Advisory Board has been serving CMOs for decades. When we started, the CMO role was scoped: It focused on hospital quality and safety and oversaw the medical staff. However, we've seen notable changes in the role across the past decade.

As the physician enterprise has grown to integrate multiple hospitals and the medical group, the CMO's purview has expanded from the hospital to include the ambulatory setting. In our 2019 CMO benchmarking survey, we learned that CMOs spent almost one-third of their time on cross-continuum responsibilities, and 83% of CMOs think that time will only increase.

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Covid-19 has only intensified this trend. Physician leaders were the crux of coordinating the Covid-19 response and communicating across sites of care. The pandemic put a lot more decisions on CMOs and added to their roles both clinically and in terms of leadership responsibilities.

While the role often feels ever-changing, most physician leaders welcome this trend. With greater oversight over the patient journey, leaders can more effectively oversee the quality of patient care and manage costs. Here are three ways CMOs have seen their role transform.

Three ways the CMO role has changed

1. CMOs' span of control is expanding to oversee new strategic initiatives.

Physician executives are increasingly taking on more ad hoc responsibilities and overseeing initiatives that were not historically under their purview or didn't exist even a year ago. Interestingly, the responsibilities being added to CMOs' plates vary across organizations. Some physician leaders are now leading pharmacy initiatives; others are playing more active roles in ambulatory growth. And with Covid-19, new programs, like telehealth, emerged that CMOs' began to oversee. Physician executives explain that organizations often place these initiatives under the CMOs purview because these programs align with quality and safety and need physician buy-in.

What to watch: Physician executives' spans of control is constantly growing, but the jury is out on whether it should be. Some physician leaders feel tension between whether they should continue to take on more new-in-kind responsibilities or whether the organization should be creating new or dividing existing executive roles to make the day-to-day more sustainable in the long term.

2. As the CMO role shifts to Chief Physician Executive, the team and skills required evolve in tandem.

With a more elevated role across the enterprise, the traditional hospital CMO is evolving into a chief physician executive. Over the years, we've seen CMOs shift from being "influencer-in-chief" to having formalized teams with direct reports and counterparts across the system. The new skills necessary for the role are more similar to those needed by a CEO than the historic CMO. For example, physician leaders point to executive leadership, strategy/planning, and innovation as becoming increasingly important for success in their role. Physician executives even anticipate that influencing the executive team will become a more important skill than influencing the medical staff. However, without formal training in these areas, most physician leaders have found their success or failure hinges on their ability to develop these soft skills on the job.

What to watch: Although physician executives are taking on more cross-continuum strategic priorities, budget authority doesn't always follow them outside of the hospital. As the CMO becomes more elevated, the role might require more decision-making authority in the ambulatory space.

3. The continued success of the physician executive role hinges on succession planning.

Many current CMOs were pushed into an expanding role while on the job and thus had to rapidly build new skills and teams without formal training. Today, it's safe to assume that some of these changes that expanded the role are cemented and that the role will be ever-growing and require an adaptive leader. Consequently, physician executives recognize that selecting and training their successor is more important than ever, but few have succession plans in place. This is surprising given that today's physician workforce is ripe with leadership potential. Covid-19 was a testing ground where many physicians stepped into leadership roles and demonstrated an agile mindset in an environment constantly in flux. Not to mention, many of these physicians have dual degrees and specialized skills that match the evolving physician executive job description. To start succession planning, physician leaders can identify clinicians who stepped up during Covid-19 and/or have shown interest in the business side of healthcare.

What to watch: Because most physician executives are already eyeing their next-level role, leadership development and succession planning are no longer optional. Organizations should be strengthening their leadership development pipelines and having their physician executives build succession plans right now.