Military medical personnel comprise a large and disproportionately expensive part of the total uniformed force. They also comprise a majority of the governmental manpower for the Military Health System (MHS). According to Departmental guidance on military essentiality, medical manpower requirements should derive from the MHS’s operational mission of providing care to deployed forces rather than commercial activities such as beneficiary care. However, pressures from the beneficiary care mission have historically created imbalances in the execution of medical requirements among medical specialties. Furthermore, certain components of the medical requirement and utilization patterns of the medical force may be inconsistent with guidance on military essentiality. While the former pattern shows signs of abating, questions of the military essentiality of elements of the medical force should be scrutinized in today’s tight budgetary environments.