The Publishing Paywall: How Plastic Surgery Researchers Struggle to Afford Recognition

INTRODUCTION: Publishing in high-impact journals offers significant advantages, including greater name recognition and an increased likelihood of citation in future studies (1). For medical students aspiring to enter an integrated plastic surgery residency, these factors can play a crucial role in strengthening their applications (2). However, the cost of publishing-particularly in high-impact journals-varies widely and can be prohibitively expensive, creating financial barriers for students seeking to contribute to and gain recognition in the field (3). This study aims to assess whether a journal's impact factor influences the cost of article processing charges (APCs). By examining this relationship, we seek to quantify the financial burden associated with high-impact publishing and explore its implications for accessibility in academic research. METHODS: A comprehensive search for plastic surgery journals was conducted using PubMed (NLM), Embase (Elsevier), Cochrane Central (Wiley), Web of Science Core Collection (Clarivate), ScienceDirect (Elsevier), and CINAHL (EBSCOhost). Journal titles were deduplicated, and the Journal Citation Reports (JCR) database was used to obtain impact factors and other publication metrics. Fundamental descriptive statistics, including mean, median, and standard deviation, were calculated. Pearson's correlation analysis and linear regression were performed to assess relationships between citation metrics. RESULTS: The search identified 25 journal publishers, with an average article processing charge (APC) of $2,428, an average impact factor of 1.35, 33 years of activity, and 33% open-access articles. A significant positive correlation was found between APC and impact factor (r = 0.459, p = 0.021), indicating that higher-impact journals tend to have higher publication costs. Linear regression showed that impact factor explained 22.1% of APC variation (R² = 0.221). No significant correlation was found between years active and APC CONCLUSION: This study highlights a statistically significant trend: publishing in high-impact journals comes at a premium, further intensifying the financial barriers medical students face in disseminating their research. The correlation between impact factor and APCs underscores how prestigious journals demand substantially higher fees than their lower-impact counterparts, limiting accessibility for aspiring researchers. These financial challenges are especially pronounced for students at institutions without a home plastic surgery residency, where research opportunities and funding often rely on personal resources (4). With an average of 34.7 publications among students who successfully matched into an integrated plastic surgery residency, the expectations for research productivity are undeniably high (5). Addressing this disparity is crucial-not only for medical students but also for faculty at smaller institutions or those without an integrated residency program, who may ultimately bear the financial burden.