The nominee must also be confirmed via majority by the Senate. The assistant secretary serves at the pleasure of the president. Appointees who are a serving uniformed officer of the commissioned corps, by statute, are appointed as a four-star admiral and is the highest ranking officer in the commissioned corps, as no other position in the Public Health Service is designated as a four-star office.
The nominee must receive approval from two-thirds of the Senate. The assistant secretary serves at the pleasure of the president. Those serving as uniformed officers in the commissioned corps are appointed to the rank of four-star admiral and hold the highest position within the corps, due to no other role in the Public Health Service being designated as a four-star office.