Open Access Fees: A Barrier to Scholarly Activity Among Neurology Trainees


Keng Lam, MD1; Annette Langer-Gould, MD, PhD2

Perm J 2021;25:21.041

The open access publishing model provides readers of all back- grounds access to articles free of charge. To cover the costs of open access, however, many journals now charge substantial article processing fees. This has inadvertently created yet another barrier for trainees to engage in scholarly activity. Herein, we describe the issue, review the literature, and provide suggestions for addressing this barrier with the focus on the neurology specialty.

Open access is the publishing model in which peer- reviewed research articles are distributed online free of charge regardless of whether the reader is a subscriber to the journal or not. Originally developed in the 1990s to increase access to knowledge for scholars from all backgrounds, it has become increasingly popular since 2000 with an estimated average annual growth of 18% of journals and 30% of all articles.1 There are two main routes for open access: Gold or Green. Gold Open Access allows manuscripts to be made online immediately for all readers and usually requires a fee. Green Open Access archives a version of the article on behalf of the authors (or allows for self-archiving) into a trusted repository, such as PubMed Central, after a specified embargo period (usually 6 to 12 months). During this embargo period the article is available to readers through a subscription or article purchasing fee.

In many ways, this is a positive development for research- ers as well as trainees because they can now easily access cita- tions online without paying subscription fees, worrying about whether their institutions are subscribers or having to pay out of pocket to access manuscripts. Rather than cover- ing the cost of publication through subscriptions fee, how- ever, journals are increasingly requiring authors to pay an article processing charge (APC). In 2011, 27% of journals that provided open access required APCs.2 Open access APCs may also inadvertently give rise to predatory journals; these are journals that state misleading information, lack a rigorous peer review process, publish poor quality works, and aim to make a profit rather than elevating the scientific discourse.3 Both unintended consequences of open access have created additional barriers for traineesengagement in scholarly activity.

Medical journals charge the highest APCs among aca demic disciplines. Approximately 50% of medical journals registered on the Directory of Open Access Journals Seal, a mark of certification for open access journals with high pub- lication standards, charge at least $1,500 United States dol- lars (USD) per manuscript based on the most recent data; these figures have likely increased.4 Medical journals that operate exclusively under the open access model, charged an average of $2,000 USD and neuroscience journals charged over $2,100 USD in 2013.5 Curiously, average open access APCs are higher ($3,000 USD) in hybrid journals, should an author choose this option.5

Options for avoiding APCs include submitting to journals that use a hybrid model, offering the author the option of making their work available only to subscribers and forgoing open access. One can also submit to journals that provide open access but do not require APCs (usually through the Green Open Access). The trade-off for foregoing open access, however, is a lower citation index as articles published open access are more likely to be cited than those available to subscribers only.6,7 Improved citation index may explain the increasing popularity of open access publications, which now account for 40% of major cardiovascular journals and 60% of oncology articles.6,7 Requesting fee waivers or dis- counts, a potential option for authors from low- or middle- income countries, is usually not an option when there is a co-author from the United States.8 Journals that offer open access and do not require APCs tend to be higher impact journals than the journals in which case reports or reviews written by trainees are unlikely to be accepted. Appropriate target journals for this type of entry level scholarly activity are increasingly operating solely on an open access model.1 A full list of journals from Elsevier or Springer publishing companies with their APCs can be found in references 9 and 10.

The effect of high APCs on trainees is beginning to show. Over 86% of clinical and research fellows from Memorial Sloan Kettering Cancer Center listed APC as a barrier for choosing open access journals in a 2020 study, with some quoted in the semi-structured interviews that they could not afford the APC due to lack of funding.11 In a study of 200 scholars at University of California, San Francisco, 36% of them agree that open access adds administrative burden to the already busy researchers, with some stating publishing can be expensive for those with limited funds.12 We are con- cerned that this leaves trainees vulnerable to predatory jour- nals paradoxically with lower APCs. A review of publication fees among 85 predatory neuroscience journals ranged from $521 USD to $637 USD.13 In an attempt to save money, trainees may accidentally publish in predatory journals. As of matter fact, given that they want to publish quickly and their inexperience with identifying journals with poor integrity, trainees are already vulnerable to predatory journals.14,15 Publishing in predatory journals contributes to the process of threatening the science integrity; it hurts the traineesrep- utations and puts them at risk of losing their works when the journals disappear.16

Precisely how open access APCs affect neurology trainees has not been studied but based on experience, are likely simi- lar. To begin creating a list of potential journals without APCs for our trainees to consider, we conducted a non- comprehensive review of selected neurological journalswebsites, emailing editors for clarification when necessary. The results are shown in Table 1. None offered waivers for neu rology trainees.



