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 Dr. Phyllis Hollenbeck, a primary care physician, took a job at the Veterans Affairs medical center in Jackson, Miss., in 2008 expecting fulfilling work and a lighter patient load than she had had in private practice. 
 
 
 
 
 
 
 
 
 
 What she found was quite different: 13-hour workdays fueled by large patient loads that kept growing as colleagues quit and were not replaced. 
 
 Appalled by what she saw, Dr. Hollenbeck filed a whistle-blower complaint and changed jobs. A subsequent investigation by the Department of Veterans Affairs concluded last fall that indeed the Jackson hospital did not have enough primary care doctors, resulting in nurse practitioners’ handling far too many complex cases and in numerous complaints from veterans about delayed care. “It was unethical to put us in that position,” Dr. Hollenbeck said of the overstressed primary care unit in Jackson. “Your heart gets broken.” 
 
 Her complaint is resonating across the 150-hospital Veterans Affairs medical system after the department’s inspector general released findings on Wednesday that the Phoenix medical center falsified data about long waiting times for veterans seeking doctor appointments. 
 
 In Washington, the number of lawmakers in Congress calling for the resignation of Eric Shinseki, the Veterans Affairs secretary, grew by late Thursday to nearly 100 — including almost a dozen Democrats — as President Obama prepared to receive an internal audit on Friday from Mr. Shinseki assessing the breadth of misconduct at veterans hospitals. White House aides declined to say whether Mr. Obama would ask Mr. Shinseki to step down. 
 
 At the heart of the falsified data in Phoenix, and possibly many other veterans hospitals, is an acute shortage of doctors, particularly primary care ones, to handle a patient population swelled both by aging veterans from the Vietnam War and younger ones who served in Iraq and Afghanistan, according to congressional officials, Veterans Affairs doctors and medical industry experts. 
 
 The department says it is trying to fill 400 vacancies to add to its roster of primary care doctors, which last year numbered 5,100. 
 
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 “The doctors are good but they are overworked, and they feel inadequate in the face of the inordinate demands made on them,” said Senator Richard Blumenthal, Democrat of Connecticut and a member of the Senate Veterans Affairs Committee. “The exploding workload is suffocating them.” The inspector general’s report also pointed to another factor that may explain why hospital officials in Phoenix and elsewhere might have falsified wait-time data: pressures to excel in the annual performance reviews used to determine raises, bonuses, promotions and other benefits. Instituted widely 20 years ago to increase accountability for weak employees as well as reward strong ones, those reviews and their attendant benefits may have become perverse incentives for manipulating wait-time data, some lawmakers and experts say. 
 
 Representative Jeff Miller, a Florida Republican who is chairman of the House Veterans Affairs Committee, said whistle-blowers at several veterans hospitals had told his staff members that they would be threatened if they failed to alter data to make patient-access numbers look good for their supervisors, one reason he has called for a criminal investigation into the Veterans Affairs hospital system. 
 
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 “Fear was instilled in lower-level employees by their superiors, and those superiors did not want long wait times,” Mr. Miller said in an interview. “Bonuses are tied directly to the waiting times of the veterans, and anybody that showed long wait times was less likely to receive a favorable review.” 
 
 The precise role incentives and performance reviews might have played in falsifying waiting-list data remains unclear. In Phoenix, the inspector general’s office said, investigators plan to interview scheduling supervisors and administrators to “identify management’s involvement in manipulating wait times.” 
 
 But documents suggest that using the data in annual performance reviews may be commonplace. One review at a Pennsylvania veterans medical center showed that a significant portion of the director’s job rating was tied to “timely and appropriate access,” which would include waiting times for doctor appointments. One of those goals would be met only if nearly all patients were seen within 14 days of their desired appointment date — a requirement not found in the private hospital industry. 
 
 Schemes to disguise wait times generally followed a handful of approaches, whistle-blowers and officials in Congress say. In Phoenix, where administrators were overwhelmed by new patients, many veterans were not logged into the official electronic waiting list, making it easier to cloak delays in providing care. 
 
