DOD releases updated, detailed plans for proposed billet cuts across the military health system

[LTMCUSN]

https://www.health.mil/Reference-Center/Reports/2021/08/23/Limitation-on-the-Realignment-or-Reduction-of-Military-Medical-Manning-End-Strength

Just released: This is the full report from the DOD-as requested by Congress- on the proposed force reduction across the military health system, and how DOD plans to ensure their obligation to beneficiaries is met.

The report includes breakdowns of proposed position cuts by installation, occupation code, and service branch.

Two keys points from the report:

1) Planned medical billet cuts have been reduced by 25% from the original 17,005 submitted in FY 2020 to 12,801- the majority of these restored billets belong to the Army.

2) The services plan to replace 56% of the uniformed medical billets with civilian hires and “absorb” 26% of the cuts where remaining staff at a location is assumed to be sufficient to cover current and future health care delivery demands. Of the other cuts, 9% are student positions and 1% will be addressed by sending care to the TRICARE network.

Watch for the calls to action as the NDAA process moves forward and then be ready to write or call your congressmen….we’ll wait to see how the Armed Forces Committee responds but there is a lot at stake here…

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[DrMetal]

1) Planned medical billet cuts have been reduced by 25% from the original 17,005 submitted in FY 2020 to 12,801- the majority of these restored billets belong to the Army.

Something tells me the plan was never really to cut 17K billets, it was to cut >10K. So they put out 17K as their standard diversion number, uproar ensues, they 'decide' to cut less (12K), and they look like winners for 'scaling back' on their original number. Classic tactic.

Hiring civilians? eh, good luck with.

Might as well shut it all down . . .defer everything to the VA or the civilian world, with strong military liasoning. The MTF really need not exist.

 

[LTMCUSN]

Something tells me the plan was never really to cut 17K billets, it was to cut >10K. So they put out 17K as their standard diversion number, uproar ensues, they 'decide' to cut less (12K), and they look like winners for 'scaling back' on their original number. Classic tactic.

Hiring civilians? eh, good luck with.

Might as well shut it all down . . .defer everything to the VA or the civilian world, with strong military liasoning. The MTF really need not exist.

Esper said “find me 2.2 billion in cuts to the military health system and still carry out services to beneficiaries” and that’s where the 17k billets came from….whether that was backed up by a thorough needs assessment or they really did prepare for an uproar over this and then are now willing to settle for 12k, I don’t know.

There are real questions about whether the civilian healthcare system can absorb our patients though- just look at the “high risk markets” listed in the report. I know there is debate over the extent of the physician shortage but 1.1 million patients is going to cause some serious strain across certain networks.

There are also questions about long term cost savings- the MHS has actually kept the cost of care relatively flat over the past decade while the VA and civilian cost curves increase every year.

We’ll see how the Armed Services Committee responds to this….hope they call every one of these bureaucrats to testify and explain why this is a good idea.

 

[DrMetal]

There are real questions about whether the civilian healthcare system can absorb our patients though- just look at the “high risk markets” listed in the report.

Well in some sense, the civilian healthcare system is already absorbing much of it. The >65yo crowd is being deferred to medicare, the dependent crowd is mostly deferred as well. This leaves the active duty crowd, much of which doesn't need acute nor complex care. A 32-yo AD servicemember who needs a lap chole can just as easily be serviced at the local civilian community hospital that does 10 a day, vs the MTF that does 10 a year.

My problem is this 'gray area' we create, where we have a mil health system that's not completely gutted, but not robust either. Either return it to the full-fledged system it use to be (with complex care, taking care of the elderly crowd, etc), or shut it down completely. This half-assery is very difficult and frustrating.

 

[TheEarDoc]

Esper said “find me 2.2 billion in cuts to the military health system and still carry out services to beneficiaries” and that’s where the 17k billets came from….whether that was backed up by a thorough needs assessment or they really did prepare for an uproar over this and then are now willing to settle for 12k, I don’t know.

There are real questions about whether the civilian healthcare system can absorb our patients though- just look at the “high risk markets” listed in the report. I know there is debate over the extent of the physician shortage but 1.1 million patients is going to cause some serious strain across certain networks.

