We conducted a prospective 9-month survey to assess the refereeing work load of British Medical Journal referees, and, in particular, to compare the work loads of pediatricians and psychiatrists. Referees completed a record form for each manuscript reviewed and a questionnaire on demographic characteristics and attitudes toward refereeing. Two hundred eleven referees formed a sample of one sixth of the British Medical Journal's active referees; all remaining pediatricians (n = 67) and psychiatrists (n = 65) formed two further samples. Of the 343 referees selected, 301 returned forms or questionnaires. One hundred forty-six referees were editors or on editorial boards. They reviewed for a mean of five journals. They reviewed 1980 manuscripts (a median of 6 for the main sample, 6.5 for the pediatricians, and 8 for the psychiatrists). Most manuscripts were reviewed for journals in the referee's own specialty; only one third were reviewed for other journals. Psychiatrists did significantly more work for general journals than pediatricians (13% vs 9%). All three groups spent less than 2 hours per manuscript.