The Bench Is the Buy

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This issue is the companion to "Who Holds the Hospital," Part 2 of the Mission Meets Tech series on DHA's FY27 campaign plan. The public piece follows Line of Effort 2, medical warrior currency, into the staffing question: who holds the Core 15 hospitals when uniformed clinicians deploy. This brief reads the campaign plan's LOE 2 and workforce tasks as a buying schedule, then works the market underneath: which workforce lines move, what three years of practical nurse postings say to clinical support vendors, and what each plausible staffing path buys. The October 2 Capture Corner, "Where the Recapture Money Moves," covered insourcing exposure by function family and the three appropriation scenarios; this brief builds on it and does not repeat it.

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1. The picture at a glance

Field	Detail
Line of effort	LOE 2, medical warrior currency: by 2028, 85 percent of identified, deployable military medical personnel meet 100 percent of their wartime knowledge, skills, and abilities standards; Core 15 acuity and surgical case mix up 20 percent, TRICARE For Life enrollment up 15 percent, direct care appointments for specialty TRICARE For Life patients, network referrals, and veterans up 50 percent; led by Brig. Gen. James Burk, deputy Lt. Col. Jonathan Drew [CC1]
Workforce tasks in the plan	Core 15 staffing plans "based on current authorizations" by October 31, 2026; manpower alignment by December 31; reserve-component business case, ahead of contracting options, by March 31, 2027; surge staffing requirements by April 30 and alternate crisis staffing solutions by September 30, 2027; no numeric target [CC1]
Workforce direction, FY27	Uniformed average strength +1,486 in In-House Care (end strength +215); civilian FTEs 41,969 to 41,961; contractor FTEs flat at 13,572 [CC2]
Contract dollars	In-House Care contract services -$294.3 million; -$331.9 million across the operating program [CC2]
Civilian money	+$52.8 million civilian pay for retention in critical skills, tied to reducing contracted labor in "certain administrative, clinical support, and operational functions" [CC2]
Practical nurse postings	GS-6 or GS-7 top grade on 88 percent of 2024 DHA LPN announcements, 32 percent in 2025, 6 percent in 2026; all 486 GS-5 announcements in 2025 and 2026 list promotion potential "None" [CC3]
Hiring speed baseline	115 days from tentative offer to start for nurse hires, November 2022 to September 2023 [CC4]

Confidence: High on campaign plan tasks and dates, read from the plan's LOE 2, LOE 3, and general support task lists. High on every budget and posting figure, read from the FY27 MHS justification and the USAJOBS historic announcement data. Medium on the market reads in Sections 4 and 6, which infer vendor demand from budget language, plan tasks, and posting patterns. Analytical on the staffing paths in Section 5.

The lead finding for a capture team: the campaign plan gives currency hard numbers and gives the workforce dated tasks with no number, and its sequencing puts reservists ahead of contractors. The Core 15 plan their staffing "based on current authorizations," a reserve-component business case comes before contracting options, and the crisis staffing work sits in LOE 3 with an end date of September 30, 2027. Fiscal 2027 pays for uniforms through the services, pays to retain the civilians DHA already has, and holds contractor headcount flat while cutting contract dollars. The near-term market is analytics, workforce systems, hiring throughput, and VA partnership operations. Contract backfill is the fallback the plan is written to reach last.

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2. The buying schedule

Confidence: High on dates and lead offices, which come from the plan. Analytical on the capture column. The plan calls for quarterly updates that can adapt, refine, or add tasks, so dates can move. [CC1]

