On 15 March 2024, the College of Physicians and Surgeons of BC (CPSBC) closed its Library, which came as a shock to many of us. Physicians across British Columbia have expressed their dismay at this decision, both privately and in the pages of the BCMJ.[1,2]

There is minimal information about the closure on the CPSBC’s website, so I reached out to understand the rationale. The response read: “Registrants were not consulted. This difficult decision was made by the College Board after careful consideration of data showing significant decrease in library use over the years. There are no further details on the public record.”

During the Library’s final days, I called Dr Karen MacDonell (PhD), the former director of library services for CPSBC, to say thank you. I was an avid user of the Library, often requesting literature searches to help inform research projects and manuscript writing. The team was always thorough and prompt. As Dr MacDonell put it: “The Library was entirely focused on serving physicians so physicians might serve their patients.” 

As we reminisced on the Library’s varied functions, it occurred to me that perhaps registrants underused the Library’s services or weren’t aware of its history. If we had known the Library needed our support, could we have advocated for it better? As the saying goes, you don’t know what you’ve got until it’s gone.

The first medical library in BC was established in 1906 by the Vancouver Medical Association.[3] Eventually, the demand for and breadth of its services expanded to a point where a central provincial administration was warranted. In 1960, after a vote by BC physicians, the Library was taken on by the CPSBC. Chronicling the Library’s transition for a 1963 article in the Canadian Medical Association Journal, Dick and colleagues wrote: “This proposal was met favourably on the basis that the [College] Council, under the Medical Act, had a duty to maintain the standard of medical practice throughout the province. What better way was available than through an active medical library service?”[3]

In 1963, each doctor in the province was assessed an annual fee of $25—noted to be the approximate cost of one annual medical journal subscription—demonstrating excellent value for money.[3] The fee would be equivalent to about $250 today, reflecting that we paid significantly less for the Library’s services in the present day than physicians did in 1963. In 2022–2023, 60 years later, the portion of the CPSBC’s expenses accounting for library services (including salaries and benefits) was $1 863 000, or $126.54 per active registrant, based on 14 723 professionally active registrants.[4] For context, that is 5% of the CPSBC’s $36.7 million in expenditures, the largest of which are accreditation programs (16%), complaints and practice investigations (16%), and legal services (14%).

In 1963 there were two librarians and two clerical staff; most recently, there were four librarians and four library technicians. Among the team’s responsibilities was locating articles, books, documents, and electronic resources from the CPSBC’s collection, local libraries, and around the world. The team curated and maintained collections of books, journals, audio recordings, question banks, point-of-care tools, pharmacopeia, drug interaction checkers, therapeutic monitoring guidance, instructional videos, and reading lists. Many of you probably read the monthly Cites & Bytes newsletter, which presented physicians with a selection of clinically relevant citations from emerging literature.

According to the CPSBC’s committee reports, for each of the last 3 reported years, an average of 1710 physicians posed over 10 000 queries, Library staff provided almost 13 000 copies of articles, and about 46 500 articles were downloaded from the Library’s website.[5-7] On average, almost 1200 in-depth literature searches were done each year. One librarian recalled that the “queries were endlessly varied, just as are physicians’ patients.” Physicians also had self-serve access to top-ranked point-of-care tools such as BMJ Best Practice and DynaMed and a variety of other online clinical information sources. 

When I asked the Library team what they were most proud of in their work, one member replied: “I am proud to rest in the conviction that every single request was taken with utmost seriousness and engagement. We felt the responsibility to provide the best evidence we could find in response to clinical (and medicolegal, administrative, educational, etc.) questions. We saw the vulnerability of the physician saying ‘I don’t know the best way to help my patient,’ so we applied our specialized skills plus that crucial characteristic of every successful library technician and librarian: curiosity.”

Sir William Osler was the first donor to the Vancouver Medical Association’s medical library, stating: “There is no better index of the intellectual status of the profession in any town than the condition of its medical library.”[3] Is it possible that in 118 years, Dr Osler’s vision has gone from essential to obsolete? Are medical library services truly no longer necessary? Since the summer of 2023, three major Canadian health libraries either closed or were diminished: the CMA library (CMA Joule) closed, the CPSBC’s library closed, and the Canadian Agency for Drugs and Technologies in Health recently laid off half of its research information services staff.[8]

The future of medical information seeking is uncertain. Do we as a collective value a variety of information sources or a small number of corporate information tools? Medical libraries help ensure equitable access to skilled information professionals and a healthy, varied, expansive literature base, specific to each physician’s unique clinical circumstances. In losing the CPSBC Library, I believe we’ve lost a valuable member of our health care team. 

In the May issue, Dr Ian A. Gillespie, former president of Doctors of BC, proposes in a letter to the editor that Doctors of BC take over the Library.[1] I am curious to hear from more of our readers about what a medical library, or lack thereof, means to you.
—Caitlin Dunne, MD, FRCSC

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License [10].

References

1.    Gillespie IA. Closure of the College Library: A proposal [11]. BCMJ 2024. In press.

2.    Szasz G. Memories of our profession’s library. BCMJ. 13 March 2024. Accessed 20 March 2024. https://bcmj.org/blog/memories-our-profession-s-library [12].

3.    Dick J, Harrison WE, Fraser CW, Williams DH. The medical library service of the College of Physicians and Surgeons of British Columbia. Can Med Assoc J 1963;88:741-744.

4.    College of Physicians and Surgeons of British Columbia. Annual report 2022/23. Accessed 20 March 2024. www.cpsbc.ca/files/pdf/2022-23-Annual-Report.pdf [13].

5.    College of Physicians and Surgeons of British Columbia. Committee reports 2020/21. Accessed 20 March 2024. www.cpsbc.ca/files/pdf/2020-21-AR-Committee-Reports.pdf [14].

6.    College of Physicians and Surgeons of British Columbia. Committee reports 2021/22. Accessed 20 March 2024. www.cpsbc.ca/files/pdf/2021-22-AR-Committee-Reports.pdf [15].

7.    College of Physicians and Surgeons of British Columbia. Committee reports 2022/23. Accessed 20 March 2024. www.cpsbc.ca/files/pdf/2022-23-AR-Committee-Reports.pdf [16].

8.    Ross-White A. Canadians need independent information and evaluation of drugs [petition]. Change.org. 4 March 2024. Accessed 20 March 2024. www.change.org/p/canadians-need-independent-information-and-evaluation-of-drugs [17].