Publishing in medicine: why, when, where, what and how

‘Publish or perish’. This well-known phrase, likely first mentioned over a century ago, was even once the title of a one-day course run in central London, which I attended. Thankfully, this mantra has faded from prominence in recent years, but what does it mean, why did it become so (in)famous and what have the consequences been? Oxford physician, clinical pharmacologist and writer Dr Jeffrey Aronson proposed a definition for the ‘publish or perish’ paradigm last year, suggesting the following:

“An aphorism that describes the pressure on an academic to have innovative scholarly material published in reputable journals or other forms of scholarly output, sufficiently often, in order to avoid demotion, dismissal, failure to progress in one’s scholarly career, or diminishing the status or reputation of one’s scholarly community or discipline.”¹

There are many reasons why doctors choose to publish in the medical literature. At its origin, publishing was designed to help disseminate new medical findings and knowledge around the world, to stimulate progress in medicine and update the global medical community on novel therapies or breakthroughs in disease understanding. Over time, however, publishing papers came to be viewed by some as a marker of dedication to a field among trainees, to the extent that, 30–40 years ago, it was nigh on impossible to enter specialist training in cardiology without multiple publications and a higher research degree (e.g. MD or PhD). Hence, one had to ‘publish or perish’ – in this case, perish meaning fail to enter specialist training in your desired specialty.

In 1993, the Chief Medical Officer, Sir Kenneth Calman, published his proposed reforms for higher specialist training in the UK,² which included combining the old ‘registrar’ and ‘senior registrar’ roles into a single ‘specialist registrar’ (SpR) position. These registrars would be appointed to National Training Numbers (NTN) and would receive a Certificate of Completion of Specialist Training (CCST) at the end of this period. Higher specialist training in cardiology became a six-year programme in Deaneries around the UK. The necessity to have undertaken research – and published multiple papers – prior to obtaining a NTN gradually also diminished, as cardiologists and educationalists acknowledged that many doctors undertook research and publishing, not out of genuine scientific curiosity (a motivation likely to promote continuation of research endeavours in the future), but merely to obtain a NTN, and ceased academic activities soon thereafter.

Why should I publish?

So, if one no longer needs to publish in order to enter higher specialist training (or indeed to attain a consultant post), why do doctors still publish? The reasons are varied, as well as numerous, including a desire to explore a genuine scientific interest in greater detail, an opportunity that happens to arise during work (e.g. an interesting clinical case), a desire to raise one’s own personal profile in a field, a desire to be considered a key thought leader in a field and join the ‘lecture circuit’, a belief it is required to be competitive at times of job applications, or a requirement to publish due to a position held by the individual (e.g. a university appointment).

Beyond all of the above, however, why doctors publish may be boiled down to the more fundamental question of why we write. The process of writing about a topic forces us to think carefully and constructively about said topic, and, thus, helps us understand what our opinions are on a certain matter. Many doctors have found, through writing papers, that the research they conduct (e.g. literature review), and then appraise with critical thinking, leads to a better and more complete understanding of a topic (headline concepts as well as the nuances), and, thus, this process is educational, not just for the potential readers of a subsequent paper, but also for the author themselves.

When can I publish?

It is possible to publish articles all the way from medical student level through to established consultant. Medical students may assist in data collection within a department’s ongoing study, and, thus, earn co-authorship on a paper, or may undertake their own audit or retrospective data collection exercise (typically under the supervision of a consultant) and, thus, be the first author on the paper. The same is true for younger resident doctors during their clinical posts in training. Registrars and research fellows often have more time and more opportunities to publish, but a take-home message here is that it is never too early nor too late to start publishing.

What can I publish?

There are many different types of articles published by journals, ranging from original research studies and scholarly reviews, to case reports and opinion pieces. Whether a doctor can publish any or all of these types of article will often depend on level of training and experience – for example, a recently qualified resident doctor is unlikely to have sufficient knowledge and experience to write a review article, but a case report may be a more appropriate opportunity, whereas a tenured Professor would likely be in a strong position to write a scholarly review article, but would be less inclined to pursue a case report. Box 1 lists the different types of articles published by most journals. Resident doctors should seek advice from consultants, preferably those that publish regularly, to obtain ideas for a potential paper, and ensure its appropriateness and likelihood of success in publishing.

Where should I publish (and where not)?

There are many scientific databases that register publications, such as Scopus, Embase and Web of Science (Clarivate). However, the most famous is Medline (PubMed), hosted by the National Institute of Health (NIH) in America, and most trainees will be encouraged to publish articles in journals that are listed on PubMed, as some job application forms only consider publications in a PubMed-listed journal. Resident doctors will usually publish together with a consultant, and they should be able to provide guidance on appropriate journals to consider for submission.

