BMJ 'Under Review': What Each Status Means and When to Expect a Decision
If your BMJ submission shows Under Review, here is what each status means, how long each stage typically takes, and when a follow-up is reasonable.
Associate Professor, Clinical Medicine & Public Health
Author context
Specializes in clinical and epidemiological research publishing, with direct experience preparing manuscripts for NEJM, JAMA, BMJ, and The Lancet.
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Decision cue: BMJ is fast by medical journal standards. The median time from submission to first decision is about 17 days. If your paper shows "Under Review," it has already passed the initial editorial screen, which rejects roughly 70% of submissions. That is a strong signal. The question now is what the reviewers find.
Quick answer
BMJ screens most submissions editorially first, desk rejecting about 70% within 1 to 2 weeks. Papers that survive go to 2 to 3 external reviewers and a statistical reviewer. The total time from submission to first decision is typically 14 to 21 days. BMJ is one of the fastest top-tier medical journals.
The acceptance rate is approximately 7%. If your paper has moved past the editorial screen to "Under Review," the probability of eventual acceptance improves substantially, though it is still not guaranteed.
BMJ's review pipeline
Status | What is happening | Typical duration |
|---|---|---|
Received | Administrative processing | 1 to 2 days |
With Editor | Editor reviewing for desk decision | 3 to 7 days |
Awaiting Reviewer Selection | Editor identifying potential reviewers | 2 to 5 days |
Awaiting Reviewer Assignment | Invited reviewers being confirmed | 2 to 5 days |
Under Review | Reviewers actively evaluating | 2 to 3 weeks |
Awaiting Third Opinion | Conflicting reviews, additional expert consulted | 1 to 2 weeks |
Decision Pending | Editor preparing recommendation | 3 to 5 days |
Decision Made | Check email | Same day |
What each status actually means
With Editor (days 1 to 7)
This is the desk screen. A BMJ editor reads the manuscript and decides whether to send it for external review. About 70% of submissions are rejected at this stage.
The editor is asking:
- does the study address a question that matters for clinical practice?
- is the study design strong enough to support the conclusions?
- will the findings change how doctors treat patients?
- is the topic relevant to BMJ's broad international clinical readership?
If you receive a desk rejection, it typically arrives within 5 to 7 days. The feedback is usually brief but indicates whether the issue was scope, significance, or design.
Awaiting Reviewer Selection / Assignment (days 5 to 14)
The editor is finding and confirming reviewers. BMJ sends papers to 2 to 3 clinical experts plus a statistical reviewer. Finding qualified reviewers who are available can take time, especially for specialized topics.
The status may alternate between "Awaiting Reviewer Selection" and "Awaiting Reviewer Assignment" as the editor invites and re-invites potential reviewers. This is normal and does not mean anything is wrong.
Under Review (days 7 to 21)
Reviewers have accepted and are actively evaluating your paper. BMJ asks reviewers to return reports within 2 weeks. Most do, which is why BMJ's overall decision time is faster than many comparable journals.
Reviewers evaluate:
- scientific validity and methodological rigor
- clinical significance and practice implications
- appropriateness of statistical methods
- quality of reporting (CONSORT, STROBE, etc.)
- clarity and accessibility for a general medical audience
BMJ also sends papers for independent statistical review. The statistical reviewer checks the analytical methods, sample size justification, and reporting of results. This review runs in parallel with the clinical reviews.
Awaiting Third Opinion (variable)
If the two primary reviewers have conflicting assessments, the editor may invite a third reviewer. This adds 1 to 2 weeks to the process. If you see this status, it means the decision is not straightforward, which can go either way.
Decision Pending (days after reviews complete)
The editor has received all reviewer reports (including statistical review) and is preparing the final decision. This stage typically takes 3 to 5 days. The editor weighs the reviews, considers the statistical review, and makes a recommendation that a senior editor signs off on.
What each decision means
Accept
Rare on first round at BMJ. Almost all acceptances follow at least one revision. If you receive an outright acceptance, the paper was exceptionally clean.
Minor Revision
Specific, addressable changes. You have 6 weeks to respond. The revision may or may not return to reviewers. This is a strong position.
Major Revision
Substantive concerns about the study or its presentation. You have 3 months. The statistical review results are included in the decision letter. The revised paper returns to the original reviewers and statistical reviewer.
Reject After Review
The reviewers found problems that the editor does not believe can be adequately addressed through revision. The decision letter includes the full reviewer reports, which are often detailed and constructive even in rejection.
Reject at Desk
The most common outcome (~70%). This is not a quality judgment. BMJ receives far more strong papers than it can publish. The editor may suggest resubmission to BMJ Open or another BMJ-family journal.
When to follow up
Situation | Action |
|---|---|
With Editor for 5 to 7 days | Normal desk review period. Wait. |
With Editor for 10+ days | The paper may be in discussion. Wait a few more days. |
Awaiting Reviewer for 14+ days | Normal; finding reviewers takes time. |
Under Review for 14 to 21 days | Normal BMJ review period. |
Under Review for 28+ days | Slightly slow. Polite inquiry is reasonable. |
No status change for 21+ days | Contact the editorial office. |
BMJ's editorial office is professional and responsive to author inquiries. Use the manuscript tracking system for status questions.
What to do while waiting
- do not submit the same paper elsewhere
- prepare for the possibility that the statistical review will flag issues you did not anticipate
- if you know of new data or a published study that is relevant to your paper, note it for potential inclusion in a revision
- BMJ's review is fast enough that the waiting period is rarely long enough to start new projects
How BMJ status tracking compares
Feature | BMJ | |||
|---|---|---|---|---|
Desk rejection rate | ~70% | ~90% | ~80% | ~85% |
Desk decision speed | 5 to 7 days | 1 to 2 weeks | 1 to 2 weeks | 1 to 2 weeks |
Status granularity | High (reviewer selection, assignment, third opinion) | Low | Low | Moderate |
Total review time | 14 to 21 days | 21 to 28 days | 21 to 28 days | ~14 days |
Statistical review | Yes, independent | Yes | Yes | Yes |
Best for | Broad clinical practice, international | Highest-impact clinical trials | Global health, policy | US-focused clinical practice |
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Sources
On this page
Reference library
Use the core publishing datasets alongside this guide
This article answers one part of the publishing decision. The reference library covers the recurring questions that usually come next: how selective journals are, how long review takes, and what the submission requirements look like across journals.
Dataset / reference guide
Peer Review Timelines by Journal
Reference-grade journal timeline data that authors, labs, and writing centers can cite when discussing realistic review timing.
Dataset / benchmark
Biomedical Journal Acceptance Rates
A field-organized acceptance-rate guide that works as a neutral benchmark when authors are deciding how selective to target.
Reference table
Journal Submission Specs
A high-utility submission table covering word limits, figure caps, reference limits, and formatting expectations.
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