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Trends in Medical Publishing: Where the Publishing Industry Is Going

Rohrich, Rod J. M.D.; Sullivan, Daniel M.Div.

Plastic and Reconstructive Surgery: January 2013 - Volume 131 - Issue 1 - p 179–181
doi: 10.1097/PRS.0b013e318273284d

Dallas, Texas

From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.

Received for publication September 6, 2012; revised September 6, 2012.

Disclosure: The authors serve as Editor-in-Chief and Managing Editor of Plastic and Reconstructive Surgery. They have no financial interest to declare in relation to the content of this Editorial.

Nearly once a week, we receive an email from a new journal, asking us to submit an article to it to give it content and help it establish credibility. The vast majority of these new journals are “open access” journals. Although open access journals have existed for nearly 20 years, it is only within the past decade that they have begun in the science, technology, and medical fields. You also may have received solicitations from open access journals. We wanted to provide insight for you on open access journals, to show you what the current and foreseeable trends are in medical publishing.

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Open access journals represent a new business model in the field of biomedical journal publications. PLOS ONE began in 2006 and published 138 articles. It published 1200 articles in 2007. In 2011, PLOS ONE published 13,798 articles. In 2011, approximately one in 60 of all articles indexed by PubMed were published by PLOS ONE, making the publication today the largest journal in the world.

There are 7706 open access journals listed in the Directory of Open Access, with almost 800,000 articles published (as of May 8, 2012). Some open access journals are indexed on MEDLINE; all open access journals are discoverable on PubMed by depositing in PubMed Central.

Almost 1000 open access journals are published by major open access publishers, including BioMed Central (owned by Springer), Hindawi, Dove Press, Public Library of Science, and Medknow. Close to 20 percent of those journals have impact factors, as issued by Thomson Scientific. Commercial publishers such as John Wiley & Sons, Sage Publications, and Nature Publishing Group have also launched and are continuing to grow their open access publication portfolios.

Open access is growing in acceptance not only among research and granting institutions but also among authors. From 1993 to 2009, open access articles grew 3.5 percent. Extrapolations indicate that open access research could reach 60 percent between 2019 and 2025. In addition, major data aggregators (including PubMed, Index Medicus, PubMed Central, and most recently OVID) have open access databases and search platforms dedicated to open access material.

From the beginning of organized, formal publication of modern medical journals, many medical journals have been subsidized to some degree. An example of this subsidization is seen in the Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery (currently published as the Journal of Plastic Surgery and Hand Surgery). This journal is completely funded by an endowment to the journal, providing free subscription and access to journal content.

The first digital-only free journals were published on the Internet in the late 1980s, including Bryn Mawr Classical Review,1 Postmodern Culture,2 Psycoloquy,3 and The Public-Access Computer Systems Review.4 One of the first open access journals in medicine, the Journal of Medical Internet Research,5 was created in 1998; it is now in its 14th volume and has an impact factor of 4.7.

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Currently, there are two primary business models for medical journals, the “traditional” model and the newer open access model. (A third business model does exist, the “hybrid model,” which combines both subscription-based content and open access content.) Describing essential elements of both models will help show what is new and different with the open access architecture (Table 1).

Table 1

Table 1

As is the situation with anything that involves funding and the distribution of information, there is an ongoing debate regarding advantages and disadvantages of open access publication among scholars, publishers, and funding agencies. Many publishers were hesitant to accept open access proposals, as the new business plan was a clear shift away from the subscription model, which was once a key component of the publishing business, but more recently publishers have begun to embrace open access journals. The Public Library of Science publishes perhaps the best known scientific open access journal. It began in 2006 with 138 articles; in 2011 PLOS ONE published nearly 14,000 articles.

One of the primary arguments against open access journals is that they possibly damage, or diminish the quality, of the peer-review system. Traditional journals often contend that open access peer-review processes are ineffective or that peer review is conducted too quickly, giving articles inadequate scrutiny as compared with the peer-review processes of traditional journals. This argument has been undercut in recent years, as evidenced by the emergence of high-quality, well-reviewed open access publishers and the growing understanding and expectation that open access content can and should require the same high levels of quality peer review that the more established traditional journals demand.