There are also questions about long term cost savings- the MHS has actually kept the cost of care relatively flat over the past decade while the VA and civilian cost curves increase every year.

We’ll see how the Armed Services Committee responds to this….hope they call every one of these bureaucrats to testify and explain why this is a good idea.

VA only costs so much because the VBA and VHA share the same budget, but it's not split equally. Almost 85% of the total VA budget goes right back into the pockets of veteran's through compensation and pension payments. The actual healthcare portion of the budget is less than 9%. including overhead costs. The VA cemeteries section takes about 5%. The VHS which handles the healthcare runs very lean for the size and scope of it. Also when they started throwing people out into community care that's when you saw the healthcare budget balloon. Why? Private sector will not accept the same payment the VA would accept.

So they can push their figures and I will sit back and grin because sorry you might get a civilian to see the dependents on post or maybe off post if you are in a large enough urban area, but for the meat of what my job entails in the actual Army you will not have civilians doing that. I mean the VA has been trying to push audiology patients out into the community for years now and the communities cannot handle the case load. When they do get seen the care is usually substandard or the community provider doesn't follow the contract so what ends up happening is that same veteran who was pissed he couldn't get an appointment to see an audiologist for 2 months now shows up about a year later still without hearing aids and gets to start the whole process again.

 

[j4pac]

How do much do civilian contractors make in the military? Is it competitive?

 

[DrSambo]

How do much do civilian contractors make in the military? Is it competitive?

I've just accepted a civilian position with the Army. While I wouldn't say that what they will be paying me is anywhere close to the best I've ever seen, it's also not the worst. I'd say it appears reasonable. I will say that they need to do a better job with salary transparency however. The system they use to determine the pay is absurdly convoluted and confusing. Ultimately, they made me a "Tentative" offer based upon the base salary, which is frankly absurdly low. The HR guy told me "Don't worry. That's just the tentative amount, but once they factor in your years of experience, past income, etc., the final offer will be higher." He was correct that it was, but there was about a 4 month period between the tentative and the final offers during which I had no idea how much they would ultimately offer me. If had been anywhere close to the tentative amount, there is no way I'd have accepted it. I'm assuming that if I was fresh out of residency, with no significant high salary history and minimum years work years under my belt, that they amount would have been close to that base number and that would be a total non-starter for me.

 

[DrSambo]

I've just accepted a civilian position with the Army. While I wouldn't say that what they will be paying me is anywhere close to the best I've ever seen, it's also not the worst. I'd say it appears reasonable. I will say that they need to do a better job with salary transparency however. The system they use to determine the pay is absurdly convoluted and confusing. Ultimately, they made me a "Tentative" offer based upon the base salary, which is frankly absurdly low. The HR guy told me "Don't worry. That's just the tentative amount, but once they factor in your years of experience, past income, etc., the final offer will be higher." He was correct that it was, but there was about a 4 month period between the tentative and the final offers during which I had no idea how much they would ultimately offer me. If had been anywhere close to the tentative amount, there is no way I'd have accepted it. I'm assuming that if I was fresh out of residency, with no significant high salary history and minimum years work years under my belt, that they amount would have been close to that base number and that would be a total non-starter for me.

Just to comment on this a bit further. Probably something like 15 years ago, I threw my hat in the ring for a civilian job with the Army. Had a telephone interview and didn't hear anything further for a month or two, so sort of forgot about it. Then, out of the blue I received an email saying something along the lines of "Congratulations. You've been selected." and it included orders with a start date not too far into the future. This job was in Germany and I was in the US. I was like "Wait a minute. They're sending me orders to show up without even telling me how much it pays." So, I reached out to them via email and basically got told "We can't tell you how much you'll be paid. Here's a link to the OPM website and you can sort of figure it out on your own." After an eternity of going through rabbit holes there, I finally came upon a salary that seemed to match up with the job they were offering, and it was absurdly absurdly low (similar to the base salary before adjustments of the job I'm about to start). Only at that time, nobody bothered to mention anything to me about it being adjusted upwards from there, so I passed. The HR person accidentally included me in her email letting others know when she said something along the lines of "Well, looks like we lost another one." Had they done a better job of communicating with me at that time, I suspect I would have found out the salary was better than what I was led to believe and would taken the job as I liked the idea of working in Germany again. Oh well.

