Defense and service leaders have racheted down the number of military medical billets they plan to cut at military treatment facilities, and spread the cuts over a longer period of time, according to a new report to Congress.

Following a reevaluation of their original plan to cut 17,005 medical billets such as military doctors, nurses, dentists and enlisted medical personnel, DoD and the services have reduced the number of cuts by one-fourth. Officials now plan to cut 12,801 medical billets through fiscal 2027, representing about a 6 percent decrease in military medical billets from the nearly 213,000 medical billets in fiscal 2020.

The vast majority of the restored billets are in the Army.

While there will be fewer cuts, “this doesn’t change our concerns,” said Karen Ruedisueli, director of health affairs issues for the Military Officers Association of America. “We remain concerned about beneficiaries’ access to care once this is undertaken.”

She said MOAA supports a provision included in the House Armed Services Committee’s version of the 2022 defense policy bill that would further halt cuts and require an evaluation by the Government Accountability Office.

The cuts include 9,029 enlisted, 3,765 officer and seven warrant officer medical billets, according to the report to Congress signed Aug. 23 by Virginia Penrod, acting undersecretary of defense for personnel and readiness.

The report was required by Congress in the 2020 National Defense Authorization Act after advocates and lawmakers raised questions about the DoD’s original plan, revealed in 2019. At that time, there were virtually no details about how and where the cuts would be made.

In effect, some active-duty family members, retirees and their family members who get their health care at military treatment facilities will get their care from civilian or contract medical providers at those facilities.

In some areas, the reduction in military medical billets will transfer some specialty care and primary care to the local Tricare network. The Defense Health Agency will monitor the adequacy of the network regarding specialty care to make sure patients are getting quality care. It will also ensure “maximum transparency of enrollment changes” by working with the Tricare contractor, military treatment facilities and the communities that are affected, the report stated.

The changes affect 220 different units, including hospitals, clinics, medical centers, research organizations and educational facilities. The National Capital Region will take the most cuts, officials say, because the ability to hire civilian providers in the region is greater.

Most of the cuts are planned for fiscal 2023, officials said, and will taper off through fiscal 2027.

With most of the military personnel cuts, the plan is to either replace the active-duty personnel with federal civilians or contractors in-house or “absorb” the cuts with remaining staff deemed to be sufficient to take care of the workload. The plan is to hire 7,114 federal civilians or contract positions, and to absorb 3,266 positions across the board. As a result of 163 billet reductions, patients will be moved to the Tricare network. In addition, 375 positions will be replaced, 684 will be “reshaped,” and 1,199 of the cuts are students.

For example, at Fort Belvoir Community Hospital, Virginia, officials plan to eliminate 308 billets; of those, the workload of 45 people can be “absorbed” by others, and 263 people will be hired in federal civilian or contract positions to replace the other billets.

In their reevaluation, Army officials didn’t recommend any reductions that would cause MTF care to be transferred to the Tricare network, or any reductions where it would be difficult to hire a civilian replacement.

Overall Army medical billets fare best in the reevaluation: While the original plan was to convert 6,935 positions within Army medical and dental facilities to civilian positions; that number has now been reduced to 2,948, according to the report.

The Navy will cut the most — 5,169 billets. It appears they took 375 billets from the chopping block, primarily in cases where the military staff lost couldn’t be replaced by hiring civilians or using the Tricare network, according to the report. The Air Force will cut 4,684 billets.

Over the past several years, lawmakers have authorized DoD to convert military medical or dental positions, if the Secretary of Defense determines that these military positions aren’t necessary to meet operational medical force readiness requirements. DoD’s goal is to reduce medical billets in order to increase the number of operational billets “needed for lethality” according to the report.

There has been scant information about DoD’s plan, other than a top line figure of more than 17,005 cuts. Advocates and lawmakers pressed for more specifics.

Ruedisueli noted the cuts in pharmacy (644), pediatrics (73) and pediatric sub-specialties (29), pediatric nurse practitioners (26) and cuts of 70 positions in behavioral sciences/mental health services. “We’re always on the watch for anything that would signal a reduction in access to pharmacy services, because we know a lot of retirees plan where they’re going to live based on access to the pharmacy. …

“I know this is all intended to focus the uniformed force on operational requirements, but when we know we have difficulties getting access for beneficiaries in the network when it comes to behavioral health as it is, I can’t see why they would cut any behavioral health positions,” she said.

While there are details in the report on which MTFs will be affected, cuts by medical specialty and information on the time frame, “they don’t put it all together to say this is the number of pediatricians at this facility in this time frame,” she said.

DoD paused the process in early 2020 in order to focus on the pandemic. The services are also assessing the impact of COVID-19, which could change their medical personnel requirements.

But as DoD starts to rely less on military personnel at its military treatment facilities, officials will “closely monitor” the ability of local networks to take on the additional workload and the ability for MTFs to hire or contract for replacement staff, the report states.

Overall, it appears the intent is to make civilian hires for many of the cuts, Ruedisueli said, but advocates are concerned about the possible difficulty in hiring these professionals.

“We’re glad it does seem like this isn’t set in stone,” she said. “They’re committed to making adjustments along the way as more information becomes available, as lessons learned from COVID become more clear, or if they get more information about the actual availability of civilian hires.

“It does seem like there’s willingness to reassess.”

Karen has covered military families, quality of life and consumer issues for Military Times for more than 30 years, and is co-author of a chapter on media coverage of military families in the book "A Battle Plan for Supporting Military Families." She previously worked for newspapers in Guam, Norfolk, Jacksonville, Fla., and Athens, Ga.

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