Abstract
In medical publishing, the peer-review process is the gold standard for evaluating science. Peer review plays a crucial role, due to the potential risks if poor-quality studies or inaccurate conclusions are published. It is widely recognized that there is a peer-review crisis, responsible for significantly delaying the publication of manuscripts. 1 Securing peer reviewers has become increasingly challenging across the spectrum of academic publishing, and perhaps more so in a niche community such as Obstetric Medicine. Academics are increasingly overburdened, and often reject peer review requests due to time constraints for this unpaid (and often unrecognized) task. The American College of Cardiology identified the five most significant concerns related to the peer review process: the effect of preprints, reviewer blinding, reviewer selection, reviewer incentivization and the publication of peer reviewer comments. 2
In our field of Obstetric Medicine, many potential peer reviewers may feel that they may have a primary obligation to their subspecialty journal, rather than to Obstetric Medicine. In our tight-knit group of physician-scientists and researchers, the pool of potential reviewers is further limited by excluding the authors’ colleagues, collaborators and mentors, and those who have recently accepted peer review tasks. The volume of manuscripts is increasing (a big win!), but this is aggravating the peer-review crisis. We are asking a small group of global experts to adjudicate the progress of their entire field. When an expert declines, the Editors must search into the periphery of the specialty, compromising the depth of the review and potentially delaying publication of vital data for months.
We have evaluated data from this journal over the past 5 years. These data demonstrate an increase in reviewer invitations from 2481 in 2020 to 4306 in 2025, corresponding to the increase in submissions we have seen in that time. The number agreeing to review has dropped from 1052 annually (42% of invitees) to 828 (19% of invitees) over this period. Frustratingly, 50% of invitations in 2025 received no response whatsoever, the system causing them to ‘autodecline’ after 6 weeks. A reviewer actively declining to review actually speeds up the process by enabling the search for an alternate reviewer in a more timely manner.
What are the solutions? Increasing ‘desk rejection’ by Editors will reduce the reviewer load, but may inappropriately lose valuable contributions that only the niche expert may recognize. Clinicians receive no training in the process of peer review, and a process of peer-review training and co-review has been suggested. 3 Training our resident doctors in peer review is both educational for them as individuals and beneficial to the specialty in which they work. However, when clinical work is already busy and many doctors are overstretched, this is unlikely to be a personal priority for either the resident doctor or the educators.
The incentivization of reviewers is a controversial topic. Many journals (such as our own) publish a list of reviewers annually in recognition of their service, but some form of more meaningful academic credit or financial compensation may eventually become necessary. Non-financial incentives include letters to academic institutions recognizing the work, CME certificates, or perhaps the prestige of an invitation to the Editorial Board or to author an Editorial (although associated with an increased workload). 2 In the UK, peer review can be recognized as self-entered Continuing Professional Development for many specialties and contributes to the achievement of yearly targets for each clinician, but anecdotally, this does not appear well known to clinician colleagues.
Many journals have adopted an open review system, where reviews (with reviewer identified) are published, which can act as an added educational process. In a small field like Obstetric Medicine, this may disincentivize reviewers as well as authors, given the high chance of existing or future personal relationships between them.
Artificial Intelligence tools may play a role, for example in identifying researchers who could act as reviewers, assessing the accuracy of reviews, providing reviewer feedback, and perhaps, in the future, even performing the role of expert reviewer.4,5
The problem is further compounded by the vast number of unsolicited automated emails that academics and clinicians receive, so even when review requests are appropriately sent to potentially suitable reviewers, it is difficult to know how to ensure that our approaches stand out.
To our readers, authors and reviewers, you are such an important and appreciated part of our journal, and responsible for the journal growing in size, reach and prominence. Our search for reviewers is now the most time-consuming part of the editorial process and is responsible for significant delays. We would ask that you consider a request to review as an important act of stewardship for our small but essential field, and help us actively expand the pool of available reviewers to more effectively share the workload.