 

[SurfingDoctor]

Not specific to other specialties, but within the realm of pediatric critical care, I know for a fact that one 1) military positions can't match the acuity and skill set as civilian centers and 2) because of that, we get referrals frequently from the local army hospital. It has nothing to do to ability of the physicians per se (actually my favorite PCCM physician went up through the army system... until they burned out)... it has to do with general experience.

In non-battlefield scenarios, the civilian system of training/experience is far greater than the military system. It is just what it is...

 

[Brouillet2017]

If I'm reading the note correctly, at least from the Navy side, they are planning significant reductions at the majority of full-fledged hospitals. Minimal reductions for clinics in the boonies, though. I'm sure someone out there is excited that China Lake and Lemoore aren't slated for any reductions, but the number of fully-functioning hospitals set to have reductions isn't exactly reassuring. How much can they reduce staff or services and still support GME? Even if they say they are going to protect it, how much more can the hospitals reduce and still be accredited?

 

[Chonal Atresia]

Esper said “find me 2.2 billion in cuts to the military health system and still carry out services to beneficiaries” and that’s where the 17k billets came from….whether that was backed up by a thorough needs assessment or they really did prepare for an uproar over this and then are now willing to settle for 12k, I don’t know.

There are real questions about whether the civilian healthcare system can absorb our patients though- just look at the “high risk markets” listed in the report. I know there is debate over the extent of the physician shortage but 1.1 million patients is going to cause some serious strain across certain networks.

There are also questions about long term cost savings- the MHS has actually kept the cost of care relatively flat over the past decade while the VA and civilian cost curves increase every year.

We’ll see how the Armed Services Committee responds to this….hope they call every one of these bureaucrats to testify and explain why this is a good idea.

The civilian network does not want your patients. The reimbursement from Tricare sucks and is not worth the headache.

An another note, good luck getting civilian providers. The only docs you’ll get are retired military and FMGs due to the pathetic pay for GS physicians. Really….how do you expect to get ANYBODY when you routinely pay less than half (anybody that is not primary care) what the market rate is? It’s just absurd.

As has been said in previous threads, get out the popcorn ‘cause it’s going to be a s$&@ show!

 

[el mero mero]

I haven't worked for a GS job, but have looked into them. The system is stupid. It looks insanely unattractive based on base pay, but locality makes up a significant difference. At least in the area I looked into, in my specialty, the military docs made about 80% of the private docs... but that's based on a 40h workweek (at most).
i may consider it in the future. For people with prior service but didn't do 20, the ability to buy back years and get a FERS pension is appealing.

my idealized path is to work private for another 10ish years... then go goverment doc for 15 ish years...
i would be in my early 60s... FERS retirement, military reserve retirement, and nest egg from my private practice years.

as an aside, one of the interesting caveats of the reserve retirement is that it is one of the ways one is allowed to double dip. A SM can buyback their military time for a FERS retirement while also using it in a military reserve retirement.
FERS and AD retirement are additive.. but AD has a much higher % so still a good deal for those that decide to stick out 20.

 

[Trefoil]

I really think this means the benefit of staying in for 20 is significantly reduced. As already mentioned, civilian networks have a tendency to avoid Tricare patients, which seems to imply that the burden will ultimately fall on retirees who will be unable to get into the MTF and will not be accepted by the civilian network.

The “absorption” category is likely already based on sub optimized clinics. I have never seen a military clinic with the correct doc to support staff ratio, which means they are probably expecting docs to sit at the front desk and check their patients in before screening them without a nurse or technician.

This entire premise is obscuration via abstractions to trick Congress into thinking they know what they are doing. Look at any MTF, and it’s obvious they haven’t got a clue how to run a hospital. Now they are disguising their gutting of retirees health benefits with pseudo logistical babble, all so they can buy bigger long range weapon systems.

As if we haven’t poured enough money into enormous phallic shaped weapons systems that either grow dusty or blow up innocent civilians in other countries due to bad intelligence. Great, we just wasted two trillion dollars giving the Taliban a bunch of new toys over a 20 year installment plan, and now we need to restock our shelves so we can dish out some more. Cut the healthcare, that’s obviously the problem with our military spending.