 Another strategy, according to documents and interviews, was for Veterans Affairs employees to record the first date a doctor was available as the desired date requested by the veteran, even if they wanted an earlier date. 
 
 “Yes, it is gaming the system a bit,” one employee at the Veterans Affairs medical center in Cheyenne, Wyo., explained in an email to colleagues. “But you have to know the rules of the game you are playing, and when we exceed the 14-day measure, the front office gets very upset.” 
 
 In Jackson, Dr. Hollenbeck reported that hospital administrators created “ghost clinics” in which veterans were assigned to nonexistent primary care clinics to make it appear that they were receiving timely care. 
 
 And in Albuquerque, an employee at the veterans center said some doctors were shocked when they received a memo a few months ago stating that 20 percent of physician “performance pay” would be doled out only to doctors who found a way to limit patient follow-up visits to an average of two a year — a tactic to reduce waiting times by persuading veterans to make fewer appointments. 
 
 “Clinic staff were instructed to enter false information into veterans’ charts because it would improve the data about clinic availability,” states a whistle-blower complaint filed by the employee, who did not want to be identified. “The reason anyone would care to do this is that clinic availability is a performance measure, and there are incentives for management to meet performance measures.” 
 
 Experts point out that performance reviews and incentives were a crucial element in transforming the Veterans Affairs medical system, considered a medical backwater after the Vietnam War, into a national health care system that, for all its problems, is generally well regarded. 
 
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 Debra A. Draper, the director of the Health Care Government Accountability Office, said that performance-contract incentives were only one possible explanation for inaccurate wait-list data, and that other factors included lack of oversight and training. 
 
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 Most experts agree that soaring demand for veterans’ care has outpaced the availability of doctors in many locations, and that high turnover is a major problem. In the past three years, primary-care appointments have leapt 50 percent while the department’s staff of primary care doctors has grown by only 9 percent, according to department statistics. 
 
 Those primary care doctors are supposed to be responsible for about 1,200 patients each, but many now treat upward of 2,000, said J. David Cox Sr., national president of the American Federation of Government Employees, which represents nurses and other support staff. He said the department spent too much hiring midlevel administrators and not enough on doctors and nurses, a complaint shared by some lawmakers and veterans groups. 
 
 The department said this week that it was reviewing the size of patient panels at its hundreds of outpatient clinics and assessing whether more could provide night and weekend hours. The department also said it would increase the number of patients it referred to private medical care, to reduce waiting times. 
 
 Critics and supporters of the department agree that many facilities do not have enough physicians. But they disagree about whether that is because the department has poured too much of its hefty federal budget increases into hiring midlevel managers instead of clinicians, or whether the system simply does not have enough funding — or a large enough pool of doctors to hire from — to keep up. 
 
 Supporters of the department also note that hospitals everywhere are struggling to find primary care doctors. But some experts say the department has additional hurdles, including lower pay scales. Primary care doctors and internists at veterans centers generally earn from about $98,000 to $195,000, compared with private-sector primary care physicians whose total median compensation was $221,000 in 2012, according to the Medical Group Management Association, a trade group. 
 
 Many veteran medical center directors tend to make $160,000 to $190,000; according to 2012 data, those directors given performance awards typically received $8,000 to $15,000 more. 
 
 Dr. Atul Grover, chief public policy officer at the Association of American Medical Colleges, said the department’s doctor shortage came down to a simple fact: “It’s just harder to attract physicians to care for more challenging patients while paying them less.” 
 
 There are long delays for specialty care, too, veterans say. Kent Carson, a former Marine with epilepsy, said he had tried to make an appointment with his neurologist at the veterans hospital in Nashville after having five seizures in four days in 2012. But Mr. Carson, 29, said he was told he would have to wait more than two months — or go to the emergency room. He has since switched to private insurance through his job as an accountant in Lenexa, Kan. The Nashville hospital did not respond to a request for comment. 
 
