Most people understand the CBO as the person who does the deals. From inside the seat, the role is broader, messier and more exposed than that. This white paper draws on an off-the-record bioCatalyst roundtable with 4 biotech CBOs across the US and Europe, exploring what the job is really like the first time you do it: how it differs from a VP BD role, how to build a team (and where AI helps), aligning a CEO and board who each carry a different version of the job, protecting a live negotiation from well-meaning interference, and carrying accountability for outcomes you don't fully control. Practical and honest, whether you're weighing a first CBO seat, hiring for one, or backing a founder who needs one.