JAMA Internal Medicine 'Under Review': What Each Status Means

JAMA Internal Medicine operates the JAMA Network deputy editor model with parallel statistical review for clinical-trial submissions and complex observational studies. The deputy editor reads the entire paper and evaluates scope fit, novelty, and basic quality during the desk-screen stage. A deputy editor at JAMA Internal Medicine typically handles 50 to 80 manuscripts per quarter and spends 30 to 60 minutes on the initial read. The 2-day median first decision at JAMA Internal Medicine is among the fastest desk decisions at JAMA Network, reflecting decisive editorial culture.

JAMA Network editorial culture at JAMA Internal Medicine is decisive: most rejections happen at the deputy editor read within 1 to 3 weeks, with the median desk decision arriving in 2 days. Papers that pass the deputy editor stage have cleared the steepest filter at JAMA Network's internal medicine flagship.

Before the paper reaches external reviewers, a JAMA Network deputy editor at JAMA Internal Medicine evaluates whether the broad-internal-medicine significance warrants JAMA Internal Medicine's selective editorial slots. The 2-day median first decision reflects the fast desk-rejection cadence: roughly 85 to 90 percent of submissions are rejected at this stage. A desk rejection most often means the deputy editor concluded that the work would fit better at a sister JAMA Network title (JAMA Network Open, JAMA) or that the broad-internal-medicine audience appeal is uncertain.

The JAMA Network editorial office confirms files are complete: manuscript with figures embedded, supplementary information separate, reporting checklists where applicable (CONSORT for clinical trials, STROBE for observational studies, PRISMA for systematic reviews, STARD for diagnostic-accuracy studies, SQUIRE for quality-improvement reports), cover letter directed to the editor, conflict-of-interest declarations, ethics-statement documentation, IRB approvals, trial-registration documentation (JAMA Network requires registered clinical trials), and statistical analysis plan for clinical-trial submissions.

The deputy editor reads the paper and evaluates broad-internal-medicine significance, novelty, basic-quality threshold, and broad-clinical audience fit. The 2-day median desk decision at JAMA Internal Medicine is fast even by JAMA Network standards.

In parallel with the deputy editor's primary read, clinical-trial submissions and complex observational studies are routed to JAMA Network in-house statistical reviewers who evaluate trial design, pre-specification compliance, statistical methods, and reporting completeness. This statistical-review stage runs alongside the external reviewer recruitment and contributes to JAMA Internal Medicine's reputation for methodological rigor.

JAMA Network deputy editors at JAMA Internal Medicine typically invite 2 to 3 external reviewers. Common delay causes during recruitment include slow reviewer recruitment for specialized topics and split reviewer opinions requiring additional reviewers.

Once reviewers agree to review, the typical JAMA Internal Medicine peer-review cycle lasts 2 to 3 weeks per reviewer, contributing to the 39-day median first-decision-with-review target. Reviewers are asked to evaluate broad-internal-medicine significance, trial design and rigor, statistical methodology, and reproducibility. Reviewer reports for JAMA Internal Medicine tend to be thorough.

After reports return, the deputy editor synthesizes them and consults with statistical reviewers for clinical-trial papers before issuing a decision. The 39-day median first-decision-with-review target reflects the combined recruitment-review-synthesis cycle.

• Rejection within 1 to 3 days: Deputy editor desk rejection. The 2-day median desk decision means most rejections happen here.

• Rejection within 1 to 2 weeks: Late deputy editor desk rejection after internal consultation.

• Still Under Review after 3 weeks: Strong signal. Paper passed the steepest JAMA Network filter.

• Still Under Review after 8 weeks: Reviewer-recruitment or reviewer-report delay despite the 39-day median target. A polite inquiry via the submission portal is appropriate.

• Status changes to "Reports Received": Reports are in; expect a decision within 1 to 2 weeks.

This is the most common anxiety we hear from JAMA Internal Medicine authors during the active editorial window. The honest answer: no, 5 weeks at Under Review puts you right at JAMA Internal Medicine's 39-day median with-review target. Reports may already be in editorial synthesis with the deputy editor preparing a recommendation. Most reviewer-driven delays come from reviewer-recruitment timing for internal-medicine specialists rather than slow reviews.

If the portal still says Under Review at the 7-week mark, the most likely explanation is that one of the assigned reviewers asked for an extension and the deputy editor granted it, or that the deputy editor invited a third reviewer to break a split opinion. This is normal practice at JAMA Network.

What you should NOT do during the 5-to-7-week window is email the editorial office. JAMA Network deputy editors at JAMA Internal Medicine are managing 50+ active papers; an inquiry at 5 weeks adds friction without accelerating the timeline.

If your JAMA Internal Medicine paper is rejected after review, the natural cascade depends on what the reviewers and deputy editor cited:

JAMA Network Open is the most natural JAMA Network cascade because JAMA Network supports manuscript-transfer where the receiving editor can request reviewer reports from JAMA Internal Medicine, preserving substantial peer-review work. JAMA Network Open has a broader scope and an open-access publishing model. The transfer process takes 5 to 10 days.

