How Much Peer Review Is Enough? Rethinking Scholarly Service in Academic Medicine.

Peer review is widely regarded as the cornerstone of scientific publishing, yet it depends on the voluntary efforts of a limited portion of the academic workforce. For clinician-scientists in academic medicine, peer review represents an essential but largely unrecognized component of faculty workload, competing directly with research, clinical care, teaching, and administrative responsibilities. Despite its central role in ensuring scientific rigor, peer review is rarely formally measured, incentivized, or incorporated into promotion and evaluation processes. This commentary examines the growing burden of peer review from the perspective of a mid-career clinician-scientist and journal editor. As publication productivity increases, so do invitations to review, often concentrating requests among a subset of highly active investigators. At the same time, editors report difficulty recruiting reviewers, sometimes requiring numerous invitations to secure adequate peer review. These dynamics may delay publication, affect dissemination of clinically relevant knowledge, and influence the career progression of authors. This system reflects a misalignment between institutional priorities and the labor required to sustain scholarly publishing. Addressing this imbalance will require greater recognition of peer review as scholarly work, clearer expectations for participation, and broader engagement to ensure sustainability.