Sustaining Progress of the Journal of Korean Neurosurgical Society Amidst the Crisis in Korean Healthcare System

Abstract

The 2024 Journal Citation Reports (JCR) reveal that the impact factor (IF) for the Journal of Korean Neurosurgical Society (JKNS) has risen to 1.7, an increase from 1.4 in 2023. Meanwhile, Republic of Korea has been in turmoil in healthcare system since February 2024, provoked by government’s sudden and drastic policy to increase medical school admissions. This situation has profoundly impacted medical research activities, in addition to clinical practice. There is concern about whether the Korean medical community can sustain and build upon its academic achievements once this situation is resolved. Maintaining the growth of a medical journal is becoming increasingly challenging. The JKNS must continue its previous efforts to sustain its current progress. To enhance its IF, JKNS should focus on recruiting high-quality review articles and becoming a preferred journal for authors by offering a rapid review process. Collaboration with subspecialty journals is also crucial to ensure that both JKNS and those journals can grow together.

INTRODUCTION

The 2024 Journal Citation Reports (JCR) reveal that the impact factor (IF) for the Journal of Korean Neurosurgical Society (JKNS) has risen to 1.7, an increase from 1.4 in 2023 [1]. While this figure does not quite reach the journal’s peak of 2.25 in 2021, it is comparable to the 2022 IF [4,5,7].

Meanwhile, there has been great turmoil in Korean healthcare system. In February 2024, the Republic of Korea government's sudden and drastic policy to increase medical school admissions led to significant protests from the medical community, especially interns, residents and medical students. The majority of residents resigned from their training hospitals, while medical students boycotted classes and refused to take the national medical licensing examination. This situation remains unresolved and has profoundly impacted not only clinical practice but also medical academic activities.

This paper examines the current status of JKNS as reflected in the JCR 2024 and reviews recent changes in the journal, including its manuscript submission and review process. It also explores strategies for JKNS to sustain the progress it has achieved amidst these circumstances.

JCR 2024

The improvement in the IF of JKNS resulted from two factors; a reduced number of articles published (denominator) and an increase in citations (numerator), as summarized in Table 1. Table 1 shows that the basic strategy of filtering out articles of suboptimal quality through a rigorous review process is still effective in improving the IF. Although we cannot be sure which manuscript have a better probability of being cited, those that pass a rigorous screening process will have a better chance of being cited. At the same time, there will be a reduction in the number of manuscripts with a lower probability of being cited.

Table 1.

Impact factor (IF) change over years

Year	2021	2022	2023	2024
IF	2.2	1.6	1.4	1.7
Published articles	169	189	196	173
Received citations	380	302	281	300

The journals citing JKNS are summarized in Table 2. It is notable that citations from the World Neurosurgery are increasing continuously, whereas citations from JKNS itself and Neurospine are decreasing. Although the decrease in the self-citation rate is a desirable feature, the decrease in the absolute number of citations from Korean neurosurgical journal might not be desirable. Strategies to increase citations from these journals are required. One of the positive finding is that the number of citing sources has increased to 169 from 137 in the previous year, which means JKNS is gaining interest from more diverse fields of medicine.

Table 2.

Citing sources of JKNS

Year	2022	2023	2024
JKNS	24	13	11
Neurospine	19	15	0
World Neurosurgery	10	13	27
Child’s Nervous System	8	10	4
Frontiers in Oncology	7	0	0
Medicine	7	0	0
Frontiers in Neurology	6	8	0
Journal of Clinical Medicine	6	10	8
Cures Journal of Medicine	5	10	11
European Journal of Neurology	5	0	0
Neurosurgery	0	10	9
Operative Neurosurgery	0	6	0
Acta Neurochirurgica	0	5	0
Clinical Neurology and Neurosurgery	0	0	5
Frontiers in Surgery	0	0	5
Scientific Reports	0	0	5
Others	205	181	208
Total citations	302	281	326

JKNS : Journal of Korean Neurosurgical Society

Table 3 shows the influence of review articles on the improvement of the IF. Although the proportion of articles receiving no citations is similar in both types of articles, the highest citation count and average citation count are higher in review articles. Therefore, selecting topics of interest and recruiting authors who can handle these topics well are crucial. It is already known that the case reports have the least chance of being cited based on previous analyses of citations for JKNS. Despite the editorial board’s efforts to filter out case reports with optimal quality and novel findings, the citation rate for case reports has not improved significantly (from 0.75 to 0.67) as summarized in Table 3 and previous report [6]. Therefore, the policy of applying strict criteria to case reports should be maintained.

Table 3.

Distribution of citations according to article type

Article type	Total No.	Articles without citation	Highest citation	Citations per article
Review	41	11 (26.8)	10	2.56
Original article*	117	30 (25.6)	6	1.61
Case report	15	7 (46.7)	2	0.67

Values are presented as number (%).

^*Including special article and technical note

Considering which fields have a better chance of being cited is also important. Tumor and cerebrovascular diseases constitute a significant proportion of published articles but do not contribute to raising the IF. Identifying the cause of low citation rates in these fields and exploring solutions is a challenge that must be addressed to improve IF (Table 4).

Table 4.

