Has open access in neurosurgery made access easier but sharing harder? A National survey from an LMIC (Turkey)

Open access (OA) publishing facilitates free access to knowledge. However, OA journals often demand high article processing charges (APCs), which pose significant challenges for authors from low- and middle-income countries (LMICs). This study aimed to investigate the perspectives of Turkish neurosurgeons on OA publishing, and to identify the challenges they face during the publication process. A national online survey was conducted in April-May 2025 and was completed by 210 neurosurgeons. The survey collected data on demographics, academic productivity, funding access, and opinions on OA versus hybrid publishing models. The highest participation rate was among specialists (n = 86), followed by residents (30.5%), associate professors (12.9%), professors (10.5%), and assistant professors (5.2%). In total, 43.3% reported authorship of at least one SCI-E publication in the past year. Of the 70 participants who had paid APCs, 23 obtained support for at least one manuscript, 49 fully self-funded at least one, and 15 reported adding non-contributing co-authors to reduce costs. Among those who paid alone, 28/49 stated they would not have done so if they had already achieved their target academic title. Additionally, 49.5% believed that selecting the OA option increases the likelihood of acceptance, while 30.5% anticipated a long-term decline in the quality of fully OA journals compared to hybrid ones. While OA publishing improves access to academic content, the lack of adequate funding mechanisms in LMICs hinders the ability of researchers to disseminate their findings. This imbalance may risk driving authors toward predatory journals and compromise academic integrity.