Almost 18,000 uniformed health care jobs—including those of doctors, dentists, nurses, medics and administrative staff—could be cut from across the services because of reductions proposed in the Defense Health Program portion of the Pentagon’s fiscal 2020 budget request.

How this might affect the Army is not yet fully known.

“This is an area we’ve been working on very closely with the services,” Navy Vice Adm. Raquel Bono, director of the Defense Health Agency, told the Senate Appropriations Committee’s defense subcommittee on April 3.

“While I can’t speak directly to those exact billets that the services have identified, what I can speak to is how we’re working together to make sure that our patients continue to have access to the care that they need,” she said.

The changes are part of the Military Health System’s modernization strategy to reduce redundancies and increase efficiency and effectiveness across the system.

The health care jobs will become civil service positions, and while the changes are expected to begin Oct. 1, they will not occur all at once. Bono said DHA and the services are looking at different models of hiring, contracting and network use as they transition to a market-based approached for health care delivery.

The Military Health System transformation was set in motion by the 2017 National Defense Authorization Act, which requires management and administration of military treatment facilities to transition from the services to the Defense Health Agency.

Lt. Gen. Nadja West, the Army surgeon general and commanding general of Army Medical Command, said Army medicine continues to drive efforts for health care improvements as it implements the requirements of the act.

“We are working closely with the Defense Health Agency and the rest of the [Joint Health Services Enterprise] to implement these legislative changes, with thorough analysis, deliberate planning, and ongoing coordination,” West told the committee.

The transition to DHA will occur in waves over the next few years. Military treatment facilities in the Pacific Northwest were the first to move under DHA administration and management on Oct. 1, 2018. Facilities in the Eastern region of the U.S. will make the move this October, while remaining continental and overseas military treatment facilities will transition in October 2020 and October 2021, Bono said.