 “I have seizures, but it’s not life-threatening,” Mr. Carson said. “But I really do worry about vets who have more serious problems.” ||||| Story highlights Obama accepts VA secretary's resignation, says Shinseki doesn't want to be a distraction 
 
 Shinseki says his commitment to veterans drove his decision to resign 
 
 The move comes after months of reports about problems with the VA medical system 
 
 Eric Shinseki resigned Friday as the head of the Department of Veterans Affairs, leaving behind the daunting task of repairing a broken health care system that has left thousands of veterans at risk as they wait for medical care. 
 
 Shinseki's resignation concluded a firestorm of criticism and growing calls for him to step down following revelations of sometimes deadly delays for veterans waiting for care at VA hospitals, allegations exposed by CNN in a series of exclusive reports. 
 
 Details of the delays were first exposed by CNN last November in an investigation into two VA hospitals in the Southeast. Since then, CNN's reporting has expanded to include numerous other VA hospitals, culminating with details about secret waiting lists at the Phoenix VA that may have played a role in the deaths of 40 veterans. 
 
 President Barack Obama went before reporters at the White House minutes after meeting with Shinseki, saying the retired Army general told him "the VA needs new leadership" to address widespread issues that were chronicled in new reports this week. Obama said Shinseki "does not want to be a distraction." 
 
 JUST WATCHED New details about Shinseki resignation Replay More Videos ... MUST WATCH New details about Shinseki resignation 02:07 
 
 "That was Ric's judgment on behalf of his fellow veterans, and I agree. We don't have time for distractions. We need to fix the problem," Obama said. 
 
 Calls for Shinseki's resignation snowballed in recent days from across the political spectrum -- Republicans and Democrats, as well as veterans' advocacy groups -- because of the misconduct . 
 
 In a farewell message to VA employees, Shinseki didn't address the scandal specifically but did say he resigned with veterans' interests in mind. 
 
 "My personal and professional commitment and my loyalty to veterans, their families and our survivors was the driving force behind that decision," he said. "That loyalty has never wavered, and it will never wane." 
 
 Shinseki says 'situation can be fixed,' but not by him 
 
 Earlier Friday, Shinseki announced steps to address the VA shortcomings, including removing senior leaders in the Phoenix VA medical system , eliminating performance awards for VA leaders in 2014 and wait times as a metric for evaluations and accelerating care to veterans. 
 
 He also apologized to veterans and Congress, but declared: "This situation can be fixed." 
 
 But Shinseki won't be part of the solution. 
 
 He went to the White House to present Obama with findings from his internal audit of what was happening in the VA system, including that many audited facilities had "questionable scheduling practices" that signaled a "systemic lack of integrity." 
 
 The President acknowledged that scheduling issues didn't rise to the attention of Shinseki, whom he praised as a man who "has served his country with honor for nearly 50 years." 
 
 At the same time, Obama said that he and Shinseki agreed that a shift in leadership was necessary. 
 
 For now, Sloan Gibson -- a Shinseki deputy -- will head the VA until a new secretary is named and confirmed. 
 
 "Part of that is going to be technology. Part of that is management," the President said. "But as Ric Shinseki himself indicated, there is a need for a change in culture within the VHA, and perhaps the VHA as a whole -- or the VA as a whole that makes sure that bad news gets surfaced quickly so that things can be fixed." 
 
 Breaking open the scandal 
 
 Problems in the VA system date back decades, but CNN's reporting of long waits at VA hospitals brought the issue into national focus at the end of 2013. 
 
 An April report by CNN in which sources said 40 veterans died at a Phoenix VA facility that used secret waiting lists to cover up the problem prompted angry calls for action. 
 
 The VA has acknowledged 23 deaths nationwide due to delayed care. 
 
 CNN also obtained an e-mail written by an employee at a Wyoming VA clinic that said staff was instructed to "game the system" to make the clinic appear more efficient. 
 