The incentives for journals to publish have changed with time as well. Doctors do not receive money to publish in scientific journals, nor do they receive money from the journals for undertaking scientific peer review, but the journals that publish research do earn money from selling access to articles (either on a single-article basis or selling access to an institution on an annual basis) or selling reprints to Industry for promoting their products, as well as from advertising in the journals on their websites. The biggest publishing houses are enormously profitable, earning billions in revenue each year. Accordingly, with time there has been an enormous expansion in the number of medical journals (some of which was required but some less so).

Table 1 illustrates the expansion in journals produced by three leading cardiological societies, the American College of Cardiology (ACC), American Heart Association (AHA) and European Society of Cardiology (ESC), before and since 2006. Some expansion in the number of journals was undoubtedly required, as with time and medical advances – and growth of new treatments and new procedures – there was simply insufficient space in existing journals to disseminate new ideas and discuss new therapies. Indeed, entire sub-disciplines, such as cardio-oncology and structural heart interventions, simply did not exist until recently.

However, this has also been accompanied by a huge increase in the number of so-called ‘predatory journals’, which often seek large fees to publish papers on an open-access basis, and which, too often, publish papers that do little to advance science or medicine.³ Doctors of all levels are discouraged from publishing in such journals. I have never paid to publish my work and have no plans to do so in the future either. Sometimes doctors may work within institutions or with Professors that have institutional access to funds to cover the cost of (open access) publishing, but I would strongly urge individual doctors not to pay to publish themselves, as there are many journals that publish papers (on a restricted-access basis) without charging authors.

How do I start publishing?

Undergraduate and postgraduate teaching encompasses learning about the human body, diseases and treatments, but the skillset required to publish is not formally taught and, thus, the process can appear opaque, and almost impossible, from the outside. Knowledge, such as how to perform a literature search, how to insert references into a manuscript, how to create multi-panel figures, how to structure a manuscript and how to respond to reviewer comments, are all unknown to the freshly qualified doctor, let alone other questions, such as what to pursue (i.e. what makes a good research idea) and where (and how) to submit a manuscript.

Until now, doctors have been expected to pick these skills up by word of mouth, relying on others that have previously published to pass on some tips, but often leaving an incomplete understanding of the publishing process and what is expected of them. In recent years, courses have been launched to assist with this. Some courses focus on doctors about to commence a research degree, while others focus on the overall process for students and doctors at any level. One such course is Get Published In Medicine (www.get-published.com).

How to ensure my publication is noticed?

Medical journals pre-date both the internet, and thus social media, by decades. Prior to the world wide web, medical knowledge could be found in books or in medical journals only. Before the advent of the internet, authors were limited to article citations as a means of quantifying the impact of their papers. The internet has democratised knowledge and, now that research is online, has come the ability to track access to papers. In this era of multiple channels for gleaning medical information, how does a single publication receive attention?

The Altmetrics score is a measure of non-traditional attention and engagement that an article has received, and is calculated by tracking how often a paper is mentioned in sources, such as news outlets, social media, and blogs.⁴ There are now many studies that demonstrate that authors can increase the visual impact of their work by promoting their studies on social media sites (e.g. LinkedIn, X and Facebook).⁵ Skilful and well-curated online content promoting a publication can have significant effects on the visibility of published papers. Box 2 lists ten top tips for those looking to publish.

Conclusion

Publishing papers in the medical literature retains a crucial role for advancement of medicine and dissemination of knowledge, and also remains important for the development and career progression of medical professionals themselves. The process of writing a paper on a particular subject of interest inevitably requires the author to gain a deeper understanding of the topic, thus, leading to their own self-development as well. Many different types of articles can be published, by medical students, resident doctors and established consultants, alike. Predatory journals that seek hefty article processing charges should be avoided. Courses (e.g. Get Published in Medicine) can help develop the skillsets needed to maximise the chances of successful publishing.

Conflicts of interest

None declared.

Funding

None.

References

1. Aronson JK. When I use a word … publish or perish: origins and a definition. BMJ 2025;390:r1456. https://doi.org/10.1136/bmj.r1456

2. Working Group on Specialist Medical Training. Hospital doctors: training for the future. Heywood, Lancs: Health Publications Unit, 1993. Available from: https://wellcomecollection.org/works/d8hmptte

3. Clark J, Smith R. Firm action needed on predatory journals. BMJ 2015;350:h210. https://doi.org/10.1136/bmj.h210

4. Priem J, Groth P, Taraborelli D. The Altmetrics collection. PLoS Med 2012;7:e48753. https://doi.org/10.1371/journal.pone.0048753

5. Gholampour S, Lim WM, Lund BD et al. Does social media contribute to research impact? An Altmetric study of highly cited marketing research. Total Quality Management & Business Excellence 2024;35:1671–701. https://doi.org/10.1080/14783363.2024.2393339