Twenty-eight managers at Dorset County Hospital have been axed in the first wave of cuts to fill a £7m financial black hole.
They will be made redundant by next March with staff consultations likely to start in January, the trust said.
It said the hospital was losing more than £500,000 a month which could reach £11m by March 2011, without any action.
The trust added that its "recovery" plan could mean up to 200 staff redundancies over the next two years.
Nick Hateboer, the county hospital's medical director, said: "The hospital has got into these financial problems because since 2006 it has recruited over 300 new staff and invested heavily in services in the hope that it would attract more patients.
"But these extra patients never came and so we are left with rising costs but without the income to cover them."
He added that as part of the recovery plan the hospital would have to return to its "2007 staffing levels when the costs of the hospital matched its income".
"This will be an extremely difficult period for all those staff who have to leave us," he added.
Mr Hateboer went on to the say "checks" were being made to ensure that the planned changes do not have a "negative effect" on patient care.
Earlier, Jim Knight, MP for South Dorset and Minister for the South West, said that if some specialists were moved from the hospital, then transport links needed to be improved for patients.
In October, Robin SeQueira CBE, who served as chairman of the hospital for 12 years, resigned.