JAMA 'Under Review': What Each Status Means and What It Signals About Your Paper

Source: JAMA instructions for authors, editorial process documentation, April 2026.

With Editor

This is the desk screening phase. Your manuscript has been assigned to a handling editor (at JAMA, these are physician-editors with active clinical or research backgrounds) who is reading it against JAMA's editorial threshold.

JAMA's threshold is specific and unforgiving: the journal asks whether the study could directly change clinical practice. Not "could theoretically contribute to knowledge," not "advances understanding of mechanism," but "will a practicing clinician do something differently tomorrow because of this result."

The editor is evaluating:

• Clinical practice impact: Does the finding directly change what a physician does for patients? JAMA is read across all specialties, so the result needs to matter broadly, not just to subspecialists in one niche.
• Study design strength: Is the study design appropriate to support the claims? JAMA has a strong preference for RCTs, large prospective cohorts, and well-powered observational studies. Small single-center studies, case series, and preliminary findings rarely make it past the desk.
• Statistical defensibility: Even at the desk stage, JAMA editors assess whether the statistical analysis is likely to survive their independent statistical reviewer. Missing sample size justification, inappropriate tests for the data type, or unreported confidence intervals are red flags.
• Topic breadth: JAMA reaches a broad physician audience. Research relevant only to subspecialists in a narrow field belongs in a specialty journal, not JAMA.

About 85% of submissions end here, usually within 3-10 days. The desk rejection email is brief. JAMA editors sometimes suggest a more appropriate JAMA Network specialty journal (JAMA Internal Medicine, JAMA Cardiology, etc.) if the science is sound but the scope is too narrow for JAMA.

What a longer "With Editor" period means:

If you are past 10 days at this status, it does not mean rejection is imminent. Two things cause extended desk review at JAMA:

1. The paper is close to the threshold and the editor is consulting a second opinion from a senior editor or subject expert before deciding.
2. The manuscript was submitted during a period when the assigned editor had competing commitments (conferences, editorial board meetings).

Neither is a negative signal about your paper.

Under Review

Your paper has passed the desk. The editor has sent it to external peer reviewers.

JAMA sends reviewed papers to two groups simultaneously:

Clinical reviewers (2-3 experts): Active researchers or clinicians with expertise in your specific area. They evaluate the clinical significance, study design appropriateness, and whether the findings genuinely advance practice. JAMA asks reviewers to return reports within 2 weeks, though actual turnaround varies.

Independent statistical reviewer (1 reviewer): A biostatistician or epidemiologist who evaluates your methods independently from the clinical reviewers. This is JAMA's most distinctive process feature, and the one authors most frequently underestimate.

#### What the statistical reviewer is specifically checking

The statistical review at JAMA covers ground that clinical peer reviewers typically don't. Based on JAMA's published statistical guidelines and documented author revision patterns:

• Sample size and power: Was the study adequately powered? Is there a priori sample size justification? If you report a non-significant result, is the study powered to have detected a clinically meaningful effect?
• Statistical test selection: Is the statistical test appropriate for your data type and design? Applying t-tests to skewed distributions or ordinal data is a common trigger for major revision requests.
• Multiple comparisons: If you conducted multiple comparisons, did you correct for multiplicity? JAMA is strict about unadjusted secondary endpoints being presented as if they had the same evidentiary weight as primary outcomes.
• Confidence intervals: JAMA requires confidence intervals alongside (or instead of) p-values. Papers reporting only p-values without effect estimates and CIs consistently receive revision requests.
• Missing data handling: How was missing data handled? Listwise deletion without sensitivity analysis is a red flag. JAMA expects explicit missing data reporting and often requests multiple imputation for studies with substantial missingness.
• Subgroup analyses: Pre-specified versus post-hoc subgroup analyses must be clearly distinguished. Post-hoc subgroup analyses presented as pre-specified is one of the more serious problems the statistical reviewer flags.

Authors often receive revision requests about statistical issues they didn't anticipate from peer review. The statistical review runs independently, so the clinical reviewers can find the study compelling while the statistical reviewer flags a methodological concern.

#### Timeline during Under Review

JAMA's peer review is fast relative to its selectivity. The journal asks reviewers to respond within 2 weeks. Statistical reviewers typically respond faster. The main source of delay at this stage is reviewer recruitment: the editor may need to invite 5-8 potential reviewers before two or three accept.

If Under Review persists beyond 6 weeks, it usually means one reviewer is late, not that the decision is negative. A polite one-sentence inquiry to the editorial office is reasonable after 8 weeks at this status.

Awaiting Decision

All reviewer and statistical reviewer reports have been submitted. The editor is reading through them, weighing them against each other (reviewers often disagree on significance or statistical concerns), and drafting the decision letter.

This stage is brief. 3-7 days is typical. Awaiting Decision does not predict the outcome: the editor is deliberating among accept, minor revision, major revision, and reject based on the full body of reviewer input.

One scenario extends this stage: if the clinical and statistical reviewers reach conflicting conclusions on a core methodological issue, the editor sometimes brings in a third expert opinion. This can add 1-2 weeks and is not a negative sign about your paper.

