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President Donald Trump fired Veterans Affairs Secretary David Shulkin and nominated White House doctor Ronny Jackson to replace him following a bruising ethics scandal and a mounting rebellion within the agency.

A Navy rear admiral, Jackson is a surprise choice to succeed Shulkin, a former Obama administration official and the first nonveteran to head the VA. Trump had been considering replacing Shulkin for weeks but had not been known to be considering Jackson for the role.

In a statement, Trump praised Jackson as “highly trained and qualified.” It was a decision that signaled Trump chose to go with someone he knows and trusts, rather than choosing a candidate with a longer resume, to run a massive agency facing huge bureaucratic challenges.

Shulkin said he was undone by advocates of privatization within the administration. He wrote in a New York Times opinion piece that they “saw me as an obstacle to privatization who had to be removed.” He added: “That is because I am convinced that privatization is a political issue aimed at rewarding select people and companies with profits, even if it undermines care for veterans.”

Jackson has served since 2013 as the physician to the president, one of the people in closest proximity to Trump day in and day out.

His profile rose after he conducted a sweeping press conference about the president’s medical exam in January in which he impressed Trump with his camera-ready demeanor and deft navigation of reporters’ questions as he delivered a rosy depiction of the president’s health, according to a person familiar with the president’s thinking but not authorized to discuss private conversations.

Jackson eagerly embraced the idea of moving to the VA, according to a White House official who spoke on condition of anonymity to discuss personnel matters. Ironically, it was Shulkin who had recommended Jackson for an undersecretary position at the agency in fall. Jackson was vetted during that time on his policy positions and other issues, the official said.

The promotion of Jackson marks the latest Trump hire to be driven at least as much by personal familiarity with the president as by his vision for the role at government’s second-largest department, responsible for 9 million military veterans in more than 1,700 government-run health facilities.

Brig. Gen. Dr. Richard Tubb, who trained Jackson, said in a letter read at Jackson’s briefing that the doctor had been attached like “Velcro” to Trump since Inauguration Day.

“On any given day,” he wrote, “the ‘physician’s office,’ as it is known, is generally the first and last to see the President.”