In the ecosystem of academic medicine, peer review is celebrated as the cornerstone of scientific rigour. We are told that evaluating our peers’ research is an essential professional duty—a pillar of academic citizenship that ensures the literature remains credible, accurate, and safe for clinical translation.

As one of many who balances active clinical practice, research, and education, I tend to review about 2 manuscripts a month. I’m sure that’s a lot less than most and I can already sense some readers rolling their eyes. I value the process, and I understand its importance. Yet, looking at the structural reality of academic publishing, a glaring economic paradox persists: why is peer review the only professional expert labour that is expected to be done entirely for free?

The Business Model of Academic Publishing

To understand why this model is broken, we need to look at who actually benefits. Commercial publishing houses are for profit sectors. They rely entirely on a donated supply chain.

Consider the sequence of events:

1. Public/Institutional Funding: Academic research is funded by taxpayers, universities, or philanthropic trusts.
2. Free Labour: Researchers (who often have other roles (clinicians/ educator/ administrator) design, execute, and write the study without pay from the journal.
3. Free Peer Review: Expert peers review, critique, and improve the manuscript voluntarily, donating their specialized knowledge.
4. Paywalls: The publisher packages this donated intellectual property and sells it back to the authors’ institutions at subscription or open-access publication (APC) rates. There may also be a significant article processing charge for the author.

In what other industry do highly specialized professionals donate thousands of hours of intellectual labour to a corporate entity under the guise of “professional duty”? Why does the professional duty end once the work gets to a publisher? Should it all be published online as open-source content with no paywalls(free to all)?

For most of us, reviewing a manuscript is not something that happens during regular working hours. It is squeezed into evenings, weekends, or stolen moments between cases (if you’re a procedurist).

When reviewing becomes an unpaid, unacknowledged burden, the entire system suffers:

• Delayed Turnarounds: Reviewers juggling clinical emergencies inevitably push unpaid administrative tasks like manuscript reviews to the bottom of the pile, leading to frustrating editorial bottlenecks.
• Burnout and Fatigue: Experienced senior researchers experience review fatigue, leading them to decline invitations or pass manuscripts down to junior trainees who, while capable, may lack the expertise to provide deep methodological critique.
• The Erosion of Quality: When reviewing is treated as a low-priority chore rather than compensated professional work, the depth and thoughtfulness of peer critique naturally degrade.

The Antidote to Predatory Publishing

There is an overlooked structural benefit to paying for peer review: it would instantly disrupt the predatory publishing market.

Currently, low-quality and predatory journals proliferate precisely because the barrier to entry is near zero. They spam researchers with invitations, set up fake editorial boards, and publish unverified junk science because they don’t actually invest in genuine peer review. They operate on volume, charging high Article Processing Charges (APCs) while running automated or non-existent review processes.

If legitimate peer review were universally recognized as a compensated, professional service, the economics of fake publishing would collapse:

• Predatory publishers, whose business models rely entirely on cheap or fabricated operations, could not afford to pay for legitimate, credentialed expert reviewers.
• Authors would quickly learn to spot the difference: a real journal invests financial capital into vetting science through paid, expert scrutiny, whereas a predatory outfit offers instant publication with no genuine editorial friction.

By failing to value review work, legitimate publishers have inadvertently created a vacuum that bad-faith operators exploit.

Moving Toward a Sustainable Model

Critics of paid peer review often argue that introducing financial compensation would introduce conflicts of interest or corrupt the integrity of the scientific process. This argument does not hold up to scrutiny. We routinely pay for expert opinion, medicolegal review, grant assessment etc. Compensation does not inherently compromise objectivity; rather, it acknowledges the value of the expertise being applied.

Journals could easily adopt structured models that respect reviewers’ time:

• Micro-Stipends or Voucher Systems: Providing direct financial compensation, reductions in article processing charges (APCs) for the reviewer’s own future publications, or journal subscription credits.
• Transparent Recognition: Elevating the status of peer review so that institutions officially recognize it as funded, billable academic output during performance and promotion reviews.

The Verdict

Peer review is not a hobby. It is specialized, intellectual labour that protects the integrity of medical science and weeds out substandard work.

If publishing houses wish to maintain a sustainable, high-quality pipeline of rigorous scientific critique—and crowd out the predatory journals flooding our inboxes—the era of treating expert clinicians and researchers as free labour must end. Valuing the review process financially isn’t just about fairness; it is about protecting the fundamental trustworthiness of medical literature.