In response to a journal budget cut of more than 30%, the Duke University Medical Center Library devised a multifaceted approach to meet the challenge of sharply reduced funding. The availability of electronic format added considerable complexity to the process and impacted the budget as well. In some cases, e-content offered cost savings, but in many others, it presented even higher costs. Major discussion points include surveying library users, developing a comprehensive database of criteria for a thorough review, engaging faculty in the review process, weighing the pros and cons of electronic access, and implementing a wide-ranging publicity campaign. [ABSTRACT FROM AUTHOR]