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

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.

Three patterns generate the most consistent reviewer concerns we see at JAMA Internal Medicine.

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.

This page was created from JAMA Network's public author guidance at jamanetwork.com/journals/jamainternalmedicine/pages/instructions-for-authors, 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.

For the JAMA Network internal-medicine landscape beyond JAMA Internal Medicine, see JAMA Network Open (broader open-access), JAMA (top general-medicine), and JAMA specialty titles (JAMA Cardiology, JAMA Oncology). The choice across these titles depends on whether the central contribution is broad-internal-medicine (JAMA Internal Medicine), broader-clinical-medicine (JAMA), open-access (JAMA Network Open), or subspecialty-focused (JAMA Cardiology, JAMA Oncology).

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.