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

JAMA's instructions say all submitted manuscripts are reviewed initially by one of the editors, who evaluate whether the material is original and timely, the writing is clear, the study methods are appropriate, the data are valid, the conclusions are reasonable and supported by the data, the information is important, and the topic has general interest to readers of the journal. Manuscripts with insufficient priority for publication are rejected promptly; other manuscripts are sent to expert consultants for peer review. Final decisions are made by an editor who has no relevant conflicts of interest.

JAMA accepts 10% of submissions, so papers that are sent to external review have cleared a meaningful filter.

Before a paper goes out for external review, an editor reviews it first; the JAMA With Editor status explained page walks through that screen.

Before the paper reaches external reviewers, one of JAMA's editors reviews it and can reject it promptly. JAMA accepts 10% of the more than 12,700 manuscripts it receives each year (4% of research manuscripts) and does not publish a desk-rejection rate. In our pre-submission review work, the most common desk rejection reason is not weak methodology but rather insufficient general-medicine readership fit. If the paper is wrong for the JAMA flagship, authors often learn that very quickly: the published median is 2 days.

JAMA asks for a Word manuscript prepared in AMA style, with a title page, abstract, text, references, and as appropriate figure legends and tables, plus a cover letter with complete contact information for the corresponding author. For clinical trials, the manuscript also needs the trial protocol with the complete statistical analysis plan, the CONSORT flow diagram and checklist, trial registration, and a Data Sharing Statement. For observational studies and reviews, JAMA tells authors to follow the matching EQUATOR guideline (STROBE or PRISMA, for example). After submission, every author is emailed a link to the Authorship Form, which collects conflict-of-interest disclosures and the publishing agreement.

The editor evaluates the criteria listed above: originality and timeliness, clear writing, appropriate methods, valid data, conclusions supported by the data, importance, and general interest to readers of the journal. JAMA does not publish how editorial responsibilities are divided among the editor in chief, deputy editors, and associate editors.

JAMA's published instructions do not describe a separate statistical review step or associate-editor consultation, or how long either would add. The published medians (2 days without external review, 24 days with it) are the timing figures to use.

JAMA does not publish how many reviewers it invites or how long recruitment takes. Manuscripts that are not rejected promptly are sent to expert consultants for peer review. JAMA uses a single-anonymized process: reviewer identities are kept confidential, and reviewers know who the authors are.

JAMA's median first decision for manuscripts that go to external review is 24 days. Reviewers are required to keep manuscripts confidential and are instructed not to submit confidential manuscripts into a chatbot, language model, or similar tool.

Final decisions are made by an editor who has no relevant conflicts of interest, and JAMA has a formal recusal process for editors who do. Authors are notified of decisions by email. Authors may appeal decisions; all appeals are reviewed by the editor in chief, case by case, or by a designated editor if the editor in chief is recused.

• Rejection within days: Consistent with JAMA's 2-day median for decisions without external review; often a general-medicine readership fit judgment.

• Still Under Review after 4 weeks: Past JAMA's 24-day median for a first decision with external review, which is common and not in itself a warning sign.

• Still Under Review after 12 weeks: Reviewer-recruitment or reviewer-report delay is possible. A polite inquiry that references your manuscript number is appropriate.

This is the most common anxiety we hear from JAMA authors during the active editorial window. Eight weeks is longer than JAMA's published 24-day median for a first decision with external review, but JAMA does not publish a distribution or the reasons for longer waits, so 8 weeks alone is not a reason for alarm.

Delays often come from reviewer availability. If the portal still says Under Review at the 12-week mark, one polite inquiry is reasonable.

What you should NOT do during the 8-to-12-week window is send repeated emails to the editorial office; frequent inquiries add friction without accelerating the timeline.

If your JAMA paper is rejected after review, the natural cascade depends on what the reviewers and editors cited:

JAMA Network Open is the natural JAMA Network open-access cascade for clinical-research papers where the general-medicine readership fit of JAMA flagship is not met but the rigor is high. JAMA Network lets authors preselect referral at submission, with reviewers' comments if available.

JAMA Internal Medicine is the JAMA Network cascade for internal-medicine-focused clinical-research papers.

JAMA specialty journals (JAMA Cardiology, JAMA Oncology, JAMA Neurology, JAMA Pediatrics, etc.) are JAMA Network 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.

