The health board has been warned are no “easy solutions or answers” to cutting £20 million from its budget.
Finance boss Katy Kerr has warned it is not “business as usual” as officials try to balance the books.
And chief executive Jeff Ace believes the health service will look “very different” once the cuts are made.
NHS Dumfries and Galloway needs to find £20 million worth of savings in 2022/23 to reach a break-even position against its “revenue resource limit”.
Finance director Ms Kerr told Monday’s health board meeting that since her previous update “it is fair to say the financial risk has not reduced”.
Instead a number of additional pressures, such as inflation, had been identified.
And she revealed the national position was “really challenging” across health and social care, with “no easy solutions or answers”.
She told members: “The key thing is this really isn’t business as usual.
“This isn’t just tinkering around the edges of the financial position.
“This is about looking at the full extent of the savings we need to deliver and assessing and understanding it will have some impact on services.”
Mr Ace said in previous years the finance team had managed to find one or two per cent of cash releasing efficiency saving (CRES) but that wasn’t the situation this time.
He explained: “We are looking at five per cent of cash releasing savings from our business model.
“We will look very different after delivering those sorts of savings than we do at the moment in terms of how our services are organised and the breadth of offering that we are providing.
“The financial challenge in itself will be transformational to us and how do we deliver that whilst dealing with the service pressures is going to be quite a dominant feature of this board for the next few years.”
Health board chairman Nick Morris said he and colleagues across Scotland had raised concerns about the five per cent approach to all of the country’s health boards, believing savings could potentially be made at a national scale.
However, he added if that position is accepted, there wouldn’t be any impact to the savings needed in the next 18 months.