President Donald Trump has nominated wellness influencer Casey Means to become the next U.S. surgeon general, a decision that has sparked debate among lawmakers and health experts about whether she has the traditional qualifications for the role.

The surgeon general, often referred to as the nation’s “top doctor,” serves as a leading spokesperson on public health and oversees the United States Public Health Service Commissioned Corps, a group of more than 6,000 medical professionals who work across federal agencies. While the position does not technically require a specific set of credentials, past surgeon generals have typically completed full medical training and held major leadership roles in government, research, or academia.

Means graduated from Stanford University with a degree in human biology and later earned her medical degree there as well. She began a five-year residency in otolaryngology—head and neck surgery—at Oregon Health & Science University. However, she left the program during her final year and never completed the residency. According to the American Medical Association, residency is considered a critical stage in physician training, typically lasting between three and seven years depending on the specialty. Means’ medical license is currently listed as inactive.

Critics say this breaks with the background of most surgeon generals over the past 50 years. A review of past officeholders shows that all completed their residency training before being confirmed. Many also had decades of experience in public health or leadership roles. For example, C. Everett Koop, who served as surgeon general in the 1980s, spent more than three decades as a pediatric surgeon and helped establish the nation’s first neonatal intensive care unit. Another former surgeon general, David Satcher, previously led the Centers for Disease Control and Preventionbefore his nomination.

Means defended her background during a recent Senate committee hearing, arguing that her career path brings valuable experience to the role. She told senators that her work in entrepreneurship, public health advocacy, and medical research gives her a “multidisciplinary” perspective on the American health system. After leaving clinical training, she co-founded the health technology company Levels Health, which sells memberships that include continuous glucose monitoring devices. She also wrote the best-selling book Good Energy: The Surprising Connection Between Metabolism and Limitless Health with her brother Calley Means, who works as an adviser to Health and Human Services Secretary Robert F. Kennedy Jr..

During the hearing, Means argued that her time treating patients and completing more than four years of surgical training qualifies her for the position. “My professional history is a feature, it’s not a bug,” she told lawmakers, emphasizing her work in medical communication and public health.

Still, some senators raised concerns about her views on vaccines and other health issues. In one tense exchange, committee chairman Bill Cassidy, a physician himself, asked Means about the widely disproven claim that vaccines are linked to autism. Means said she believes vaccines save lives but also stated that the medical community should continue researching the causes of autism. Many scientific studies have found no evidence that vaccines cause autism, and experts generally believe the condition is largely genetic.

The nomination comes during a politically sensitive moment for public health leadership. The Senate previously confirmed Robert F. Kennedy Jr. as Secretary of Health and Human Services despite his long-standing skepticism about vaccines. Trump’s earlier nominee for surgeon general, Janette Nesheiwat, withdrew after reports questioned her credentials.

Means has gained support from several Republican senators, including Josh Hawley of Missouri and Roger Marshall of Kansas, who have indicated they plan to vote in favor of her confirmation. Others, including Susan Collins and Lisa Murkowski, say they are still reviewing her record before making a final decision.

If confirmed, Means would become the public face of federal health messaging at a time when the U.S. continues to deal with chronic disease, vaccination debates, and public trust in health institutions. Her nomination highlights an ongoing debate about what qualifications are most important for leading the nation’s public health efforts: traditional medical training or “broader” experience in health advocacy and communication.