At a signing ceremony for one of those bills in June, Mr. Trump said his secretary did not have to worry about hearing the president's old reality-show catchphrase, "You're fired".
A source familiar with the White House discussions told The Associated Press that Mr. Trump has floated the notion of the Cabinet reshuffle as a way to right the ship at the VA, believing Shulkin has become a distraction to the department's work.
Then last week, Missal issued another damning report charging that "serious leadership failures" resulted in conditions at the Washington, D.C., Medical Center, a flagship hospital in the VA's system, that put patients at risk.
The dispute spilled into public over the last month, following a scathing report by department's inspector general on a business trip that Dr. Shulkin took to Britain and Denmark past year.
The White House didn't comment on the rumors.
In the midst of the controversies, Shulkin has complained that he is the victim of "subversion" from within the VA and at the White House organized by Trump administration political appointees who see him as an obstacle to expansion of the choice program allowing veterans to opt for private health care.
Shulkin met with Trump's chief of staff, John Kelly, at the White House March 5 to discuss the agency's turmoil. Engaged in an all-out cold war with senior staffers, Shulkin managed to avoid the axe following accusations that he misused taxpayer funds to bring his wife on a European vacation.
The secretary appeared to be regaining his footing. But the people said the president has grown impatient with the department's current secretary, David Shulkin, and may want to replace him with someone already in his cabinet. The secretary maintains the support of top Democrats and Republicans on Capitol Hill. Perry's immediate predecessor under the Obama administration was a nuclear physicist.