President-elect Trump’s decision on Wednesday to nominate David Shulkin, undersecretary for health at the Department of Veterans Affairs, to lead the embattled agency was a move that may have satisfied some of his skeptics — but it left veterans advocates who had hoped for radical change feeling stunned and confused.

After dedicating a significant portion of his campaign toward criticism of the VA’s recent failures, Trump’s choice of a senior VA leader who has participated in some of the very same practices he once blasted came as a surprise to several people who have been involved in shaping his reform plans.