When peer review drags on: the harm to early career researchers

I am an infectious diseases resident and early career researcher (ECR) from Italy interested in global health. In August 2024, I submitted my first manuscript to a reputable peer-reviewed journal from a major publisher: an original article on barriers and facilitators to Cervical Cancer Screening with data I collected in Northern Uganda in the context of research fellowship for my medical school thesis. After months of fieldwork with peers and senior supervisors, I was excited to share our findings. I checked the submission web platforem weekly and sent periodic reminders to the editorial office. Yet, the paper remained unassigned to an editor for more than a year (380 days)! This experience , though frustrating, is far not merely anecdotal. Large-scale analyses have documented a global growing strain on the peer review system, characterised by prolonged review timelines, reviewer shortages, and increasing mismatches between submission volumes and reviewing capacity from unique: (1-3)it reflects a widening crisis in the peer review system that demands urgent attention (1). In this Opinion piece, we argue that peer review delays disproportionately harm ECRs, affecting not only scientific progress but also confidence, career opportunities, and trust in the academic system. WAfter outlining the structural drivers of the peer review crisis, we also examine reform proposals and their potential to make peer review more sustainable, transparent, and equitable, especially for ECRs.Peer review remains a cornerstone of scientific integrity. It ensures methodological rigor, improves reporting, and guides editorial decisions. However, the system is increasingly strained. A recent cross-sectional study of 57 health policy journals found that thereported median total time from submission-to-publication times ranginged from 35 to 353 days, with. T time to first editorial decision reachinged up to 67 days, and with the peer review phase extending to 314 days (4)(2). Similar delays have been documented inly, primary care journals, where reported submission-to-publication lags average ing 243 days, with peaks of over one year (5) (3). Delays in peer review reflect interacting constraints across multiple stakeholders, including authors, reviewers, editors, publishers, and academic institutions (6,7).The efficiency of a journal's editorial office and administrative support playss a major role. Consequent:ly, hhigh-impact and highly selective journals often exhibit faster turnaround times, while journals with limited editorial staff can introduce longer bottlenecks in review copyediting, proofing, and scheduling for publication (4). However, editorial constraints alone do not fully explain the scale of current delays.After a paper is submitted, several factors contribute to delays before publication. A central challenge lies in securing peer reviewers. Editors must often send multiple invitations for each manuscript, as many are declined, ignored, or accepted but never completed (8). In a 2016 Publons editor survey, 75% of editors identified "finding reviewers and getting them to accept review invitations" as the most difficult aspect of their role (1). At the heart of this crisis is a widening mismatch between demand and supply (2). Article submission and publication output have risen steadily, especially after the Covid-19 pandemic: for example, the number of peer reviewed public health articles increased by 25% between 2019 and 2020 and by a further 21% between 2020 and 2021 (9). However, the pool of active reviewers appears stagnant or is even shrinking (2).Formatted: Normale1, JustifiedThe most commonly cited reason for declining a review invitation is that the manuscript falls outside the reviewer's area of expertise. Increasing specialization across research fields narrows relevant expertise and complicates the identification of appropriate reviewers (7). Time constraints represent another major barrier, as reviewing requires time and competes with researcher's own funded work (10). The ongoing decline in secure academic positions has further eroded both the time and willingness of researchers to engage in unpaid service (11). As a result, the reviewing burden is concentrated among a small minority: within biomedical sciences, an estimated 20% of researchers perform up to 90% of reviews, intensifying fatigue and delay (11).Additional delays arise once reviewers are secured.R Reviewers often take considerable time to deliver reports, especially if they ask formay require extensions, and multiple rounds of revision requested from authors can further prolong the process. Review times tend to decrease with increasing journal impact factor, despite reviews often being longer. This apparent contradiction could be due to stricter deadlines, greater editorial oversight, or stronger motivation to review for prestigious journals (1). However, the central challenge lies before, as editors struggle to secure reviewers: for each manuscript they must send multiple invitations, many of which are declined, ignored, or accepted but never completed (5,6). At the heart of this crisis is a widening mismatch between demand and supply. Manuscript submissions continue to rise (7), while the pool of active reviewers appears stagnant or is even shrinking (1). The ongoing decline in secure academic positions has eroded both the time and willingness of researchers to engage in unpaid service (8). As a result, the reviewing burden is concentrated among a small minority: within biomedical sciences, an estimated 20% of researchers perform up to 90% of reviews, intensifying fatigue and delay (8).Limited access to formal peer review training further constrains system capacity and quality. In the 2018 Publons survey, 88% of respondents considered training important for ensuring highquality peer review ( 1), yet peer review is not traditionally included in medical or graduate education (7). Entry into peer