BMJ 'Under Review': What Each Status Means and When to Expect a Decision

Before the paper reaches external reviewers, a handling editor evaluates whether the work merits further evaluation at The BMJ. BMJ says the usual reasons for rejection at this stage are insufficient originality, the absence of a message that is important to a general medical audience, or a topic outside the journal's purview, and that it lets authors know promptly if The BMJ is not the right journal. A desk rejection can mean the work fits better at another BMJ journal such as BMJ Open, and authors who chose an alternate journal at submission, or who receive an editor-led suggestion, can complete a transfer.

About half of original research articles are rejected at this first stage, and roughly two thirds of all submissions are rejected without external peer review.

BMJ's guidance lists what a research submission should carry: a research manuscript built around a clinical decision, figures uploaded as separate files, the correct EQUATOR reporting checklist, protocol or trial-registration evidence for clinical trials, author-contribution statements, a Patient and Public Involvement subsection when reporting research, competing-interest declarations, ethics approval, and a data sharing statement. For research articles submitted from 1 June 2026, BMJ also lists an open access fee of £6260 / €7490 / $8330, asked for on acceptance, so authors should confirm funder or institutional coverage while the paper is still active.

The handling editor reads the paper and evaluates general-medicine relevance, methodological rigor, and BMJ family routing. Papers rejected at this stage most often fit a specialty BMJ journal or BMJ Open better than the flagship's broad-readership bar. BMJ aims for a first decision within two or three weeks, but often the initial decision comes within a few days of submission. Papers that pass the screen move toward external peer review and patient review.

BMJ's research manuscript meeting includes a statistics editor. BMJ says it may ask for an additional detailed report from the statistics editor or another reviewer before the decision letter goes out, which can lengthen the wait. Expect the review to focus on study design, sample-size justification, multiple-testing adjustments, and missing-data handling for quantitative papers.

The BMJ Author Hub, which covers BMJ journals generally, says that for most articles a minimum of two reviews are required and that articles can be sent to multiple prospective reviewers before the required number are secured. In The BMJ's open peer review system, reviewers' names are disclosed to authors.

BMJ Author Hub says peer reviewers are given 2 weeks to submit their review once the minimum number of reviewers is secured, and that the process restarts reviewer selection if a reviewer withdraws. The BMJ operates open peer review: authors are told who reviewed their manuscript, reviewers sign their reports, and accepted research and analysis papers usually have their prepublication history posted alongside them. Reviewers are asked whether the article is important, whether it will help readers make better decisions, and, for research articles, about originality, design, methods, results, and interpretation.

The next step for your research article, if it is still in the running after peer and patient review, is full appraisal at the weekly research manuscript meeting. A statistics editor, your paper's handling editor, and four to seven research editors read and discuss the article's importance, originality, and scientific quality. Decisions usually include provisional acceptance, a request for revisions, or rejection. BMJ sends the decision letter and the meeting report as soon as possible, usually within a few days.

• Rejection within days: Normal for research papers screened out early. For 2019 submissions the median time to reject a research paper without review was 3 days.

• Rejection after 1 to 3 weeks: BMJ aims to reach a first decision within two or three weeks.

• Still Under Review after 3 weeks: Strong signal. The paper likely passed the first screen.

• Still Under Review after 8 to 10 weeks from submission: BMJ aims for a final decision within eight to 10 weeks of submission, so a polite inquiry via the ScholarOne portal or papersadmin@bmj.com is appropriate.

• After the weekly manuscript meeting: BMJ sends the decision letter and meeting report usually within a few days, longer if it asked for an additional detailed report.

This is the most common anxiety we hear from BMJ authors during the active editorial window. The honest answer: no. For 2019 submissions, BMJ reported a median of 58 days (about 8 weeks) to first decision for research papers sent for external review, and it aims for a final decision within eight to 10 weeks of submission. Reports may already be in editorial synthesis, with the paper heading to the next weekly research manuscript meeting.

Most delays come from reviewer recruitment and the manuscript meeting cycle rather than from slow reviews. If the portal still says Under Review well past the 8 to 10 week mark, a polite status inquiry is reasonable.

What you should usually NOT do during the first weeks is email the editorial office. An inquiry at 8 weeks seldom speeds up the decision.

• Do not email the editorial office during the first 6 weeks unless an urgent ethics issue surfaces.

• Do not submit the paper anywhere else while it is Under Review at The BMJ. The BMJ has explicit prohibitions on dual submission.

• Prepare a point-by-point response template for likely reviewer concerns: general-medicine relevance, statistical rigor, CONSORT compliance, reproducibility. Anticipate that reports will be public under open peer review.

• If you have related work submitted elsewhere or recently published, prepare disclosure language for when revisions are requested.

• Read recent BMJ research articles in your subfield to calibrate the current editorial bar.

• If the decision comes back as a major revision, read what a major revision at The BMJ means before replying, because the reviewer reports and your answers are published alongside the paper.

Before you cascade, decide whether the rejection is one of the few worth contesting; the BMJ rejection appeal guide sorts them by rejection type. If your BMJ paper is rejected after review, the natural cascade depends on what the reviewers and editor cited:

BMJ Open is the natural BMJ open-access cascade for clinical-research papers where the general-medicine relevance bar of The BMJ is not met but the rigor is high. BMJ supports manuscript-transfer with reviewer reports preserved.