Decision Made

The decision letter is in your email. If no email arrives within 24 hours:

1. Check spam and promotions folders
2. Verify the email address on your ScholarOne account matches your current inbox
3. Log back into mc.manuscriptcentral.com/jama (the decision letter may be viewable there)
4. Contact the JAMA editorial office with your manuscript number

Accept

Extremely rare on first round: under 3% of papers that reach external review at JAMA. A clean accept means the editor, clinical reviewers, and statistical reviewer all found no substantive concerns. This typically requires exceptionally clean statistical reporting, a design that preempts the standard critique points, and a clinical finding with unusually broad relevance.

Minor Revision

Specific changes: clarification of methods, adjustment of statistical reporting (confidence intervals added, p-values supplemented with effect sizes), rewording of conclusions to match data strength, or additional citations. The editor handles the revision without returning to reviewers in most cases. Address every point in your response. Turn it around in 2-3 weeks rather than using the maximum window.

Major Revision

Substantive work required: additional analyses, new sensitivity analyses, extended limitations discussion, or in some cases new data. The statistical reviewer's concerns are almost always included here. 60 days is the standard window; extensions are available for requests requiring new data.

Major revision at JAMA is not rejection. A substantial fraction of major revision papers are eventually accepted after one revision round. Read the reports to distinguish between:

• Analytical concerns from the statistical reviewer: These require actual work: running new analyses, adding missing data sensitivity analyses, correcting test selection. They cannot be argued away.
• Clinical significance concerns from peer reviewers: These can often be addressed with additional discussion, better framing of the advance, and citations to related practice-changing studies.
• Scope concerns: If reviewers suggest the finding is too narrow for JAMA, the editor usually gives you one chance to make the broader case before suggesting a JAMA Network journal.

Do not respond defensively to the statistical reviewer. Their concerns are technical, not editorial. Provide the requested analysis, explain what you did, and report the results.

Reject

Reject after desk screen: 85% of submissions. The finding was solid but didn't meet JAMA's clinical-impact threshold, or the study design was too limited for the claims. The JAMA Network transfer system is the fastest path forward.

Reject after review: Reviewers identified concerns with the study design, statistical analysis, or clinical interpretation that cannot be resolved with revision. The decision letter includes the full reviewer reports. Read the statistical reviewer's report carefully: it will be specific about what the methodological problems are. These comments are useful for revision before submitting elsewhere even if you don't transfer within the JAMA Network.

If JAMA rejects your paper, editors often suggest transfer to a JAMA Network specialty journal. The network includes 12 specialty titles:

• JAMA Internal Medicine
• JAMA Cardiology
• JAMA Oncology
• JAMA Neurology
• JAMA Psychiatry
• JAMA Surgery
• JAMA Dermatology
• JAMA Ophthalmology
• JAMA Otolaryngology
• JAMA Pediatrics
• JAMA Network Open (open access, broader scope)

Transfers preserve your manuscript files, cover letter, and sometimes reviewer reports. The receiving journal's editors evaluate the paper with full context. This is usually faster than starting a fresh submission elsewhere.

JAMA Network Open has higher acceptance rates than the specialty journals and is the right destination for methodologically sound studies that don't have the narrow specialty significance the disease-specific titles require but do represent genuine scientific advances.

In our pre-submission review work with manuscripts targeting JAMA, three failure patterns generate the most consistent desk rejections. We find these across manuscripts we've reviewed through our JAMA desk-rejection risk check, and they reliably predict which papers will clear the editorial desk.

The study that advances the field without changing practice. We observe this in roughly 40% of JAMA desk rejections we see. The research is rigorous and the finding is real, but a practicing clinician reading the abstract cannot answer "what do I do differently for my next patient?" JAMA editors specifically screen for practice-change potential. A study showing "biomarker X is associated with worse outcomes in condition Y" fails this screen; a study showing "measuring biomarker X and acting on high levels reduced mortality by 22% in a randomized trial" passes it. The difference is not quality. It is whether the clinician's behavior changes.

Missing or implicit confidence intervals. In our review work, this is the most common statistical reporting problem we flag in manuscripts targeting JAMA. JAMA's statistical guidelines explicitly require confidence intervals alongside p-values for all primary outcomes. We find that roughly 30% of manuscripts report only p-values for secondary outcomes or subgroup analyses. The statistical reviewer flags this immediately. Papers that pre-empt this request by reporting CIs throughout move through the revision cycle faster.

A results section structured as separate experiments rather than a single clinical argument. We observe this in multi-cohort or multi-endpoint papers. The paper reports five outcomes across two populations, each with its own analysis, but there is no single sentence stating what the study proves for clinical practice. JAMA editors specifically look for a single coherent finding that a physician can act on. When the results read like three loosely related analyses, editors often ask whether the paper belongs in a specialty journal where the full methodological detail can be properly contextualized.

Contact JAMA through your ScholarOne account messaging function or at jama@jamanetwork.org with your manuscript number.