Due	Task	Lead office	Capture read
October 31, 2026	Core 15 staffing plans based on current authorizations, with barriers elevated through the networks; ARMOR governance cell for readiness and resource modeling	Core 15 hospitals with the Defense Health Networks; OWHA	No new positions assumed; the barriers list is the demand signal
December 31, 2026	Core 15 manpower aligned to target complexity and surgical volume using manning documents and programmed authorizations; VA agreements on authorization and on DoW providers practicing at VA medical centers	Defense Health Networks; Healthcare Operations with CDAO and VHA	Manpower modeling; VA partnership operations
January 30 and 31, 2027	Enterprise capture and scoring of clinical workload done outside the hospitals, including civilian partnerships and VA care; centralized and regionalized appointing to keep and recapture care	OWHA; Healthcare Operations	Workload and readiness data integration; appointing operations
March 31, 2027	Reserve-component business case ahead of contracting options; standardized position descriptions with circuit-rider travel up to 20 percent, preceptor, and emergency-essential designations; security checks inside the hiring action; ARMOR timekeeping and scheduling to retire DMHRSi; access policy corrective action plans for every hospital short of standard; acuity modeling; perioperative standards; network referral recapture guidance; DoW and VA supply and demand data guidance	J1 with Reserve Affairs and the service surgeons general; PAE Medical Digital Solutions; Defense Health Networks; OWHA; Healthcare Operations; CDAO	The densest workforce and analytics date in the plan
April 30, 2027	Core 15 surge staffing requirements above current manning, under LOE 3	J5	Deployment-day staffing requirements in writing
May 30, 2027	Operating room dashboard with performance targets and a mandate for 100 percent provider and staff proficiency; measurable volume and complexity targets for each Core 15 hospital; VA partnerships scaled to all Core 15; refined troop-to-task guidance under LOE 3	OWHA; Healthcare Operations	Dashboard analytics and the first hospital-level targets
June 30, 2027	Quarterly reporting of staffed operating rooms, block utilization, case throughput, active-duty surgical wait time, purchased-care recapture, and proficiency, with corrective plans for hospitals below target; 10 percent more complexity through less leakage to external resource sharing agreements and more network referrals; training agreements library and corrective plans; EMQAS credentialing to retire CCQAS; standardized civilian-military partnership agreements with proficiency data sharing	Defense Health Networks; RDA Agreements and Partnership Management; PAE Medical Digital Solutions; J8	Operating room analytics, credentialing, and partnership data
July 30 to August 31, 2027	Policy enabling veterans to use military hospitals; simplified VA authorization; proficiency data streams from civilian partners	Healthcare Operations; OWHA	VA volume operations and partner data feeds
September 30, 2027	Alternate staffing solutions for overseas and Core 15 shortfalls in a crisis, under LOE 3; ARMOR proficiency predictive modeling; Blue Book update with the American College of Surgeons on proficiency data sharing; care coordination guidance for the five Centers of Excellence	J1; PAE Medical Digital Solutions; Joint Trauma System; Healthcare Operations	Crisis backfill design; workforce prediction tools

Outside the plan, the continuing resolution expires December 11, TRICARE Open Season is expected to run November 9 through December 8, and the FY28 request and FY28 NDAA markups arrive in the first half of 2027. [CC5][CC6][CC7] MOAA characterizes the halt on military medical billet reductions enacted in the FY2023 NDAA as five years, which would reopen the billet question in late 2027; verify against statute. [CC8]

My read is that March 31 is the date that decides this market. The reserve business case, the position descriptions, the hiring security model, and two ARMOR deliverables all land that day, and together they show whether DHA plans to hold its hospitals with reservists, with civilians on new terms, or with contracts.

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3. The workforce lines that move

Confidence: High on amounts. Analytical on the capture column.

In-House Care line	FY25 to FY26	FY26 to FY27	Capture read
Uniformed end strength	+2,756	+215 (average strength +1,486)	Funded from service military personnel accounts, so growth creates no DHA contract demand directly; raises demand for tools that make uniformed clinicians more productive [CC2]
Civilian FTEs	+1,905	-8	The civilian hiring surge is over for FY27, which matches the plan's "current authorizations" language [CC2][CC1]
Contractor FTEs	-1,260 (14,832 to 13,572)	Flat at 13,572	Headcount holds while dollars fall: repricing and consolidation at option, more than a headcount cliff [CC2]
Contract services	n/a	-$294.3 million	Pressure lands on staffing-heavy MTF support task orders after a full-year appropriation [CC2]
Civilian pay	n/a	+$52.8 million; average salary $134,900 to $136,700	Retention in critical skills; competes with contractor wages in the same labor markets [CC2]
Weighted admissions	n/a	93,256 to 93,641 (+0.4 percent)	The budget does not project LOE 2's volume growth enterprise-wide [CC2]
MERHCF receipts for MTF care	$1,889.9 million (FY26)	$2,201.2 million (FY27)	Retiree workload sits outside In-House Care; sell retiree volume as currency, never as In-House Care savings [CC2][CC9]
Digital health	n/a	+$200.4 million	Ambient listening, video visits, Tele-Critical Care: the budget's productivity lever for a flat civilian base [CC2]

Uniformed pay never touches DHA's operating accounts, so a budget that grows uniforms and holds civilians flat is also a budget that shifts cost off DHA's books. [CC2] The $52.8 million is the only civilian line that grows, and it buys retention on the existing base, the same labor pool clinical support contractors recruit from.

