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Mayo Clin Proc. 2010 January; 85(1): 15–17.
PMCID: PMC2800292

The Physiognomy of Mayo Clinic Proceedings, 2010

William L. Lanier, MD, Editor-in-Chief

The concept of physiognomy holds that the inner character and qualities of a being are reflected in its external features. There is some basis for this concept when applied to humans, because the human form can be modified as the result of activities and environmental exposure, both influenced by inner temperament. Taken a step further, the more a person interacts with the environment, the more likely outward appearances may change. The same concepts can hold for biomedical publications. Textbooks never (single editions) or seldom (multiple editions) change in response to their environments. Perhaps this is why it is difficult to judge a book by its cover. In contrast, contemporary biomedical journals must continually respond to their evolving environments in attempts to provide higher-quality information and services to readers and deliver them more rapidly and in increasingly more palatable forms. As such, the many features of a contemporary biomedical journal can speak volumes about the intent and motivation of the journal to better serve its audience.

In this regard, Mayo Clinic Proceedings is a fine example. Less than a decade ago, faculty and trainees at Mayo Clinic overwhelmingly authored the Proceedings content, and the journal's Web site offered little content beyond a listing of the monthly tables of contents. Today, the Proceedings, as its byline proclaims, is “authored by physicians worldwide,” and the facade and content of the print journal and Web site reveal the journal's highly engaged (and evolving) relationship with a dynamic, diverse medical world.

Continuous quality improvement is not unique to Mayo Clinic Proceedings. It is practiced at all leading biomedical journals, although the approach may vary depending on a given journal's mission. While all journals would like to boast of ongoing, unimpeded improvements, the contemporary publishing business, whether in biomedical or other forms of publishing, has experienced historic challenges since 2008. Specifically, the downturn in the global economy, superimposed on a preexisting recession in the publishing industry, created a challenge for many biomedical journals unlike anything they had experienced in more than 4 decades. The magnitude of the insult depends somewhat on the profile of the individual journal or groups of journals, with general/internal medicine journals (the genre of the Proceedings) and multispecialty journals (an advertising market from which the Proceedings also samples) experiencing severe challenges. As a result, journals' missions and programs have required alteration. For example, within the past few weeks, the Canadian Medical Association Journal (CMAJ), one of the pioneers in open access to journal content, has announced that it must restrict open access because of financial concerns.1,2 Other journals are expected to follow.

These aforementioned challenges have caused the leadership of the Proceedings, and our sponsoring organization Mayo Clinic, to closely examine our mission, practices, and future. The months-long review process was unlike anything the journal had heretofore experienced and, as a result, it caused all to gain a better appreciation of the operations and value of the journal. I am thankful to all who participated in this process, and I am extremely thankful that the process caused us to rededicate ourselves to you, our readers, in an attempt to more effectively deliver a unique, relevant, and timely product each month. This process will cause some alterations in the Proceedings you read in print and online. These changes will make the journal more focused and more extensively engage readers, but they also may lead to more restricted access to the print journal unless readers' voluntary support of the journal expands.

During 2009, we asked Proceedings' readers to contribute to a voluntary paid subscription (VPS) program. The numerous individual contributions proved the viability of this concept as a revenue stream, and readers' acts of kindness (both through the VPS program and through direct communications with us) profoundly affected the journal's Editorial Board and staff. Unfortunately, the revenue generated by this program was insufficient to offset 2009 losses of advertising and other revenue streams critical to the journal's well-being. Thus, the Editorial Board and I are asking that each of you reexamine your relationship with the Proceedings and again consider VPS participation in 2010 and beyond, either through the journal's Web site or through requests mailed to you. We will await the response to this effort before taking the next steps to ensure sustained journal vitality. Those next steps will most likely involve restricting many complimentary subscriptions to the print journal.

In the few months that we await your response to this petition, the journal will continue its planning to be a more effective and efficient source of information for readers. Let me share with you some of the changes you will witness in 2010 and the rationale for implementation.