reviewing often depends on informal pathways: 41% of survey respondents reported receiving their first review invitation only after being identified by an editor as a corresponding author (1). This mechanism systematically disadvantages ECRs, who are less likely to hold senior authorship positions and therefore remain excluded from reviewer pools.Long review timelines slow the dissemination of knowledge and delay the translation of findings into practice. In rapidly evolving fields such as global health, slow reviews can render publications outdated, undermining their potential to inform programmes and policy-making. More overlooked are the consequences of delays for individual researchers, especially at early career stages.For ECRs, publication delays are not merely inconvenient: they carry practical, scientific, and personal costs. While slow decisions frustrate any author, for ECRs they can directly derail career progression, as timely publications are needed essential to secure jobsacademic positions, grants, and fellowships. Months of waiting can translate into weaker applications, missed funding windows, or postponed graduations. In particular, early career funding schemes rely heavily on recent publications as indicators of productivity and independence. When manuscripts remain under review for extended periods, ECRs may be unable to demonstrate sufficient output, resulting in lost opportunities for essential financial support, missed or weaker grant applications, postponed graduation, or interruptions to contract continuity on research programs (11).Prolonged review timelines also increase the risk of being scooped, whereby similar findings are published first by competitors, eroding the perceived novelty of the work and potentially leading to rejection on grounds of originality. Graduate students and postdoctoral fellows are particularly vulnerable to the consequences of an inefficient publication process, especiallythose consequences within an academic landscape already characterized by reduced institutional funding and growing competition (10, 12)(9, 10).The mental health impact of delayed publication is equally significant. Several recent studies have identified isolation, heavy workload, and highly competitive academic environments as major drivers of psychological distress among PhD candidates and ECRs (13,14) (11,12). When career advancement depends heavily on publication output, citation metricss, and journal impact factors, prolonged review timelines amplify stress, and uncertainty, and feelings of professional precarity (11) (8).Furthermore, delays have systemic implications for equity that disproportionally affect ECRs in low-and middle-income countries. Papers from Asia, Africa, and South America are reported to spend longer under review than comparable submissions from the Global North (15) (13). For ECRs in low-and middle-income countries (LMICs), who often face limited funding, weaker institutional support, and fewer opportunities for international collaboration, these delays directly undermine competitiveness for grants, fellowships, and mobility schemes. Importantly, large-scale peer review data indicate that these inequities are driven by structural features of the editorial system rather than lower engagement: over 96% of editors are based in established regions and are more likely to invite reviewers from their own geographic area (1). Consequently, despite reviewers from emerging regions showing higher acceptance and completion rates, they conducted only 18.9% of ScholarOne reviews between 2013-2017, far below their contribution to global publication output (1). This low participation in reviewing activity further restricts professional networking and visibility, marginalising ECRs from LMICs in This slower pathway to visibility exacerbates existing inequalities in global knowledge production, reinforcing the marginalization of low-and middle-income countries in research participation and topic representation.Beyond the consequences for individuals, long review times slow the dissemination of knowledge and delay the translation of findings into practice. In rapidly evolving fields such as global health, slow reviews can render publications outdated, undermining their potential to inform programmes and policy. During the Covid-19 pandemic, many researchers turned to preprints to maintain timeliness when journals could not keep pace with urgent public health needs (14). While this approach enabled rapid dissemination, preprints still carry less credibility than peerreviewed articles and are valued less in hiring, funding, and promotion decisions.The challenges outlined above have prompted a range of Ddifferent reforms, have been proposed with mixed varying success and impact onimplications for ECRs.Preprints. During the Covid-19 pandemic, many researchers turned to preprints to enable rapid dissemination when journals could not keep pace with urgent public health needs (16). Since then, preprint use has expanded, with over 56 active servers across multiple disciplines including medical research (17). Preprints could be used for grant application or to support academic promotion or tenure, offering particular benefits for ECRs. However, concerns regarding misinformation and the spreading of incorrect conclusions underscore the importance of peer review for ensuring scientific reliability (1).Multiple process improvements can be implemented by journals to accelerate peer review without compromising quality. Editors should be encouraged to makeJournals can promote rapid desk-rejection decisions rather than sending unsuitable papers for external review. Journals canof unsuitable manuscripts, set clear deadlines for reviewers, with automatic reassignment if reports are not received within a defined timeframein time, and limit revisions to one or two rounds. Evidence suggests that shorter deadlines reduce review time without substantially affecting completion rates (1). Additionally, . Ttransparent