As a first step, we recommend creating and updating a comprehensive list of journals. The list should include their respective operating models, APCs, and waiver policies, and should clearly label legitimate vs predatory journals that resi- dents can easily search and minimize cross-referencing. This type of service could be jointly generated by professional societies, like the American Academy of Neurology for those in the neurology specialty, and librarians from the academic institutions. Our local librarians at Kaiser Permanente Southern California already have resources available to help authors avoid predatory journals, but it would still require individual journal lookup to find out about the APCs. While this does not solve the problem of the increasing popularity of requiring fees for open access, it does help trainees and their mentors avoid predatory journals and select appropriate target journals while preparing manuscripts.

Table 1. Non-comprehensive review of selected neurological journals
Name of journal 2020 Impact factor Require publication feea APC feea Open access route
Annals of Clinical and Translational Neurology 4.510 Yes Varies Gold with APC
Annals of Neurology 10.42 Nob Varies Gold with APC, or Green at no charge
BMC Neurology 2.48 Yes $2,490 Gold with APC
Epilepsia 5.86 No Varies Gold with APC, or Green at no charge
Frontiers in Neurology 3.55 Yes Varies Gold with APC
Journal of Neurology, Neurosurgery & Psychiatry 8.26 No $3,328 Gold with APC
Journal of Neuro- Oncology 3.27 No $3,860 Gold with APC
Lancet Neurology 44.18 No $5,000 Gold with APC. Policy for Green varies.
Movement Disorders 10.34 Nob $3,300 Gold with APC, or Green at no charge
Multiple Sclerosis Journal 6.31 No $3,000 Gold with APC
Multiple Sclerosis and Related Disorders 2.89 No $3,050 Gold with APC, or Green at no charge
Neurology 9.90 No Varies Gold with APC, or Green at no charge
Neurology: Clinical Practice 1.61 No Varies Gold with APC, or Green at no charge
Neurology: Genetics 3.49 Yes Varies Gold or Green with APC
Neuro-Oncology 10.25 Yes Varies Gold with APC
The Permanente Journal 1.10 No None Gold at no charge
Practical Neurology 1.71 No $3,189 Gold with APC
Stroke 7.19 Depends on licensing choice Varies Depends on licensing choice
World Neurosurgery 2.10 No $2,600 Gold with APC

a Up to date as of August 14, 2021.

 b May charge for printing color.

APC = article processing charge.



Given the advantages of open access, this mode of pub- lishing is likely to continue to increase in popularity. With that in mind, it would be critical for educators, publishers, institutions, and professional societies to find a mutually agreeable path for alleviating the barrier of APCs for train- ees. Setting a maximum charge for trainee publications (eg, $100 USD per research article per trainee, less for case reports and reviews) across journals could be considered. Under certain circumstances, full waivers could be granted and in others a cost-sharing approach, with the journals pro- viding a discount for students, residents, or fellows and the training institutions picking up the remaining (reasonable) fees, should be considered. This is similar to how research conferences offer discounts to trainees for registration, and their respective academic programs often fund the trainees to attend those conferences. By establishing transparent APC policies for trainees, we hope that the journals will fol- low through and be peer pressured into supporting trainees to publish their works in a more cost-conscious way.

Neurology trainees already face multiple barriers to engaging in scholarly activity, including finding engaged mentors and time. Existing barriers have already led to a shortage of physician-scientists entering academia.17 For those highly motivated individuals that can complete manuscripts, the steps involved in choosing journals are complicated because, in addition to the journal fit, impact factor, and decision time, they now face the additional barriers of figuring out how to pay for APCs and avoiding predatory journals. With an increasing number of journals moving to open access,1 we expect to see fewer and fewer journals with no publication fees and an increase in predatory journals. Many rising scholars do not have the financial means to afford over a thousand dollars to publish each article. If affordability becomes a major factor in traineesability to publish, it will likely disproportionately affect those trainees from disadvan- taged backgrounds, potentially exacerbating the already troublesome lack of diversity among neurologists in academia.18

By starting now, we can work together to find creative sol-utions before these unintended consequences of open access publishing take hold. We have begun by contacting the American Academy of Neurology to inquire about the con- cern of publication fees and if funding is available for train- ees. Locally, we have reached out to the librarians regarding resources available to help navigate the trainees away from the predatory journals. We will also start the discussion with the graduate medical education office regarding flexibility in funding our residents and fellows to present their scholarly work. Finally, within our department, we have compiled our own list of neurology journals that do not require open access fees. We are hopeful that by starting to take small steps, we can bring changes to the future of publishing

Disclosure Statement

The author(s) have no conflicts of interest to disclose.