Migration From Print-Predominant to Electronic-Predominant Dissemination of Information

One of the most common discussion topics at Mayo Clinic Proceedings is the association between journal finances and methods of publication. Many have asked, “Why don't you simply cease print publication and begin an electronic journal?” There are many answers to this, not the least of which is that we already run a complete print and complete electronic journal, each wholly capable of disseminating existing journal content. However, this is where the simple answers end. Our decisions on journal form relate to both readers' preferences and the business models that dictate print vs electronic publication. It is difficult to predict whether an individual reader will prefer to use print exclusively, electronic exclusively, or both. Readers' ages, specialty interests, and familiarity with computers play a role, but, even after knowing these factors, predicting preferences is an inexact science. Furthermore, traditional journal financial modeling dictates that print subscription sales, print advertising sales, and the marketing and licensing of subsets of journal content are important revenue streams. The cost of printing and mailing the print journal accounts for approximately one-fourth to one-half of journal expenses at most medical journals, depending on the size and quality of the printed journal and the frequency of its publication. Abolishing the print journal may eliminate substantial expense, but the costs of peer review, editing, and related factors still remain in an environment in which revenue from print advertisement has now been removed.3 Web sites can have immense readership, but advertisers do not pay parity for audiences reached electronically compared with those reached in print. Thus, in the current era, print journals tend to subsidize their Web versions, not vice versa. Additionally, according to industry experts our journal has consulted, there is no historic precedent for a long-standing print-predominant journal of the scope and magnitude of the Proceedings converting to electronic-only and surviving. Hence, it is imperative that we act with caution.

For all the aforementioned reasons, the Proceedings will continue to maintain both its print and electronic forms, although we will continue to migrate activities in the direction of the Web site, predominantly by growing Web activities coupled with highly targeted diminution of print activities. The ambient financial markets and the extent of readers' participation in the VPS program will dictate the end effect on the print journal.

New Web Site Activities for Previously Printed Materials

The Proceedings plans to entice readers to use its Web site more often by improving the quality and novelty of its Web content. Specifically, the Web site will contain added features that are not found in the print-only journal.

Beginning in October 2009, the Proceedings began publishing 2 Residents Clinics articles per month, with 1 of these published as electronic only and the other as both electronic and print. We will continue this pattern for the foreseeable future. In 2010, we also will begin migrating Medical Images to the Web site, and we will publish more of the images. Book reviews and the few historical articles we publish will also move to the Web site.

We will begin a new approach to publishing select full-length original articles, reviews, and other content through a program entitled “Online First.” These articles will be published on the Web site before print publication, some in mid-month. Our attempt is to share time-sensitive articles with readers more rapidly and to have weekly or biweekly updates to Web-based content so that readers will experience new content more frequently when they visit our Web site. We will periodically create Web-based—only appendices for print articles so that the print journal content will be more focused, yet readers will not be deprived of valuable background information for an individual article. Furthermore, we will attempt to include more color images on the electronic version of articles, regardless of whether the print version contains black-and-white or color images. Authors' fees for color figures will be initiated to help cover the costs in the print, but not in the electronic journal.

Materials released to our Web site, whether as Online First articles or in some other format, will receive the same high-quality editing and layout that you have come to expect from the Proceedings. Articles published online only will be indexed in MEDLINE and will be acknowledged in the monthly print table of contents and will receive a DOI (Digital Object Identifier) number to facilitate indexing.

The Proceedings' archives of articles available online will also expand in 2010 and cover the interval from 1995 to the present. Given that Mayo Clinic Proceedings has a respectable impact factor (currently 4.81) plus a 7.9-year citation half-life (Thompson ISI, New York, NY) for published articles, this combination places the journal among the upper tier of those having long-term value to readers. As such, by expanding the beginning of our archive collection of articles from the previous 2002 to 1995, readers should find additional, valuable materials that have withstood the test of time.

Additional New Web Site Activities

Beginning in August 2009, the Proceedings began publishing on its Web site audiovisual podcasts of interviews with authors, as well as a monthly audio podcast from the Editor-in-Chief reviewing highlights of each monthly issue. From the former, Proceedings' readers have been able to attach a face to the names of authors and learn from those authors the interpretation of their articles, the motivation behind their research, and other valuable features. For example, in September, Dr Gordon Dewald4 discussed his original research article on new biomarkers for pancreatic cancer. Also that month, Dr Barbara Yawn5 reviewed her research that quantified the effects of herpes zoster infection on health care utilization and cost of care in a community population of patients. In October, Dr Bernard Gersh discussed cell therapy for cardiac injury, a topic covered in his review article.6 Through these interviews, we hope that the written words and images will come alive for readers, enhancing their journal experience.