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4. What the practical nurse postings tell staffing vendors

Confidence: High on the counts. Medium on the market read.

Year	DHA and MTF LPN announcements	Top grade GS-6 or GS-7	Share
2022	194	171	88 percent
2023	487	403	83 percent
2024	502	444	88 percent
2025	195	63	32 percent
2026 (through October 9)	376	22	6 percent

Source: USAJOBS historic announcement data for series 0620. Counts are announcements; they do not measure hires or incumbents. [CC3]

Every one of the 486 GS-5 announcements in 2025 and 2026 lists promotion potential as "None," while the rare DHA posting with a ladder reads "6." [CC3][CC10] The duties did not shrink: a 2026 GS-5 posting at Walter Reed requires IV fluid and medication experience and lists sterile field setup, the same work a 2024 GS-6 posting at Lyster covered. [CC11][CC12] DHA is posting in volume at the new ceiling, with 376 announcements through October 9 against 195 in all of 2025. [CC3] The March 31 position description standardization is the first plan task that could change the ceiling. [CC1]

My read for clinical support vendors is a split market. Where a hospital can fill civil service LPN jobs at GS-5, the contract clinical support line shrinks on schedule. Where it cannot, the contracted LPN remains the backstop, and the $294.3 million cut becomes harder to execute. Womack Army Medical Center posted 19 GS-5 LPN announcements between January 2025 and October 7, 2026. [CC3][CC13] Repeat postings at a single site can mean multiple vacancies, turnover, or positions that did not fill; the announcement data cannot tell them apart, so treat repost frequency as a signal to investigate.

The qualification rule compounds it. Under OPM's nurse standard, an associate-degree RN needs a full year of RN experience to qualify for any GS grade, and LPN experience does not count. [CC14] The FY2025 NDAA's Section 716 waiver covers bachelor's-degree nurses only; an associate-degree version proposed in a Senate amendment did not survive conference. [CC7] Contract employers can hire the same nurse the week the license arrives.

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5. Four staffing paths and what each buys

Confidence: Analytical. Built on the FY27 justification, the plan's tasks, and the public record on deployment backfill.

Path	What it looks like	Signal that confirms it	What it buys
A. Uniform-led	FY27 direction holds: uniformed share rises from 47.2 to 48.3 percent, civilians flat, contract dollars down [CC2]	Core 15 staffing plans built on current authorizations; FY28 request repeats flat civilian FTEs	Productivity for uniformed clinicians: acuity and case-mix measurement, operating room analytics, scheduling, ambient documentation; repricing pressure on clinical support staffing
B. Civilian rebuild	Civilian positions grow; LPN postings regain a GS-6 path; Section 716 extends to associate degrees	Civilian FTE growth in the FY28 exhibit; new position descriptions with ladders; associate-degree language in a FY28 NDAA mark	Hiring throughput, onboarding, credentialing, contract-to-civil-service transition support
C. Specialty-tiered mix	Uniforms concentrated in high-deploy specialties, civilian benches where clinicians rarely deploy	Hospital-level volume targets in May and surge staffing requirements in April that break out by specialty	Workforce modeling by specialty and deployment rate; backfill coverage for high-deploy specialties
D. Reserve-first backfill	Reservists cover deployment gaps before contracts do, as at Madigan in 2009	March 31 business case findings; alternate staffing solutions in September 2027 that name the reserve component	Reserve scheduling, credentialing, and readiness tracking; contract backfill as a priced fallback

Path A is the default through FY27 because it is the request on the table and the plan builds staffing on current authorizations. [CC2][CC1] Path B is the one the public record argues for most loudly: GAO documented DHA's FY2025 inability to hire civilians, and the Inspector General found clinics below DHA's own model of two clinical support staff per provider. [CC15][CC16] Path D is the one the plan's sequencing points to. When Madigan Army Medical Center had 462 soldiers ordered to deploy under PROFIS in 2009, it covered four deployed nurse anesthetists with six reservist anesthetists on 90-day rotations. [CC17] RAND's 2013 evaluation recorded the cost from the inside: medical personnel perceived that PROFIS deployments increased workload and reduced access at the hospitals left behind. [CC18]

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6. Where the demand sits

Confidence: High on the cited budget, report, and plan language. Analytical on the demand map.

