Mozibox has set an audacious but necessary goal:
Increase the percentage of physicians in leadership roles by 50% by 2035.
That’s not just an HR initiative. It’s a survival strategy for healthcare, and the same holds true for healthcare startups. Whether you’re running a hospital system or building a digital health company from scratch, the absence of physician leadership creates the same blind spots: products and processes that look great on paper but fall apart in the real world of patient care.
The Chief Medical Information (or Informatics) Officer (CMIO) role itself grew out of one of those blind spots. In the wake of Meaningful Use and the nationwide push for electronic health record (EHR) adoption, health systems quickly realized something: you can’t just drop technology into clinical care and expect it to work. Early EHR rollouts exposed the gulf between IT priorities and clinical realities. Physicians were frustrated. Workflows broke. Burnout spiked. The CMIO role emerged as a corrective, a physician leader who could bridge the gap between the technical build and the bedside. Over time, the CMIO expanded from “EHR translator” into a true strategic leader, shaping digital health, data strategy, and care delivery transformation.
Because when physicians aren’t in the room, decisions drift. They drift toward financial engineering, vendor priorities, or operational convenience. But when physicians lead, decisions align with patient realities, frontline workflows, and clinical nuance. That’s the difference between a health system that functions in practice and a startup that actually achieves clinical adoption.
Here’s the catch: “leadership” can’t just mean titles. It has to mean capability, the ability to operate effectively at the messy intersection of care delivery, operations, and technology.
The CMIO as a Case Study in Physician Leadership
Few roles capture the messy intersection of clinical care, technology, and operations better than the Chief Medical Information (or Informatics) Officer. But the flavor of the job changes dramatically depending on the size of the institution.
At a small institution, the CMIO is the Swiss Army knife of leadership. One moment they’re listening to nurses explain why an order set is unworkable; the next, they’re tweaking the EHR build themselves; by afternoon, they’re troubleshooting a medication reconciliation workflow with IT. It’s high-touch, scrappy, and deeply personal, because if they don’t fix it, no one else will.
At a medium-sized institution, the CMIO starts to scale. They’re no longer building every widget themselves but instead guiding analysts, vendors, and governance committees. Their credibility depends on staying close enough to the ground to know the pain points while pushing the system toward bigger priorities like interoperability, analytics, and AI. Here, the tension is constant: too deep in the weeds, and you lose altitude; too high up, and you lose trust.
At a large institution, the CMIO becomes more politician than builder. The role shifts to enterprise alignment, multi-year digital strategy, and navigating the bureaucracy of competing agendas. In these environments, the CMIO rarely touches the build, but their decisions ripple across thousands of clinicians and millions of patient encounters. The risk here isn’t irrelevance, it’s inertia. At this scale, even the right ideas can die in committee if the CMIO doesn’t know how to move the machine.
Small is scrappy. Medium is balancing act. Large is politics. Same title, wildly different realities.
Operational vs. Applied CMIOs
Within this landscape, two archetypes often emerge, and they couldn’t feel more different.
- The Operational CMIO is the strategist. They live in governance meetings, negotiate priorities, and keep the organization aligned. Their influence is in what gets built and why. They’re measured by adoption rates, clinical outcomes, and organizational harmony. They set the direction, but they rarely touch the tools.
- The Applied Informatics CMIO is the builder. They’re in the EHR, configuring workflows, testing prototypes, and translating strategy into reality. They shorten the distance between idea and implementation because they can move from whiteboard to build environment in the same afternoon. Their influence is in how things actually work at the bedside.
In many organizations, this tension resolves into a CMIO–ACMIO pairing: the CMIO zooms out, tackling strategy, budgets, and politics, while the Associate CMIO zooms in, executing the applied informatics work. But here’s the truth: it’s not always that clean. In some systems, the CMIO is both strategist and builder, by necessity, by choice, or because the organization hasn’t matured enough to split the responsibilities.
One model isn’t better than the other. What matters is clarity. When the CMIO is expected to do both without support, they risk being spread too thin. When they’re only strategic without staying grounded, they risk losing clinical trust. The strongest CMIOs know how, and when, to wear both hats.
The Variability of the CMIO Role
No two CMIO jobs are identical. In fact, the variability is the point.
Some CMIOs are deeply embedded in clinical operations, shaping care models and workflow design. Others are driving technology strategy, vetting AI partners, or leading cybersecurity governance. Many find themselves pulled into quality improvement, population health, or even revenue cycle optimization because digital systems touch all of it.
That’s why the CMIO has become the jack-of-all-trades, master of none, C-suite leader. Not because they lack expertise, but because they’re the only physician executive expected to have meaningful input across every single dimension of healthcare delivery and every tech-enabled startup function. From workflow design to regulatory compliance, from vendor negotiations to clinical analytics, the CMIO is everywhere, influencing everything, whether or not it’s formally in their remit.