Currently, the above-mentioned podcasts are disseminated additionally on SciVee (www.scivee.tv) and YouTube (www.youtube.com).

e-TOCs (Electronic Tables-of-Contents)

In 2008, by vote of the Editorial Board, the journal began sending tables of contents via e-mail to readers, but (so as not to invade the privacy of our readers) only to those who requested them. Since then, the numbers of requesters have grown impressively. Furthermore, the fraction of recipients who open and read the e-TOCs has increased in parallel with the total number of recipients. Specifically, approximately one-half of the recipients currently open the e-TOCs, far greater than industry averages. We interpret this as evidence that readers are increasingly discovering value in our journal and in its electronic notices. Readers who wish to participate in this program can register by selecting Alerts from the upper righthand toolbar of our Web site home page at www.mayoclinicproceedings.com. You will then be able to choose whether you wish to receive alerts when e-TOCs (current issue), future tables of contents, and/or Online First articles are published.

Invitations to Participate in the VPS Program

In 2010, just as in 2009, we will send readers requests for VPS support in the February and August issues. On receipt, we would appreciate if you would indicate whether you prefer to contribute toward a print subscription or an electronic-only subscription or whether your current circumstances do not allow you to participate. Any of these responses will provide us valuable information that will be used for planning purposes.

You can participate in the VPS program by returning the print request form or by purchasing a subscription on our Web site and choosing the box indicating you would like to voluntarily pay for a subscription.

We will use targeted mailings in an attempt to send VPS invitations only to those who have not contributed within the previous 6 months. We estimate that participation in the VPS program by 25% of readers who currently receive complimentary subscriptions will allow us to continue the existing mission of the journal, including the changes mentioned earlier. As I have shared with you previously,7 in accordance with the journal's core principles, should we experience any revenue excesses from the VPS program, all funds will remain with the journal and will be used to improve the quality and scope of the journal's mission. Specifically, funds will not be diverted to the general funds of our sponsor or publisher.

In Closing

Through circumstances not of our choosing, the contemporary Mayo Clinic Proceedings, along with its brother and sister general/internal medicine journals, has experienced a financial environment that threatens both the form and the substance of the monthly journal. We choose not to let this challenge consume us but instead will use it as an opportunity to make our journal even better and more relevant to readers' needs. From one perspective, these changes are just another step in a continuum of improvements the journal has made in recent years; however, this time there is a greater sense of urgency. Throughout these changes, the Editorial Board and staff have gained comfort from the veneration of the journal expressed in readers' notes, telephone calls, and other contacts. However, we must ask you, the readers, to consider taking one more step in your support of the journal. Participation in the VPS program will help ensure valuable journal activities in this time of transition and beyond, regardless of whether the financial challenges seen in 2008 and 2009 decrease or persist. Either way, through your support, we intend to survive and continually improve the journal so that, for years to come, it will be a favorite source of information for you and your fellow students of medicine.

Thank you for your ongoing interest in and support of Mayo Clinic Proceedings.

References

1. Hébert PC. Letter from the editor: no longer free for all [editorial]. CMAJ 2009;181(11):E244 [PMC free article] [PubMed]
2. Proctor G. Letter from the publisher: no longer free for all [editorial]. CMAJ 2009;181(11):E245 [PMC free article] [PubMed]
3. Sox HC. Medical journal editing: who shall pay [editorial]? Ann Intern Med. 2009;151(1):68-69 [PubMed]
4. Dewald GW, Smyrk TC, Thorland EC, et al. Fluorescence in situ hybridization to visualize genetic abnormalities in interphase cells of acinar cell carcinoma, ductal adenocarcinoma, and islet cell carcinoma of the pancreas. Mayo Clin Proc. 2009;84(9):801-810 [PMC free article] [PubMed]
5. Yawn BP, Itzler RF, Wollan PC, Pellissier JM, Sy LS, Saddier P. Health care utilization and cost burden of herpes zoster in a community population. Mayo Clin Proc. 2009;84(9):787-794 [PMC free article] [PubMed]
6. Gersh BJ, Simari RD, Behfar A, Terzic CM, Terzic A. Cardiac cell repair therapy: a clinical perspective. Mayo Clin Proc. 2009;84(10):876-892 [PMC free article] [PubMed]
7. Lanier WL. The business of providing high-quality content to Mayo Clinic Proceedings' readers: 2009 and beyond [editorial]. Mayo Clin Proc. 2009;84(1):7-10 [PMC free article] [PubMed]

Articles from Mayo Clinic Proceedings are provided here courtesy of The Mayo Foundation for Medical Education and Research