Joel Garfinkle

The room fell silent when the VP of clinical development walked in. She wasn’t the most senior person there, but when she spoke, people listened. Her recommendations carried weight. Her presence, grounded in confidence, clarity, and conviction, commanded the room.

She had executive presence: the leadership edge that projects certainty, earns respect, and generates impact.

The Executive Presence Gap in Pharma

The pharmaceutical industry’s strong bias toward technical expertise creates a blind spot. I’ve seen it time and again: brilliant molecular biologists rise through breakthrough research. Clinical leaders rise by leading complex Phase III trials. Commercial leaders advance through deep market access expertise.

Then they hit a wall.

What got them here, deep expertise, isn’t enough to lead cross-functional teams, influence senior stakeholders, or rally people around decisions. Strategic insights get lost in meetings. Detailed recommendations fail to resonate with executives who need direction, not more analysis.

In pharma's high-stakes environment, decisions impact patient lives and company valuations. Leaders need the presence to inspire confidence in crises, align diverse stakeholders, and clearly communicate complex information to senior leaders and external partners.

The 3x3 Executive Presence Model

Executive presence isn’t about being flashy, dominant, or the loudest voice in the room. It's about how you show up as a leader: the confidence you project, the clarity with which you communicate, and the conviction behind your decisions.

Click to enlarge

Source: Joel Garfinkle; Garfinkleexecutivecoaching.com

Over the past 25 years coaching leaders in pharma and biotech, I’ve developed the 3x3 Executive Presence Model (see chart; click to enlarge). It breaks executive presence into nine core competencies across three dimensions.

Below is a snapshot of the nine traits. In the sections that follow, you’ll see real-world examples from pharma and biotech that bring each one to life.

GRAVITAS (How you carry yourself)

• Confident: Convey conviction in how you lead, communicate, and make decisions.
• Commanding: Take ownership and take charge of situations.
• Charismatic: Motivate and energize others toward action.

AUTHORITY (How you lead)

• Decisive: Make timely, clear choices, and act without hesitation.
• Bold: Take calculated risks, push boundaries, and challenge the status quo.
• Influential: Persuade others, drive alignment, and move people to action.

EXPRESSION (How you communicate)

• Vocal: Speak up and make your voice heard.
• Insightful: Share insights, make recommendations, and provide guidance.
• Clear: Communicate with precision, clarity, and impact.

Building Executive Presence: A Practical Framework

Now let's see how these nine traits play out in real pharma and biotech leadership situations.

RADIATING GRAVITAS

1. Confident communication matters

A chief medical officer realized his habit of softening statements with "I think" or "maybe" was signaling doubt, even when he was certain. In science-heavy environments, leaders often default to tentative language to avoid overcommitting, but this weakens their presence and erodes how their ideas are received. We replaced hedging phrases with decisive language. Instead of "I think we should consider moving forward," he learned to say, "Based on the data, I strongly recommend we advance to Phase III." The shift strengthened his influence and improved stakeholder buy-in.

2. Commanding presence leads

When a director of regulatory affairs faced an unexpected FDA information request, tensions were high, timelines were tight, and cross-functional teams were scattered in their approach. Rather than reacting passively, she took immediate action, pulling together a cross-functional response team, outlining a clear plan, and communicating exactly what would happen and when. She brought a presence that was poised yet commanding, calm, confident, and clearly in control. Her presence said, "You don't need to worry, I've got it."

3. Charisma fueled by energy

Many pharmaceutical leaders come from scientific backgrounds, thoughtful, analytical, and reserved. These traits make them excellent scientists, but cause them to come across as emotionally flat. One senior medical affairs leader had brilliant insights, but his delivery felt muted. Even when he supported a key idea, no one could feel his enthusiasm. We worked on infusing his communication with energy. The result? People leaned in when he spoke, and he became known not just for what he knew, but for how he made others feel.

ACTING WITH AUTHORITY

4. Decisiveness delivers results

One commercial analytics director struggled with analysis paralysis, constantly refining assumptions and chasing consensus before making a move. We developed a decision-making framework to identify when there’s enough information (usually around 70%), engage key voices early, then make timely, confident decisions. Decisiveness isn’t about rushing, it’s about moving forward with clarity when it counts.

5. Boldness drives progress

In pharma, where the stakes are high and systems complex, it’s easy to default to caution. A VP of global market access challenged legacy thinking in their go-to-market strategy, identifying inefficiencies, proposing a bold new path, and galvanizing partners to act. She didn’t wait for permission. She moved with clarity and conviction, even when the outcome wasn’t guaranteed.

6. Influence inspires action

An executive director in clinical development had deep expertise but struggled to gain traction for his ideas. He presented data thoroughly, but his message lacked urgency and a compelling point of view. We focused on framing recommendations with confidence, highlighting business impact, and delivering ideas that drove action. In pharma, being smart isn’t enough, leaders must also be compelling.

EXPRESSING YOURSELF FULLY

7. Vocal presence matters

A medical director with a strong track record was often overlooked in key conversations. She realized that staying quiet, even when she had valuable insights, meant decisions were made without her input. We worked on strengthening her vocal presence: speaking earlier in meetings, sharing ideas before they were fully formed, and actively advocating for her recommendations. She became more influential and trusted across the organization.

8. Insight elevates thinking

A director of market access had deep expertise in data and payer strategy, but his contributions rarely influenced direction. His updates were thorough but focused more on information than insight. We shifted his approach to framing implications, making strategic recommendations, and asking forward-looking questions. He became a go-to voice, respected for elevating conversations and driving smarter decisions.

9. Clarity commands attention

The lead in translational medicine had deep scientific expertise, but her insights got lost in technical detail. In pharma, where complexity is the norm, messages must cut through the noise. We focused on highlighting the most relevant insight for each audience and simplifying data into concise, actionable messages. Her ideas became easier to understand, quicker to support, and influenced direction.

Ask for Feedback: Discover How Others Perceive You

Executive presence is built on perception, and perception lives in the minds of others. Most leaders have blind spots about how their presence is being received.

Start by identifying five colleagues who matter to your career, senior leaders and key stakeholders.

Then, schedule a 20-minute feedback conversation with each, clearly stating your intent: you're seeking honest, constructive feedback to grow as a leader.

Bring the 3x3 Executive Presence Model to guide the conversation and ask the following questions:

1. Am I perceived as having executive presence?
2. Where do you see me demonstrating executive presence?
3. What do I do that might weaken or undermine it?
4. What’s one area I should focus on to strengthen my executive presence?
5. Would you be open to offering support or accountability as I work on this?

Patterns will emerge. Those patterns are your roadmap. Focus on the themes that show where to grow and what to build on.

Executive Presence Matters

Executive presence isn’t a luxury; it’s a leadership imperative. In pharma, where the stakes are enormous, how you show up matters as much as what you know.

Your expertise earned you a seat at the table. Your executive presence is what moves the room.

When presence matches expertise, ideas move faster, teams align, and patients benefit. That’s the power of presence.

About the Author

Joel Garfinkle, author of Executive Presence: Step Into Your Power, Convey Confidence, & Lead With Conviction, has coached more than 2,500 leaders, including helping pharma and biotech executives become confident, commanding leaders.