Other C-suite roles are clean and contained. CFOs own money. CMOs own brand. CIOs own infrastructure. But CMIOs? They end up owning everything that no one else quite knows how to handle, all the messy, clinical-technical-operational intersections where the system is most fragile and where failure hurts the most. That’s both the burden and the opportunity of the role.
And importantly, the role has evolved far beyond its origin. What began as a physician safeguard during the Meaningful Use era, ensuring EHR rollouts didn’t derail care, has grown into a leadership platform that now includes enterprise data strategy, digital transformation, and applied AI. In many systems, the CMIO is just as likely to be leading conversations about predictive analytics, virtual care, and consumer experience as they are about order sets and documentation.
Even the title itself reflects this evolution. Some organizations call it Chief Medical Information Officer to signal a tighter link to IT governance, while others prefer Chief Medical Informatics Officer to emphasize applied clinical translation. Both labels are valid. What matters far more is the CMIO’s ability to straddle two worlds, the technology and the bedside, and make them work together.
Unlike many C-suite roles, the CMIO often has the latitude to dictate the contours of their own position. What they focus on, and how they do it, is often a negotiation between personal expertise, organizational need, and institutional politics.
Reporting structures add another layer of variability:
- In traditional C-suites, the CMIO may report directly to the President or CEO, giving them real authority to push cross-functional change.
- In other settings, the CMIO reports up through an operational leader, like a COO or CMO, which can either anchor them in clinical credibility or limit their influence depending on that relationship.
This variability isn’t a weakness. It’s the defining characteristic of the role, and a signal of just how wide the leadership aperture is for physicians who step into it.
The Path to Becoming a CMIO
For aspiring CMIOs, the question is always the same: How do you actually get there?
Historically, the path was almost entirely experience-based. If you were the physician who took an interest in the EHR, who could translate between IT and clinical staff, or who raised your hand for informatics projects, you eventually found yourself in the role. Over the past several years, though, the pathway has professionalized. Clinical informatics fellowships now exist to provide a formal foundation for this career, and board certification in clinical informatics has become another differentiator. While neither is strictly required, both can help given the competitive nature of these roles and the reality that many organizations use them as screening tools.
Even so, I still believe the best path to becoming a CMIO is to just start doing the work, even informally. Help your colleagues in the clinic. Share tips that make the system easier to use. Volunteer to support pilots or test new features. Early in my own career, I signed up for everything—video visits, new release features, even launching a one-person pilot for video-based translation and interpretive services. Those actions weren’t glamorous, but they got noticed, and when they got noticed, new opportunities opened. If you stick to that plan, you’ll rise through the ranks.
What Has to Change to Hit the 2035 Goal
At the system level:
Healthcare organizations, and healthcare startups, need to stop treating physician leadership as an afterthought or a box-check. Leadership pipelines should run parallel to clinical career tracks, not as bolt-ons once someone “slows down” in practice. Physicians should be embedded in technology and operational governance from the start of their careers, not dropped in after the fact to clean up broken workflows.
At the training level:
Medical education still trains physicians for a 20th-century world. Informatics, change management, and digital literacy need to be treated as core competencies, not electives for the nerds. Leadership rotations, short, immersive stints in operations, IT, or strategy, would let physicians “try on” these roles early and discover their appetite for them. Imagine if exposure to governance committees was as standard as exposure to gross anatomy.
At the individual level:
Physicians can’t wait for someone to tap them on the shoulder. The door rarely opens, you have to push it.
Early in my own career, I signed up for everything. Video visits? I’ll pilot them. New version features? I’ll test them first.I even launched my own one-person pilot for video-based translation and interpretive services because I saw the need and wanted to see if it could work. None of it was glamorous, and some of it was messy, but it got noticed. And when it got noticed, new opportunities opened.
That’s the playbook: stay scrappy, volunteer, and offer to help. Get into governance committees, technology pilots, and quality projects. Learn the language of operations and technology. Because knowing how the system works is just as powerful, maybe more powerful, than knowing how the body works.
Physician leadership in 2035 won’t happen by chance. It won’t come from “more titles.” It will come when we treat leadership itself as a core physician skillset, no different than interpreting an EKG or running a code.
That same scrappy spirit, the willingness to pilot, to test, to raise your hand and say “I’ll try it”, is exactly the kind of leadership we need scaled across the profession. Healthcare without physician leadership is like an EHR without clinicians: technically functional, but clinically useless. That’s the gap Mozibox is pushing us to close. And it’s not just aspirational, it’s existential.