Perceptions of Academic Authorship in Medicine: A Multi-Specialty Survey of Physicians.

Background: This study aims to determine the prevalence of perceived unfairness in authorship inclusion and byline ordering, two common concerns in the literature on authorship, among a sample of the physician population at the University of North Carolina School of Medicine. Methods: We developed and distributed a survey among eight different departments at a large U.S. academic medical center, with questions pertaining to basic demographics, contributions to research, and perceptions of authorship inclusion and ordering on their publications. Responses were analyzed using chi-squared test for predictors of perceived author order misplacement or exclusion from authorship. Results: Out of 83 respondents (9.2% response rate) from eight clinical departments, 52% perceived unfair authorship ordering and 34% perceived unwarranted exclusion from a project. Perceived lower positioning of the author byline was reported to occur more commonly in the earlier stages of training (medical student and resident levels). The most common reasons for these occurrences were related to issues with communication. Conclusions: Difficulties around communication and the hierarchical nature of medical training contribute to the perceived unfairness of author ordering and authorship inclusion. Structured authorship agreements and education in publication ethics may reduce these perceived inequities.