Is it based on who contributed the most? How is this determined? Is it alphabetical? If so then someone with an A last name can contribute barely anything and everyone will still call it “Alberts et. al”
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Most medical journals have rules regarding who can claim authorship on a paper, and the authors work it out amongst themselves, ideally at the beginning of the project…
If the study is your idea AND you do the bulk of the work, you will generally be first author. If the study is your idea and you pass the framework off to others to do the legwork, and you remain involved as an editor and to some extent referee, you may end up as the senior/last author. In academic medicine, first, second, and last author generally have some relevance for recognition in the academic community.
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