Workforce and readiness systems. ARMOR, the plan's Assessment of Readiness and Mission Operational Resources requirement, gets a governance cell in October, a timekeeping and scheduling capability to retire DMHRSi in March, the EMQAS credentialing capability to retire CCQAS in June, and proficiency predictive modeling in September 2027, all under PAE Medical Digital Solutions. [CC1] Outside workload capture by January 30 and partner proficiency data streams by August 31 feed the same picture. [CC1] GAO found 39 percent of personnel with partnership work on readiness dashboards had no partnership hours in the timecard system, which is the baseline problem these tasks exist to fix. [CC19]

Hiring throughput. DHA's 2025 nursing staffing report measured 115 days from tentative offer to start and named four initiatives to shorten it, and the plan adds a security check model inside the hiring action by March 31. [CC4][CC1] Work that executes DHA's own named initiatives grows under every path.

Operating room and acuity analytics. Perioperative standards in March, acuity modeling in March, an operating room dashboard in May, and quarterly reporting of staffed rooms, block utilization, throughput, surgical wait, recapture, and proficiency from June 30 make LOE 2 the most dashboard-dense line in the plan. [CC1]

VA partnership operations. Agreements on authorization and on DoW providers at VA medical centers by December 31, data sharing guidance by March 31, hospital-level targets by May 30, veteran access policy by July 30, and a simplified authorization process by August 30, 2027 add up to an operating workstream with no named contractor. [CC1]

Staffing models and ratios. The Inspector General found clinics below the family medicine model finalized July 2, 2025, and the plan's manpower alignment by December 31 runs against manning documents. [CC16][CC1] Ratio measurement by clinic and support-staff gap analysis have an IG finding and a plan task behind them.

What to avoid. Retiree volume does not create In-House Care savings, because MERHCF pays for it, and a business case that claims otherwise will fail review. [CC9] Pitches that assume a civilian hiring surge in FY27 will fail too; the plan builds on current authorizations and the request funds none. [CC2][CC1]

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7. The counterargument, stated fairly

Confidence: This is the strongest case against the reads above, and parts of it are right.

The plan does address backfill. Surge staffing requirements, alternate crisis staffing solutions, and the reserve business case are real tasks with dates. The missing number may reflect sequencing, with requirements first and targets later, and the May hospital-level targets could carry one.

The GS-5 ceiling may be working. DHA posted 376 LPN announcements in the first nine months of 2026, nearly double all of 2025. [CC3] If those positions fill, the civil service is absorbing clinical support at a lower grade and the contract line shrinks on schedule. Fill rates and time-to-fill would settle it; the posting data cannot.

Uniformed growth is the strategy. LOE 2 measures success in military clinicians who meet their wartime standards, and civilians do not count toward it. [CC1] A budget that grows uniforms is executing the plan, and contractors who sell against that direction are selling against the Director's line of effort.

Contract dollars can fall without capacity loss. Contractor FTEs hold flat while dollars fall, which is consistent with consolidation and repricing of administrative work more than loss of clinical support. [CC2] The October 2 brief rated administrative functions as the highest exposure for that reason. [CC9]

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8. What to do in the next ninety days

Confidence: Analytical.

1. Re-sort your MTF clinical support portfolio by labor category and site. For each LPN, medical assistant, and technician position you hold, note whether the site's civil service postings for the same series stop at GS-5. Sites with repeat GS-5 postings are where your contracted staff are hardest to replace and where your option position is strongest.

