When Dr. Casey Means was just months away from finishing her grueling residency in head and neck surgery at Oregon Health & Science University in Portland, Oregon, she did something that stunned her fellow residents in the tight-knit, high-octane program: She quit.
In the years since that 2018 career swerve, Means has leveraged the decision into a platform as a critic in chief of the medical establishment, a medical entrepreneur, and a New York Times best-selling author. Her book, Good Energy, which she cowrote with her brother, Calley Means, a White House special government employee and top adviser to Health and Human Services Secretary Robert F. Kennedy Jr., describes her transformation from a cog in a profit-driven sick-care system, with medical training that taught her nothing about the root causes of illness, to a physician freed to have “deep conversations” with her patients to help “restore and maintain good health.”
It’s a classic conversion story—and for the Means’s hundreds of thousands of followers, it’s proven hugely potent. Casey Means’s time in the trenches, and her claim of willingness to sacrifice her own medical advancement in a corrupt system to fight for America’s health, have, in some corners of the internet, given her apostle status. All of it has also helped make her book a number one New York Times bestseller, with a total of roughly 38 weeks on the best-seller list.
On Wednesday, President Donald Trump said he would nominate Means to be America’s next surgeon general. He pulled his previous choice, Dr. Janette Nesheiwat, a former Fox News medical contributor, after it emerged that she had earned her medical degree not at the University of Arkansas School for Medical Sciences College of Medicine, where she claimed to have gone and where she completed her residency, but at the American University of the Caribbean School of Medicine in St. Maarten. (After having her nomination rescinded, Nesheiwat wrote on X that she looked forward to serving Kennedy in a “senior policy role.” Nesheiwat did not immediately respond to Vanity Fair’s request for comment.)
Means’s nomination has now placed her—as well as her brother, Calley—under an intense spotlight, the culmination of their rapid transformation into standard-bearers of the “Make America Healthy Again” movement, a loose coalition that has largely rallied behind the distrust in mainstream medicine that Kennedy has frequently espoused. In celebrating the news of her nomination, FDA commissioner Marty Makary posted that Means is a “genius physician who has educated millions of Americans about the real story on health.” It’s also brought with it new attacks; online agitator Laura Loomer and Kennedy’s former running mate, Nicole Shanahan, both derided the pick in the hours after Trump announced it.
MAGA world convulsions aside, the more salient question about America’s future top doctor, say some who trained with Means, is her level of authority to issue such a sweeping indictment of the medical establishment. Two former residents and a now retired department chairman tell Vanity Fair that she left the program after suffering from stress, then spun the story as a revelation about medical corruption, benefiting from that retrofitted narrative.
Dr. Paul W. Flint, who was chairman of the Department of Otolaryngology—Head and Neck Surgery at OHSU at the time, tells Vanity Fair that when Means left the program, it was because she found the surgical work “too stressful” and was not able to continue in the residency.
“At least she had the strength to recognize that in her fourth year,” Flint says. “It took a lot of guts. I didn’t push her out the door.” He adds, however, that “you lose some credibility when you just drop out.” He says he believes that since then, she has mischaracterized US medicine as a “conspiracy” to keep people sick. “She’s wrong,” he says, adding, “It’s a certain attitude that denies all the successes that occur in medicine.”
When asked for on-the-record responses to questions provided to her for this story, Means did not reply. (Flint’s perspective was first reported by the LA Times.)
Casey Means has spent the last year as a burgeoning star of the MAHA movement. She and Calley have appeared on shows hosted by Joe Rogan and Tucker Carlson, the latter of whom told her—after she described reading “sacred texts and the Bible and Rumi and [Ayn] Rand” from a young age, and discussing those at the family dinner table—“I honestly think you’re going to change the world.” In this media ecosystem, Means’s life story of renouncing the establishment is a key selling point.
As she explains in Good Energy, “For most of my adult life, I was a vocal advocate for the modern health care system and collected credentials to rise within its ranks.” Among those credentials: president of her Stanford undergraduate class, a standout student at the Stanford School of Medicine, and an acceptee into the competitive surgical residency at OHSU. There, in 2018, on the precipice of a promising and lucrative career as a surgeon, she found the medical-industrial complex so hyperspecialized and profit-driven, as she has said, that she turned in her scalpel to preach a holistic view of health and wellness.
