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Does Self-Citation Influence The H-Index Among Full-Time Academic Hand Surgeons Affiliated With Fellowship Programs
Joseph Lopez, MD, MBA; Srinivas Susarla, MD, DMD, MPH; Edward W. Swanson, MD, JD Luck Luck, BA; Sami H. Tuffaha, MD; Scott D. Lifchez, MD, FACS
Johns Hopkins University School of Medicine, Baltimore, MD

Purpose: Academic promotion is based, in part, upon achievement in research. In recent years, numerous studies have linked the h-index (number of papers h with at least h citations each) to academic rank among various surgical specialists, including plastic and hand surgeons. One criticism of the h-index is its susceptibility to manipulation via self-citation. Self-citation rates in the literature have been reported to be in the range of 3-5%. Surgeons who frequently cite their own work may artificially inflate their h-index, due to its dependence on citations as a unit measure of productivity. The purpose of this study was to estimate the magnitude of self-citation among a cohort of academic hand surgeons and estimate the effect of self-citation on the h-index.
Materials and Methods: This was a cross-sectional study of full-time academic hand surgeons affiliated with fellowship programs in the United States. The primary predictor variable was the frequency of self-citation. The primary outcome of interest was the h-index. Descriptive, bivariate, and regression statistics were computed to assess the associations between self-citation and the h-index. For all analyses, a p-value < 0.05 was considered significant.
Results: The study sample was comprised of 364 full-time academic hand surgeons. Approximately 70% were members of the American Society for Surgery of the Hand (ASSH). The majority (71.4%) had primary academic appointments in Orthopedic Surgery. Eighty-five percent of the surgeons were male; nearly all (99.5%) had completed post-residency fellowship training. The average number of years since completing training was 17.4 + 11.0. Study subjects had an average of 45 + 73 publications. The mean total number of citations was 800 + 1738, the median number of self-citations was 2.5 (IQR 0-14.8), and the average frequency of self-citation was 2.2 + 3.7%. The h-index decreased as a result of self-citation in 57 surgeons (15.7%). After adjusting for ASSH status and academic rank, increasing rates of self-citation were associated with a decrease in the h-index (OR 1.4, 95% CI 1.2-1.5, p < 0.001). Surgeons with 7 or more self-citations were more likely to have their h-index influenced by self-citation.
Conclusions: The rate of self-citation among full-time academic hand surgeons affiliated with fellowship programs is comparable to rates in plastic surgery and other specialties. For the majority of surgeons, self-citation did not affect the h-index.

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