Here's what I know/have heard (or both) so far (Army specific):
A panel recommendation to OTSG stated that the Army would save a lot of money by closing all inpatient facilities with fewer than 20 beds. For the Army, this includes about 9 hospitals. The facilities (for the most part) would remain open, but with no inpatient services (superclinics). For primary care, this means little in terms of stations, but could mean a great deal in terms of skill maintenence, unless you're allowed to moonlight. For subspecialists this could be a big game changer.
Facilities performing no surgery would, of course, lose surgical support. Facilities offering outpatient-surgery only would lose a significant amount of surgical support (and make skill maintenence more or less impossible). The combat this, the Army is investigating it's options with contractual agreements with civilian hospitals within range of each of these medical facilities. The idea is that a surgeon would see patients in the Army superclinic, and operate at the local civilian hospital, where they have inpatient and ICU support. In many cases, I think these agreements will happen if necessary. In theory, these agreements could allow Army primary care to see patients and admit patients at the local facility also, but I don't know if that is being pursued.
Keep in mind that the panel recommendations are just that: recommendations. OTSG has not made many final decisions at this point, although they are starting to trickle down the pipe. Even if they agreed to implement the entire scope of these changes, they would likely not be complete for at least 1-2 years. It is a slow process.
Worst case scenario: The Army chooses to eliminate inpatient services or close all of the hospitals (implement all recommendations). The number of Army hospitals offering surgical support would diminish significantly. The hospitals that still offer surgery would be required to absorb a massive number of surgeons from other locations. The Army has made no plans to decrease the number of incoming trainees. While retention is poor, this scenario creates quite a bottleneck in terms of case-loads and skill maintenence.
Best case scenario: The Army chooses not to implement any of these changes, or they implement the changes but the effected hospitals obtain ERSA agreements with local facilities, and nothing much changes.
Most likely scenario: Some hospitals close, some don't. Some surgeons move, some don't. The facilities that are required to absorb additional surgeons become overstaffed.
I have heard nothing about downsizing the physician pop in ADSO. That deam is so fragile, so delicate, that to even think it may cause it to shatter. It's like a cross between a rainbow and a unicorn that brews beer and grants wishes.
