I disagree that the quality of military residency training is on a decline.
Agreed, and another thing to keep in mind is the everpresent SDN Bias.
Everyone student on SDN has 250 Step 1 scores, high honors on clinical rotations, LORs from world renowned leaders in the field, a chiseled jaw (if male) or stunning beauty (if female), keen wit, a good eye for horseflesh, and an enviable track record of universally successful fishing and/or Vegas trips. Naturally, first-hand experience with top tier residency programs is a given.
Are military residencies top tier? No. Then again, neither are 90%+ of civilian residencies.
Are military fellowships top tier? Well, maybe - most of them are FTOS at civilian institutions and are as good as the candidate's qualifications.
The quality of HPSP graduates hit a nadir about 5 years ago (naturally, not counting any of the brilliant and handsome SDN grads of that era), but they have measurably improved since then. To an extent, that cohort's lack of excellence may have reflected less well on the .mil residency programs, as measured by board pass rates, but whether the programs themselves were better or worse is another issue.
If anything, the loss of pathology and patients Tricare inflicted has lessened or even started to reverse, given some of the aggressive reclaiming that has gone on the last couple years. MTFs are pulling retirees back into the system, driven by money saving concerns of course, but a pleasant side effect is that some departments are able to cherrypick the cases they want and bring more business and more pathology back to the .mil side.
My program was solid (again, not top tier ... but solid) and effectively overcame case load shortcomings with guest rotations at other institutions. As a resident I spent time working with residents at several other programs, ranging from highly regarded to genuinely top tier, and I never really felt outclassed. One could surely do a lot worse than a .mil program. Then again, perhaps that's just my SDN Bias showing.
Skill rot after training is another issue. It's a problem that affects me and one that I have managed (with difficulty and variable success) via moonlighting. One of my ongoing concerns is that moonlighting for skill maintenance and extra income is forever at my CO's discretion.