Cancelling UpToDate?

Unfortunately, the news is true. The Library budget simply does not have enough funding to continue it.

Cancelling UpToDate has been an exceedingly difficult decision for the Library and one we are not comfortable with, but one that has to be made given the realities of the Library's budget situation. The Library agrees that UpToDate is an important resource, but our journals and core databases are even more critical to the research, educational and patient care missions of Duke Medicine. We are now facing additional cuts in all these areas, and UpToDate must be one of the cancellations in order to balance the budget. Given the additional budget cut of $100,000, we will be contacting the Duke Medicine community about further cuts in databases, books, and journals in the near future.

Here's a history of the funding for UpToDate and why we need to cancel it.

About 5 years ago the Library was approached by Medicine and other departments to subscribe to UpToDate. We did not have enough funding to cover even the deeply discounted price. [We are not at liberty to publicly release the pricing information, but it is in the tens of thousands of dollars PER YEAR]. Fortunately, several departments pledged a total of $9,000 per year to help with the cost, and the Library paid the remaining portion of the annual cost.

However, the department pledges fell off after the first year and amounted to only $3,000 each year [even less this past year]. The Library had to pick up more and more of the subscription cost each year.

The Library protected UpToDate when we underwent some major budget cuts (about 25% to 30% of our budget, including numerous layoffs) at the expense of its book budget and general operating expenses. Our budget continued to be flat, while journal and database costs increased at a rate of 10% or more per year, and the Library eliminated additional positions to balance the budget. It is simply not feasible to make those cuts any longer.

Last year (July 2006 renewal) the annual price for UpToDate DOUBLED. The Library did not have funding to cover this, but Financial Services allowed us to go over budget for one year and one year only. They told us to find funding from other departments. Last May, I contacted the department chairs and the residency directors and was only able to find $6,000 in pledges -- a pledge from one new department and another from an existing supporter. Both pledged money with the expectation that the larger departments would give their fair share, but that did not happen.

In the budget for FY08 (for the upcoming July renewal) I asked for additional funding for UpToDate. Due to very difficult financial situations within the Medical Center, the funding for UpToDate was NOT approved. In addition, we will have to cut another $100,000 from our budget, most of which will come from books, journals, and other databases. We have already identified several other databases that will be cut, and now have to look at books and journals.

The Library has experienced flat budgets for the last several years, which has meant we have had to continue to cut books, journals, and databases every year to balance our budget. We have already cut our operational expenses to the point that we can barely meet basic expenses. At the same time, our books now average about $150 per title, our database costs increase 6% to 10% every year, and e-journal prices increase about 10% per year, with some titles doubling or tripling in one year.

The Library simply cannot afford to keep UpToDate with its current budget, especially since cutting-edge information from journals is essential to education, research and patient care. Unless other departments step forward, we can no longer pay for it.

I have already been asked about dropping MD Consult. First, it only costs $33,000 per year (less than the cost of UpToDate) and meets numerous needs. We have considered cancelling it for several years, but there is no cost-effective replacement. It is heavily used by students and faculty. Everyone is demanding online access to books, and to replace this with another resource would be fairly costly and would not provide the 53 core textbooks found in MD Consult.

MD Consult is also more than books. It provides electronic access to the Clinics journal series. To purchase them separately is $28,000, and they are also heavily-used resources. It contains about 8 other important clinical journals, and to purchase them separately could easily cost $10,000 per year or more. It also has patient handouts (10% of the use of MD Consult), and whenever we talk about cutting it, we receive complaints from clinicians about the loss of these handouts. To replace them would probably cost well over $20,000 to $30,000. In summary, cancelling MD Consult does not gain us much, would not meet the needs of our students and some faculty, and it would cost us much more to gain access to those materials elsewhere.

There is just not enough money in the Library's budget to meet all the information needs of Duke Medicine, and with the additional cut, we will be purchasing even fewer resources.

The Library truly regrets this decision.

Pat Thibodeau
Associate Dean
Duke Medical Center Library & Archives