BMJ specialty journals (Heart, Gut, Thorax, Annals of the Rheumatic Diseases, etc.) are BMJ cascades where the specialty editorial scope fits.

NEJM is the external general-medicine cascade for top-tier evidence-changes-practice clinical-research. NEJM uses ScholarOne at ScholarOne submission portal; editorial contact nejm@nejm.org.

The Lancet is the external general-medicine cascade for top-tier global-clinical-impact work. The Lancet uses Editorial Manager at Editorial Manager submission portal; editorial contact editorial@lancet.com.

JAMA is the AMA general-medicine cascade. JAMA uses ScholarOne at ScholarOne submission portal; editorial contact jama-editor@jamanetwork.org.

The BMJ asks reviewers to evaluate four things specifically. The table below maps each to actionable preparation.

Across BMJ-targeted manuscripts, three named patterns generate the most consistent reviewer concerns and the most common reasons an "Under Review" status later turns into rejection, major revision, or BMJ Open transfer. The BMJ editors first ask whether the paper matters to a broad clinical readership. Reviewers and statistical editors then test whether the methods, reporting checklist, patient relevance, and data-sharing story can support that claim.

Specialty-only framing is flagged at the BMJ editor screen. When the title, introduction, and abstract frame the work as a narrow specialty result without general-medicine readership relevance, BMJ editors often decide the paper belongs in a specialty journal or BMJ Open. The strongest BMJ manuscripts make a practicing clinician understand the decision consequence in the first page. If your first screen still reads like a specialist paper, run a Check whether your BMJ clinical relevance is clear → before the committee conversation.

Statistical methodology gaps surface before or during review. When statistical methods documentation is thin, especially sample-size justification, multiple-testing adjustments, missing-data handling, subgroup analysis, model selection, or sensitivity analysis, BMJ statistical review consistently flags concerns. The strongest revisions include pre-registration documentation, an analysis-plan crosswalk, table shells that match the protocol, and a clear explanation of deviations. If this is the weak point, use a Check your BMJ statistical-methods package → while the paper is still under review.

BMJ Open or specialty cascade language usually signals fit, not uselessness. When the handling editor concludes the work is rigorous but below The BMJ's general-medicine bar, transfer offers to BMJ Open or a specialty BMJ journal are common. In the manuscripts we review, this pattern usually appears when the evidence is credible but the cover letter, abstract, and discussion do not explain why the result changes practice across specialties.

The right preparation is a transfer-ready response file that preserves reviewer work and reframes the manuscript for the receiving journal. If you need that fallback mapped now, run a Check whether your BMJ fallback route is ready →.

This page helps BMJ authors decide whether to prepare a revision, tighten the statistical package, or plan a BMJ Open cascade while the portal is quiet. It tells you what BMJ editors look for while the manuscript is being routed or reviewed. The review tells you whether your paper passes that check before the decision arrives.

Manusights review data from BMJ and adjacent clinical-journal manuscripts shows these failure patterns repeatedly; in practice, we see committee-readiness and statistics alignment matter more than the visible ScholarOne label. 60-day money-back guarantee. Your manuscript is not used for model training, and access is limited to the review workflow.

This page was created from The BMJ's public editorial documentation at bmj.com, BMJ Author Hub tracking and review-process guidance, BMJ editorial process documentation (roughly two thirds of submissions rejected without external review, a 2019 median of 58 days to first decision for research papers, the weekly research manuscript meeting, the open peer review system), SciRev community data where available, and Manusights pre-submission review experience with BMJ-targeted manuscripts.

Official guidance covers the visible workflow; the Manusights sections add status-anxiety interpretation from recent BMJ-style manuscripts where reviewers focused on general-medicine relevance, statistics, reporting checklists, and cascade fit. Source limitation: BMJ public tracking explains where a paper is in ScholarOne, but not whether the next risk is clinical relevance, statistics, or manuscript-committee priority.

For the BMJ general-medicine landscape beyond The BMJ flagship, see BMJ Open (open-access cascade), BMJ specialty journals (Heart, Gut, Thorax, Annals of the Rheumatic Diseases for specialty editorial scope), and external general-medicine alternatives (NEJM, Lancet, JAMA, Annals of Internal Medicine).

The choice across these titles depends on whether the central contribution is top-tier general-medicine (The BMJ), BMJ open-access clinical-research (BMJ Open), specialty BMJ scope (BMJ specialty journals), top-tier evidence-changes-practice (NEJM), top-tier global-clinical-impact (Lancet), AMA general-medicine (JAMA), or internal-medicine clinical-research (Annals of Internal Medicine).

Editors screen and triage manuscripts before any external reviewer sees them, and a statistics editor attends the weekly research manuscript meeting. That meeting is a distinctive BMJ feature that ensures multi-perspective decisions. Preparing a response template that addresses general-medicine relevance, statistical methodology, and CONSORT compliance accelerates revision rounds substantially.

For a pre-upload check of your manuscript against the BMJ general-medicine-relevance-plus-weekly-committee bar before submission, our BMJ pre-submission diagnostic flags the framing and CONSORT-compliance weaknesses most likely to surface in reviewer reports.