From the report: "Total force mix, defined as the choice between military, civilian, and contractor performance of Department of Defense (DoD) activities, has long been an important area of defense management. The wrong total force mix puts mission accomplishment at risk and inefficiently consumes scarce defense resources. The fiscal crisis confronting DoD has added to the urgency of improving force mix decisions—saving money through more efficient total force decisions is essential to minimize cuts in warfighting capability. DoD is also adjusting to a new strategy and incorporating the lessons learned from Iraq and Afghanistan, which demonstrate fundamental changes to the way the United States fights wars. With these factors in mind, the Director of Total Force Planning and Requirements within the Office of the Under Secretary of Defense for Personnel and Readiness (OUSD(P&R)) tasked the Institute for Defense Analyses (IDA) to examine total force mix issues within the DoD medical community, provide specific recommendations for improvement, and to draw lessons from this community that may provide insights for the improvement of force mix across the DoD."