Should Medical Journals Pay Doctors?

I’ve seen this debate come up more and more recently. It’s an interesting one. It even relates well to the discussion about whether college athletes should be paid. The basic question is this: Should medical journals pay doctors?

Before I wade into this debate and share my thoughts, we must first address: Why would medical journals pay doctors? This argument is pretty straight forward.

Most medical journals are largely for-profit. They make money through advertising, paid access to articles, journal memberships, and annual fees.

The product that medical journals are selling is their content. Namely, studies. Studies that are designed, executed, and authored by doctors. Studies that are peer-reviewed by doctors. And, in the case of open-access articles, studies that are published for a fee paid for by doctors. That’s how far away journals are from paying doctors for their work — oftentimes, doctors are paying journals to publish their work.

Additionally, doctors play other key roles in creating, curating, and maintaining the content that makes medical journals money. Some of these other roles include:

• Peer reviewers
• Editorial board members
• Editorial columnists
• Social media ambassadors

In essence, doctors are a necessity for medical journals. Medical journals would simply be kaput without the content they provide.

A caveat: There are many roles that non-medical doctors and non-PhDs play in the publication, processing, and upkeep of a journal. These are very important roles and the journal would also be kaput without them. So, I’m not diminishing that at all. But doctors make up a large portion of the content creators. Doctors are the college football players in this analogy. Coaches and administrators are still needed in college football, but without players, it’s game over.

I also recognize that the editors-in-chief of major medical journals get paid, usually very well. But that is only at the top of the pyramid.

How Much Money Do Medical Journals Make?

There is no perfect or one-size-fits-all answer because the quality of journals is so variable. But let’s assume we are talking about reputable, established medical journals. The kinds of journals that we, as doctors, want to publish in.

In a 2011 study, researchers found that medical journals generally pocket 28 to 39 cents for every $1 generated. This is a greater profit margin than book and periodical publishers. Another article cites that the profit margin for major scientific publishing companies is a staggering 12-15%. And yet another quotes the worldwide revenue of academic publishing at $19 billion U.S. dollars — somewhere between the music industry and the film industry.

So, they make a lot of money.

Don’t Medical Journals Already Pay Doctors?

In the direct sense, no. Unless you are the editor-in-chief, which is a very small, minuscule percentage of physicians.

But perhaps doctors are getting paid by medical journals in an indirect sense. Hear me out.

Many academic physicians grow their salaries as they advance through the academic ranks. They go from assistant professor to associate professor to (full) professor. And compensation increases across those promotions.

How do physicians advance through these ranks? An important component is the amount and quality of research they conduct, measured in impactful publications. That means the more doctors publish, the more they advance academically, and the more their compensation increases.

In that sense, medical journals are providing an avenue for physicians to increase their compensation. And therefore, they indirectly compensate doctors for their work.

But does this really add up? To me, it does not.

From the publisher’s perspective, journals and publishing companies are making a ton of money, largely based on content. The increase in compensation that doctors may see from climbing the academic ladder is not commensurate.

From the institution or hospital’s perspective, this really doesn’t matter. Researchers will still need grants for big projects that also benefit the hospital. And doctors should be more motivated to publish, which will increase name recognition and status of the sponsoring institution.

Doctors must realize this is a game that benefits academic institutions. Do hospitals make money from research? No, not really. Certainly not as much as they do from doctors actually treating patients. So, your increase in pay from academic output is much less than if you just increased your clinical output. Or focused on demonstrating to your hospital why your value is much greater than your compensation.

Unfortunately, this whole system plays to our general ambition to achieve titles above fair compensation.

I know because I played this game.

I published over 60 manuscripts in residency. And it burned me out because I thought I’d be happy once I reached a certain level of notoriety. But once I did, it was an arrival fallacy. While I still love and do research, I now do it for fulfillment and to help my patients. I feel no need or pressure to do research beyond that.

Should Medical Journals Pay Doctors?

With all of this laid out, we come back the central question. I believe, yes, medical journals should pay doctors.

I’m not saying it needs to be some exorbitant amount. We certainly won’t be getting million-dollar sponsorships like some of the best college athletes. But some compensation is only fair.

Publishers can afford it. Journals will still undoubtedly stay afloat and be able to provide the same quality framework to support the doctors’ content.

Plus, it will further incentivize doctors to publish. And to publish high-quality studies, as the best journals will have the most money and will pay the best.

One Sticky Situation

It’s rare that any study is authored by just one doctor. It’s more usually a group ranging anywhere from 2-10. Sometimes more.

So how would a payment from a medical journal be split up?

In this case, we should let the authors decide. If I ran the show, I would pay the submitting authors and they would have to split it among the rest as they all see fit.

In my situation, all would be split among the residents and medical students on the paper. They need it most. You could also divide and weight it by pre-agreed upon terms based on contribution to the paper. Either way, it should be agreed upon before submitting the paper.

Of course, there is room for some conflict. But we are professionals and can work it out.

So yes, I am in favor of medical journals paying doctors for their work!

But how can we actually achieve this? Broad coordination among doctors will be needed. Maybe it starts with one doctor-led independent journal that pays other doctors. And then more may follow suit. Until one day, the traditional publishers don’t have a choice.

No matter how we get there, it is something worth talking about and working on.

Jordan Frey, MD, is a plastic surgeon at Erie County Medical Center in Buffalo, New York, and founder of The Prudent Plastic Surgeon.

Looking to improve your financial well-being? Check out Frey’s online course, Graduating to Success, a comprehensive and interactive 12-module course that helps doctors achieve personal, professional, and financial success during and after their transition from trainee to attending.