Planning a medical book

Planning a medical book means defining its readers, purpose and market before committing to the manuscript. A proposal turns that plan into a project a publisher can assess, with scope, length, delivery, rights and payment agreed before the full work begins.

Purpose, readers and market

Medical textbooks support organised learning, reference books support looking up information, and enrichment books offer pleasure and personal growth for medical readers, general readers or both. ¹ Trade books address general readers, while academic and professional publishing serves smaller, specialised audiences. ^{1, 2, 3} Edited books contain contributions coordinated by editors, whereas authored books are written by one person or a small team whose names appear as authors. ¹ An anthology or proceedings volume may offer less editorial control over content and style than an edited reference book. ¹

Before writing, four questions need detailed, researched answers. ⁴

1. What is the book about?
2. Who is it for?
3. Why is it needed?
4. Does the author have the knowledge, ability and, especially, time to write it?

⁴

A short descriptive title and a description no longer than a paragraph help define the idea. ⁵ The market assessment should consider both primary and secondary audiences, including other health disciplines and other countries, and estimate their size for the publisher. ⁶ A 2007 planning estimate suggested that a publisher might need at least 1,000 sales for a reasonably priced book and a potential audience 10–20 times larger. ⁶

Competing titles should be researched in bookshops, libraries and online catalogues, recording their scope, strengths, weaknesses, age and price. ⁷ Authors should aim to create a book they would like to read. ⁸ A desired book still needs purchasers: Robert Taylor's illustrated history Why Doctors Give Children Shots found no publisher because the children were too young to read it, their parents were not interested enough, and clinicians found it too consumer-oriented. ⁹

For an edited book, the minimum plan includes the following. ¹⁰

• A compelling need.
• A clear idea of who will buy it.
• Overall length.
• Chapter numbers and titles.
• A short account of each chapter's contents.
• Potential authors.
• The time and commitment required.

¹⁰

A focused book can combine a group of health problems with an age group, gender, location or specialty, while another large reference book may present an unattractive financial risk in a crowded market. ¹⁰ Organising a clinical book by diagnoses differs from organising it by presenting symptoms or signs; patients present with complaints, but contributors are easier to recruit for diseases than for clinical presentations. ¹⁰

A detailed contents outline should place chapters coherently, establish subheadings and any recurring chapter structure, and specify tone, style and reference arrangements; colleagues can review it before extensive drafting. ¹¹

Publisher and acquisitions editor

A publisher's subject list and production capabilities should match the project, such as illustrated specialties or primary care. ¹² Smaller publishers may offer niche access, professional prestige and closer author relationships; size alone does not establish quality. ⁷ Authors should examine design, copyediting and print quality and ask colleagues about their experience. ⁷ Focused enrichment books with modest potential sales may suit university presses, specialty societies or smaller publishers. ¹³

The commissioning editor, called an acquisitions editor in the United States, is normally the relevant contact. ¹⁴ An acquisitions editor can offer a contract with the publisher’s approval. ¹² Publisher websites, telephone enquiries and exhibits at specialist meetings can help locate that person; an appointment arranged before a meeting can be useful. ¹² An early discussion can identify competing projects, market concerns or ways to modify the concept. ¹⁵ An informal enquiry is appropriate if the subject's fit is uncertain, but publishers generally want a formal proposal and may provide specific instructions. ¹⁴

A 2018 account described most trade publishers as accepting submissions through recognised literary agents, while professional medical publishing had no literary agents known to the author. ¹⁶ Advice for nonfiction authors in 2012 favoured an agent, arguing that negotiating help could outweigh the agent's 15% share. ¹⁷ An invitation from a publisher still requires evaluating the project as carefully as an author-originated idea. ^{3, 4}

The proposal

Authors should normally approach a publisher before writing the entire book, because editors usually want to help develop its concept and style. ^{13, 16, 14} Even after an enthusiastic discussion, the acquisitions editor needs a complete, polished proposal to advocate for the project at internal approval meetings. ¹⁸

A scientific, technical or medical book proposal should ideally include the following. ¹⁴

1. Book title.
2. Author details, CV and publication list showing writing experience.
3. Description of the book.
4. Description and, if known, size of the market.
5. Chapter titles and brief descriptions.
6. Estimated word count.
7. Estimated number of illustrations and photographs.
8. Colour requirements.
9. Proposed completion date.
10. Competing titles and distinguishing features.
11. Potential proposal reviewers.
12. Sample chapter.

¹⁴

A second proposal specification separates the cover letter, supporting documents and desirable additions. ¹⁹

Part	Contents
Cover letter	Title and subtitle; anticipated single-spaced manuscript pages; number of tables and figures; purchasing audience; principal competitors and differences; qualifications to write or edit; anticipated submission date.
Supporting documents	Description of intent and scope; table of contents; sample chapter demonstrating style and ability; CV.
Optional but desirable	Expanded outline with headings and subheadings; annotated table of contents describing each chapter.

¹⁹

For nonfiction proposals, seven elements have distinct selling purposes. ¹⁷

1. Overview: sell the idea, the author's suitability and the author's platform.
2. Contents: provide enough detail to sell the book.
3. Sample chapter: may be optional if the contents are sufficiently detailed.
4. Marketing plan: explain how the book will be marketed, ideally with a hired publicist.
5. Audience description: establish that readers exist.
6. Competitor list: demonstrate an existing market, since publishers resist entirely new genres.
7. Foreword or cover-blurb contributors: demonstrate connections and the ability to attract support.

