Americans deserve a surgeon general with the highest level of expertise and a proven record in public health — not a symbolic figurehead or media influencer.
President Trump’s current nominee, Dr. Casey Means, holds a medical degree from a respected institution, but her professional qualifications raise significant concerns. She is not board certified, does not hold an active state medical license, never completed a medical residency and lacks substantial experience in clinical practice, public health, policy and scalable leadership.
By law, the surgeon general must be a commissioned officer with significant training or experience in public health. Historically, this has meant licensed physicians with deep clinical, scientific and operational credentials — individuals who have led through complex crises and earned the trust of both the public and the uniformed services. To lower that bar is to undermine the office.
The U.S. Public Health Service Commissioned Corps is one of eight uniformed services in our nation. It is charged with protecting the health and safety of all Americans. The surgeon general serves as its operational and symbolic leader. That person must be capable of directing public health efforts across agencies, advising Congress on critical issues and working alongside military and civilian leaders on matters of national importance.
Public health crises are rarely simple. From pandemics to natural disasters, bioterrorism to chronic disease, the person occupying this office must be fully prepared to lead under pressure.
Leadership in the Public Health Service must remain merit-based and above politics. Appointing a nominee who lacks the credentials expected of even entry-level officers in the corps threatens the credibility of this proud institution.
During my tenure as surgeon general, I was tasked with responding to a range of complex emergencies: coordinating U.S. efforts after the 2004 tsunami in Southeast Asia, leading public health operations during Hurricane Katrina and participating in the rollout of the Human Genome Project. I was frequently called on to address urgent public health issues, including vaccine policy, abortion access, pharmaceutical ethics and combat casualty care.
Each of these responsibilities required deep clinical expertise, global collaboration, operational leadership and a commitment to scientific integrity. These were not ceremonial roles — they were real-time, high-stakes leadership demands.
Public health is a national security imperative. We must treat it that way.
History teaches us that the most impactful surgeons general have been those who brought courage, competence and scientific clarity to the nation’s most difficult conversations. Dr. C. Everett Koop took a stand against tobacco and led a science-driven national education effort on AIDS. Dr. David Satcher confronted addiction and health disparities at a time of political polarization. They didn’t just hold office — they led with authority earned through decades of experience.
This legacy should not be diminished by placing symbolism or politics above readiness and expertise. The surgeon general is not just an advisor but a field-tested leader who must command respect, coordinate with other uniformed services and represent the nation on the global public health stage.
We owe it to the American people — and to those who built the Public Health Service on a tradition of merit and mission — to demand the very best.
The U.S. Public Health Service traces its roots to the birth of our nation, when President John Adams signed legislation in 1798 to care for sick and injured seamen. Since then, the service has remained a meritocracy grounded in competence and readiness — like all our uniformed services.
Our health, our security and our future depend on it.
Richard H. Carmona, M.D., M.P.H., F.A.C.S., was the 17th U.S. surgeon general. He is Laureate Professor of Public Health at the University of Arizona.
