[Skip to Content]
[Skip to Content Landing]

Courtesy Authorship in Academic Surgery Publications

Educational Objective To identify courtesy authorship in high- and low-impact journals by survey of first and senior authors.
1 Credit CME
Key Points

Question  What are the prevalence and motivations surrounding courtesy authorship in current surgical academia?

Findings  This survey study found that courtesy authorship remains prevalent (17%). The rates and motivations of courtesy authorship vary greatly between first and senior authors as well as in high and low impact factor journals.

Meaning  Courtesy authorship remains a common practice in surgical academia, and by understanding the motivations and incentives, clinicians can work to eliminate its occurrence.


Importance  Courtesy authorship is defined as including an individual who has not met authorship criteria as an author. Although most journals follow strict authorship criteria, the current incidence of courtesy authorship is unknown.

Objective  To assess the practices related to courtesy authorship in surgical journals and academia.

Design, Setting, and Participants  A survey was conducted from July 15 to October 27, 2017, of the first authors and senior authors of original articles, reviews, and clinical trials published between 2014 and 2015 in 8 surgical journals categorized as having a high or low impact factor.

Main Outcomes and Measures  The prevalence of courtesy authorship overall and among subgroups of authors in high impact factor journals and low impact factor journals and among first authors and senior authors, as well as author opinions regarding courtesy authorship.

Results  A total of 203 first authors and 254 senior authors responded (of 369 respondents who provided data on sex, 271 were men and 98 were women), with most being in academic programs (first authors, 116 of 168 [69.0%]; senior authors, 173 of 202 [85.6%]). A total of 17.2% of respondents (42 of 244) reported adding courtesy authors for the surveyed publications: 20.4% by first authors (32 of 157) and 11.5% by senior authors (10 of 87), but 53.7% (131 of 244) reported adding courtesy authorship on prior publications and 33.2% (81 of 244) had been added as a courtesy author in the past. Although 45 of 85 senior authors (52.9%) thought that courtesy authorship has decreased, 93 of 144 first authors (64.6%) thought that courtesy authorship has not changed or had increased (P = .03). There was no difference in the incidence of courtesy authorship for low vs high impact factor journals. Both first authors (29 of 149 [19.5%]) and senior authors (19 of 85 [22.4%]) reported pressures to add courtesy authorship, but external pressure was greater for low impact factor journals than for high impact factor journals (77 of 166 [46.4%] vs 60 of 167 [35.9%]; P = .04). More authors in low impact factor journals than in high impact factor journals thought that courtesy authorship was less harmful to academia (55 of 114 [48.2%] vs 34 of 117 [29.1%]). Overall, senior authors reported more positive outcomes with courtesy authorship (eg, improved morale and avoided author conflicts) than did first authors.

Conclusions and Relevance  Courtesy authorship use is common by both first and senior authors in low impact factor journals and high impact factor journals. There are different perceptions, practices, and pressures to include courtesy authorship for first and senior authors. Understanding these issues will lead to better education to eliminate this practice.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 Credit(s)™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: June 17, 2019.

Corresponding Author: Matthew J. Martin, MD, Trauma and Emergency Surgery Service, Legacy Emanuel Medical Center, 2801 N Gantenbein, Portland, OR 97227 (traumadoc22@gmail.com).

Published Online: September 18, 2019. doi:10.1001/jamasurg.2019.3140

Author Contributions: Dr Martin had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: McClellan, Mansukhani, Moe, Kibbe, Martin.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: McClellan, Moe, Derickson, Chiu, Martin.

Critical revision of the manuscript for important intellectual content: McClellan, Mansukhani, Moe, Kibbe, Martin.

Statistical analysis: McClellan, Mansukhani, Moe, Derickson, Martin.

Obtained funding: McClellan.

Administrative, technical, or material support: McClellan, Mansukhani, Moe, Derickson, Kibbe.

Supervision: Mansukhani, Kibbe, Martin.

Conflict of Interest Disclosures: None reported.

Disclaimer: Dr Kibbe is editor of JAMA Surgery, but she was not involved in any of the decisions regarding review of the manuscript or its acceptance.

Meeting Presentation: This paper was presented at the Annual Meeting of the Pacific Coast Surgical Association; February 16; Tucson, Arizona.

