Authorship Order: Modest Proposals From a Retired Japanese Obstetrics‐Gynecology Professor

Author order is important for academic transparency and impacts promotion [1]. Hashimoto et al. [1] identified three clusters of countries regarding who serves as corresponding author: the first, second, or last author. Previous studies [2-4] also noted that the first and last authors often carry the greatest weight, consistent with this study. Thus, three positions matter most: the first, corresponding, and last authors. I wish to add an important consideration: how about the second-to-last author? The second-to-last author, if greatly contributing, should become the last author. As Hashimoto et al. noted, in France, “a software system allocates 4 points for first or last author, 3 points for second author, 2 points for third and second-to-last author” [4]; the second-to-last gains only half the last author's points. I examined case reports published in a formal Japanese obstetrics-gynecology (OBGYN) journal and confirmed the department director is almost always listed last (Table 1). Take a typical case: a university OBGYN department has three teams (gynecology, obstetrics, reproduction). In a “gynecologic” case report, the order may be A, C, B, D, E, F (A → F; hierarchy): A is the attending doctor, C the corresponding author, E the “gynecology” team leader, and F the OBGYN department director. This sequence reflects hierarchy. However, in many cases, the practical “supervisor” was the team leader (E), not the director (F); if so, the order should be A, C, B, D, F, E. The last author carries more weight than the second last [1-4] and should represent real contribution. The director should not automatically become the last author. Search for “Is the last author a department director?” I hand-searched these manuscripts to determine whether the last author was the department director, applying the following criteria: Result: Out of the 236 papers, 68 met the criteria. Among these, 66 listed the department director as the last author. In one paper, the director was the second last, with the subspecialty chief listed as the last author. This particular paper was from our department (PMID: 30094884). In the remaining paper, the last author was a professor from another university but was described as affiliated with the university where patients were treated. Therefore, this paper remains pending. I have two additional proposals. The corresponding author should be determined early, for example, at the time of planning the research. Some directors seem to automatically assume this role. However, careful consideration is required because this role can influence promotion [1-5]. Directors, already promoted, should help staff members secure this role if they have contributed sufficiently. Lastly, the department director should clearly state the authorship policy to foster transparency and reduce stress, which supports Hashimoto et al.'s emphasis on authorship translucency. I used case reports because they are typically authored within a single department and are easier to analyze. These proposals may hold true beyond OBGYN and Japan. While we wait the establishment of international standards for authorship as Hashimoto et al. stated, directors should not hide behind traditional habits but take responsibility for fairer practices. These three proposals may enhance academic integrity. Shigeki Matsubara designed this study, and wrote, edited, and approved the final manuscript. Shigeki Matsubara meets the ICMJE criteria for authorship. The author has nothing to report. The author has nothing to report. The author has nothing to report. The author declares no conflicts of interest. Data sharing is not applicable to this article as no new data were created or analyzed in this study.