BMJ is the British general-medicine open-access cascade.

JAMA's published editorial criteria cover four things we see authors need to prepare for. The table below maps each to actionable preparation.

Across JAMA-targeted manuscripts, three named patterns generate the most consistent reviewer concerns and the most common reasons papers miss the editorial bar or fail the desk screen.

Across 39 reviews in the Manusights pre-submission corpus for JAMA, JAMA Network Open, and peer general-medicine journals, the repeat pattern is not usually a weak clinical question; it is a weak general-medicine and statistical-readiness package. JAMA editors specifically look for general-medicine relevance, statistical rigor, reporting checklist integrity, and data-sharing clarity before a specialty result can compete. JAMA is a general-medicine journal that screens for statistical readiness.

The manuscript has to make a general clinical audience care, and it has to make reviewers comfortable that the design, checklist, and analysis plan are not being reconstructed after the fact. Many otherwise strong JAMA submissions fail because the specialty rationale is clear but the general-medicine rationale, reporting checklist, or statistical methods are not.

Specialty-only framing flagged at the initial editor review. When the introduction frames the work too narrowly without general-medicine readership relevance, an early editorial rejection is common. We see this when a manuscript is excellent for cardiology, oncology, neurology, or infectious disease readers but does not explain why the JAMA general-medicine audience should change interpretation, policy, screening, diagnosis, or treatment. The strongest manuscripts state that broader clinical implication in the abstract and first page.

Check whether your JAMA framing reaches a general-medicine reader →

Reporting checklist gaps surface during review. When the CONSORT, STROBE, PRISMA, or ARRIVE checklist is incomplete or items say "see Methods" without actual Methods coverage, editors and reviewers can raise the gap early in the process. The highest-risk manuscripts have unclear prespecified outcomes, missing-data handling, multiplicity adjustment, trial registration timing, or subgroup-analysis logic. The strongest submissions make the checklist a map to specific Methods paragraphs, tables, and figures.

Check if your JAMA checklist and statistics package are complete →

JAMA Network cascade through preselected referral. When the work is rigorous but the general-medicine readership fit of JAMA flagship is not met, authors who preselected referral can have it referred to JAMA Network Open or a JAMA specialty journal. In our JAMA-targeted reviews, the key distinction is whether the problem is audience fit or methods readiness. A strong specialty paper with a complete statistical package can transfer well; a paper with unresolved CONSORT/STROBE/PRISMA gaps usually needs repair before transfer.

Check your JAMA Network cascade route before transfer →

This guide tells you what JAMA 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. We have reviewed manuscripts targeting JAMA and peer general-medicine venues; the named patterns above are the same ones editors and outside reviewers flag during first review. 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 JAMA's public Instructions for Authors at Jamanetwork author instructions, JAMA Network editorial documentation (more than 12,700 submissions/year, 10% acceptance, 4% research acceptance, median 2 and 24 days to first decision), and Manusights pre-submission review experience with JAMA-targeted manuscripts.

Source limitation: JAMA public materials explain the author requirements and editorial model, but they do not expose editor notes, reviewer comments, or reviewer-invitation timing for a specific manuscript. Official guidance covers the visible workflow; the added Manusights layer comes from our pre-submission review work on status-anxiety manuscripts across JAMA and adjacent general-medicine venues, where the strongest predictor of author confusion was whether the abstract, checklist, and statistical methods made general-medicine readiness visible before the senior editorial discussion.

For the JAMA Network landscape beyond JAMA flagship, see JAMA Network Open (open-access cascade), JAMA Internal Medicine (internal-medicine specialty), JAMA specialty journals (JAMA Cardiology, JAMA Oncology, JAMA Neurology, JAMA Pediatrics for specialty editorial scope), and external general-medicine alternatives (NEJM, Lancet, BMJ, Annals of Internal Medicine).

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

JAMA does not publish how many reviewers a manuscript receives or who they are. Editors screen manuscripts before any external reviewer sees them. Preparing a response template that addresses general-medicine relevance, statistical methodology, and CONSORT/STROBE/PRISMA compliance accelerates revision rounds substantially.

For a pre-upload check of your manuscript against the JAMA general-medicine-relevance-plus-checklist-rigor bar before submission, our JAMA pre-submission diagnostic flags the framing and checklist-compliance weaknesses most likely to surface during review.