SECRETS OF THE CMO: PERSPECTIVES AND SUCCESS
Much ink has been spilled about the role of the chief medical officer (CMO). We all have mental models of what the CMO is and what motivates them.
Hanging on the walls in our medical staff conference room are depictions of physicians representing each of our medical departments. In each depiction, the physician is attending to a patient — not wrestling with an electronic medical record, checking a smartphone, or dealing with pre-authorization. This is the model of the physician that is at the core of our professional belief system.
Similarly, there is a mythos surrounding the CMO that has evolved over centuries, shaped by the changing landscape of medicine, healthcare systems, and the increasing demand for clinical leadership within hospitals and health organizations.
The journey from ancient origins to the modern CMO role is both fascinating and illustrative of the growing complexity of healthcare delivery and the need for leadership at every level of medical practice.(1)
The Archiatros of the Byzantine Empire: The Ancient Roots
The earliest predecessor to the modern CMO can be traced to the Byzantine Empire, where the role of the archiatros held prominence.(2) Just as architect means “chief worker,” the archiatros was the chief physician (recall iatrogenic meaning “physician caused”). This figure was responsible for overseeing medical practice and ensuring the quality of care provided within the empire’s extensive network of hospitals.(3) During the Byzantine era, healthcare was organized under religious institutions, and medical practice was often intertwined with religious duties. The archiatros was tasked with managing the medical staff, which included physicians and other healers, and ensuring that the standards of care adhered to the religious and societal norms of the time.
This role was not that different from the modern CMO: It shared the underlying responsibility of maintaining high standards in medical care. It was the first glimpse of what would later become the strategic leadership role in medicine: an individual who not only practiced medicine, but also governed and administered medical practices.
Medieval and Renaissance Physicians: A Transition in Power
During the medieval and Renaissance periods, medical practices in Europe were closely aligned with universities and academic institutions, which were primarily responsible for the training and accreditation of physicians. Medical governance was largely decentralized, and physicians were often self-regulated through guilds or local councils.(4)
As self-organized and independent entities that ensure the qualifications and professionalism of their members, the organized medical staff of a hospital, the county medical society, and state boards of physicians are the descendants of medical guilds. However, the need for oversight of the growing healthcare institutions — often monasteries or other religious settings — began to surface.
As the Renaissance ushered in new ideas about science and humanism, healthcare systems started to take a more formal shape, particularly in the Western world. The establishment of more structured hospitals required oversight of medical professionals, and the role of the chief physician or head doctor became more defined. This position, however, was still primarily focused on medical practice rather than organizational leadership. The transition from being solely a practitioner to assuming leadership roles within the healthcare environment would continue to evolve.
The Rise of the Medical Director and Vice President of Medical Affairs (19th to Early 20th Century)
By the late 19th and early 20th centuries, the healthcare system in the United States began to develop more formal administrative structures. The urbanization and civic-mindedness of the post-Civil War era saw the emergence of hospitals. As they grew in size and complexity, it became apparent that physicians would need to be involved in leadership beyond just providing direct patient care.
The introduction of the medical director title in hospitals in the late 1800s marked the beginning of a more formalized leadership role for physicians within the healthcare system.
The medical director was primarily responsible for overseeing medical staff, ensuring the quality of clinical care, and implementing hospital policies related to patient care. The role, however, was still mainly focused on the clinical side of the hospital, with little involvement in the broader administrative and business operations. As hospitals became more complex, with the rise of insurance systems and government regulations, it became clear that the medical director’s role needed to evolve further.
By the mid-20th century, as healthcare systems grew more bureaucratic and corporatized, the role of vice president of medical affairs emerged. This title reflected a growing need for physicians to have a formal seat at the table in hospital and health system executive management.
The vice president of medical affairs was typically involved in clinical oversight, medical staff management, and the development of policies that aligned with both clinical excellence and the hospital’s operational goals. However, this role was still a hybrid — combining clinical expertise with some level of administrative responsibility but not yet fully integrated into the executive leadership of the organization.
The Emergence of the Chief Medical Officer
(Late 20th Century)
By the latter half of the 20th century, healthcare organizations were growing larger, and the complexity of managing hospitals and health systems required new leadership structures.(5)
The traditional titles of medical director and vice president of medical affairs were no longer sufficient to address the demands of modern healthcare systems. The role of chief medical officer (CMO) emerged to fill this gap, representing a new era in the intersection of clinical leadership and organizational governance.
The CMO title signified a shift toward a more comprehensive and strategic leadership role within healthcare. The CMO was now expected not only to manage the medical staff, but also to play a key role in shaping the strategic direction of the healthcare organization. This included participating in decision-making processes related to patient care, quality assurance, compliance, regulatory matters, and, importantly, healthcare finance.