Distribution of citations according to subspecialties

Subspecialties	Total No.	Articles without citation	Highest citation	Average citation per article
Tumor	22	6 (27.3)	5	1.41
Cerebrovascular	44	14 (31.8)	4	1.36
Spine	30	5 (16.7)	9	1.80
Neurotrauma	18	7 (38.9)	6	1.89
Pediatric	28	8 (28.6)	6	1.75
Functional	13	3 (23.1)	10	2.69
Peripheral nerve	3	0 (0.0)	3	1.67
Other	15	5 (33.3)	8	1.67

Values are presented as number (%)

THE CRISIS IN KOREA’S HEALTHCARE SYSTEM : GENESIS, EVOLUTION, AND OUTLOOK

February 2024 will be remembered as a pivotal moment in South Korea’s medical history. The government's abrupt and poorly justified announcement of a 60% increase in medical school admissions for the upcoming year sparked a massive backlash throughout the medical community, particularly among young doctors in training and medical students [3].

While there is hope that medical students who refused to attend classes and take the licensing exam will eventually return, a significant number of interns and residents resigned, and their return remains uncertain. The government’s aggressive policy formulation and implementation forced young doctors to seriously reconsider their career paths. The absence of interns and residents, who are on the front lines of patient care, has also led to significant difficulties in clinical settings.

The absence of interns and residents has directly led to an increased workload for specialists. In nearly all hospitals, specialists have been strained by providing emergency patient care and covering night duties, forcing many to reduce non-emergency services to maintain their capacity for urgent cases.

Beyond these clinical challenges, the crisis has also had a significant impact on academic research. Many medical journals, including the JKNS, have seen a sharp decline in manuscript submissions from South Korea. The fact that the number of overseas submissions has remained largely unchanged, while domestic submissions have plummeted, can only be explained by a decline in academic activity due to the increased workload on specialists. This phenomenon is also evident in the decreasing number of papers published by Korean researchers in medical journals worldwide, not just in domestic academic journals [2]. An increase in the workload of specialists has left them with less time to dedicate to research. This is not only reflected in a decrease in manuscript submissions but also in an increase in requests for extended revision periods after peer review [8]. This is also thought to have impacted on the review process itself.

It is expected that the resigned interns and residents will return to their positions within this year. However, it will likely take a significant amount of time for the chaos to subside. Professors who remained in their positions may be able to regain their previous research capabilities. Nevertheless, there is a concern that this situation may intensify the tendency among young doctors to avoid difficult, demanding, and high-risk work. It could be perceived by younger doctors that working in a teaching hospital—conducting research and training residents—is no longer an attractive career path. This could lead not to a temporary decline in academic activity, but to long-term stagnation or even regression.

ACTIONS NEEDED FOR THE PROGRESS OF JKNS

JCR reflects the number of articles published in 2022 and 2023 that received citations in 2024. It is not easy to predict the influence of this situation on the IF of next year. Unfortunately, it is concerning that this may lead to a negative outcome rather than a positive one. To solve this problem, cooperation and effort are required not only from outside the medical community but also from the medical community as a whole. As that issue is beyond the scope of this paper, I would like to focus solely on ways to ensure the continued development of the journal as its editor.

The first strategy is to recruit more submissions. A large number of manuscript submissions provides the opportunity to select high-quality papers. A decrease in submissions is like a well running dry, making it incredibly difficult to manage. To be attractive to potential contributors, JKNS should maintain certain level of IF and provide a fast review process. Publication costs can also be a factor. Therefore, we must continue our efforts to maintain the IF of JKNS while providing authors with quick feedback through a fair and prompt review process. While this may place a greater burden on our domestic reviewers, their cooperation is crucial for the journal’s continued development. We are trying to recruit new reviewers for more expeditious reviews and encourage them to submit their research products.

Publishing review articles should remain a key strategy for improving our citation impact. To increase the likelihood of these reviews being cited, we must select topics with a strategic viewpoint. While it is important to choose subjects that are currently of high interest, it is equally crucial to identify underserved topics that are needed within the field. Relevant subjects could include the use of artificial intelligence and minimally invasive surgery, both of which have recently garnered increased attention. Suggestions from our members could also be of great help in selection of promising topics. Given that review articles by Korean researchers are frequently cited, choosing the right topics will not only enhance the IF of JKNS but also help to widely publicize the achievements of Korean researchers.

There are eight journals published by the branch societies of Korean Neurosurgical Society (KNS). One is indexed in SCI, and three are in SCOPUS. Cooperation with international database-indexed journals and providing support for journals that are not yet indexed is another desirable strategy. The concurrent progress of the JKNS and other subspecialty journals is a driving force that not only contributes to the advancement of neurosurgery in Korea but also ensures the sustainable growth of Korean neurosurgical journals.

CONCLUSION

The COVID-19 pandemic was an unprecedented event. Although the medical community in Korea faced significant challenges, it ultimately overcame them. It is hoped that the current situation will be resolved without causing further negative impacts on medical research and the training of the next generation of doctors.

Looking at these events, it is likely the medical community will face other unpredictable difficulties in the future. In this respect, achieving progress for a medical journal is truly a difficult task. However, we cannot give up simply because it is difficult, as it is nearly impossible to catch up once we fall behind.

Therefore, the interest and participation of the members of the KNS are absolutely essential. I hope that by overcoming the current challenges, we can continue to advance JKNS and build a solid system that prepares us for future difficulties.