Objectives: We aimed to assess journal authors' current knowledge and perceptions of open access and author-pays publishing. Design: An electronic survey. Setting: Authors of research papers submitted to BMJ, Archives of Disease in Childhood, and Journal of Medical Genetics in 2004. Main outcome measures: Familiarity with and perceptions of open access and author-pays publishing. Results: 468/1113 (42%) responded. Prior to definitions being provided, 47% (222/468) and 38% (176/468) reported they were familiar with the terms 'open access' and 'author-pays' publishing, respectively. Some who did not at first recognize the terms, did claim to recognize them when they were defined. Only 10% (49/468) had submitted to an author-pays journal. Compared with non-open access subscription-based journals, 35% agreed that open access author-pays journals have a greater capacity to publish more content making it easier to get published, 27% thought they had lower impact factors, 31% thought they had taster and more timely publicaitons, and 46% agreed that people will think anyone can pay to get published. 55% (256/468) thought they would not continue to submit to their respective journal if it became open access and charged, largely because of the reputaiton of the journals. Half (54%, 255/468) said open access has 'no impact' or was 'low priority' in their submission decisions. Two-thirds (66%, 308/468) said they would prefer to submit to a non-open access subscription-based journal than an open access author-pays journal. Over half thought they would have to make a contribution or pay the full cost of an author charge (56%, 262/468). Conclusions: The survey yielded useful information about respondents' knowledge and perceptions of these publishing models. Authors have limited familiarity with the concept of open-access publishing and surrounding issues. Currently, open access policies have little impact on authors' decision of where to submit papers.