The issue of peer review reimbursement is not novel. A recent publication demonstrated the sobering results that an estimated 130 million hours (equivalent to 15,000 years) are spent globally on the peer review process, and in the United States alone this estimation of cost was $1.5 billion.¹ This estimate assumed a postdoctorate’s income was $65K, and a professor’s salary was $179K. After we’ve let that billion-dollar figure settle in, consider how remarkably greater the estimated cost would be for a practicing urological surgeon (community or academic) to devote an average of 5 hours per review,² at a median of 4.73 reviews per year.³

First, let’s be clear. We have a duty to our profession to progress the field of urology with evidence-based publications and reviews. Our knowledge is based on the education and mentorship of prior generations, a community of physicians who passed down their wisdom, surgical skills and research infrastructure. The points that follow below should be read with the caveat that we will continue to peer review manuscripts in the current system, because reviewing possible publications is truly a privilege and we have a debt to this field that has enriched our careers.

The current reimbursement paradigm includes 2 pillars: knowledge of future scientific direction and continuing medical education (CME) credits. While CME may be appealing to urologists in private practice, the academic community that directs the majority of published literature may not benefit in the same way. Additionally, CME has no appeal or benefit to residents or fellows who are asked to review a manuscript. The Journal of Urology® announced in fall 2021 that it would publish the reviews associated with an accepted manuscript, which we anticipate will incentivize acceptance of review requests and improve the overall quality of reviews. Linking an ORCID (Open Researcher and Contributor ID) to reviewers of published articles could further acknowledge reviewers’ scientific contributions.

This issue of reviewer compensation parallels the current collegiate athletics “Pay-for-Play” conundrum: we obviously can’t pay everybody, but it seems wrong to compensate no one. Given that hundreds of millions of hours are invested per year in peer review globally,¹ we must incentivize the review process for practicing urologists who weigh the cost of hours outside of regular clinic, surgeries and research.

There are several options that publishers should consider for reviewers who consistently review manuscripts. First, and most publisher-friendly, is granting reviewers limited duration open access to that journal’s prior publications. This could further improve the knowledge base of the reviewer and indirectly result in increased citations of that journal’s publications as the reviewer becomes more familiar with its past work. Another option would include discounted rates or waivers for meeting fees, registration or annual memberships for reviewers who produce a certain quantity of high-quality reviews per year (eg 5–6 high-quality reviews per year).

(Side note: a waiver of the $115 AUA annual membership fee would go a long way on a fellow’s salary.)

Lastly, top reviewers could be offered presentation priority at annual journal-affiliated highlight sessions during academic conferences, which would improve exposure of up-and-coming researchers.

There is no simple solution to the peer review controversy. Urological journals have taken progressive steps to incentivize publication reviews, but further work is needed to compensate the time investment from urologists in the peer review process. With some creativity and attention to the time and expertise invested by reviewers, we can further improve the peer review process and progress the field of urology.