“In September 2018, on my thirty-first birthday and just months shy of completing my five-year residency, I walked into the chairman’s office at OHSU and quit,” she writes in Good Energy. “With a full wall of awards and honors for my clinical and research performance and with prominent hospital systems pursuing me for mid-six-figure faculty roles, I walked out of the hospital and embarked on a journey to understand the real reasons why people get sick and to figure out how to help patients restore and sustain their health”
In January 2019, according to Oregon business records, she set up a small medical practice in Portland, focusing on metabolic health despite lacking a degree in nutrition science. In her book, she describes a “plant-filled office, which intentionally looked more like a peaceful living room than a clinical space,” where her patients sat in comfortable armchairs and she addressed the “root causes of illness rather than just treating isolated symptoms.”
Seven months later, in August 2019, she cofounded and launched Levels, a health technology company that helps customers track their blood glucose levels using continuous glucose monitors. Her medical license is currently inactive, according to records from the Oregon medical board.
Less than two years later, the Means’s mother, Gayle Brown Means, was diagnosed with pancreatic cancer and died within a few weeks at age 71. It was a devastating loss, and it inspired them to take action, as Calley told Rogan last year. “Casey and I, on her grave site, literally hugged each other and said we want to write a book” to raise awareness about the missed warning signs of poor health that led their mother to be “chopped down by cancer.” By that point, Casey had already “embarked on a journey to understand the real reasons why people get sick,” their book recounts.
Some of the doctors who trained with Casey Means, in the program she has since lambasted, question her characterizations as well as her motives for making them.
“[It] feels unfair and odd that she passes judgment when she’s never worked truly in this system and has a myopic view because of what she’s left,” one former junior resident who worked with Means tells Vanity Fair.
At OHSU, Means entered a program in which she was training to perform ear, nose, throat, and neck surgeries. The hours were grueling and the stakes were often high. In the small training program, the residents were exhausted and “trauma-bonded” because of the workload and stress, as one of them puts it.
Two former residents she served alongside offer a version of her departure from the program that matches with Flint’s. They say that contrary to Means’s oft-told version of events, she exited due to her inability to handle the admittedly high pressure. They describe her as being deeply unhappy and fearful of harming patients, and say she took a leave of absence before departing altogether. The former residents also tell VF that they do not recognize the version of events laid out in the book. In their view, Means misrepresented her residency training and proclaimed a medical conspiracy against good health that simply doesn’t exist. (Both former residents have asked not to be named because they fear retaliation from the Trump administration.)
Another resident, who was one year ahead of Means in the program and has asked not to have his name used due to restrictions imposed by his current employer, says, “I thought she handled the stress of the program exceedingly well, and that’s one of the reasons why people wanted her to stay and see it through.” He adds, “The way she explained it to me at the time, she felt it wasn’t the best fit for her, the residency in general and otolaryngology in particular. It wasn’t as fulfilling or rewarding as she expected.”
He recalls Means as “overdedicated, sometimes to a fault, and that may have caused some issues with burnout.”
Means certainly could have started harboring skepticism of her training while still undergoing it and kept it private. Her book describes her taking a three-month leave of absence to treat her own neck pain a short while before making her decision to leave the program.
Flint says that Means returned from leave saying, “‘I still can’t do this.’ She was tearful about it.”
He adds that the other residents had to “cover for her, and we’re a small department and all the call falls on them. That’s the problem with late departures.”
After she left, the two former residents grew increasingly skeptical of her public claims. “I did not witness a spiritual awakening,” the former junior resident says. “It felt more and more like she was preying on the less educated and using the MD she had to tout these pseudoscience things.”
The other former resident observes, “She’s a good person and does care for people and wants what’s best. But it feels disingenuous, demonizing your training. She didn’t make it through.” The former resident adds, “By trying to question our entire field and sowing distrust in medicine, it’s hard to ignore that she may benefit from that.”
But as Kennedy wrote on X on Thursday in defense of her nomination, “Casey is the perfect choice for Surgeon General precisely because she left the traditional medical system—not in spite of it. Her leadership has inspired many doctors to reform the system and forge a new path away from sick care, which fills corporate coffers, and toward health care, which enriches all of us.”
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The post “She Was Tearful About It”: The Nuances of Casey Means’s Medical Exit and Antiestablishment Origins appeared first on Vanity Fair.
