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What does an early stage CEO actually do?

Updated: Sep 13

Several of my newer clients have asked me “What does a CEO of an early stage biotech company actually do?”

It's a great question. As a first-time founder, it’s often hard to know if you’re doing the right things as a CEO and building effective skills and competencies.

As a coach, I work across a lot of early stage biotech companies and have seen this role play out in many different ways across different teams and structures. While everyone has their own style and each company has its own unique mission, vision, and structure, there are some commonalities to what this job entails at this stage of organizational development.

Here are some broad-strokes ideas for you to consider as frameworks for your new role. There are basically two modes for CEOs: when you’re fundraising - and when you're not. Let’s talk about what a CEO does when it’s not time for a fundraising sprint:

Non-fundraising CEO activities:


  • Administration: getting bills paid, legal, infrastructure set-up

  • Internal operations: team meetings, manager support, 1:1 meetings

  • Scaling the company: hiring, setting up organizational systems, meeting advisors


  • Investor/board relations: meeting with current and potential future leaders

  • Grant applications: applying for non-dilutive funding

  • External relations: meeting people, raising your profile and the company’s

  • Partnerships: securing high-value collaborators


  • Company strategy: scientific and business strategy, talking to thought leaders

  • Goal setting: product road mapping, team goal setting, delivering on your own OKRs

  • Business development: understanding your market and customers’ needs


  • Basic functional needs: exercise, food, etc.

  • Getting your own stuff done: email, tasks, meeting agendas, decks etc.

  • Learning: reading, coaching, getting mentored

When it's time to fundraise

As you gear up to fundraise, investor relations ramp up significantly. For a targeted sprint that can last from weeks to months, fundraising becomes >80% of your job. You have to scale back almost everything you do while you are in the diligence process so that you can jump on a call and answer questions immediately from potential investors. Expect that you will have to delegate a ton during this time and limit your engagement in day-to-day life at the company in order to close your round.


Let’s set the record straight: you do not need to be the next Jeff Bezos or Elon Musk to be an effective CEO. You don’t need to have a giant personality or be a gregarious extrovert who loves to party. There are a billion ways to lead effectively, maximizing your strengths. Here are the key skills and competencies that I’ve noticed that CEOs need regardless of their personal style:

Building + maintaining relationships

As a CEO, you need to be great at building and maintaining relationships. Internally, this means being a human-first leader and manager who cares deeply about the other people on your team. Externally, this means keeping a strong network to attract talent, advisors, and investors to your team.

Self-awareness + humility

You need to be able to identify the skills, personalities, and talents you need to surround yourself with to augment your own strengths and assets. You also need to know yourself extremely well to be able manage yourself on a daily basis and build a high-functioning team. One of the most valuable skills you will flex is your ability to ask questions and find answers. The CEO doesn’t need to have all of the answers, they need to know how to ask the right questions - and to whom.

Effective communication

As CEO you will need to be communicating often to a wide range of audiences. You will need to share a vision of what you aim to achieve as well as how you are going to align the team and resources to get there. While you may have a particular communication mode or style that you prefer, you will need to be flexible across many mediums including virtual meetings and slide decks. Internal communications with your team about what is important and how we behave are just as important as securing your next round of funding.

Getting stuff done - and exceptionally

You need to be able to deliver. Whether you are acting on your own to-do list or you are executing through others, you need to be able to push progress forward meaningfully. If you say you are going to do something, you need to get it done on-time or early. You need to have a high bar for excellence and hold yourself and others accountable for achieving results.

Strategic thinking

CEOs are responsible for being the captain of the ship, steering the organizational boat in the right direction. This means that you are the front-runner and are seeking the best insights and advice from everywhere to guide your thinking so that you can bring back these ideas to your team. You need to be well ahead of everyone else, thinking about where you need to be in 1 year, 3 years and 10 years - so you can figure out how to get there with your team.

Designing clear systems

As an early stage leader, you need to be thinking about scale from day one. You need to be thinking always in systems. How do you build today, that enables you to grow tomorrow? Whether this is setting up an onboarding system for new employees well before you need it, or thinking about how to grow talent within your team, you always have to be thinking about creating clear and predictable patterns to help your team operate smoothly today - and in the future.

Learning and growing

As a first-time CEO, you will need to grow faster than your team and your company. This means you will need to fast-track your own development. While you can certainly read a ton and listen to every podcast out there, it’s coaches, mentors, and advisors who will help you accelerate your own learning. These are people who can give you the Cliff Notes and save you hours by telling you short-cuts and customizing your learning experience so that you get what you need to just in time to help you get to that next milestone or goal.


I often encourage first-time founders to look around and find a CEO they respect and admire. It could be in biotech or another field - it doesn’t matter. What’s important is that you find someone that inspires you. Take some time to learn about this person and observe how they choose to play the CEO role. You don’t want to necessarily copy them, but you can learn a lot from observing someone else as you figure out what kind of a CEO you want to be.

Remember: being a learning CEO is hard. You are learning on the job and the stakes are already pretty high. If you can, try to stack the odd in your favor for success by learning as much as you can and having a mentor or coach to optimize the efficiency of your feedback loop so you can grow faster than your team.


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