 

[pgg]

How do much do civilian contractors make in the military? Is it competitive?

It seems to vary a lot by specialty and location. The contractor anesthesiologists we have earn a competitive wage, considering it's a 50 hour per week contract with no weekends and no call. I'm not sure I could do better for a similar lifestyle position as a civilian, to be honest.

GS positions on the other hand ... a few years back we tried to hire one of our retiring pediatric anesthesiologists as a GS. He wanted to stay. I don't know all the details but in the end they couldn't make it work.

 

[HopefulPilot]

I've just accepted a civilian position with the Army. While I wouldn't say that what they will be paying me is anywhere close to the best I've ever seen, it's also not the worst. I'd say it appears reasonable. I will say that they need to do a better job with salary transparency however. The system they use to determine the pay is absurdly convoluted and confusing. Ultimately, they made me a "Tentative" offer based upon the base salary, which is frankly absurdly low. The HR guy told me "Don't worry. That's just the tentative amount, but once they factor in your years of experience, past income, etc., the final offer will be higher." He was correct that it was, but there was about a 4 month period between the tentative and the final offers during which I had no idea how much they would ultimately offer me. If had been anywhere close to the tentative amount, there is no way I'd have accepted it. I'm assuming that if I was fresh out of residency, with no significant high salary history and minimum years work years under my belt, that they amount would have been close to that base number and that would be a total non-starter for me.

Do you mind sharing the basics of what this formula is?

 

[DrSambo]

Do you mind sharing the basics of what this formula is?

If I felt able to do so, I would not mind at all. That said, I honestly don't understand it well enough. In essence, my understanding is that they have a base GS level pay for the position, but then factor in various adjustments for a physician, locality, past work experience, education level, etc.

 

[sarahlindner]

I read the report and still don't really understand; can someone explain like I'm 5 years old what this means for military physicians? Are they going to stop commissioning new doctors into active duty? Are they planning on laying off current active duty docs? Both, neither?

 

[TheEarDoc]

Just to comment on this a bit further. Probably something like 15 years ago, I threw my hat in the ring for a civilian job with the Army. Had a telephone interview and didn't hear anything further for a month or two, so sort of forgot about it. Then, out of the blue I received an email saying something along the lines of "Congratulations. You've been selected." and it included orders with a start date not too far into the future. This job was in Germany and I was in the US. I was like "Wait a minute. They're sending me orders to show up without even telling me how much it pays." So, I reached out to them via email and basically got told "We can't tell you how much you'll be paid. Here's a link to the OPM website and you can sort of figure it out on your own." After an eternity of going through rabbit holes there, I finally came upon a salary that seemed to match up with the job they were offering, and it was absurdly absurdly low (similar to the base salary before adjustments of the job I'm about to start). Only at that time, nobody bothered to mention anything to me about it being adjusted upwards from there, so I passed. The HR person accidentally included me in her email letting others know when she said something along the lines of "Well, looks like we lost another one." Had they done a better job of communicating with me at that time, I suspect I would have found out the salary was better than what I was led to believe and would taken the job as I liked the idea of working in Germany again. Oh well.

DOD civilian and VA HR are horrible. Half the time they know very little about how to do their job. It's horrible. I could tell several stories.

 

[TheEarDoc]

I haven't worked for a GS job, but have looked into them. The system is stupid. It looks insanely unattractive based on base pay, but locality makes up a significant difference. At least in the area I looked into, in my specialty, the military docs made about 80% of the private docs... but that's based on a 40h workweek (at most).
i may consider it in the future. For people with prior service but didn't do 20, the ability to buy back years and get a FERS pension is appealing.

my idealized path is to work private for another 10ish years... then go goverment doc for 15 ish years...
i would be in my early 60s... FERS retirement, military reserve retirement, and nest egg from my private practice years.

as an aside, one of the interesting caveats of the reserve retirement is that it is one of the ways one is allowed to double dip. A SM can buyback their military time for a FERS retirement while also using it in a military reserve retirement.
FERS and AD retirement are additive.. but AD has a much higher % so still a good deal for those that decide to stick out 20.

Might double check on the reserves retirement. I think you can only buy back your active duty time ie. deployed/mobilized time. Your basic drill years you cannot buy back.

