By Jennifer Haberkorn


February 02, 2014 – President Barack Obama’s selection (last November) of a 36-year-old founder of an Obamacare advocacy group to serve as the nation’s top doctor has brought accusations that he’s too young and too political to be surgeon general.

Vivek Murthy, a Boston physician, software entrepreneur and political ally of the president, will face a Senate confirmation hearing on Tuesday.

If confirmed, Murthy would be one of the youngest surgeons general in history. And he’s expected to be a much more vocal national presence than recent physicians who have held the post. His immediate predecessor, Regina Benjamin, had a low political profile.

But first, Murthy has to get through the Senate Health, Education, Labor and Pensions Committee’s confirmation hearing, at which Republicans are expected to ask tough questions about his experience and his background with the political organization Doctors for America, which began in 2008 as Doctors for Obama and evolved into a physicians association closely associated with the president’s health law.

Richard Carmona, who served as surgeon general in the George W. Bush administration and then ran unsuccessfully as a Democrat against Sen. Jeff Flake in Arizona in 2012, warned the White House against nominating such a “relatively inexperienced and untested physician” who doesn’t have the “right” to be considered for surgeon general at this point in his career.

In letter to Obama, Carmona said that a nominee without significant public health experience or a background in the career uniformed services risks “a distinctive disadvantage in credibility, knowledge and depth and breadth of experience when attempting to address complex public health issues.”

Murthy is an attending physician at Brigham and Women’s Hospital in Boston and an instructor at Harvard Medical School. He’s also the founder of TrialNetworks, an Internet portal for clinical-trial operations that counts Merck and Biogen Idec as customers. Earlier, he helped start a rural community health program in Sringeri, India, and an HIV/AIDS youth education program in India and the United States. He went to Harvard for his undergraduate degree and Yale for medical and business degrees.

The concerns over Murthy’s nomination are unlikely to kill his chances of getting through the Senate, especially if his nomination requires only 51 votes under newly adopted Senate procedures. Republicans — especially those up for reelection this fall — have been skeptical about doing anything that could remotely be seen as supporting Obamacare. He is expected to have wide support from Democrats, although those facing reelection in states that opposed Obama might be nervous about backing the nominee.

The surgeon general’s job is to oversee the U.S. Public Health Service Commissioned Corps and to be the voice for improving health and wellness, on topics as wide ranging as HIV/AIDS, smoking cessation and flu outbreaks. The post has little direct association with Obamacare besides leading the National Prevention Council, which organizes a national strategy on health promotion and prevention. Murthy was appointed to that council in 2011.

Kenneth Moritsugu, who was a deputy surgeon general in the Clinton administration and an acting surgeon general in the George W. Bush administration, told POLITICO that he’s not “for or against” Murthy’s nomination but stressed that experience in the public health field and a track record of success are the top qualifications for a surgeon general.

“There is concern regarding an individual’s background and experience,” Moritsugu said. “In addition, the surgeon general, while politically appointed, needs to become science-based upon acceptance and confirmation and swearing-in. Science-based is extremely important in being a successful spokesperson to and for the American people, and individuals who are younger in their career may not possess those capabilities.”

At Tuesday’s hearing, Murthy is likely to be asked whether he plans to speak publicly on Obamacare and about his history with Doctors for America. He could also face questions about a series of tweets from his personal Twitter account that link gun safety with health and whether he has the background needed for the job, which does bring a potential public-health bully pulpit.

Murthy’s supporters say that his political activism and leadership skills will bring dynamism to a job that hasn’t been very high profile in many years.

David Satcher, who was surgeon general in the Clinton administration, said he’s impressed with Murthy’s résumé and has no qualms over his age or lack of experience in the commissioned corps.

“I don’t believe the president should be constrained in his nominations to people who are in the commissioned corps,” Satcher said. “Because I think sometimes the president uses political appointments to try to make an impact,” he said, noting that Murthy’s nomination could boost diversity and further outreach to underserved communities.

Sen. Tom Harkin, chairman of the HELP Committee and the Senate’s strongest advocate for public health, said he supports Murthy’s nomination and that he expects him to be a public face of prevention and wellness.

“What I’m hopeful [for] is that the surgeon general will begin to highlight the aspect of the Affordable Care Act that goes to exactly what he should be doing — prevention and keeping people healthy in the first place,” Harkin said last week. “This needs to be more publicly supported and talked about by the surgeon general. So I hope that’s one of the things that he will do, assuming he gets the position. I think he probably will.”

Ali Khan, a friend of Murthy’s who is a physician at Iora Health and on the faculty at Yale-New Haven Hospital, said the fact that Murthy is “only slightly gray and not perfectly gray” shouldn’t be a roadblock.

“The nomination makes perfect sense for the simple reason that he has an absolutely extraordinary depth of experience,” Khan said. “I’m thinking about not only questions of medicine and health care but really around public leadership and deep-seated community service.”

Khan said Murthy’s wide range of experience — particularly his M.B.A. and entrepreneurship — should be seen as a positive in an age when physicians are being pushed to use technology to advance health.

If confirmed, Murthy is expected to be a vocal surgeon general, a stark contrast from Benjamin, who held the job for most of the Obama administration. Benjamin was nominated after television correspondent Sanjay Gupta, a physician, took his name out of the running for the job in the early days of the administration.