Some benefits of open access publishing include free access to scientific content; the broadest possible dissemination ensues because all that is needed to access it is an Internet connection. Another benefit to open access publishing is the less-limiting restrictions on permissions to reuse, republish, and create derivatives of open access content. Authors retain the copyright for all open access content, but they provide readers and other authors with the rights to reuse, republish, and, in some cases, create derivatives of their work. Open access is not just making the content freely available, it is also about making the content freer of limitations on how it can be used. Open access publication enables libraries to save funds. Some will argue that open access publication increases a journal's impact factor; one study, however, determined that traditional subscription journals enjoyed higher impact factors.6,7

A primary argument in favor of open access publication is made by major public funding agencies who sponsor research with public funds. Open access publication is mandated by a large and growing number of research institutions; those institutions argue that if public money was spent to fund research, resulting published reports on that research should be available to the public (thus, in an open access journal). Fully 170 research institutions and 51 funding agencies mandate open access publication research output, as of December of 2011. That number is growing. In the past, cost for publishing in open access journals was typically written into grant proposals, thus incurring either no or minimal cost burden to the authors of these articles. The United Kingdom's Wellcome Trust and the U.S. National Institutes of Health mandate that published articles based on their funded studies be published in open access journals. As recently as July 16, 2012, the United Kingdom recommended that all research funded by its main grant-funding bodies, within 6 months of publication, should be made free and open to the world (open access).

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As mentioned earlier, open access journal publishing of science, technology, and medicine is increasing rapidly. Estimates project that 60 percent of all such journal content will be published by open access journals by 2019. Even though clinical and pharmaceutical journal titles have been somewhat slower to adopt open access than the life sciences, we anticipate that the clinical medical journals will change and begin adopting open access publication. They are already shifting to incorporate/adopt open access into publishing to address the needs of key funders and the desire for greater globalization of scientific research. A brief list of open access surgical journal titles shows the breadth and depth of this trend (Table 2).

Table 2

Table 2

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A number of conclusions and observations regarding open access publication bear mentioning:

  • Many key global funding agencies now mandate open access publication of studies they fund.
  • Open access journals now form an important source of peer-reviewed data for medicine.
  • Many open access journals are now highly trusted, highly referenced, indexed, and well received. This shift in perception and public trust solidifies the role open access has in medical publishing.
  • Open access journals are now established and accepted outside the United States.
  • Open access journals represent the fastest growing business model for journals and one that is sustainable and supporting of the shifting mandates of funding agencies and declining library budgets.
  • Open access journals offer advantages over traditional journals.
  • Open access journals are here to stay.
  • Open access publication spans the gamut of medical literature, including plastic and reconstructive surgery–related titles.

The plastic surgery community and authors need to be aware of the new publishing model. Open access represents a shift in thinking for United States–based authors, but it is nothing for us to shun. Open access publication simply represents another avenue for truly excellent plastic surgery material to be disseminated to the plastic surgery community worldwide. We at Plastic and Reconstructive Surgery look forward to new developments in the open access model of publishing.

Rod J. Rohrich, M.D.


Plastic and Reconstructive Surgery

5959 Harry Hines Boulevard

POB 1, Suite 300

Dallas, Texas 75390-8820

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The authors acknowledge and appreciate the assistance of Elizabeth Durzy in the research and editing of this Editorial.

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1. Bryn Mawr Classical Review. Available at: Accessed August 29, 2012.
2. Postmodern Culture. Available at: Accessed August 29, 2012.
3. Psycoloquy. Available at: Accessed August 29, 2012.
4. The Public-Access Computer Systems Review. Available at: Accessed August 29, 2012.
5. Journal of Medical Internet Research. Available at: Accessed August 29, 2012.
6. Antelman K. Do open-access articles have a greater research impact? Coll Res Libr News 2004;65:372–382.
7. Eysenbach G. Citation advantage of open access articles. PLoS Biol. 2006;4:e157.
©2013American Society of Plastic Surgeons