 A preliminary inspector general's report made public Wednesday described a "systemic" practice of manipulating appointments and wait lists at the Veterans Affairs Medical Center in Phoenix. 
 
 According to the report, at least 1,700 military veterans waiting to see a doctor were never scheduled for an appointment or were placed on a waiting list at the Phoenix VA, raising the question of just how many more may have been "forgotten or lost" in the system. 
 
 In a recent USA Today opinion piece, Shinseki ordered VA officials to contact each of these veterans "in order to bring the care they need and deserve." 
 
 The latest report by the VA inspector general's office and Shinseki's auditors indicated a link between employee bonuses and covering up patient wait times. 
 
 There also have been calls for a criminal investigation into fraudulent record-keeping to cover up delays at VA hospitals. Obama said Friday that would be up to the Justice Department, which has been collecting information but has not launched any investigation. 
 
 Shortly before he resigned, Shinseki told a veterans group that he was shocked by the inspector general's report, especially the prevalence of wait lists for veterans needing medical care. 
 
 "That breach of integrity is irresponsible, it is indefensible and unacceptable to me," he told the National Coalition for Homeless Veterans just before heading over to his final meeting with Obama. 
 
 "I said when this situation began weeks to months ago and I thought the problem was limited and isolated because I believed that. I no longer believe that. It is systemic," he said. 
 
 At the same time, the VA chief of more than five years said that others had misled him. 
 
 "I was too trusting of some, and I accepted as accurate reports that I now know to have been misleading with regard to patient wait times," he said. "I can't explain the lack of integrity among some of the leaders of our health care facilities. This is something I rarely encountered during 38 years in uniform and so I will not defend it because it's indefensible, but I can take responsibility for it and I do." 
 
 Whistleblower: VA was 'way too focused on ... good numbers' 
 
 As the accusations mounted -- including the latest one in which Reps. Mike Doyle and Tim Murphy of Pennsylvania claimed 700 veterans had been placed on a primary care waiting list for doctor appointments at the Pittsburgh VA center, with some waiting since 2012 -- so too did the pressure on Shinseki. 
 
 Politicians largely applauded Shinseki's resignation on Friday, even as they said that the VA needed to do more than put new people in his place to resolve its shortcomings. 
 
 "The denial of care to our veterans is a national disgrace, and it's fitting that the person who oversees the Department of Veterans Affairs has accepted responsibility for this growing scandal and resigned," Senate Republican leader Mitch McConnell of Kentucky said in a statement. 
 
 Meanwhile, a VA whistleblower who told CNN about the problems at the Phoenix facility said Friday he was saddened by Shinseki's resignation under such circumstances. 
 
 "The VA administrators got way too focused on having good numbers and they forgot the most important mandate, the reason we all work at the VA -- to take care of veterans, to save their lives and give them good medical care," Dr. Sam Foote said. 
 
 "The next secretary's biggest challenge will be to get that refocused and make sure the number one job is taking care of veterans - not worrying about their bureaucratic careers," Foote added.
– Eric Shinseki has begun the process to fire the senior leaders of the infamous Phoenix VA medical center, he announced today, as he apologized for his department's lapses. When the crisis broke, Shinseki said he believed the problem was isolated. "I no longer believe that. It is systemic," he said. "I can't explain the lack of integrity among some of the leaders of our health care facilities." Shinseki has also ordered that senior VA executives receive no performance bonuses this year, and that patient wait times be deleted from employees' performance evaluations. That last move is significant, because the inspector general's report cited evaluation reports as a potential motive for sweeping waiting veterans under the rug. "Bonuses are tied directly to the waiting times of the veterans," the chair of the House Veterans Affairs Committee tells the New York Times, so managers pressured low-level employees to drive figures down. As in his op-ed yesterday, Shinseki didn't sound like a man who was about to step down, despite mounting calls for him to do so. President Obama said in an interview last night that he would have a "serious conversation" with Shinseki today about whether he was the best person for the job, CNN reports.