2. Position for March 31. Bring reserve credentialing, scheduling, and readiness support to the reserve business case, and price contract backfill as the fallback the plan describes. [CC1]

3. Build a hiring-throughput offer around DHA's named initiatives. Price pre-employment processing and onboarding as a fixed-fee service measured in days from tentative offer to start, against the 115-day baseline, and include the security check model due in March. [CC4][CC1]

4. Write the deployment-day white paper now, aimed at April and September. Model a Core 15-sized hospital losing one in five uniformed staff, by specialty, against the two-per-provider support model, using Madigan 2009 and the RAND evaluation as precedent. It feeds the surge staffing requirements due April 30 and the alternate staffing solutions due September 30, 2027. [CC17][CC18][CC16][CC1]

5. Bring operating room and acuity analytics to the May dashboard. The 20 percent targets need baselines by hospital, and the quarterly reporting starts June 30. [CC1][CC2]

6. Map your workforce data offer to ARMOR and the workload capture task. Timekeeping, credentialing, and proficiency modeling land between March and September 2027, and outside workload capture is due January 30. [CC1][CC19]

7. Keep retiree volume out of savings math. Sell it as currency and capacity, the way the October 2 brief laid out. [CC9]

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Mary

Mission Meets Tech Premium

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Sources

[CC1] Defense Health Agency, FY27 campaign plan, including "Delivering Warfighter Readiness, Fiscal Year 2027," October 2026. Source for: the LOE 2 North Star, targets, and leads; the Core 15 staffing, manpower alignment, workload capture, appointing, VA partnership, operating room, and recapture tasks and dates; the general support workforce tasks, including the reserve-component business case, position descriptions, security checks, and ARMOR and EMQAS milestones; and the LOE 3 surge and alternate staffing tasks.

[CC2] Department of War, Office of the Under Secretary of War (Comptroller), "Military Health System, Fiscal Year 2027 Budget Estimates, Volume 1, Combat and Operational Medicine Program (0130D) and Private Sector Care Program (0146D)," April 2026, cleared for open publication April 21, 2026. Source for: In-House Care uniformed end and average strength, civilian and contractor FTEs, the $294.3 million and $331.9 million contract services reductions, the $52.8 million civilian pay increase and its stated aim, average civilian salary, military personnel funded through service military personnel appropriations, weighted admissions, MERHCF receipts, and the $200.4 million digital health increase. Workforce shares are the author's analysis. https://comptroller.war.gov/Portals/45/Documents/defbudget/FY2027/budget_justification/pdfs/09_Military_Health_System/MHS_PB27_J-Book-Vol1-COMP_PSCP.pdf

[CC3] USAJOBS Historic Job Opportunity Announcement API, position series 0620, Department of Defense hiring, agencies Defense Health Agency and Military Treatment Facilities under DHA, pulled October 9, 2026, with the author's review of promotion potential on each 2025-2026 GS-5 announcement page. Source for: announcement counts and top grades by year, promotion potential "None" on all 486 GS-5 announcements in 2025 and 2026, and the 19 Womack announcements. Counts are announcements; they do not measure hires or incumbents. https://data.usajobs.gov/api/historicjoa?PositionSeries=0620&HiringDepartmentCodes=DD

[CC4] Defense Health Agency, "Nursing Staffing Levels," report to Congress, June 30, 2025. Source for: 115 days from tentative offer to start for nurse hires, November 2022 through September 2023, and DHA's four hiring initiatives. https://health.mil/Reference-Center/Reports/2025/06/30/Nursing-Staffing-Levels

[CC5] American Association of Colleges of Osteopathic Medicine, "President Trump Signs Continuing Resolution to Fund Government Through December 11," September 8, 2026. Source for: the December 11 expiration and timing ahead of the November midterms. https://www.aacom.org/news-reports/news/2026/09/08/president-trump-signs-continuing-resolution-to-fund-government-through-december-11

[CC6] FedTools, "TRICARE Open Season for 2027 coverage," updated August 24, 2026. Source for: expected open season dates of November 9 through December 8, 2026. Secondary; confirm against tricare.mil/openseason. https://www.fedtools.com/blog/tricare-open-season-2027-switch-guide

