A JRSM reader recently told me that she was switching back to the print publication because visiting the website (jrsm.rsmjournals.com) to read JRSM wasn't part of her routine and was never likely to be. The only way to read JRSM, then, was to pick up the print edition. We know visitors to journal websites are usually seeking specific information, a particular article that they have discovered via a web search. They may not necessarily be regular readers of your journal, and have no particular loyalty to it. Reading one article is unlikely to convert them into regular readers. The first challenge for journals, therefore, is to develop online services that will be valuable to readers and are not possible in print. Despite radio, television, the Internet, and now Kindle, people still enjoy reading a book or a journal in print. Will print journals ever disappear entirely? Many will die – eventually – but plenty will survive to satisfy our desire for touching words on a page. The journals that endure will publish much else besides research. They will major on editorials, essays and reviews. They will synthesize knowledge for a community instead of publishing random bites of information. They will also need to entertain. The second challenge for journals, therefore, is to develop a print version that will be valuable to readers without publishing research. None of this is new, these prophecies have been written for more than a decade, but the challenge is more immediate. Online-only journals, many with an author-pays model like JRSM Short Reports (shortreports.rsmjournals.com), are attracting a larger number of submissions. Their value is in publishing research quickly and being less selective about their publication policies. JRSM Short Reports is now on PubMed Central and we have applied for full indexing. The online world is moving rapidly in terms of publication of research. Meanwhile, the print world is more sedate but it needs to quicken its speed of change. Bigger, richer, weekly journals have sufficient resources to adapt and have an in built inertia that can weather the winds of change. The predicament is more acute for smaller journals, and their battle for survival, because of the laws of economics, will become more acute. These are dangerous times. JRSM floats somewhere between the big beasts of the publishing ocean and the minnows battling for survival, although our aspiration is to swim with big beasts rather than be consumed like minnows. As such, we are considering the next stage in the evolution of both print and online versions of JRSM. We have many ideas for development but we welcome suggestions from JRSM readers about how the journal might better serve their needs in print and online while positioning itself cleverly for the future of medical journals.