Publishing a Book in the 2020s

The digital revolution has dramatically reshaped the publishing world over the last 30-40 years coinciding with my professional years in the field of surgery. Academic surgery has an important symbiotic relationship with publishing, both in the surgical journal arena as well as textbooks. Consequently surgeons including me have had to learn to evolve. Let’s look at academic journals first.

Surgical Journals

My own relationship with surgical journals evolved from being a reader who wanted to keep up with advances in the field as well as an author who wanted to publish clinical advances like the development of new techniques in the OR and their outcomes. I also wanted to share the results of our lab research in areas like conduit porosity, homograft storage and neurological protection. I learned the subtleties of corresponding with editors and responding to peer reviewers and increasingly participated in the process as a peer reviewer myself. In time my work with journals evolved into working with John Waldhausen when he was Editor of the Journal of Thoracic and Cardiovascular Surgery as his Associate Editor for congenital. And when I became Treasurer of the American Association for Thoracic Surgery, I came to understand the hugely important role our journal played in supporting the financial stability of the organization. Up until the 1990’s and early 2000's, journal revenue, together with income from the main annual meeting provided at least 60-70% of the AATS annual income and effectively subsidized member dues substantially.

The digital revolution has drastically reduced the revenue generated by journals in much the same way that it has for newspapers. Advertising has all but disappeared from the few printed journals that still exist. As for newspapers, subscribers to journals can read all published material behind a pay wall but increasingly “Open Access” articles are available where the authors or their institutions pay for the privilege of making their findings available. The Open Access financial model has spawned a massive new problem of “Predatory Journals” that suck sometimes unsuspecting authors into their financial web of deception. Probably even more authors know exactly what they are getting when they pay to publish and thereby pad their resume. Even the major reputable publishing houses seem to have adopted the attitude of “if you can’t beat it, join it” and have assembled huge stables of borderline to bogus journals. Buyer beware!

Book Publishing

The world of book publishing, whether text books, novels or memoirs has been upended just as much as the world of medical journal publishing. Before Amazon and the digital revolution, authors would spend years writing and polishing their manuscript on paper which they (or more likely their agent) would then try to coax a traditional publisher into printing. There used to be dozens if not hundreds of independent publishing companies. Today after years of mergers and acquisitions as publishers struggled to stay ahead of the digital revolution, there are only a handful left.

Traditional publishers had to take a gamble (and still do) on the success of a book because they were taking on the substantial costs of editing, type-setting, printing and binding and then warehousing and marketing a print run that usually ran into the thousands. In return they paid a royalty to the author which was usually in the range of 10% of “net sales”, though they were on the honor system in that regard because who knows what discounts they were actually giving to induce independent book stores and the evolving chains like Barnes and Noble to stock their books.

At the other end of the author hand-holding spectrum is “Kindle Direct Publishing” or KDP. Amazon first offered self-publishing of e-books at the same time it sold its first Kindle e-reader in 2007. In 2018 KDP introduced “print to order” for authors, who are required to perform all the functions previously done by publishers, namely copy editing, type setting, proofing, cover design and marketing. As for journal publishing, fully autonomous self-publishing has led to an explosion of low quality and in many cases little more than scam books particularly in areas like travel guides. The royalty rates are far more generous than traditional publishing with two levels, 70% and 35% depending on the services selected from Amazon by the author.

In the middle between traditional and KDP publishing is “Hybrid Publishing” where an author utilizes a professional company to undertake the pre-production aspects. Troubador Publishing in the UK, whom I worked with to publish Little Hearts, Lifelong Impact, falls under this rubric. As with Open Access journal publishing, the author pays up front for these services from a menu of production and publishing options. International printing can be performed locally as an on-demand option, often using KDP though other companies also offer this service. Usually the print run in the country where the publisher is based will be much smaller than traditional publishers will choose. They may offer warehousing, distribution and marketing as additional menu items. Royalty rates can approach those offered by KDP.

Traditional publishing has become increasingly challenging for the major publishing houses who have had to cede much of the control and publishing rights to authors in much the same way that Taylor Swift led musical artists towards greater control of their intellectual property. Where this is all heading, particularly in the new world of AI, is hard to know but for now, the author is in a far stronger position than they were before the digital revolution introduced among others by the Jeff Bezos’s, Steve Jobs and Bill Gates of the world.