[CC7] Congressional Research Service, "FY2025 NDAA: Military Treatment Facility Staffing," IN12595, August 15, 2025. Source for: Section 716 of the FY2025 NDAA and the House bachelor's-only text adopted in conference over the associate-degree version proposed in S.Amdt. 3290, sec. 5741. https://www.congress.gov/crs_external_products/IN/HTML/IN12595.html

[CC8] Military Officers Association of America, "Another Big Victory in MOAA's Fight to Stop Military Medical Cuts," 2023. Source for: the five-year characterization of the FY2023 NDAA halt on military medical billet reductions. https://www.moaa.org/content/publications-and-media/news-articles/2023-news-articles/advocacy/another-big-victory-in-moaas-fight-to-stop-military-medical-cuts/

[CC9] Mission Meets Tech, Capture Corner, "Where the Recapture Money Moves," October 2, 2026. Source for: the insourcing exposure by function family, the three appropriation scenarios, and the retiree math. Author's prior work.

[CC10] USAJOBS, Defense Health Agency practical nurse announcement 854531700, February to July 2026. Source for: a GS-5/6 practical nurse posting listing promotion potential to GS-6. https://www.usajobs.gov/job/854531700

[CC11] USAJOBS, "Practical Nurse," Walter Reed, announcement 853447400, 2026. Source for: GS-5 grade, the sterile field duty, IV fluid and medication experience in the qualifications, and promotion potential "None." https://www.usajobs.gov/job/853447400

[CC12] USAJOBS, "Practical Nurse," Lyster, announcement 768276700, 2024. Source for: GS-6 grade and the comparable duties and qualifications. https://www.usajobs.gov/job/768276700

[CC13] USAJOBS, "Practical Nurse (Outpatient)," Womack Army Medical Center, announcement 887862700, opened October 7, 2026. Source for: GS-5 grade and promotion potential "None." https://www.usajobs.gov/job/887862700

[CC14] U.S. Office of Personnel Management, "Nurse Series 0610," General Schedule Qualification Standards. Source for: GS-5 qualification with a bachelor's degree in nursing, or an associate degree or diploma plus one full year of professional nursing experience. https://www.opm.gov/policy-data-oversight/classification-qualifications/general-schedule-qualification-standards/0600/nurse-series-0610/

[CC15] U.S. Government Accountability Office, "Defense Health Care," GAO-25-106988. Source for: DHA officials' statement that they were unable to hire civilian employees for the rest of fiscal year 2025. https://files.gao.gov/reports/GAO-25-106988/index.html

[CC16] Department of War Office of Inspector General, "Audit of the Defense Health Agency's Management of Military Medical Treatment Facility Access to Care," DODIG-2026-025, December 8, 2025. Source for: the family medicine staffing model of two clinical support staff and 0.5 FTE medical support assistant per provider, finalized July 2, 2025; clinics below the model; and the open staffing review recommendation. https://www.oversight.gov/sites/default/files/documents/reports/2025-12/DODIG-2026-025_Redacted%20SECURE.pdf

[CC17] U.S. Army, Lorin Smith, "Madigan's dual mission: support locally, globally through PROFIS," December 14, 2009. Source for: 462 Madigan soldiers ordered to deploy under PROFIS in one year, six reservist nurse anesthetists activated on 90-day rotations to backfill four deployed anesthetists, and two active-duty cardiologists deployed in one summer from the 41-person cardiology clinic. https://www.army.mil/article/31815/madigans_dual_mission_support_locally_globally_through_profis

[CC18] RAND Corporation, Melony E. Sorbero et al., "Improving the Deployment of Army Health Care Professionals: An Evaluation of PROFIS," TR-1227, 2013. Source for: medical personnel's perception that PROFIS deployments increase workload and reduce access to care at the facilities they leave. https://www.rand.org/pubs/technical_reports/TR1227.html

[CC19] U.S. Government Accountability Office, "Defense Health Care: Actions Needed to Assess Civilian Partnerships' Contributions to Readiness," GAO-26-107677, June 4, 2026. Source for: the Department operating one Level I trauma center as of December 2025, approximately 723,800 partnership hours reported by military medical personnel from fiscal 2020 through 2024, and 39 percent of personnel with partnership work on readiness dashboards showing no partnership hours in the timecard system. https://files.gao.gov/reports/GAO-26-107677/index.html

Sources verified as of October 9, 2026.