Eric Shinseki

Veterans Affairs Secretary Eric Shinseki is seated before speaking at a meeting of the National Coalition for Homeless Veterans, Friday, May 30, 2014, in Washington.

Charles Dharapak / AP

The scandal that led to Veterans Administration Secretary Eric Shinseki’s resignation Friday centers on wait times for appointments at hospitals and clinics that are part of the Veterans Health Administration. Here is a primer on the agency and some of the internal problems that fed the scandal.

What is the Veterans Health Administration?

The Veteran’s Health Administration is part of the Department of Veterans Affairs. It is an enormous, government-run network of 1,700 hospitals, clinics, counseling centers and nursing homes across the country.

The VA health system is available to virtually anyone who served in the military and was discharged under any condition aside from dishonorable. It annually serves about 9 million of the nation’s 22 million veterans.

Why are there such long waits to get appointments?

One contributing factor is a doctor shortage. According to the Association of Federal Government Employees, some VA doctors are carrying workloads of more than 2,000 patients — far more than the 1,200 goal set forth in the Veterans Health Administration handbook.

The agency is struggling to hire 400 primary-care physicians, a position that is notoriously hard to fill because of a nationwide shortage of these types of doctors. This is not just a VA problem but an issue plaguing the U.S. medical system as a whole.

At the same time, there has been an increase in demand for VA services. The Obama administration recently made it easier for veterans to qualify for care for post-traumatic stress disorder and exposure to toxic chemicals such as Agent Orange. Waves of veterans of recent wars have flowed into the system. The Vietnam War generation has aged.

The system handled about 84 million outpatient visits in 2012, an increase of 23 percent from 2008.

So the system is overburdened. Is that the only problem?

No. Media organizations and government watchdogs have reported some pretty serious malfeasance on the part of managers at VA medical centers in Phoenix and elsewhere, accusing them of falsifying records to give the impression that patients are being seen on a timely basis.

These managers got bonuses for sticking to VA guidelines for what constitutes a timely appointment — up to about 14 days from the patient’s requested appointment date. Officially, according to paperwork they submitted to their superiors, they did a good job.

But based on secret lists that they hid from their bosses in Washington, patients in Phoenix waited an average of 115 days for an appointment. Some 40 veterans died while waiting for care, according to the CNN report that sparked widespread outrage about these problems. A recent VA inspector general’s report determined that the problems were “systemic” and extended beyond Phoenix.

What kind of care do veterans get from the VA?

Despite the troubles, the care veterans receive from the VA is considered pretty good, and satisfaction among patients is relatively high, according to a number of studies and surveys.

In 2005, the RAND Corp. compared the medical records of VA health system patients with a national sample, and found that the VA patients had a better quality of care, particularly for depression, diabetes, high cholesterol and hypertension.

A 2013 survey released by the VA found that 93 percent of patients had a favorable impression of the care they received. And a lot of veterans take pride in the fact that there is an entire health system exclusively tailored to their needs.

But a large percentage of veterans — about a third, according to a 2010 VA survey — get their health-care through other means. Another third uses it primarily as a safety net. Only about 16 percent of respondents said they use the system as their primary source of health care.

Are the problems going to be addressed?

President Barack Obama and Congress have vowed to root out the problem, and Secretary Shinseki’s resignation on Friday underscored their seriousness. But this isn’t exactly a new problem.

The Government Accountability Office and the VA inspector general have for years been churning out reports about the long wait times experienced by veterans seeking medical care. The American Legion has been raising the issue with Congress and the public for more than a decade through a project it dubbed, “System Worth Saving.”

In the wake of the scandal, the VA announced it will allow veterans to use non-VA doctors and facilities to reduce backlogs. Veteran’s advocates have also proposed changing the way bonuses are awarded, modernizing its records system and increasing funding so the system can attract more doctors.

And Republicans in Congress have proposed legislation that would allow veterans to bypass the VA altogether and get their care at a private hospitals and clinics — with taxpayers picking up the tab.

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