MEMBER VOICES: We need a Texas family medicine peer-reviewed journal

By Larry Kravitz, MD, Tim Heintz, Peter Zhang
May 09, 2024

Medical research journals offer physicians, residents, and medical students the opportunity to expand their education and share research with the academic community. While many of us may not be academics, Texas hosts a large quantity of medical students and clinicians who may be interested in academic research. Currently, there are approximately 23,000 licensed primary care physicians,1 900 family medicine residents,2 750 primary care PhD and MD faculty members,3-18 and 10,000 medical students19-34 across the state. Despite the abundance of this workforce, a peer-reviewed family medicine research journal has yet to exist for the state of Texas.

Full-time faculty are generally expected to do research to achieve tenure. Teaching alone accounts for only 5% of tenure tracks.35 Furthermore, the vast majority of faculty positions in medical schools are no longer tenure track positions, there being more focus on income generation and less on academic pursuits.36 Medical students need to do research for their residency resumes. Faculty and students are the main pool who might want to publish research in family medicine. Other than subsidized pharmaceutical company studies, it’s safe to say that few family physicians in private practice do research. Residents just mostly want to survive. Since Texas is expected to have a shortage of 1,760 FTE primary care physicians in 2025, residency graduates can have their pick of a multitude of family medicine positions even without research on their resumes.37

How much publishing capacity is there for family medicine research? Reputable research journals for family physicians include the American Family Physician, Annals of Family Medicine, Journal of the American Board of Family Medicine, and the Osteopathic Family Physician. Looking at recent issues of these five mainstream peer-reviewed family medicine journals, the sum of original articles within them total about 70 per month, or about 800-900 per year. Clearly, this is not even close to the publishing capacity ideal for the pool of submissions from a robust family medicine research community.

Peer-review journals incur expenses to maintain viability. Direct costs include content acquisition, content preparation, and content dissemination and archiving; indirect costs are typically related to staff overhead. Journals that utilize a specialized full-service provider (e.g., Scholastica) to perform every step of the publication process will pay more for that convenience. In contrast, journals may opt for the open-source and free software Open Journal Systems and acquire volunteer editors to reduce their direct costs. Grossmann and Brembs38 estimate that the per-paper cost of an article produced by a journal operating on a minimal budget is near $200. On the other end of the spectrum, the per-paper cost of an article can exceed $700 (i.e., journals being run by billion-dollar corporations with “professional in-house staff handling every individual step”). These estimates were based on assumptions of each article containing 12 printed pages with 1,500 words on each page and the pre-publication rejection rate being 50%. There is an approximate 35% increase in per-paper cost when increasing the rejection rate from 50% to 90%. Thus, journals that want a low per-paper cost could adopt a post-publication peer review model and increase the rate at which they publish their articles.

There are two fundamental publishing models: open access versus subscription-based. In the subscription-based model, the cost to the researcher to publish articles is minimal as it is typically institutional or individual subscribers who pay for the publication costs.39 In open access publishing, the primary financial burden is carried by the individual researcher in the form of article processing charges that average from $2,000 to $3,000 per article. While open access publishing offers benefits such as increased accessibility and visibility of their articles by eliminating the viewer paywall, researchers will find the fees daunting. In fact, the financial barrier to publication is the primary reason that more than half of medical researchers would not publish in open access journals, despite the “vast majority of medical researchers”39 supporting the open access concept, and sometimes, even grants for research cover such article processing charges. In the end, researchers want to publish in prominent journals with high “h-index”, meaning the index of how often an article is cited in other published research articles. Many open access journals are bogus fronts for generating profit from article processing charges and have almost no readership.

Here’s what we are proposing for a Texas family medicine research journal. It would be a quarterly journal, online for three issues and in print for one issue. The printed issue could perhaps be included in an issue of Texas Family Physician magazine — a slightly thicker version of TAFP’s printed magazine.

The content would change throughout the year. One whole issue would be devoted to showcasing all the entries of the TAFP Research Poster Competition that takes place in October or November each year. This is a simple win-win as it promotes the research of our future family medicine Texas colleagues and is an effortless production since all the entries would have already been peer-reviewed. The other three issues could have a more formal layout. The issues could include categories such as “Pearls from Texas Family Medicine Conferences,” gleaned from events like the TAFP C. Frank Webber Lectureship, letting speakers publish a written version of their presentations. Hopefully, we could obtain three original research articles, probably focusing on evidence-based medicine and health services research. We could have a journal club review of a major recent article and a translational medicine article of new upcoming technology, medications, or procedures. Also, like the CDC Morbidity and Mortality Report, we could include reports of Texas health department trends in diseases.

With 750 family medicine faculty in the state, surely a few would welcome a chance to pad their resumes as editors, reviewing what would amount to tentatively 30 to 50 total articles a year — a simple metamorphosis from the tedious family medicine journal clubs that always seem to spring up and then wither of the enthusiasm that generates them. This ambitious content proposal could be pared down, but more importantly, there is potentially an abundance of content that might be available.

Family medicine should have a niche — a piece of the pie — in medical research. Our roles make sense in translational medicine, evidence-based medicine, and health services medicine.40 We would propose that we are the front-line scouts of the disease landscape, needing to report new trends that may present to our office doors ahead of the tertiary referral centers. To promote this body of research work, we need to be able to fund, to mentor, to question, and to publish. A state society research journal could be a good precedent — the culmination of research is publication — and access to peer-reviewed journals is a bottleneck area needing to be addressed in promoting family medicine research. We need to expand the outlets for family medicine research to be disseminated into the medical community.

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