Schimanski  LA, Alperin  JP.  The evaluation of scholarship in academic promotion and tenure processes: past, present, and future.  F1000Res. 2018;7:1605. doi:10.12688/f1000research.16493.1PubMedGoogle ScholarCrossref
Mentzelopoulos  SD, Zakynthinos  SG.  Research integrity, academic promotion, and attribution of authorship and nonauthor contributions.  JAMA. 2017;318(13):1221-1222. doi:10.1001/jama.2017.11790PubMedGoogle ScholarCrossref
Warner  ET, Carapinha  R, Weber  GM, Hill  EV, Reede  JY.  Faculty promotion and attrition: the importance of coauthor network reach at an academic medical center.  J Gen Intern Med. 2016;31(1):60-67. doi:10.1007/s11606-015-3463-7PubMedGoogle ScholarCrossref
Gast  KM, Kuzon  WM  Jr, Waljee  JF.  Bibliometric indices and academic promotion within plastic surgery.  Plast Reconstr Surg. 2014;134(5):838e-844e. doi:10.1097/PRS.0000000000000594PubMedGoogle ScholarCrossref
Gasparyan  AY, Ayvazyan  L, Kitas  GD.  Authorship problems in scholarly journals: considerations for authors, peer reviewers and editors.  Rheumatol Int. 2013;33(2):277-284. doi:10.1007/s00296-012-2582-2PubMedGoogle ScholarCrossref
Dempsey  JA.  Impact factor and its role in academic promotion: a statement adopted by the International Respiratory Journal Editors Roundtable.  J Appl Physiol (1985). 2009;107(4):1005. doi:10.1152/japplphysiol.00891.2009PubMedGoogle ScholarCrossref
Mowatt  G, Shirran  L, Grimshaw  JM,  et al.  Prevalence of honorary and ghost authorship in Cochrane reviews.  JAMA. 2002;287(21):2769-2771. doi:10.1001/jama.287.21.2769PubMedGoogle ScholarCrossref
International Committee of Medical Journal Editors. Defining the role of authors and contributors. http://www.icmje.org/recommendations/browse/roles-and-responsibilities/defining-the-role-of-authors-and-contributors.html. Accessed August 31, 2017.
Flanagin  A, Carey  LA, Fontanarosa  PB,  et al.  Prevalence of articles with honorary authors and ghost authors in peer-reviewed medical journals.  JAMA. 1998;280(3):222-224. doi:10.1001/jama.280.3.222PubMedGoogle ScholarCrossref
Luiten  JD, Verhemel  A, Dahi  Y, Luiten  EJT, Gadjradj  PS.  Honorary authorships in surgical literature.  World J Surg. 2019;43(3):696-703. doi:10.1007/s00268-018-4831-3PubMedGoogle ScholarCrossref
Wislar  JS, Flanagin  A, Fontanarosa  PB, DeAngelis  CD.  Honorary and ghost authorship in high impact biomedical journals: a cross sectional survey.  BMJ. 2011;343:d6128. doi:10.1136/bmj.d6128PubMedGoogle ScholarCrossref
Bates  T, Anić  A, Marusić  M, Marusić  A.  Authorship criteria and disclosure of contributions: comparison of 3 general medical journals with different author contribution forms.  JAMA. 2004;292(1):86-88. doi:10.1001/jama.292.1.86PubMedGoogle ScholarCrossref
Feeser  VR, Simon  JR.  The ethical assignment of authorship in scientific publications: issues and guidelines.  Acad Emerg Med. 2008;15(10):963-969. doi:10.1111/j.1553-2712.2008.00239.xPubMedGoogle ScholarCrossref
Moffatt  B.  Responsible authorship: why researchers must forgo honorary authorship.  Account Res. 2011;18(2):76-90. doi:10.1080/08989621.2011.557297PubMedGoogle ScholarCrossref
Adler  KB.  Impact factor and its role in academic promotion.  Am J Respir Cell Mol Biol. 2009;41(2):127. doi:10.1165/rcmb.R09ED1PubMedGoogle Scholar
Arenson  RL, Lu  Y, Elliott  SC, Jovais  C, Avrin  DE.  Measuring the academic radiologist’s clinical productivity: applying RVU adjustment factors.  Acad Radiol. 2001;8(6):533-540. doi:10.1016/S1076-6332(03)80628-1PubMedGoogle ScholarCrossref
Dixon  AK.  Publishing and academic promotion.  Singapore Med J. 2009;50(9):847-850.PubMedGoogle Scholar
Gjerde  C, Clements  W, Clements  B.  Publication characteristics of family practice faculty nominated for academic promotion.  J Fam Pract. 1982;15(4):663-666.PubMedGoogle Scholar
Vinther  S, Rosenberg  J.  Authorship trends over the past fifty years in the Journal of the Danish Medical Association (Danish: Ugeskrift for Læger).  Dan Med J. 2012;59(3):A4390.PubMedGoogle Scholar
Pile  K.  Publish or perish.  Int J Rheum Dis. 2009;12(3):183-185. doi:10.1111/j.1756-185X.2009.01408.xPubMedGoogle ScholarCrossref
Fabbri  LM.  Rank injustice and academic promotion.  Lancet. 1987;2(8563):860. doi:10.1016/S0140-6736(87)91051-8PubMedGoogle ScholarCrossref
Kenna  H, Swanson  AN, Roberts  LW.  Evidence-based metrics and other multidimensional considerations in promotion or tenure evaluations in academic psychiatry.  Acad Psychiatry. 2017;41(4):467-470. doi:10.1007/s40596-017-0741-1PubMedGoogle ScholarCrossref
Lopez  SA, Svider  PF, Misra  P, Bhagat  N, Langer  PD, Eloy  JA.  Gender differences in promotion and scholarly impact: an analysis of 1460 academic ophthalmologists.  J Surg Educ. 2014;71(6):851-859. doi:10.1016/j.jsurg.2014.03.015PubMedGoogle ScholarCrossref
Jaykaran  YP, Yadav  P, Chavda  N, Kantharia  ND.  Survey of ‘instructions to authors’ of Indian medical journals for reporting of ethics and authorship criteria.  Indian J Med Ethics. 2011;8(1):36-38. doi:10.20529/IJME.2011.012PubMedGoogle Scholar
Wager  E.  Do medical journals provide clear and consistent guidelines on authorship?  MedGenMed. 2007;9(3):16.PubMedGoogle Scholar
Samad  AKT, Siddiqui  AA.  Do the instructions to authors of Pakistani medical journals convey adequate guidance for authorship criteria?  Pak J Med Sci. 2009;25(6):879-882.Google Scholar
Johnson  TP, Wislar  JS.  Response rates and nonresponse errors in surveys.  JAMA. 2012;307(17):1805-1806. doi:10.1001/jama.2012.3532PubMedGoogle ScholarCrossref
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right

Name Your Search

Save Search
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience

Lookup An Activity


My Saved Searches

You currently have no searches saved.


My Saved Courses

You currently have no courses saved.