Should Medical Journals Pay Doctors?

I’ve seen this debate come up more and more recently. And I think it’s an interesting one. It even relates well to recent changes in and the debate around NIL (Name Image Likeness) deals for college athletes. The basic question is this: Should medical journals pay doctors?

I’m going to wade into this debate and share my thoughts.

But first…

Why would medical journals pay doctors?

This argument is pretty straight forward.

Medical journals are for profit. They make money. They make money through advertising, paid access to articles, and journal memberships and annual fees. Even the non-profit ones, like JAMA, make money.

The product that medical journals are selling is the content within them. Namely, studies. Studies that are designed, executed, and authored by doctors. Studies that are peer-review 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 we are from journals paying doctors for their work…Currently, doctors are paying journals to publish their work.)

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

Peer reviewers
Editorial board members
Editorial columnists
Social media ambassadors
And so on

In essence, doctors are not just a necessity for medical journals. Medical journals would simply be caput without the content doctors provide.

A caveat

There are many roles that non-doctors play in the publication, processing, and upkeep of a journal. These are very important roles and the journal would also be caput without them. So not diminishing that at all. But doctors remain 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.

And also, I do 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 here. 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.

However, 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 articles 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 USD, somewhere close to the music industry.

So they make a lot of money.

With this being said, I think we do need to address one consideration…

Do 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 are doctors getting paid by medical journals in an indirect sense? Maybe. Hear me out.

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

And how do physicians advance through these ranks? A huge component is the amount and quality of research that they do measured in impactful publications. Putting it all together…the more doctors publish, the more they advance academically, and the more their compensation goes up.

In that sense, maybe medical journals are providing an avenue for physicians to be able 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 from doctors. 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.

And more importantly, from the doctor’s perspective, this makes absolutely no sense.

Point A. This only applies to academic physicians whose contract and advancement is tied to academic output. Private doctors, academic doctors without such a contract, as well as trainees get completely ignored in this argument.

Point B. Doctors need to realize that 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. Or learn to create a new employment situation like PC-employment lite that is more to your benefit.

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. And while I still love and do research, I know why I do it now – for fulfillment and helping my patients. I feel no need or pressure to do research beyond that. Which is a nice change.

And now, with all of this laid out…

Yes. They should.

And 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 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, I think we have to let the authors decide this. If I ran the show (and of course I don’t), I would pay the submitting author and they have to split 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.

Of course there is room for some issues. 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?

Much easier said than done.

In a similar way to how I think doctors won’t be able to take clinical control back until we are all financially free with the ability to set our own terms, I think broad coordination among doctors is required for this issue as well.

Maybe it starts with one doctor-led independent journal that pays other doctors. And the ride begins to swing with more and more following suit. Until the traditional publishers don’t have a choice?

Who knows?

But I think it is something worth talking about and working on.

And if you are looking for ways to create alternative streams of income as a physician, check out these posts!

What do you think? Should medical journals pay doctors? Why or why not? How much? And how can we start moving things along? Let me know in the comments below!