The design and implementation of PSS as a new journal in its field was accompanied by multiple challenges and hurdles. As an anecdotal example, many friends and colleagues (as well as the publisher’s legal advisers!) discouraged the founding editors from introducing an article category on “case reports”. The underlying argument was that “only a fool will agree to publish a case report on preventable complications which lead to poor patient outcomes”. This notion is based on the rationale that such a document would provide a written testimony (and admission of guilt) which could be used in court against the individual medical practitioner in case of a malpractice claim or lawsuit. The ultimate resolution consisted of introducing a mandatory request for submitting authors to provide a written consent from patients or their legal guardians for any manuscript which provides information on specific identifiable individual patient scenarios (http://www.pssjournal.com/authors/instructions).
Strikingly, we were astonished by the unexpected high submission rate of case reports on surgical complications, preventable sentinel events, and “never events”, starting from the first weeks of the journal’s launch [6, 7], until the present day [8, 9]. This impressive fact supports the notion that health care providers all over the globe appear to strive to publicly report, analyze, and discuss root causes and preventive measures of adverse events which lead to unnecessary patient harm, in order to provide more transparency to other health care providers, and to the public. Indeed, until present, PSS published a total of 50 case reports on individual complications and medical errors, and the manuscript submissions in the “case report” category keep coming in.
Beyond a doubt, the main barrier which deters authors from submitting their work to PSS (and for that matter to open access journals in general) is represented by the extremely high publication fees. For journals published by BMC, these so-called “article processing charges” (APCs) – which have to be carried by the author – range from $1,600 to $1,900 per article (http://www.biomedcentral.com/about/apcfaq). A recent commentary published in Science discussed the findings of a large-scale survey on the perceived role of open access online journals among 50,000 researchers . While 89% of all respondents expressed their support for open access publishing in general, they admitted to publish only about 10% of their own research in open access journals . The two main reasons stated for the poor submission rate were high publication fees (40%) and the apparent lack of high-quality open access journals in the respondents’ field of interest (30%) .
And here lies the conundrum of open access publishing: Why would a hypothetical author submit high-quality research to an open access journal with low reputation and no (or low) impact factor, which comes at a price of up to $2,000 publication costs, instead of targeting a prestigious high-impact print journal, free of charge? The answer is intuitive.