Background In 2016, Congress enacted several reforms to restructure the Military Health System (MHS) and transition operational control of military treatment facilities (MTFs) from individual branches of service to the Defense Health Agency (DHA). Previous research indicated that reductions in MTF access resulting from these reforms would have negative repercussions for quality of care and patient safety among MHS beneficiaries. The onset of the COVID-19 pandemic in 2020 further challenged MHS operations, with non-urgent procedures postponed and military medical personnel deployed to civilian hospitals to improve clinical capacity. The purpose of this study is to evaluate trends in volume of surgical procedures in the National Capital Region (NCR), with a secondary objective of evaluating trends in clinician full-time equivalency (FTE) during and after MHS reforms and the pandemic. Methods We queried the MHS Data Repository (MDR) and performed a cross-sectional study on the volume of surgical procedures among MHS beneficiaries ages 18 to 64 years at acute care military and civilian facilities located within the NCR from fiscal year (FY) 2016 to 2023. We identified procedures representative of a broad range of general and orthopedic surgeries using ICD-10-PCS and CPT codes. All-cause 90-day hospital readmissions were also included in the analysis as a health care quality metric. Trend analyses were conducted to show the number of surgical procedures and percent of hospital readmissions, with additional analyses restricted to direct care to examine differences between four major MTFs in the region: Walter Reed, Alexander T. Augusta, Fort Meade, and Malcolm Grow. To evaluate the impact of MHS reforms and the pandemic on clinical care at these MTFs, we queried the MDR for total and readiness FTEs among physicians, advanced practice providers (APPs), and registered nurses (RNs). Results We identified 39,724 surgical procedures performed in the NCR during the study period, with 20,593 in direct care and 19,131 in the private sector. Across the study period, there was an overall decline in surgical volume at MTFs, with Walter Reed and AT Augusta having the largest declines, and a slight increase in surgeries in private sector care over the same period. 90-day readmissions in direct care declined between 2016 and 2019 but increased from 2020 to 2023, while readmissions in private sector increased from 2016 to 2018, followed by a decline between 2020 to 2022 and an uptick in 2023. We observed declines in total FTEs across all four MTFs for all provider types. Physicians and RNs increased readiness FTEs at all MTFs, while APPs only had increased readiness FTEs at Malcolm Grow and Ft. Meade. Conclusion The decline in surgical procedures in direct care reflects shifts in beneficiary care to civilian health facilities in the private sector as a result of the restructuring of the MHS and limited capacity of MTFs during the pandemic. Additionally, the decline in total FTEs in combination with increases in readiness FTEs indicates that MHS providers are spending less time on clinical work at MTFs and increasing readmissions compared to the time period antedating the enactment of MHS reforms.