Peer Review Takes Up to 353 Days While 20% of Biomedical Researchers Perform 90% of All Reviews

Health policy journals report median submission-to-publication times ranging from 35 to 353 days, with primary care journals averaging 243 days, while an estimated 20% of biomedical researchers perform up to 90% of all peer reviews entirely without compensation. Why it matters: early-career researchers cannot demonstrate publication output during multi-year review delays, so they lose grant funding eligibility that requires recent publications, so their contracts expire or they leave academia entirely, so the next generation of scientists shrinks in fields already facing workforce shortages, so critical research areas like pandemic preparedness and climate science lose institutional knowledge that takes decades to rebuild. The structural root cause is that peer review is an uncompensated labor system that relies on the goodwill of a shrinking pool of tenured academics, while the volume of submissions has grown exponentially (global scientific output doubles approximately every 9 years), creating a bottleneck that no individual journal can solve because the labor market itself is broken.