On Wed. Jan. 11, President-elect Donald Trump announced Dr. David Shulkin, undersecretary of health for the Department of Veterans Affairs, as his pick to assume the top leadership role at the agency, The New York Times reported. The physician currently leads the Veterans Health Administration, which serves an estimated 8.76 million former service members each year at 1,700 sites across the country. The Senate must confirm Shulkin before he can take over as VA secretary.

The choice was a pleasant surprise to veterans groups, as many had expected Trump to select an outside candidate to lead a top-down transformation of the department.

“The Trump campaign made a big deal of what a sucking chest wound the VA was,” Phillip Carter, an Iraq War veteran and director of the Military, Veterans and Society Program at the Center for a New American Security, told the newspaper. “Then they realized how hard it would be to turn around, and decided they needed to continue with the reforms that are already taking effect.”

A physician takes the helm
Shulkin, a board-certified internist, held numerous leadership positions in the private health care sector and founded a physician ratings service before joining the VA in June 2015. President Barack Obama was responsible for his appointment, according to NPR. For all his medical expertise, Shulkin is not a veteran and, if confirmed, will be the first secretary of veterans affairs without military experience. So far, key service member organizations have expressed support for the physician despite his strictly civilian resume, The Washington Post reported.

“The VFW is proud to support the nomination of Dr. David Shulkin as the next secretary of veterans affairs, and we are most appreciative of his willingness to continue serving veterans and making the VA better,” Brian Duffy, the national commander for The Veterans for Foreign Wars, said in a statement to the newspaper.

While Shulkin lacks the armed services background of past VA administrators, many believe he comes equipped with a deep knowledge of the department and the demonstrable skills needed to oversee a vast network of services. In fact, in his current position, he leads the largest integrated health care system in the country. Overall, those familiar with the day-to-day operations say Shulkin will be able to transfer into his new role seamlessly with little lag time, allowing the VA to continue with internal improvement efforts started during the Obama administration.

“Someone new coming in could take a year just to understand the issues,” Nancy Schlichting, former chief executive for the Henry Ford Health System, explained in an interview with The Times. “Someone like David Shulkin really provides continuity that can get reforms moving forward.”

Shulkin hopes to reform the VA and forge partnerships with private health care and service providers.Shulkin hopes to reform the VA and forge partnerships with private health care and service providers.

Challenges ahead
Even with recent improvements, further changes are needed to improve the inner-workings of the VA and provide better services to the veterans it serves. Shulkin has some experience in this area, as he was directly involved with improving the Veterans Choice Program, an initiative designed to connect former service members with private physicians. The program suffered from internal flaws from the outset, leaving many veterans waiting months for care. Shulkin and his colleagues stepped in to address the problems last year.

In an interview with NPR soon after interceding to correct the floundering initiative, Shulkin laid out what many now believe will serve as his modus operandi as VA secretary.

“This is a different VA. We’ve brought in people from the outside who have private sector experience. And what we’re saying is that we have to do business differently,” Shulkin explained.

If confirmed, the physician must address a number of large-scale issues impacting the VA and ex-military personnel across the country, including personnel shortages, large volumes of backlogged disability claims and growing opiate addiction and suicide rates. For his part, Shulkin plans to take the issues head on and introduce sweeping reforms that could greatly improve both the department and the former service members it serves.

Soon after announcing Shulkin’s appointment during a press conference Jan. 11, President-elect Trump issued a statement praising the VA official.

“I have no doubt Dr. Shulkin will be able to lead the turnaround our Department of Veterans Affairs needs,” Trump said. “His sole mandate will be to serve our veterans and restore the level of care we owe to our brave men and women in the military.”

The Senate is expected to hold a confirmation hearing for Shulkin in the near future, Politico reported.