What I Hope to Contribute.

Yesterday I got the reviews back for two papers I have out. One paper was rejected, one had a revision invited. The paper that was rejected had four reviews, all of which were blandly positive. Nobody hated it, but no one raved either, and the editor decided it wasn’t “focused or well-organized” enough to be of high priority for publication in his (rather august) journal. This is a relatively common result for me. People like the work, but editors think it should go to a management journal, not a medical journal. And that’s a fair criticism.

The other paper, the one written by my interns, got three similarly bland-but-positive reviews (if anything, a little less complimentary than the other paper), but this journal asked for a revision. I’m quite gratified. The journal is a perfectly respectable second or third tier specialty journal. A medical journal as well. I’m curious how much to ask for from my interns seeing as I can’t pay them anymore. I don’t like volunteer labor, but they are authors (co-first authors), and they have the right to review and contribute to work that their name is on.

I’m also gratified because this is my first grant-funded last-author paper. A revise and resubmit almost always (but not always) means that the journal wants to publish the paper. If I can respond to the review productively, and I think I can, then the paper will be accepted. Sometime around the spring, I’ll have another published piece from my work at MECMC, and that’ll be three papers in two years, which makes me feel reasonably productive, especially considering I have several other irons in fires (like that rejected piece I plan to send back out ASAP).

I’m sensitive to the suggestion that I send my work to management journals. But I don’t really want to have MBA/MHA types as my audience. I believe to do the best work that can be done of this type, to make the biggest impact, I need the clinicians on board with the process. That means a couple of things. First, it means that MDs and RNs see the work in the journals they read, and recognize its value. Second, it means that when I come in to do a job, they know that it will result in publication in a journal that will matter to their bosses and career aspirations. This is especially true when working with residents and fellows.

One of the biggest problems quality engineers have is getting buy-in and engagement from physicians. Frequently, they don’t see the value of being engaged in QI work. But “you get to be an author on a paper in a journal in your field” is a real currency to a resident or a fellow, or a junior faculty member.

So I continue to deliberately make things a little harder for myself. I have the luxury of being able to do this, because I don’t have to worry about my citation count, or a tenure package. I am able to simply go and advance my engineering agenda in medicine, and publish where my main goal with regard to my contribution to my field is that a department-head somewhere will read my paper, pick up the phone, and say, “Hey Margaret, did you see that thing in Annals of Impressive Medicine about the computer deelie? Why don’t we do that here?”

And then someone like me gets a job, and patient access and quality of care improves. That’s what I hope to contribute.