reporting of median review times would create increase accountability and help authors make informed submission choices, a benefit . Predictable timelines would that is particularly valuable also alleviate anxiety for ECRs navigating career deadlines. Artificial intelligence tools can further shorten timelines by automating routine tasks. Validated tools already assist with plagiarism and compliance checks (18) (15). Careful extension to other tasks, such as verifying references or suggesting wellmatched reviewers, can speed time to first decision, allowing reviewers to focus on substantive evaluation that requires critical thinking (19).Incentivising participation. Expanding the peer reviewer pool requires incentives that meaningfully increase participation. Financial incentives have been explored, with some pilot programmes showing improved reviewer acceptance rates (2). However, these schemes are expensive for journals and may increase publication fees, posing an additional barrier for ECRs with limited funding. Moreover, they have been shown to only marginally reduce turnaround times (20).Non-monetary incentives are more sustainable and widely valued by reviewers. These include free access to the journal, invitation to write editorials or public acknowledgment on social media (7). Open review models, ranging from publishing can bolster recognition and improve transparency and accountability. These include publishing reviewers' reports names to making full reports publicand authors' responses, or only their names, represent another strategy to improve accountability and recognition. . Such openness transparency may elevate scholarly value of reviewing and raise review standardsquality, but . However, named critique can feel risky for junior referees assessing senior colleagues (16)concerns persist that public reports may reduce objectivity and critical appraisal (7), and named critique can feel risky for junior referees assessing senior colleagues (21). Importantly,, and evidence that transparency alone reduces delays remains limited.Financial incentives have been explored, with some pilot programmes showing improved reviewer acceptance rates (1). However, these schemes are expensive for journals and may inflate article processing charges, posing an additional barrier for ECRs with limited funding. Furthermore, they have been shown to only marginally reduce turnaround times (17).A particularly promising and widely supported approachA more sustainable solution lies in formal recognition of peer review as scholarly output (2,6,7). Platforms such as Web of Science Reviewer Recognition (previously Publons) or ORCID credit systems already allow reviewers to document their activity. The problem is that universities and funders seldom include these contributions in evaluation criteria for hiring or promotion. Institutions could incorporate verified, editor-rated excellent reviews as a metric of service rather than sheer volume, thereby rewarding and encouraging not only engagement but also quality (18) (15). Recognising reviewing alongside publications, teaching, and grant participation would convert invisible labour into meaningful academic credit, with particular benefit for ECRs.Building capacity throughTraining and co-review. Finally, expanding access to structured peer review training could enable researchers to enter the reviewer pool earlier and more equitably. Several organisations, such as BMJ or Elsevier's Research Academy, have developed formal peer review training programs (22,23), and To address reviewer shortages while strengthening career pathways for ECRs, mentored co-review models are gaining traction. Sseveral Nature Portfolio journals now encourage co-review models, this approach, where senior reviewers involve one or two ECRs as co-reviewers, with all contributors acknowledged in the final publication (24) (18). These models also allow ECRs to gain hands-on experience and recognition, incentivising their participation and thereby reducing reviewer shortages. Structured training is considered to improve both the quality and efficiency of peer review (6). Importantly, evidence suggests that training is most effective when delivered early in a researcher's career, before reviewing practices become entrenched (18). This approach allows ECRs to gain hands-on experience and recognition, incentivising their participation and thereby reducing reviewer shortages and delays. Coupled with short, modular training programmes, this approach can further improve quality, with early data suggesting that early-career training is more promising than late-career remediation (15).The peer review crisis cannot be separated from broader structural challenges in academia. Increasingly precarious employment conditions, unequal access to research funding, and the undervaluation of academic service have progressively eroded the capacity and motivation to engage in peer review. These factors weight on ECRs, affecting their career perspectives and mental health.Addressing these challenges requires coordinated action across journals, institutions, and funders. Journals must commit to transparent reporting of review times and consistent editorial standards. Universities and research councils should formally recognise peer review as part of academic performance, rewarding high-quality reviewing and mentorship of junior colleagues. Funders could reinforce accountability by supporting journals that meet reasonable benchmarks for timeliness and inclusiveness.For ECRs, such measures could mean the difference between opportunity and attrition. Ultimately, improving peer review is not a technical challenge but a matter of justice and foresight. The current system risks discouraging talented young scientists and silencing diverse voices from resource-constrained settings. Restoring trust will require a shared commitment across the research community to ensure that peer review is timely, equitable, and fit for the next generation of scientists.