The phrase ‘publish or perish’ has become increasingly common in academia as a way to describe the (often unachievable and unsustainable) expectations placed on researchers to continually publish articles in peer-reviewed academic journals. Though the phrase itself has become increasingly common, the pressure to publish remains an inevitability for many researchers.
The rise of the publish or perish ecosystem
Though medical publishing has dramatically changed over recent decades, the use of publications as a metric for research success has largely remained the same. The open access publishing model is often identified as the most influential recent shift in medical publishing. While there’s much to be said about the model’s many benefits, it’s inarguable that one of the less desirable consequences is the markedly boosted publisher profits. Though this in itself isn’t necessarily a problem, it’s created an environment where it’s more profitable for journals to focus on publishing a high volume of articles rather than a smaller number of high-quality papers.
Simultaneously, competition among physician-scientists has been increasing for highly desirable jobs. A poll conducted by Nature found that over 70% of respondents believed that scientific performance metrics (including publication volume and the impact factor of journals they publish with) are used to evaluate job candidates.
These factors have combined to form a dangerous positive feedback loop: journals are motivated to publish more articles, and researchers are motivated to publish more papers. The result has been a sharp influx in the sheer number of articles published annually. While this could seem like a mutually beneficial relationship in theory, it’s led to a modern publishing ecosystem that’s inundated by manuscripts published primarily for the sake of being published rather than to spread notable and important research findings.
The modern medical publishing landscape
The positive feedback loop has fueled an intense competition to publish in highly respected and reputable journals. Top-tier journals, such as Nature, New England Journal of Medicine, and The Lancet have acceptance rates ranging from 5% to 7.6%; simultaneously, the publication process is becoming longer, with increasing time from journal submission to publication. Though experienced, well-funded authors are generally able to publish enough papers to meet the rising standards of competitive grant applications, early-career investigators are struggling to publish in reputable journals and become viable grant candidates.
This environment has led to unprecedented rates of plagiarism, manuscripts published with flagrantly incorrect or fraudulent results, and widespread redundant publication (also referred to as ‘salami publishing’). The pool of scientific literature has become so dense that it’s nearly impossible to parse through the lengthy list of publications on any niche subject. Unfortunately, however, the effects of publication pressure haven’t only been limited to the medical publication landscape.
The effects of publish or perish on clinical practice
The effects of publication pressure on clinical practice are only just beginning to be recognized and reported.
- Publication-related deadline pressure. Many healthcare staff members, from academic-physicians to nurse practitioners, are experiencing increasing strain on the academic side of their roles, forcing them to cut back on their clinical practice to meet increasing publication requirements. Patients are being shuffled and potentially receiving reduced-quality care due to the time obligations required to meet publication deadlines.
- Scientific misconduct. Some authors resort to unsavory practices to meet publication expectations, and publication pressure has been found to be significantly correlated with scientific misconduct.
- Clinical trial recruitment pressure. Healthcare staff are experiencing an increasing pressure to recruit patients to clinical trials as part of the trial-to-publication pipeline, raising doubts as to whether recruitment always meets conflict of interest requirements and safety standards for patients.
- Unclear clinical best practices. Identifying new clinical standard-of-care practices fundamentally relies on peer-reviewed literature; as the quality of peer-reviewed literature declines, it becomes increasingly difficult to identify the best practices and treatments.
Reactions to publish or perish
Clearly, a change is needed—but medical academia hasn’t yet agreed on what needs to be done to counteract this problem. A few potential solutions have been proposed and tested, but each has its own drawbacks and consequences.
- Cash bonuses for publishing. Some countries have begun offering researchers a cash bonus for publishing papers in high-impact journals, with the intention that resultant papers will be high in quality rather than in number. However, China recently banned the practice, explaining that the policy only fueled the pressure to publish and resulted in reduced scientific integrity standards.
- The rise of preprints. The preprint model has been lauded for providing opportunities for early-career investigators to publish their research, and many large grant funding bodies, such as the National Institutes of Health, have begun supporting the preprint model. However, preprint servers’ post-publication peer review model has been criticized as inherently faulty and for enabling plagiarism.
- Publishing support services. A new sub-industry has arisen around offering medical publishing support services. While I, as an academic research editor, certainly agree with the usefulness of language editing for academic manuscripts and the role of an editor as a publication coordinator, we’ve seen a recent rise in predatory editing practices, and this service doesn’t address the underlying problem of publication pressure.
How to address the publish or perish problem
As with any convoluted, multi-faceted problem, there’s no single solution that will resolve all of the industry’s problems. However, a good step in the right direction would be to internalize Goodheart’s law: “when a measure becomes a target, it ceases to be a good measure.”
Many leading experts agree that the focus on bibliometrics is counterintuitive to creating high-quality scientific research. If one thing is clear, it’s that institutions need to critically evaluate what qualities define a ‘good scientist’— and the role of a scientist’s publication list in that definition.
