The purpose of this study is to gain an understanding of current academic medical library circulation polices and examine methods libraries utilize to meet patron needs. Key informants were selected from five states. Statistics regarding financial practices, users, services, space access, and circulation practices were collected via survey instrument. Findings were analyzed to identify current services and differences in practice. Circulation practices among academic medical libraries vary, but common trends exist. Further study should compare strategies and policies in academic medical libraries with practices in other types of academic libraries to enhance service development and identify unique variables.