America Has Gone More Than a Year Without a Surgeon General. Has Anyone Noticed?

On Sunday, Jerome Adams, who served as surgeon general during President Donald Trump’s first term, publicly criticized Casey Means, Trump’s current nominee for the position. Adams pointed to her lack of an active medical license, her limited qualifications to lead the U.S. Public Health Service Commissioned Corps, and her views on vaccine safety and efficacy.

Later that day, Trump suggested he might withdraw the nomination and submit a different one. This follows an earlier false start: During the transition in late 2024, Trump nominated Jeanette Nesheiwat but pulled her nomination in May 2025 after critics pointed out discrepancies in her résumé.

In the meantime, Americans have gone over 430 days without a “nation’s doctor,” as the surgeon general is often called—and few, if any, have noticed. That should raise a more fundamental question: not who should serve as surgeon general, but whether we need one at all.

The surgeon general and the U.S. Public Health Service Commissioned Corps are vestiges of a bygone era—institutions that persist not because they are essential, but because they have never been seriously reconsidered. Today, federal public health activity is dominated by sprawling agencies like the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health. The surgeon general’s role has diminished to mainly a national spokesperson, issuing advisories that are more symbolic than practical—and that can become a platform for unnecessary political and cultural conflicts.

The Commissioned Corps, for its part—formally led by the surgeon general, though ultimately overseen by the assistant secretary for health—maintains the trappings of a uniformed service but performs functions that largely overlap with those carried out by other federal, state, and local health agencies. However well-intentioned, they add another layer to an already crowded public health apparatus. The past 430 days have offered an unintentional experiment—and the results are telling: The system continues to function just fine without a surgeon general.

In a Cato Institute policy analysis, my colleagues and I examined the origins and evolution of the surgeon general’s office and the U.S. Public Health Service Commissioned Corps. These institutions trace their roots to the late–19th century Marine Hospital Service, when a centralized, uniformed medical service played a practical role in caring for merchant seamen and controlling the spread of infectious diseases at ports of entry. At the time, a national “chief physician” and a deployable medical corps made sense. But over the decades, as public health responsibilities expanded and were dispersed across a wide array of federal, state, and local agencies, those original functions were absorbed—and often superseded—by larger and more specialized institutions. What remains today is not a critical node in the public health system, but a legacy structure whose original purpose has long since been overtaken.

As we documented in that analysis, the redundancy isn’t theoretical—it shows up in how the system actually operates. The surgeon general no longer exercises meaningful public health authority; those responsibilities have been absorbed by agencies like the CDC and the Food and Drug Administration, leaving the office largely as a platform for issuing advisories. Meanwhile, the roughly 6,000-member Public Health Service Commissioned Corps is spread across the federal bureaucracy, often in roles only loosely connected to public health and frequently duplicating work performed by civilian employees. 

The result is a system with overlapping roles, diffused accountability, and higher costs—government estimates suggest Corps officers can cost more than comparable civilian staff, and a Department of Health and Human Services analysis has estimated that eliminating the Commissioned Corps could reduce personnel costs by roughly 15 percent—without delivering anything that couldn’t be handled more directly through existing agencies. As a uniformed service, Corps officers also receive many of the same benefits as members of the armed forces, including veterans’ benefits, adding more to the taxpayer burden.

And the office itself is hardly indispensable. President Lyndon Johnson effectively eliminated the position during his administration. Unfortunately, in 1979 the breakup of the Department of Health, Education, and Welfare into the Department of Health and Human Services and the Department of Education caused the position’s resurrection. That history makes something clear: The surgeon general is not a cornerstone of the public health system; it’s a legacy position that persists largely because no one has seriously asked whether it still needs to exist.

None of this is to question the dedication of the professionals who have served as surgeon general or in the Commissioned Corps. But public institutions should not exist simply because they always have. The past 430-plus days have provided an unintentional test, and the results are hard to ignore: The system continues to function without a surgeon general, and the Corps’ responsibilities can be absorbed by existing agencies or performed more efficiently through civilian hiring. Rather than restarting a debate over who should fill these roles, Congress and the White House should ask a more practical question: Do these positions still need to exist at all?

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