¹⁷

An author platform communicates expertise to a viable readership through existing web presence, speaking, teaching, media contacts, published articles and other means of making the author and future books known. ²⁰

Authors approaching several publishers simultaneously should disclose the parallel consideration. ¹⁴ Assessment may involve editorial, production, sales, marketing and external reviewers and can take months; even rejection feedback may help improve a subsequent proposal. ¹⁴ Potential collaborators can be found among existing professional contacts, including researchers whose studies might support a book. ¹⁷

Contract and payment arrangements

A publisher may have several standard contracts, and terms can be negotiable. ¹⁹ Obligations for authors, editors and chapter contributors differ. ^{21, 19} The agreement should address format, delivery, financial terms, rights, publisher obligations, termination and reversion, including future editions, languages, territories and electronic publication. ²¹ Publisher obligations can include attribution and a commitment to publish within a specified period; progress should be communicated if delivery dates need adjustment. ²¹

Copyright practice is described differently at different dates: a 2007 account discouraged complete assignment and described retained copyright with a limited publishing licence as increasingly common; a 2018 account described publisher ownership with possible return of rights or a new edition when a book went out of print. ^{21, 19}

Six items in the 2018 contract guidance require particular attention. ¹⁹

1. Royalties: distinguish a percentage of retail sales from a percentage of publisher net receipts; 10% of net receipts can be much less than 10% of retail sales, with foreign sales historically paying less.
2. Advances: request an advance against royalties, recognising that inexperienced authors may have less bargaining power and that failure to deliver requires repayment.
3. Preparation costs: seek publisher payment for figures and indexing, or an allowance for extensive artwork; without agreement, costs may be charged to the author.
4. Author copies: the contract may provide 6–20 copies, and an edited-book contract should also provide a copy sent directly to each contributor without cost to the editor.
5. Excessive proof corrections: rewriting beyond an allowance can be charged against royalties.
6. Hold-harmless provisions: these can place responsibility on the author for damages associated with libel, slander or errors causing patient injury or death.

¹⁹

Authors may receive a fee or, more commonly, royalties. ²² Royalty bases, thresholds, schedules, advances, electronic rights and divisions between co-authors or editors should be clear, along with expenses, equipment support and complimentary copies. ²² A 2007 account put publisher receipts at around 65% of list price, author royalties commonly at 10% of receipts, varying from 5% to 15%, and edited-volume royalties typically at 5%, usually paid once or twice yearly. ²² In its worked example, £500 on signing and £500 on delivery are recouped from royalties, with no further payment until earned royalties exceed £1,000. ²²

A 2012 account described advances paid in three or four instalments: after signing, after manuscript acceptance, and after publication, with separate publication payments where hardcover precedes paperback. ¹⁷ The full manuscript is written between the first and second payments, and graphics or index costs may also come from the advance. ¹⁷ Agreed length matters because publishers set prices using length, competition and audience price points; failing to deliver a specified 150-page book can result in cancellation. ¹⁷

Commitment and a workable writing plan

Books rarely make their authors rich, but can strengthen professional recognition, career prospects, expert standing, invitations to write or speak and perhaps patient referrals. ^{23, 24, 16, 25} A Society of Authors survey in 2000 found 61% of members earned less than £10,000 annually from writing; one textbook author calculated earnings below 50p per working hour. ²⁴

Three planning tips apply. ²⁵

1. Write about something that inspires passion.
2. Set goals for length and timeline.
3. Attend to what buyers notice: the title, front and back covers and contents.

²⁵

Planning estimates in 2018 allowed around two years for an edited book if all went well, with concentrated recruitment, manuscript editing and proofreading periods, and 10–12 months from contract for an authored book, possibly optimistically. ^{10, 13} Writing takes substantial spare time and commitment, and abandoning an edited project after colleagues have contributed can damage relationships and reputation. ²⁶

Achievable chapter goals can help sustain work: examples include a 6,000-word chapter each month or completing one chapter monthly through regular short sessions. ^{17, 21} Consecutive chapters should be shown to a trusted colleague to detect drift in direction or style. ²⁷ Another drafting approach starts with headings and topics the author can discuss without notes for 20–30 minutes, records those discussions, then uses edited and reorganised transcripts as a starting manuscript. ^{28, 29, 30}

Publishing takes research, networking, patience and persistence, including repeated rejection. ^{31, 32} Relationships with contributors and medical editors remain valuable as editors move between publishing companies and can help secure consideration of later projects. ³³ A good idea can overcome limited experience: Howard Conn repeatedly sought a publisher until an acquisitions editor championed Conn's Current Therapy, first published in 1949 and selling over a million copies by his death in 1982. ³⁴

Assumptions to question

Ten assumptions were identified as myths in 2012 nonfiction publishing advice. ³⁵

1. A book will make lots of money.
2. The book should be written before finding a publisher.
3. An agent is unnecessary.
4. A cover letter and contents alone will sell the book.
5. Ghostwriting is forbidden.
6. A proposal can be written free for an author in exchange for payment if the book sells.
7. Doctors and co-authors are easy to work with.
8. A year should be blocked off to write a book.
9. Great content alone will sell the book.
10. Selling a book is easy.

³⁵