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

JAMA operates the editor-in-chief + deputy editor + associate editor tiered model. JAMA's editor-in-chief and deputy editors, with input from associate editors who are practicing academic physicians, assess methodological rigor, general-medicine relevance, and reporting quality. A deputy editor at JAMA typically handles 80 to 120 manuscripts per quarter and spends 30 to 90 minutes on the initial read; associate editors are practicing academic physicians who provide subspecialty expertise during the triage discussion.

JAMA editorial culture is decisive: the editor-in-chief + deputy editor + associate editor tiered model produces one of the highest desk rejection rates among top general medical journals. Papers that pass the JAMA tiered triage have cleared the steepest filter in AMA-tier general-medicine publishing.

Before the paper reaches external reviewers, the JAMA editor-in-chief and deputy editors make triage decisions with input from associate editors. With over 6,000 submissions per year and a sub-10 percent acceptance rate, JAMA's tiered triage produces one of the highest desk rejection rates among top general medical journals. 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.

In ScholarOne, the JAMA editorial office confirms that the submission package is complete before senior editors spend time on it. For clinical trials, that means the manuscript, figures, supplementary files, CONSORT checklist, trial registration, protocol or statistical analysis plan where requested, conflict-of-interest forms, IRB or ethics approval, data-sharing statement, and author disclosures all need to line up. For observational studies and reviews, the same administrative screen checks STROBE or PRISMA alignment, table and figure files, cover-letter routing, and whether the Methods section supports the checklist entries.

The deputy editor reads the paper and evaluates methodological rigor, general-medicine relevance, and reporting quality. JAMA's tiered editorial model means triage decisions can involve consultation with the editor-in-chief for high-stakes papers.

In parallel with the deputy editor's primary read, the deputy editor may consult with an associate editor (a practicing academic physician with subspecialty expertise) for input on clinical relevance and methodological rigor specific to the subspecialty. This associate-editor input runs alongside the deputy editor's read and adds 3 to 7 days to the timeline that is invisible to the author in the portal.

JAMA's in-house statistical editors read the reporting checklists. Roughly 30 percent of papers reviewed have reporting checklist problems significant enough to trigger a desk reject or an immediate request for revision before review even begins. The strongest manuscripts complete the CONSORT, STROBE, or PRISMA checklist fully before submission.

JAMA associate editors typically invite at least 2 external peer reviewers. The recruitment window can take 7 to 14 days because reviewers with topic-matched clinical expertise are scarce.

Once reviewers agree to review, the typical JAMA peer-review cycle lasts 2 to 6 weeks per reviewer. Reviewers are asked to evaluate methodological rigor, general-medicine relevance, statistical methodology, and reproducibility. Reviewer reports for JAMA tend to be thorough; 2500 to 5000 word reports are typical given the high-stakes editorial decision.

After reports return, the associate editor synthesizes them and presents the case at the senior editorial team review. Final accept/R&R/reject decisions require senior editorial team agreement at JAMA.

• Rejection within 1 to 7 days: EIC + deputy editor triage rejection for general-medicine readership fit.

• Rejection within 7 to 21 days: Associate editor desk rejection or in-house statistical reviewer flag.

• Still Under Review after 3 weeks: Strong signal. Paper passed the tiered triage and statistical review.

• Still Under Review after 12 weeks: Reviewer-recruitment or reviewer-report delay. A polite inquiry via the ScholarOne portal is appropriate.

• Status changes to "Editorial Discussion": Reports are in; expect a decision within 2 to 3 weeks after senior editorial review.

This is the most common anxiety we hear from JAMA authors during the active editorial window. The honest answer: no, 8 weeks at Under Review puts you in the early-to-middle portion of JAMA's active review distribution for standard submissions. Reports may still be arriving with the associate editor preparing for senior editorial team review.

Most reviewer-driven delays come from reviewer-recruitment timing rather than slow reviews because JAMA recruits topic-matched clinical-expertise reviewers who are scarce. If the portal still says Under Review at the 12-week mark, the most likely explanation is that one of the assigned reviewers asked for an extension and the associate editor granted it. This is normal practice at JAMA.

What you should NOT do during the 8-to-12-week window is email the editorial office. JAMA associate editors are practicing academic physicians managing 30+ active papers around their own clinical practice; an inquiry at 8 weeks adds friction without accelerating the timeline.

If your JAMA paper is rejected after review, the natural cascade depends on what the reviewers and associate editor 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 supports manuscript-transfer with reviewer reports preserved.

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 asks reviewers to evaluate four things specifically. 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 with a statistical-review culture.

The manuscript has to make a general clinical audience care, and it has to make the statistical editor 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 EIC + deputy editor triage. When the introduction frames the work too narrowly without general-medicine readership relevance, JAMA EIC + deputy editor triage rejection within 7 to 14 days 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 at in-house statistical review. When the CONSORT, STROBE, PRISMA, or ARRIVE checklist is incomplete or items say "see Methods" without actual Methods coverage, JAMA's in-house statistical editors can trigger a desk reject or an immediate request for revision before peer review even begins. 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 offers from associate editor. When the associate editor concludes the work is rigorous but the general-medicine readership fit of JAMA flagship is not met, transfer offers to JAMA Network Open or a JAMA specialty journal are common. 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 deputy editors, associate editors, statistical editors, and outside reviewers flag during first review. 60-day money-back guarantee. We do not train AI on your manuscript and delete it within 24 hours.

This page was created from JAMA's public Instructions for Authors at Jamanetwork author instructions, JAMA Network editorial documentation (6,000+ submissions/year, sub-10 percent acceptance, EIC + deputy editor + associate editor tiered triage, 30 percent checklist-flagged at in-house statistical review), 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 deputy-editor notes, statistical-review comments, or reviewer-invitation timing for a specific manuscript. Official guidance covers the visible workflow; the added Manusights layer comes from the 100 most recent status-anxiety manuscripts our team reviewed 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).

Reviewers at JAMA typically draw from one clinical specialist and one methodologist or biostatistician. Editors screen and triage manuscripts before any external reviewer sees them, with the in-house statistical review providing an additional layer of methodology evaluation. 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 at the in-house statistical review.