 

[Trefoil]

I read the report and still don't really understand; can someone explain like I'm 5 years old what this means for military physicians? Are they going to stop commissioning new doctors into active duty? Are they planning on laying off current active duty docs? Both, neither?

I don’t think the report specifies how. I only read bits and pieces. Previously they mentioned attrition, but they haven’t made many moves to decrease the number of students they are recruiting, so it’s hard to say how they expect attrition to occur. One possibility is that they stop promoting beyond O4 which would force a huge portion out.

 

[orbitsurgMD]

I don't think any medical student or prospective medical officer could look at this scheme with any degree of optimism for seeking resident training in a military hospital that would be done where a reasonable academic caseload for a training hospital would be encountered. As usual in military policy documents, the language in the linked document obscures (in a painful-to-decipher way) the staff reductions that can only mean fewer patient encounters, less acuity, less depth of specialty expertise and a significantly less rich training environment. Sure, HPSP and USUHS might still remain, but what sort of institutional support will train their graduates in this scheme? I very much doubt it will be one any better or more robust of resources than the system it replaces, however depleted that system has already become. [Cue the Monty Python: "Run away! Run away!"]

 

[TheEarDoc]

I don’t think the report specifies how. I only read bits and pieces. Previously they mentioned attrition, but they haven’t made many moves to decrease the number of students they are recruiting, so it’s hard to say how they expect attrition to occur. One possibility is that they stop promoting beyond O4 which would force a huge portion out.

That is what I think the tactic used will be. Make it hard to promote to O-4 and dang near impossible to promote to 0-5 or beyond. Force lots of folks out before retirement.

 

[ValeRx]

DOD civilian and VA HR are horrible. Half the time they know very little about how to do their job. It's horrible. I could tell several stories.

Took me six months to start at the VA - from job posting close date to actual start date. First you get a tentative job offer, then several months later you get a formal job offer. lol. I also love how they ask you to send in XXX right away, so you do so, and then don't hear back for several weeks/months.

 

[DrSambo]

Took me six months to start at the VA - from job posting close date to actual start date. First you get a tentative job offer, then several months later you get a formal job offer. lol. I also love how they ask you to send in XXX right away, so you do so, and then don't hear back for several weeks/months.

Similar to my experience with the job I'm about to start. Interviewed back in April. Formal job offer a few weeks ago. I've previously looked into State Dept. jobs as a Foreign Service Regional Medical Officer and speaking with some of those who are doing it, seems like the minimum amount of time from application to actually starting is about 18 months...of course I had these conversations pre-COVID, so I suspect may be longer than that now perhaps.

I've always heard the phrase "Hurry up and wait," but I think a very similar corollary to that is "Wait and hurry up."

Overall, I think the HR folks with my current upcoming gig have been pretty good, but the system is just a big ole inefficient govt. thing.

 

[Caverject]

There are also questions about long term cost savings- the MHS has actually kept the cost of care relatively flat over the past decade while the VA and civilian cost curves increase every year.

It's also worth mentioning Active Duty numbers within the MHS have been relatively flat prior to 2004 and all the way through a two fronted war which dragged on for nearly 20 years. So yeah, lets cut the one thing that never needed to be "right sized" to begin with. Before you know it, we will be sending casualties to host nation civilian hospitals...oh wait, that's already happening in Poland and Romania already. Oops! 🤣🤣

 

[TheEarDoc]

Took me six months to start at the VA - from job posting close date to actual start date. First you get a tentative job offer, then several months later you get a formal job offer. lol. I also love how they ask you to send in XXX right away, so you do so, and then don't hear back for several weeks/months.

I have transferred between VA systems and it still takes around 4 months to get it done. It's beyond ridiculous! Then again they seem have a method of hiring veterans with high service connection percentages and now formal education and they "train" them to be HR staff. Most of them are useless and make DOD civilian lifers look like high speed low drag employees.

 

[TheEarDoc]

Well we know how it works. Once someone isn't seen by mil med for care and has something horrible happen to them at a 3rd world or lower tiered care hospital in some host nation then it will hit the news and suddenly it will be "why isn't the Army/Navy/Marines/etc. taking care of their soldiers?!?!?!" and then someone will come up with some bright shiny action plan to get a promotion point.

