leaves or the role drifts. Jan de Kerpel said this directly on Willing to Win: "It is totally useless to have a superb Chief Medical Officer in your company when you are three years away from testing the first in human."

What I look for at this stage: Medical training combined with operational instinct. Comfort working part-time or as an advisor. Strategic feel for the development plan, not just protocol-writing. Real chemistry with the CSO and the CEO. Willingness to grow into the full-time role later, or to step aside cleanly when the time comes.

At Scale (Phase 3 & pre-commercial, 100-250 people)

Now the CMO is the senior clinical voice of the company. The job is running multi-site Phase 3 trials, navigating end-of-Phase-2 and pre-NDA conversations with regulators, building the clinical development organisation, and standing in front of the medical community at scientific congresses. The CMO is the public face of the science alongside the CSO, and increasingly the internal advocate for what the asset can and cannot claim in a label. The role is no longer about getting the trial designed. It is about getting the trial finished, the regulatory dossier filed, and the medical community prepared for launch.

What I look for at this stage: Phase 3 experience, ideally in the relevant therapeutic area. Regulatory track record with the FDA and EMA. Comfort with public visibility — KOL relationships, scientific congresses, investor calls. Operational leadership of a clinical organisation of 30 to 80 people. The ability to manage commercial pressure without compromising scientific integrity.

The CMO who designs Phase 2 is almost never the CMO who runs Phase 3 in seven markets. Hiring too early, or keeping the same person too long, costs the company a year of trial momentum.

The CBO and the COO follow the same pattern.

The Chief Business Officer who closes the first licensing deal at Translation is rarely the CBO who structures a USD 500M partnership at Inflection. The first kind opens doors. The second negotiates from inside the room. They are different jobs.The Chief Operating Officer is a rare hire before Scale, and almost mandatory by the time of commercial launch. In early biotech, the CEO is the COO. In late biotech, the COO is the person who keeps the company running while the CEO faces outward to investors, regulators, and acquirers.Each role has its own signals, its own timing, and its own cost of waiting. The full pattern across all six stages and five role transitions is in The Rados Method.

Read the full pattern across all six stages: The Rados Method ->