While the ousting of U.S. Department of Veterans Affairs Secretary David Shulkin, MD, was not much of a surprise, President Donald Trump’s replacement choice has left many scratching their heads.

White House Physician Rear Adm. Ronny Jackson, MD, was thrust into the spotlight in January for his glowing review of the president’s health, when he showered praise on Trump’s “incredible genes” and called him “very healthy and will remain so for the duration of his presidency.”

A review that came as a surprise for many, who, based on appearance and Trump’s admitted love of fast food, feel the president doesn’t appear that healthy.

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Jackson has held his role under three administrations, overseeing healthcare for senior staff and cabinet members. He also served as a physician supervisor at Camp David and led the White House Medical Unit. Shulkin even recommended Jackson for an undersecretary position in the fall.

Jackson began active duty naval service in 1995, and in following years, he served as an instructor at the Naval Diving and Salvage Training Center in Florida. He was also a diving medical officer for an Explosive Ordnance Disposal unit in Italy, as well as a diving safety office at the Naval Safety Center in Virginia.

In 2005, Jackson joined a 2nd Marines Combat Logistics Regiment in North Carolina. And he served as the emergency physician in charge of resuscitative medicine for a platoon in Iraq.

Jackson's Experience

The concern about Trump’s choice doesn’t stem from his medical capability: Jackson hasn’t held a managerial role of the size and capacity required of the VA.

The VA is the second largest federal agency, after the Department of Defense. As secretary, Jackson would be in charge of 370,000 employees with an agency budget of $186 billion annually. Not only that, but he’d be tasked with overhauling an agency, which has been riddled by scandal in the past few years.

[Also: With Shulkin out, what's next for the VA's EHR modernization?]

Jackson himself, in fact, was reluctant to accept the nomination as it was such a big role, according to a Washington Post report. But the president continued to push, telling senior staff that Jackson was his top pick.

Not only that, but the same report found that Jackson was given only an informal interview and did not receive any extensive vetting that is typically given to cabinet members.

Running the VA is one of the most complex jobs in the country, requiring knowledge of large systems, technology, payment models, budgets, hospital operations and Congress. https://t.co/8cd1ih3bkl

— Andy Slavitt (@ASlavitt) March 28, 2018

The White House has defended the choice and even Sen. Lindsey Graham, R- South Carolina, hailed the pick as “great news for the American Veteran.” But at least two major veterans groups disagree.

AMVETS, an inclusive veterans service organization, expressed concern.

“Veterans’ lives depend on this decision, and the Trump administration needs to substantiate that this active-duty Navy officer is qualified to run a $200 billion bureaucracy,” AMVETS Executive Director Joe Chenelly said in a statement.

The group also questions whether it’s appropriate for an active-duty military officer to run a federal agency. And even more pressing: Jackson’s official bio doesn’t contain any indication that he’s held a command, which makes the group wonder whether he’s even qualified.

Further, the VA is much more than healthcare. “This sudden change in leadership threatens to stymie ongoing responsible reforms at the VA,” the group said. 

VoteVets, a veteran group with 500,000 members, said it’s “concerned about his readiness to assume control.”

The group is calling on Congress to ask “blunt, direct questions about how the VA works … Hearings should not just examine his policy positions, but also how much he knows about VA ops and structure.”

John Brennan, former CIA director, tweeted that while he personally respects Jackson as a doctor and officer, “he has neither the experience nor the credentials to run the very large and complex VA. This is a terribly misguided nomination that will hurt both a good man and our veterans.”

I personally know and greatly respect Ronny Jackson....as a terrific doctor and Navy officer. However, he has neither the experience nor the credentials to run the very large and complex VA. This is a terribly misguided nomination that will hurt both a good man and our veterans

— John O. Brennan (@JohnBrennan) March 29, 2018

Others have pointed out the same: He’s a qualified doctor that has served the U.S. honorably, but that doesn’t make up for a lack of management experience that would prepare him for such a massive role.

Big tech shoes to fill

In just about a year into his post, Shulkin made strides at an agency often plagued by slow reform, and in recent years, scandals over ill-performing staff members and egregious wait times.

Shulkin helped to pass 11 Congressional bills, launched a 24-hour hotline for veterans’ complaints, created a platform for tracking wait times at VA medical centers, worked to ease the backlog of benefit applications and jump-started the ambitious Anywhere to Anywhere telehealth program with Trump.

A former private sector doctor and health system CEO, Shulkin was part of multiple EHR implementations and sought to sign a contract with Cerner to replace the VA’s legacy VistA EHR. 

He’s also the only Trump cabinet member who was unanimously confirmed.

This poses two concerns: Jackson’s bio lists no positions with tech leadership, and he’ll need to win over a Congressional group that supported the former secretary’s decisions.

Given that Jackson doesn’t appear qualified, his confirmation, if at all, will be a difficult task -- and, in the interim, the fate of the VA’s EHR modernizations project to improve patient care hangs in the balance.

Twitter: @JessieFDavis
Email the writer: jessica.davis@himssmedia.com