Annals of Surgery Open Access: Where is the Value, and What does the Future Hold?

More than 20 years have passed since the concept of open access publishing first emerged as part of the Budapest Open Access Initiative (BOAI).1 The primary goal of this open access effort was to make peer-reviewed journal literature freely accessible to everyone with internet access. The authors of the BOAI noted that open access literature would not be “costless to produce,” but should be less costly than the traditional model, which involved subscription fees paid to publishers for print journals. Today, there are nearly 18,000 open access journals from 130 countries registered in the Directory of Open Access Journals.2 In July 2020, Wolters Kluwer launched Annals of Surgery Open: Perspectives on Surgical History, Education, and Clinical Approaches (AOSO).3 The motivation to establish AOSO was to provide an open access alternative for researchers interested in publishing their work in Annals of Surgery. Given the relative unfamiliarity that readers may have with open access publishing and its continued expected growth, editorial team members from both AOSO (L.M.F., J.B., F.M.J., B.K.S.) and Annals of Surgery (Z.C., J.B.D., C.M.P., T.E.R., S.L.W.) highlight below some potential benefits and drawbacks of publishing in open access journals such as AOSO. OPEN ACCESS BENEFITS Increased visibility and dissemination of peer-reviewed research—the most significant benefit of publishing in an open access journal is the number of readers that research will reach since anyone with an internet connection can access the manuscripts. This audience includes clinicians and researchers, patients, policymakers, and politicians, and it is particularly valuable for groups lacking an affiliation with academic libraries. In one randomized controlled trial, open access articles were downloaded nearly twice as frequently as traditional subscription access articles during the 6 months following publication.4 Efforts to disseminate research findings on coronavirus disease-2019 over the past 2 years have highlighted the benefits of this model, as scholars around the world have collaborated by accessing rapidly published, freely available articles. Patients and interested members of the public have also be able to learn about up-to-date, peer-reviewed discoveries. This may accelerate the speed of “bench to bedside” research. Copyright ownership retention—in the traditional model, the publisher owns the copyright to the manuscript content. In most instances, authors must obtain permission from the publisher to use or adapt previously published work. In the open access model, the authors retain the copyright. This increased flexibility and ownership allows researchers to use their research materials as they see fit. This may include posting an image of a manuscript figure on their research team’s webpage or their social media accounts. Timely publication—traditional medical journals typically take 3 to 4 months to publish a manuscript after it has been accepted.5 Some traditional journals, including Annals of Surgery, are currently experiencing a backlog of articles that have been accepted but not yet published. This is primarily due to space limitations in the print journals. This is not relevant for open access journals given their electronic nature. Thus, the lag time from acceptance to online publication is minimal. Researchers may also have the opportunity to “cascade” their traditional manuscript submission to a linked open access journal if it is not accepted by the traditional journal. In some scenarios, the authors may re-submit their work to the open access journal as a revised submission (with a point-by-point response to previous reviewer comments). This offers the advantage of an expedited review, as opposed to a new submission to a different journal. As of August 1, 2022, 255 original studies have been cascaded from Annals of Surgery to AOSO, and 31% have been accepted (internal communication with the managing editor of both journals). Funding agencies often require open access publishing—in 2013, the US Office of Science and Technology Policy instructed all federal agencies that distribute more than $100 million annually in research funds to require grant recipients to share their research findings with taxpayers. Some funders, such as the National Institutes of Health (NIH), Agency for Healthcare Research and Quality (AHRQ), and Veterans Health Administration (VHA) require manuscripts to be deposited into PubMed Central and made publicly available within 12 months. More than 1000 funders, research organizations, and universities have gone 1 step further and mandated open access publication, either in an open access journal or via selecting an open access option as part of a submission to a traditional journal (termed “hybrid open access”).6 Importantly, some grant mechanisms within the NIH, including some investigator-initiated trials, now require open access publishing to meet the need for rapid dissemination of information. OPEN ACCESS CHALLENGES Perceived journal quality—the explosion of open access publishing