 

[ProwlerturnGas]

I had one job at the VA after fellowship. The department was incredibly toxic and the leadership was weak. I will never go back to VA work.

 

[SirGecko]

It doesn’t even really need to be an inherently inferior hospital, language barriers are a cause of worse outcomes even at top tier hospitals.

 

[TheEarDoc]

I had one job at the VA after fellowship. The department was incredibly toxic and the leadership was weak. I will never go back to VA work.

Oh trust me I know all about toxic leadership in departments. I lived it for a long time. Thank goodness I moved on. The VA seems to be staffed by 3 types of employees:
1. Lifers - people who have never worked anywhere outside the VA and they show it with their work ethic
2. People who worked private sector and then got tired of a lot of the crap with it so came to the VA. You can usually
tell these folks because they are highly motivated and actually work hard and don't say things like "we don't do that
here" or "well that's how we always do X"
3. The Veteran employees. These folks sadly often are the worst employees. They call in frequently. When most of them
are in the office they treat the VA as their own coffee shop social circle and do very little work. They are never taken to
task over their poor performance because well that might hurt some feelings and they will scream "I AM A VETERAN!".
You can usually tell these folks because they are never at their post or when they are they are on facebook, youtube,
on their phones, etc.. When they are asked to do something or feel they are being treated unfairly they say phrases
like "I'm X % service connected" or "I don't have to put up with this I'm a veteran!"

 

[ProwlerturnGas]

Sadly I witnessed many instances of #3. Ironically I was the only veteran in my department. I was actually written up for calling out a person’s BS that I thought interfered with a patient’s care. There were other instances of unbelievable poor quality. I resigned and it angered me so much I haven’t set foot in a VA since. That was some years ago.

 

[Gastrapathy]

Gotta give it to the Army. They’ll be the only medical service left.

 

[layman_3]

Gotta give it to the Army. They’ll be the only medical service left.

I have to wonder...why is the discrepancy between branches so pronounced? Is the Army Medical Corps just doing a better job advocating for itself thank the other branches?

 

[DD214_DOC]

I've just accepted a civilian position with the Army. While I wouldn't say that what they will be paying me is anywhere close to the best I've ever seen, it's also not the worst. I'd say it appears reasonable. I will say that they need to do a better job with salary transparency however. The system they use to determine the pay is absurdly convoluted and confusing. Ultimately, they made me a "Tentative" offer based upon the base salary, which is frankly absurdly low. The HR guy told me "Don't worry. That's just the tentative amount, but once they factor in your years of experience, past income, etc., the final offer will be higher." He was correct that it was, but there was about a 4 month period between the tentative and the final offers during which I had no idea how much they would ultimately offer me. If had been anywhere close to the tentative amount, there is no way I'd have accepted it. I'm assuming that if I was fresh out of residency, with no significant high salary history and minimum years work years under my belt, that they amount would have been close to that base number and that would be a total non-starter for me.

I spent 9 years on AD, a couple years in the private sector holding senior leadership positions, and jumped on an opportunity a few months ago to become a department chief at an MTF. Inexplicable problems such as this are absolutely due to CPAC. I abhor CPAC and they are the bane of my existence. They screw up so many things in ways that I cannot understand but that directly affect my department. Trying to bring on new staff is, so far, the most frustrating part of my current position, because I know that the process involved with a hiring action at a certain point must be turned over to CPAC -- whom I have zero control or influence over.

I signed off on an RPA to go active THREE weeks ago. There is still nothing listed. Supposedly after signing, it had to go through QA prior to being listed. I asked why they just asked me to sign something for approval that hasn't gone through QA.

The tentative offer they sent to this fantastic NP, who was a by-name DHA (can't believe it even worked), based the salary offer on the normal GS scale instead of the special table for her discipline. It took me 3 days to get that corrected and a new tentative submitted.

I have another vice action submitted 3 months ago and have heard absolutely nothing. The staff member its meant to replace is scheduled to retire in less than a month.

They don't explain things well to applicants or those who've accepted tentative offers. They screw things up all the time, so I make a point to be obnoxious as hell and pester them to know exactly what they are sending out and communicating to people I'm trying to hire, as well as soliciting for regular updates once or twice a week. Sometimes, this works.

