Tracking use of print journals over a ten-year period has allowed The University of South Carolina (USC) School of Medicine Library an essential tool for more accurate collection development, for both print and electronic selection. This lengthy study has provided usage statistics for purchasing decisions regarding electronic subscriptions still relevant to the present time. Total collection print journal use studies, never numerous in the library literature, may lose their validity as print use continues to fall. By the end of 2002, The USC School of Medicine Library's print journal use had fallen 85% from 1992 levels, including usage drops in both titles with and without electronic counterparts. The removal of print journals during a renovation is conjectured to have speeded patron use of e-journals. Based on the precipitous decline of print journal use, all library procedures are being examined closely for needed changes. (Contains 3 tables.)