In September 1998 Sakari Oramo was appointed Principal Conductor and Artistic Adviser of the City of Birmingham Symphony Orchestra, and the following year was named its Music Director. In the 2003-04 season Sakari Oramo also became Chief Conductor of the Finnish Radio Symphony Orchestra, having previously been Associate Principal Conductor. An accomplished violinist, he was originally the orchestra's leader, during which time he enrolled in Jorma Panula's conducting class at the Sibelius Academy. In 1993 he replaced an indisposed conductor at short notice with such success that he was appointed Associate Principal Conductor.

During his five seasons with the CBSO Sakari Oramo has toured extensively with the orchestra throughout Europe and Japan. His programmes reflect his Finnish origins, as well as his interest in the twentieth-century English tradition. Since his conducting debut with the Finnish Radio Symphony, Oramo has conducted regularly throughout Scandinavia with many prestigious orchestras, and in 2003-04 conducted Britten's Peter Grimes at Finnish National Opera. Other guest appearances have included the Los Angeles Philharmonic, the Orchestre de Paris, the NHK Symphony Orchestra, the New York Philharmonic and the Berlin Philharmonic.

Sakari Oramo's recordings include early-twentieth-century and contemporary Finnish music with the Finnish Radio Symphony Orchestra; with the CBSO he has recorded the Walton and Sibelius violin concertos with Akiko Suwanai, the Sibelius symphonies, and the Saint-Saens piano concertos with Stephen Hough, a recording which won several awards including a Grammy nomination and Gramophone's Recording of the Year.