“…Medical students seeking highly competitive residencies (some say even in plastic surgery) have early on recognized that first authorship in high-impact journals will be an asset in the application process. 17,19,20 Hiring policies whether for graduate programs or into the university hierarchy, career advancement, academic promotion and tenure, and even obtaining research grants may be judged on peer-reviewed output alone, 2,7,11,15,[17][18][19]21 or impact factors or citation metrics that may find their way into the curriculum vitae, 4,7,19,21,22 as quantity is easier to measure than quality. 14 To compound the problem, department, hospital, university, or even government status and reputation may depend on just numbers alone.…”