The Donut Hole of Library Access

We have heard of the donut hole for Medicare prescription drug coverage where people experience a coverage gap for their prescription drug coverage.  I think there is a donut hole for medical information. There are doctors, nurses, researchers who are affiliated with an institution (but not officially part of the institution) or they are private practice who have privileges but are not employed by the hospital.  These people often fall in the donut hole for access to medical information.

There are more and more of these people as universities buy hospitals but the university doesn’t/can’t provide library resources to the hospitals.  Hospital systems are buying other hospital systems and wrongly assuming the library resources will be cheaper (bulk discount) or that they don’t have to pay for library resource because “aren’t we all just one system now that you bought us and we want what you have.”

Library resources are expensive and when met with the surprise cost (when a new system is acquired) administrators often do not understand the basics of library resource licensing and costs. Why would they?  The amount of a library’s budget is not even on their radar when it comes to the budget of the entire hospital.  Unfortunately, they want across the board cuts and the department manager must enforce those cuts. We have little data that says medical libraries save lives and save money in the long run.  What little data we do have hasn’t made it to the minds of administrators.

IMHO the donut hole of information access is growing.  I have people who call for access because they are doing research with somebody in my system. I can give the person in my system access but I can’t give the partner, who is outside of my system, access.  This is met with confusion and dismay.  This is one of the reasons ICanHazPDF and SciHub exist.

As hospital libraries are disappearing and budgets are shrinking, the donut hole will get bigger.  The perception that all is available free on the Internet still exists among many people and when hit with the reality they are flabbergasted by the true access costs causing them to dig their heels in deeper and not pay for anything.  I know of 2 hospitals that didn’t have libraries who were seeking to get library resources only to immediately scuttle the idea completely when faced with the costs. No concept of baby steps and ramp up to more resources. Nope, in their minds the costs are just too astronomical for resources they thought would be cheaper because they are tailgating onto another library.  They totally bail and go back to the idea that everyone will just get by use PubMed and Google, or maybe one expensive (but not as expensive as a whole library) point of care tool.

So, how do we stop the donut hole from growing? Pricing isn’t going down. (When does it for anything…cars, houses, etc.?) Our value is not on the minds of administrators. It will probably be a multi pronged approach requiring cooperation from both publishers and librarians.  What are your thoughts?