volume 37  |  No. 2  |  2026

A Quiet Crisis in Peer Review for Our Clinical Journals:

If you spend enough evenings as an editor, you learn the distinctive silence of a stalled review. It is the quiet that follows the sixth invitation sent to the perfectly matched expert; the pause after a cordial ‘regret – I’m overloaded’; the dead air after two weeks, then four, then eight, while a promising manuscript sits in limbo. I ache at this point to inform the authors as to why it’s taking so long to get an initial decision. It is tempting to call this an inconvenience, but it really is more of a crisis since many authors are new in their career and need to know if we can move forward or they need to start over. The health of clinical research depends on a robust, timely, and diverse peer review ecosystem. And this system is under strain.

As Editor-in-Chief of IJOMI, I witness a contradictory truth each week: we have more scientific output than ever, yet a shrinking pool of reviewers able or willing to thoughtfully critique that output. The consequences – delays, inequities in workload, inconsistent quality, and author disillusionment, touch every point along the research-to-care continuum. If we want excellence in research and the responsible translation of evidence to clinical practice, we must confront the structural and cultural impediments that keep our best minds from reviewing, and our best science from advancing.

Why is this?

There are multiple potential issues but one way to think of this is to look at the “Anatomy of Reviewer Fatigue.”

The friction points are:

1. Shortage of time among the very experts we need most. The clinician-scientists, methodologists, and subspecialists who can best detect subtle design flaws or overreaching conclusions are the same people carrying full clinical loads, mentoring trainees, writing grants, and leading teams. When time is finite, reviewing gets triaged to the bottom. No monetary reward, limited career recognition, and the prospect of combing through opaque statistical methods on a Sunday night, it’s a hard sell.
2. Shortage of active reviewers. There are too few people asked, too often. Editorial systems tend to circle the same clusters of names – safe hands, proven turnaround times, familiar institutions. We unintentionally create reviewer bias, monocultures and burnout them. Burnout leads to disengagement.
3. Mismatch between manuscripts and reviewer expertise. Our science has become more interdisciplinary and methodologically sophisticated. It’s not uncommon to see a clinical trial incorporate adaptive designs, machine learning classifiers, complex survival models, or multi-omics correlates. Sending such papers to reviewers untrained in these methods produces either overcautious “rejects” or uncritical “accepts” – both harmful.
4. Lack of accountability. When reminders are toothless and deadlines symbolic, a two-week review quietly becomes a two-to-six-month delay. Authors feel ignored. Editors feel trapped between patience and fairness.
5. Impact of invisible labor and credit. Many institutions still do not meaningfully count peer review in promotion and tenure dossiers. We talk about reviewing as a scholarly duty but treat it as a favor.

What is the impact of publication delays?
In applied clinical fields – like implant dentistry, periodontology, prosthodontics, oral and maxillofacial surgery – a high-quality study can change practice patterns, and detailed peer review also potentially prevents weak science from informing clinical care.

When solid papers languish for months, several things can happen:

• Innovation slows. Teams postpone on going pending feedback and small startups or translational groups burnout.
• Inequity widens. Researchers with fewer resources – early-career investigators, teams outside well-funded hubs, colleagues in the Global South – are disproportionately harmed by timeline uncertainty.
• Predatory alternatives become tempting. The more respectable journals stall, the more authors – especially under career pressure – look toward pay-to-publish venues. rely on.
• Trust suffers. Clinicians grow cynical about “moving targets,” unsure if the most recent synthesis reflects the best available evidence or the artifacts of editorial delay.

We should be honest: peer review is the de facto regulatory layer of scientific integrity in our clinical community. When this level of review suffers, downstream systematic reviews, guidelines, chairside decisions all struggle and potentially inaccurate.

Reviewer diversity is also a Quality Control Mechanism
A robust reviewer pool is not only large; it is varied. Diversity of expertise, geography, discipline, gender, and career stage improves the reliability of judgments and recommendations.

What Editors can do

Editors are the stewards of this process. We have built a system respecting researchers’ time, improves the experience of reviewing, and concretely rewards excellence.

Here are steps that IJOMI and our peers have taken in the last four years:

1. Right-size the request for reviews by an aggressive triage. Editor rejections, when done carefully and transparently, are an act of respect and we use an average of 50% rejection before invitation for reviewers. Rigorous triage preserves reviewer attention for submissions that genuinely merit it.
2. Structured, checklist-driven reviews. Provide domain-tailored templates that focus reviewer attention on the highest-yield questions (internal validity, effect size interpretation, clinical significance, harms reporting, reproducibility). Structured reviews are faster to complete, easier to compare, and fairer to authors.
3. Methodological co-review. Pair content experts with methodologists or statisticians. A brief statistical audit – especially for RCTs, network meta-analyses, observational causal inference, and diagnostic accuracy studies – can protect against common errors (p-hacking, inappropriate modeling, overinterpretation).
4. We are considering time-bound commitments with explicit outcomes. Proposal is to move to shorter review time periods with a goal to complete within 14 days; automatic reassign at day 16.
5. Recognition that counts. Issue formal certificates of reviewing with quantified contributions and vouchers for Quintessence books and journals based on the number of reviews per year.
6. Mentored reviewing. Encourage senior reviewers to co-review with trainees and junior faculty, with explicit guidance. This scaffolds skill development, expands capacity, and demystifies the process.
7. Feedback loops to reviewers. Share editorial decisions and anonymized co-reviewers’ comments. Reviewers learn where their critiques aligned or diverged, improving calibration over time. It is astonishing how rarely we close this loop.

An ask I have is for reviewers to consider:

• Accept fewer reviews
• Set a structured two-hour window. Most reviews (posttriage) can be drafted in a focused 90–120 minutes using a checklist, with a short follow-up pass.
• Co-review and teach. Bring a trainee into the process, discuss your reasoning, and attribute their contribution if the journal allows.
• Be specific and kind. Precision helps authors; civility sustains a culture where experts still say, “yes.”

What IJOMI Will Do

At IJOMI, we are committing to several near-term steps:

1. Transparent timelines and dashboards for authors and reviewers.
2. Mandatory reporting checklists at submission for relevant study types, easing reviewer burden and improving comparability.
3. Paired methodological review for complex designs and analyses.
4. Reviewer development tracks with micro-credentials, vouchers for frequent reviews, and annual recognition.
5. ORCID-integrated crediting and formal service letters to support promotion dossiers.
6. Diversity targets for reviewer invitations and editorial contributors, monitored and publicly reported.
7. Ethical AI assistance for compliance checks, with human oversight and clear boundaries.
8. Baby steps, but these are a start.

A Final Invitation

When I accept an editor role, I imagine inheriting a library I did not build, filled with work I must protect and extend. Peer review is the daily maintenance of that library: being sure to short the wheat from the hulls, and showcase the exceptional.

So here is my call to our community—clinicians, scientists, methodologists, and trainees:

• If you are an experienced reviewer, mentor one new colleague.
• If you are new to reviewing, seek training and say yes to your first invitation.
• If you are a university administrator, count reviewing in performance reviews and promotion and tenure.
• If you are an author, adhere to reporting standards and be sure to follow the journals guidelines.
• And if you are an editor, join me in building systems of trust.

Excellence in clinical research doesn’t happen by accident. It is the product of thousands of small, principled choices—most of them made by volunteers. Let’s choose, together, to strengthen the scaffolding that holds up our clinical our science.

Author’s note: If you’d like to be considered for IJOMI’s reviewer development track or to co-review with a senior colleague, reach out. We will match your expertise with opportunities and support you with checklists, mentorship, and recognition.