In July, MOAA first identified four key and rather worrisome trends we've been closely tracking that are taking place in the military health care system. Now, we can add the planned reduction in the number of military medical personnel to the list.

If the numbers are as large as we have been led to believe (approximately 17,000 positions), this will exceed and intensify the impact of the other trends, and may have considerable effect on military beneficiaries in significant ways.

We will not be able to assess the impact of these large cuts in the number of practicing military physicians, nurses, medics, and other allied medical personnel until the fiscal year 2020 defense budget request is approved by the White House and sent to Congress in mid-March. If Congress approves the cuts, to be presented billet by billet, they would start to take effect quickly in FY 2021.

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Proposed personnel reductions of such magnitude surely will affect military medical training platforms. It takes years to educate physicians, and there are projections of physician shortages: A recent study released by the Association of American Medical Colleges predicts that by 2030, the United States will face a shortage of between 42,600 and 121,300 physicians. This leads us to our first question: How this will affect the military mission and medical care, and how can leaders expect to have a medically ready force without a ready medical force?

Our second question: What would these cuts mean for beneficiaries? If the plan is just to replace these health care providers with civilians, that's not a reliable strategy. Getting private-sector medical professionals to take jobs near rural bases may not be realistic or feasible.

Beneficiaries, including active duty families who receive care at military treatment facilities, may be forced to seek it in the TRICARE networks. Pediatric and obstetric care - which are now available to these beneficiaries - may vanish from the MTFs. Lab and pharmacy services, along with radiology, may be greatly reduced. We already are starting to see TRICARE Prime retirees being re-enrolled from MTFs into the civilian networks, resulting in them being charged with new, and higher, co-payments.

These are major shifts in military medicine. MOAA will watch DoD's proposed FY 2020 budget closely and will assess the impact on military beneficiaries.