White House physician, Rear Admiral Ronny Jackson, takes questions at the press briefing on January 16, 2018. Photo: NICHOLAS KAMM/AFP/Getty Images

Taking better care of veterans was a key theme of President Trump’s 2016 campaign, and when he rolled out his plan to fix the Department of Veterans Affairs in July 2016, he said his first order of business would be naming a new VA secretary with a “personal mission” to fix the department. “This person, man or women, will be outstanding with an outstanding track record,” he said.

For roughly the first year of his administration, Trump thought that person was David Shulkin, a physician who was the department’s undersecretary for health under President Obama. But as Shulkin fought Trump administration proposals to privatize services provided by the VA and faced a scandal over a trip to Europe in recent weeks, it became apparent that Trump had soured on him. On Wednesday evening he announced via tweet that Shulkin was out, and he’d tapped Rear Admiral Ronny Jackson, the White House physician, to lead the department.

White House officials spent Thursday fending off questions about whether Jackson, who currently oversees about two dozen people in the White House medical office, is really up to the task of modernizing an agency that employs 370,000 people and operates 1,243 health facilities. New reports on how Trump reached the decision suggest he made a snap call and didn’t properly alert his staff — which does a disservice to both Jackson and the 9 million veterans who receive care though the VA.

Trump has been on a firing spree of late, and it seemed fairly likely that Shulkin would be next. According to the Washington Post, the plan was to announce on Wednesday that Shulkin would leave the administration, and Robert Wilkie, undersecretary for defense personnel and readiness at the Defense Department, would serve in his place until Trump had settled on a nominee. But Trump scrapped that plan with a tweet announcing Jackson’s selection.

Earlier in the day White House staff, and even Trump himself, appeared to have no idea that the dismissal was imminent. Chief of Staff John Kelly had reportedly spoken with Shulkin on Wednesday morning and assured him that he wouldn’t be fired via tweet later in the afternoon. Shulkin said that during a separate call with Trump on Wednesday, the president gave no indication that he wanted him gone.

“We spoke about the progress that I was making, what I needed to do from a policy perspective to make sure that we‘re fixing the issues in VA,” Shulkin told MSNBC. “He was very focused, he was very inquisitive about the things we were working on, making sure we were focused on the job at hand.“

Jackson was said to be among those shocked by his appointment. The Post reports:

Jackson was taken aback by his nomination, said senior White House officials, who spoke on the condition of anonymity to discuss internal deliberations. After aides gauged his interest in recent days, he hesitated to take on such a big job. But the president continued to push and told his senior staff Monday that the doctor was his top choice. A senior White House official described an informal interview process, without the extensive vetting that typically accompanies a Cabinet selection.

Some have questioned whether Jackson was even capable of saying no, as he’s on active duty and Trump is commander-in-chief. Regardless, it’s easy to see why Jackson would be hesitant to take the job. After serving as an emergency trauma doctor in Iraq, Jackson worked as a White House physician under the last three administrations. His most recent predecessors had extensive experience running hospital systems and large companies and still found the job extremely difficult.

The Post reports that last month Jackson was up for a less demanding position: running the Veterans Health Administration, which oversees the VA’s hospital and clinics. Though Jackson said Trump wanted him to stay at the White House, a selection panel interviewed him anyway, and one source didn’t think he was up to the task:

The panel interviewed him informally anyway, asking him how he would drive change in such a large organization but not about his views on policy. One person who sits on the panel, and who spoke on the condition of anonymity because its proceedings are confidential, said they didn’t think Jackson had the requisite skills to transition from overseeing a team of about 20 doctors, nurses and physician assistants in the White House medical office to overseeing the health administration.

That’s something that might have received more consideration had Jackson gone through the normal vetting process for a Cabinet nominee. Obama ethics czar Norm Eisen points out in a New York Times op-ed that his apparent skill in his current position doesn’t mean disqualifying information wouldn’t have come up during the process.

Jackson is seen by both Republicans and Democrats as someone with great integrity, but his interactions with Trump have already done some harm to his reputation. While he’d previously only made headlines when he treated a girl who was bit by one of the Obamas’ dogs, his glowing assessment of Trump’s health following an exam in January raised concerns about his methods and judgement. The physician said he had “absolutely no concerns” about the president’s cognitive function based on one narrow test, and he offered a rather Trumpian answer when asked how a fast-food-loving, exercise-averse 71-year-old could be in such incredible shape. “Some people have just great genes,” he said. “I told the president that if he had a healthier diet over the last 20 years, he might live to be 200 years old.”

This did not allay fears that Trump will pursue a Koch-brothers backed privatization push at the VA. After his dismissal, Shulkin claimed he was pushed out over his opposition to this plan. “The advocates within the administration for privatizing VA health services … saw me as an obstacle to privatization who had to be removed,” he wrote in a Times op-ed. “That is because I am convinced that privatization is a political issue aimed at rewarding select people and companies with profits, even if it undermines care for veterans.”

Jackson’s views on the issue are unknown, and Politico reports that some veterans believe he’s being installed as a figurehead so lower-level staffers can move toward privatization.

“He’s got a department that’s in turmoil. It’s in crisis. There’s warfare there,” said Anthony Principi, who led the VA under former president George W. Bush. “And you have an acting secretary who doesn’t know the VA.”

Rather than giving Jackson the best opportunity to tame the embattled agency, every action Trump has taken has ensured that he’ll be met with skepticism in his new role. But maybe that’s the point.