The Unpaid Infrastructure of Cardiovascular Science | JACC: Advances

"Peer review and professional society service are foundational to cardiovascular medicine, yet they operate almost entirely on unpaid physician labor. Each year, millions of peer reviews are completed globally, representing tens of millions of hours devoted to evaluating manuscripts and maintaining scientific integrity.1 Behind nearly every advance in cardiology—from major clinical trials to imaging innovations and device therapies—lies a network of clinicians voluntarily assessing evidence and refining scientific work before it reaches the clinical community (Figure 1).

For decades, this work has been framed as professional obligation rather than compensated labor. Reviewing manuscripts exposes cardiologists to emerging science, sharpens critical appraisal, and provides early-career physicians with mentorship and professional development. For senior investigators, professional service represents stewardship of the field. These rationales remain valid—but the conditions under which voluntary service is expected have changed considerably."