Funding Statement

No funding was received for this work.

Author Affiliations

1Department of Neurology, Kaiser Permanente, Los Angeles, CA

2Department of Neurology, Southern California Permanente Medical Group/Kaiser Permanente, Los Angeles, CA

Corresponding Author

Keng Lam, MD (

Author Contributions

Keng Lam, MD, wrote the manuscript and prepared and submitted the final version of the article. Annette Langer-Gould, MD, PhD, revised the manuscript and supervised the project.


1. Laakso M, Welling P, Bukvova H, Nyman L, Bjrk BC, Hedlund T. The development of open access journal publishing from 1993 to 2009. PLoS One 2011 Jun;6(6):e20961 DOI:

2. Laakso M, Bjrk BC. Anatomy of open access publishing: A study of longitudinal development and internal structure. BMC Med 2012 Oct;10:124. DOI: 1186/1741-7015-10-124

3. Memon AR. Revisiting the term predatory open access publishing. J Korean Med Sci 2019 Apr;34(13):e99. DOI:

4. Rodrigues RS, Abadal E, de Ara´ujo BKH. Open access publishers: The new players. PLoS One 2020 Jun;15(6):e0233432. DOI:

5. Solomon D, Bjrk BC. Article processing charges for open access publication-the situation for research intensive universities in the USA and Canada. PeerJ 2016 Jul;4: e2264. DOI:

6. Patel RB, Vaduganathan M, Mosarla RC, Venkateswaran RV, Bhatt DL, Bonow RO. Open access publishing and subsequent citations among articles in major cardiovascular journals. Am J Med 2019 Sep;132(9):1103–5. DOI: 1016/j.amjmed.2019.02.009

7. Hua F, Sun H, Walsh T, Glenny AM, Worthington H. Open access to journal articles in oncology: current situation and citation impact. Ann Oncol 2017 Oct;28(10):2612–7. DOI:

8. Elsevier. Choice. Accessed September 5, 2020. authors/open-access/choice

9. Elsevier. Pricing. Accessed September 5, 2020. pricing

10. Springer Nature. Open access journals. Accessed September 5, 2020. https://www.

11. O’Hanlon R, McSweeney J, Stabler S. Publishing habits and perceptions of open access publishing and public access amongst clinical and research fellows. J Med Libr Assoc 2020 Jan;108(1):47–58. DOI:

12. Banks MA, Persily GL. Campus perspective on the National Institutes of Health public access policy: University of California, San Francisco, library experience. J Med Libr Assoc 2010 Jul;98(3):256–9. DOI:

13. Manca A, Martinez G, Cugusi L, Dragone D, Dvir Z, Deriu F. The surge of predatory open-access in neurosciences and neurology. Neuroscience 2017 Jun;353:166–73. DOI:

14. Al-Busaidi IS, Alamri Y, Abu-Zaid A. The hidden agenda of predatory journals: A warning call for junior researchers and student authors. Med Teach 2018 Dec;40(12): 1306–7. DOI:,

15. Alamri Y, Al-Busaidi IS, Bintalib MG, Abu-Zaid A. Understanding of medical students about predatory journals: A comparative study from KSA and New Zealand. J Taibah Univ Med Sci 2020 Aug;15(5):339–43. DOI: 2020.07.010

16. Richtig G, Berger M, Lange-Asschenfeldt B, Aberer W, Richtig E. Problems and challenges of predatory journals. J Eur Acad Dermatol Venereol 2018 Sep;32(9): 1441–9. DOI:

17. Ellaithy A, Narayanan NS. Opinion and Special Articles: Mentoring in neurology: Where are the clinician-scientists? Is residency to blame? Neurology 2019 Jun;92(24):1159–62. DOI:

18. Bank AM, Saadi A, McKee KE, Mejia NI, Lyons JL. Opinion and Special Articles: Creation of a diversity and inclusion certificate program for neurology residents. Neurology 2017 Sep;89(12):e146–8. DOI: 0000000000004387

Keywords: article processing charge; barrier; medical education;

Abbreviations:  APC=article processing charge; USD=United States dollars


Click here to join the eTOC list or text ETOC to 22828. You will receive an email notice with the Table of Contents of The Permanente Journal.


2 million page views of TPJ articles in PubMed from a broad international readership.


Indexed in MEDLINE, PubMed Central, EMBASE, EBSCO Academic Search Complete, and CrossRef.




ISSN 1552-5775 Copyright © 2021

All Rights Reserved