On Wednesday, March 28, President Trump announced the firing of Veteran Affairs Secretary David Shulkin after just 14 months as the head of the department. In addition, Trump announced that he would be nominating Dr. Ronny Jackson to fill replace Shulkin. The move comes just weeks after Trump fired Rex Tillerson as Secretary of State.

In a statement, a White House official said that the President lost confidence in Shulkin, saying that “distractions were getting in the way of carrying out the President’s agenda.” While many were optimistic of Shulkin’s leadership at the beginning of his tenure, Trump and others have grown more and more annoyed with Shulkin after he privately made comments that political appointees were attempting to undermine him.

While there have long been rumors surrounding Shulkin’s job security, no one thought that Dr. Ronny Jackson would be his replacement. Jackson, who is an active duty Rear Admiral in the U.S. Navy, is currently the Physician to the President and the head of the White House Medical Unit, the medical team that provides medical care to the President, Vice President, their families, and other prominent people in the White House.

Being the physician to the President, while critically important, is not an often talked about position. Jackson was nominated to the position in 2013 by President Obama, but recently gained media attention when he held a press briefing at the White House following Trump’s first physical examination since taking office.

While Jackson has decades of medical experience, many are likely to question Jackson’s ability to lead the second-largest department in the U.S. While Shulkin was familiar and well-liked to people on Capitol Hill, Jackson is relatively new and unknown, and he could face an upward fight towards confirmation.