Over the past twenty years, the place of the academic health sciences library (AHSL) within the university has changed markedly. These institutions include libraries that may support schools of medicine, nursing, pharmacy, dentistry, veterinary medicine, and public health. Once, they may have been established as separate entities, serving a single school or campus, but many are now consolidated under a larger university library. Have these consolidations and mergers improved the services offered or impacted cost or service quality? What new structures have emerged and how well do they meet researchers’ and clinicians’ needs?