has led to the emergence of “predatory journals,” for which legitimate open access journals can be mistaken. Although there is no consensus definition of “predatory journals,” 1 multinational group of scholars defined them as “entities that prioritize self-interest at the expense of scholarship and are characterized by false or misleading information, deviation from best editorial and publication practices, a lack of transparency, and/or the use of aggressive and indiscriminate solicitation practices.”7 In 2014, nearly 420,000 articles were published among ~8000 predatory journals.8 Similar to Annals of Surgery, AOSO involves a rigorous editorial process with peer review. Through July 2022, the AOSO editorial team had reviewed 315 original studies and accepted 32% of them. By comparison, its “sibling” journal editorial team at Annals of Surgery reviewed 4445 original studies and accepted 13% (internal communication with the managing editor of both journals). Given the negativity surrounding “predatory journals,” high-quality open access journals will likely battle perceptions of inferiority and legitimacy, although this will diminish as investigators and readers increasingly accept them. Article processing charges (APCs) are paid by the authors—the open access model shifts the costs of publishing from organizations such as universities to authors. Fees typically range from several hundred to several thousand dollars (APCs for AOSO range from $499 to $2000 depending on the type of article).3 Although the range of appropriate fees is a topic of debate, these fees typically cover the cost of the editorial management team, copyediting, journal production, online publication and hosting, and indexing (e.g. in PubMed). While open access articles, by definition, allow equitable access to all readers, these APCs may not be affordable for all researchers and could exacerbate inequities among research groups, particularly those from lower income settings. This payment model could also incentivize publishers to maximize the volume of manuscripts they publish since revenue is generated on a per manuscript basis.In contrast, the traditional model involves journal subscriptions paid by institutions or individual subscribers. This system also has drawbacks. A review published in Science in 2014 found that the amount that universities paid publishers varied substantially with limited transparency in the pricing structure.9 Numerous institutions paid more than $1 million annually for their journal subscriptions. Notably, the entire University of California (UC) system ended its agreement with Elsevier in 2019 due to cost concerns, which resulted in access disruptions to thousands of Elsevier periodicals for faculty and students.10 In their re-negotiated deal completed in 2021, UC agreed to pay Elsevier $13 million annually, which represented a cost-savings of 7%. This deal guaranteed reading access to Elsevier journals and ensured all new articles from UC authors would be open access, the largest such agreement in the US committing to this model.PubMed indexing is not immediately available for new journals—developed by the National Center for Biotechnology Information (NCBI) at the US National Library of Medicine (NLM) in 1996, PubMed currently contains more than 30 million biomedical citations and abstracts.11 Most traditional journals have their manuscripts indexed in PubMed, which allows anyone to access the citations and abstracts. Many open access journals, such as JAMA Network Open and PLOS One are also indexed on PubMed. New journals—both traditional and open access—are not initially indexed on PubMed because they are required to wait for 2 years before applying to the NLM. During the application process, new journals must prove to the NLM that their editorial processes are legitimate and align with accept.ed practices. To access articles from new journals not yet indexed on PubMed, individuals typically must go directly to the journal websites. AOSO anticipates applying for PubMed indexing in 2022. THE FUTURE OF OPEN ACCESS PUBLISHING Open access publishing represents the future of academic publishing in medicine and the natural sciences. As more funding agencies require it, additional universities follow UC’s lead, the imperative for rapid dissemination of science intensifies, and subscription plans become increasingly unaffordable, the open access model will continue to expand. Barriers such as PubMed Indexing will fade with time. Many institutions, including funders and universities, already provide additional funds to help cover APCs for authors. Concerns over the legitimacy of open access journals will ameliorate as rigorously managed titles such as AOSO increasingly capture the market, and authors and audiences gain comfort in this new space. As these challenges diminish, immediate, universal access with retained copyright will assume greater value in an increasingly digitalized, interconnected, yet unequal world. Through both hybrid open access articles in Annals of Surgery and the AOSO platform, the Annals of Surgery family of journals transitions into a new era of academic publishing.