I guess this is more venting than anything else. Did I mention how much I dislike CPAC?

 

[Mad Jack]

https://www.health.mil/Reference-Center/Reports/2021/08/23/Limitation-on-the-Realignment-or-Reduction-of-Military-Medical-Manning-End-Strength

Just released: This is the full report from the DOD-as requested by Congress- on the proposed force reduction across the military health system, and how DOD plans to ensure their obligation to beneficiaries is met.

The report includes breakdowns of proposed position cuts by installation, occupation code, and service branch.

Two keys points from the report:

1) Planned medical billet cuts have been reduced by 25% from the original 17,005 submitted in FY 2020 to 12,801- the majority of these restored billets belong to the Army.

2) The services plan to replace 56% of the uniformed medical billets with civilian hires and “absorb” 26% of the cuts where remaining staff at a location is assumed to be sufficient to cover current and future health care delivery demands. Of the other cuts, 9% are student positions and 1% will be addressed by sending care to the TRICARE network.

Watch for the calls to action as the NDAA process moves forward and then be ready to write or call your congressmen….we’ll wait to see how the Armed Forces Committee responds but there is a lot at stake here…

Looks like dental care, radiology, and pharmacy are getting hit hard. Who needs teeth and bones anyway, and they can simplify pharmacy operations by pre-printing Motrin bottles with various indications.

 

[orbitsurgMD]

Looks like dental care, radiology, and pharmacy are getting hit hard. Who needs teeth and bones anyway, and they can simplify pharmacy operations by pre-printing Motrin bottles with various indications.

This does not seem to be a logical pathway to a medical system capable of combat readiness.

 

[Mad Jack]

This does not seem to be a logical pathway to a medical system capable of combat readiness.

That's the joke

 

[orbitsurgMD]

That's the joke

Yeah, the bitter kind of joke, unfortunately. Gut a medical system that will take a generation to rebuild when you discover that you actually did use the one that was shut down and the imaginary plan to use the civilian community with a payment scheme that compares to Medicaid doesn't quite work like you hoped. And lets do this for the sake of continuing a materiel replacement plan that replaces obsolete capital ships (let's be coldly honest, a launch of forty hypersonic missiles will sink a carrier) with vastly more expensive and equally-vulnerable replacements. The vulnerabilities won't be limited to peer rivals either; these technologies are cheap enough to be genuinely asymmetrical threats. Add to that the dubious F-35 program that seems to spend ridiculous money just on advertising (for military jets!) and doesn't quite match the threat rivals on performance even if it costs a multiple of those rival aircraft. And we have plans for replacing the Minuteman III missiles, the Los Angeles class attack submarines and the current fleet of SSBNs, which are also aging. Hey, at least we get to sell some subs to Australia who have realized that their need for a credible deterrent to China and its obvious regional plans for dominance. China needs energy resources and no one wants to see what might happen if they get desperate.

 

[TheEarDoc]

Yeah, the bitter kind of joke, unfortunately. Gut a medical system that will take a generation to rebuild when you discover that you actually did use the one that was shut down and the imaginary plan to use the civilian community with a payment scheme that compares to Medicaid doesn't quite work like you hoped. And lets do this for the sake of continuing a materiel replacement plan that replaces obsolete capital ships (let's be coldly honest, a launch of forty hypersonic missiles will sink a carrier) with vastly more expensive and equally-vulnerable replacements. The vulnerabilities won't be limited to peer rivals either; these technologies are cheap enough to be genuinely asymmetrical threats. Add to that the dubious F-35 program that seems to spend ridiculous money just on advertising (for military jets!) and doesn't quite match the threat rivals on performance even if it costs a multiple of those rival aircraft. And we have plans for replacing the Minuteman III missiles, the Los Angeles class attack submarines and the current fleet of SSBNs, which are also aging. Hey, at least we get to sell some subs to Australia who have realized that their need for a credible deterrent to China and its obvious regional plans for dominance. China needs energy resources and no one wants to see what might happen if they get desperate.

If I were Japan I'd be shaking. They haven't forgotten what happened in Manchuria at all.