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The physiognomy of Mayo Clinic Proceedings, 2010.

The concept of physiognomy holds that the inner character and qualities of a being are reflected in its external features. There is some basis for this concept when applied to humans, because the human form can be modified as the result of activities and environmental exposure, both influenced by inner temperament. Taken a step further, the more a person interacts with the environment, the more likely outward appearances may change. The same concepts can hold for biomedical publications. Textbooks never (single editions) or seldom (multiple editions) change in response to their environments. Perhaps this is why it is difficult to judge a book by its cover. In contrast, contemporary biomedical journals must continually respond to their evolving environments in attempts to provide higher-quality information and services to readers and deliver them more rapidly and in increasingly more palatable forms. As such, the many features of a contemporary biomedical journal can speak volumes about the intent and motivation of the journal to better serve its audience. 
 
In this regard, Mayo Clinic Proceedings is a fine example. Less than a decade ago, faculty and trainees at Mayo Clinic overwhelmingly authored the Proceedings content, and the journal's Web site offered little content beyond a listing of the monthly tables of contents. Today, the Proceedings, as its byline proclaims, is “authored by physicians worldwide,” and the facade and content of the print journal and Web site reveal the journal's highly engaged (and evolving) relationship with a dynamic, diverse medical world. 
 
Continuous quality improvement is not unique to Mayo Clinic Proceedings. It is practiced at all leading biomedical journals, although the approach may vary depending on a given journal's mission. While all journals would like to boast of ongoing, unimpeded improvements, the contemporary publishing business, whether in biomedical or other forms of publishing, has experienced historic challenges since 2008. Specifically, the downturn in the global economy, superimposed on a preexisting recession in the publishing industry, created a challenge for many biomedical journals unlike anything they had experienced in more than 4 decades. The magnitude of the insult depends somewhat on the profile of the individual journal or groups of journals, with general/internal medicine journals (the genre of the Proceedings) and multispecialty journals (an advertising market from which the Proceedings also samples) experiencing severe challenges. As a result, journals' missions and programs have required alteration. For example, within the past few weeks, the Canadian Medical Association Journal (CMAJ), one of the pioneers in open access to journal content, has announced that it must restrict open access because of financial concerns.1,2 Other journals are expected to follow. 
 
These aforementioned challenges have caused the leadership of the Proceedings, and our sponsoring organization Mayo Clinic, to closely examine our mission, practices, and future. The months-long review process was unlike anything the journal had heretofore experienced and, as a result, it caused all to gain a better appreciation of the operations and value of the journal. I am thankful to all who participated in this process, and I am extremely thankful that the process caused us to rededicate ourselves to you, our readers, in an attempt to more effectively deliver a unique, relevant, and timely product each month. This process will cause some alterations in the Proceedings you read in print and online. These changes will make the journal more focused and more extensively engage readers, but they also may lead to more restricted access to the print journal unless readers' voluntary support of the journal expands. 
 
During 2009, we asked Proceedings' readers to contribute to a voluntary paid subscription (VPS) program. The numerous individual contributions proved the viability of this concept as a revenue stream, and readers' acts of kindness (both through the VPS program and through direct communications with us) profoundly affected the journal's Editorial Board and staff. Unfortunately, the revenue generated by this program was insufficient to offset 2009 losses of advertising and other revenue streams critical to the journal's well-being. Thus, the Editorial Board and I are asking that each of you reexamine your relationship with the Proceedings and again consider VPS participation in 2010 and beyond, either through the journal's Web site or through requests mailed to you. We will await the response to this effort before taking the next steps to ensure sustained journal vitality. Those next steps will most likely involve restricting many complimentary subscriptions to the print journal. 
 
In the few months that we await your response to this petition, the journal will continue its planning to be a more effective and efficient source of information for readers. Let me share with you some of the changes you will witness in 2010 and the rationale for implementation.