The rise of the CMO coincided with several significant changes in the healthcare landscape. The growing importance of managed care, the emergence of value-based care, and the focus on quality improvement created an environment in which physicians needed to be leaders, not just practitioners. The CMO became an essential bridge between clinical and operational aspects of the organization, ensuring that clinical quality aligned with organizational goals, including patient satisfaction, cost containment, and operational efficiency.
I have said that the key role of the CMO is that of “bridge-builder”: between clinicians and administration, the medical staff and the board of directors, the hospital and the community.
By the 1990s, as healthcare systems in the United States and around the world began to shift toward more patient-centered care models, the CMO’s role continued to evolve. CMOs were tasked with addressing concerns such as patient safety, quality metrics, patient experience, and, increasingly, population health management.
The importance of leadership and collaboration with other executives — such as the CEO and CFO — became more pronounced. This evolution has led some to comment, snarkily, that CMO stands for chief metrics officer.
The CMO as a Strategic Partner in the Modern Healthcare System
As healthcare systems became more complex in the 21st century, the role of the CMO continued to expand, with a growing emphasis on leadership, data-driven decision-making, and collaboration across disciplines.
The rise of electronic health records (EHRs), telemedicine, and AI in healthcare has significantly changed the landscape, making CMOs key players in implementing technological innovations to improve patient care and outcomes. The role evolved from solely overseeing medical staff to actively driving strategic decisions at the executive level.
One of the key developments of the 21st century was the establishment of the chief physician executive (CPE) title. The CPE role is a further evolution of the CMO, representing an even greater focus on integrating clinical leadership with the business and operational sides of healthcare organizations.
While the CMO still focuses on clinical governance, the CPE has a broader mandate that includes helping to shape organizational strategy, influence culture, and lead efforts to improve quality and efficiency at every level of patient care.
The CPE is now expected to lead the development of patient-centered initiatives, guide the use of technology in care delivery, and ensure that clinical quality is consistently aligned with organizational goals.
In the context of a rapidly evolving healthcare system, the CPE is responsible for navigating complex challenges such as reimbursement reforms, regulatory compliance, and ensuring equitable access to care.
The Future of the Chief Medical Officer
As the healthcare industry continues to evolve, so too will the roles of the chief medical officer and chief physician executive. With the increasing emphasis on value-based care, population health management, and interdisciplinary collaboration, the CMO will continue to play a crucial role in guiding healthcare organizations through transformation.
Physician leaders are being called upon not only to manage clinical teams but also to provide insight into organizational strategy, patient safety, financial sustainability, and technological innovation.
Furthermore, the CMO’s role will likely continue to grow in importance as healthcare organizations place a greater emphasis on wellness and preventive care, as well as health equity. CMOs will play an essential role in promoting these initiatives, ensuring that the healthcare system becomes more proactive rather than reactive to the health needs of the populations it serves.
Conclusion
The role of the chief medical officer has undergone a remarkable transformation, from its origins as the archiatros in the Byzantine Empire to its current status as the chief physician executive in modern healthcare organizations.
While the CMO is now an essential healthcare executive, charged with a broad portfolio of overseeing quality, metrics, population care initiatives, and organizational strategy — at their core, CMOs are still the “chief doctor.” They are responsible for motivating, understanding, persuading, and championing their “guild” — the medical staff. This is the fundamental expectation of the physicians, advanced practice providers, and allied staff. This is the essential quality of the CMO, bestowed by millennia of practice and precedent.
References
University of Pennsylvania. History of Hospitals. Nursing History & Health Care. Retrieved July 29, 2025, from https://www.nursing.upenn.edu/nhhc/nurses-institutions-caring/history-of-hospitals/#:~:text=Benjamin%20Franklin%20was%20instrumental%20in,became%20more%20difficult%20to%20apply .
Wikipedia contributors. Archiater. Wikipedia. Retrieved July 29, 2025, from https://en.wikipedia.org/wiki/Archiater .
Zimonyi Á. Archiatres id est Medicus Sapientissimus — Changes in the Meaning of the Term Archiatros in the Roman Empire. https://www.academia.edu/34671463/_Archiatres_id_est_medicus_sapientissimus_Changes_in_the_meaning_of_the_term_archiatros_in_the_Roman_Empire
McLaughlin EF. The Guilds and Medicine. Annals of Medical History. 1941; 3(5):384–394. https://pdfs.semanticscholar.org/1b6b/1680a2d8ff0094afcb8572b6cb3cddaa83e9.pdf .
Dister L. CMO or VPMA—Is There a Difference? Physician Executive. 2009;35(3): 12–16. https://www.scribd.com/document/16006231/CMO-or-VPMA-Is-There-a-Difference .