JAMA is the JAMA Network cascade option for papers with broad-clinical-impact that exceeds the internal-medicine subspecialty scope. JAMA's review process is similar but with even higher selectivity.

Annals of Internal Medicine is the ACP cascade option for internal-medicine papers where the ACP clinical-practice focus fits. ACP operates independently; reports do not transfer, but Annals editors may recognize JAMA Network reviewer reports informally.

BMJ is the BMJ cascade option for broad-medical papers with international clinical-practice implications. BMJ operates independently with its own reviewer pool.

JAMA Network asks reviewers at JAMA Internal Medicine to evaluate four things specifically. The table below maps each to actionable preparation.

Across JAMA Internal Medicine manuscripts, three patterns generate the most consistent reviewer concerns we see. JAMA Internal Medicine failures are usually not about whether the study is clinically interesting at all. They are about whether the paper proves broad internal-medicine relevance, documents the reporting and statistical package, and distinguishes prespecified claims from exploratory signals.

CONSORT/STROBE-compliance gaps surface as reviewer requests for clarification. When reporting-checklist items are incomplete or trial-pre-registration alignment is unclear, JAMA Network in-house statistical reviewers consistently flag for revision. The strongest revisions add complete reporting-checklist documentation with pre-registration alignment.

Statistical analysis plan under-documented. When the pre-specified statistical analysis plan is thin or post-hoc analyses are not clearly distinguished from pre-specified analyses, JAMA Network statistical reviewers consistently request expanded methods documentation.

Broad-internal-medicine significance under-stated in framing. When the abstract and discussion do not clearly establish the broad-clinical decision that would change, deputy editors and reviewers flag general-clinical-interest concerns. The strongest manuscripts frame the abstract around the specific internal-medicine decision the paper affects.

Check whether your JAMA Internal Medicine abstract shows broad clinical relevance ->

Check whether your JAMA Internal Medicine reporting package is complete ->

Check whether your JAMA Internal Medicine statistical analysis language is aligned ->

The first repeated failure is an abstract that sounds like a specialty-journal abstract. A strong internal-medicine paper can come from cardiology, oncology, infectious diseases, endocrinology, geriatrics, primary care, or health policy, but the first paragraph still has to tell a general internal-medicine reader why the result changes a decision they recognize. We often see manuscripts that save that statement for the discussion, where it arrives too late for a deputy editor's first read.

The second failure is statistical-package incompleteness. JAMA Network statistical review can override favorable clinical interest if the trial registration, SAP, endpoint hierarchy, missing-data plan, multiplicity handling, or subgroup language is not aligned. The most efficient pre-decision work is to build a table that connects every major result to prespecification status, analysis population, missing-data treatment, and sensitivity analysis.

The third failure is overclaiming exploratory results. JAMA Internal Medicine reviewers are receptive to clinically meaningful signals, but they scrutinize whether the title, abstract, visual abstract, discussion, and conclusion distinguish primary, secondary, exploratory, and post-hoc findings. Stronger manuscripts keep the clinical implication honest while still making the patient or practice relevance unmistakable.

This page was created from JAMA Network's public author guidance at Jamanetwork author instructions, JAMA Network editorial-process documentation, JAMA Internal Medicine first-decision data (2-day median desk decision, 39 days with review), and Manusights pre-submission review experience with JAMA Internal Medicine-targeted manuscripts.

Source limitations: official guidance describes workflow mechanics, so the reviewer-risk guidance here is inferred from those sources plus Manusights manuscript-review patterns, not from private editorial records. In Manusights' manuscript-review archive, 50+ clinical, internal-medicine, public-health, and trial manuscripts turned on broad clinical framing, statistical-documentation completeness, or reporting-package readiness rather than the ScholarOne status label itself.

For the JAMA Network internal-medicine landscape beyond JAMA Internal Medicine, compare JAMA, JAMA Network Open, Annals of Internal Medicine, BMJ, and JAMA specialty titles such as JAMA Cardiology and JAMA Oncology. The choice across these titles depends on whether the central contribution is broad internal medicine, broader clinical medicine, open access, ACP practice fit, international general medicine, or subspecialty-focused.

Reviewers at JAMA Internal Medicine typically draw from one clinical internist and one methodologist or statistician (in addition to the JAMA Network in-house statistical reviewer for clinical trials). Preparing a response template that addresses both perspectives accelerates revision rounds substantially.

For a pre-upload check of your manuscript against the JAMA Internal Medicine broad-significance-plus-statistical-rigor bar before submission, our JAMA Internal Medicine pre-submission diagnostic flags the CONSORT/STROBE-compliance gaps and statistical-methodology weaknesses most likely to surface in reviewer reports.