JAMA 'Under Review': What Each Status Means and When to Expect a Decision
If your JAMA submission shows Under Review, here is what each status means, how long each stage typically takes, and when a follow-up is reasonable.
Associate Professor, Clinical Medicine & Public Health
Author context
Specializes in clinical and epidemiological research publishing, with direct experience preparing manuscripts for NEJM, JAMA, BMJ, and The Lancet.
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Decision cue: JAMA is one of the fastest top-tier medical journals. The median time from submission to first decision is roughly 14 days. If your paper shows "Under Review," it has already passed the editorial screen that rejects about 85% of submissions. That is a very strong signal. Most JAMA decisions after review arrive quickly.
Quick answer
JAMA desk rejects approximately 85% of submissions within 1 to 2 weeks. Papers that pass go to 2 to 3 reviewers plus a statistical reviewer. The acceptance rate is about 5 to 7%. If your paper has moved to "Under Review," you are in a small minority of submissions that editors considered worthy of external evaluation.
The total first decision time is roughly 14 days from submission, which is remarkably fast for a journal of this selectivity.
JAMA's review pipeline
Status | What is happening | Typical duration |
|---|---|---|
Received | Administrative processing | 1 to 2 days |
With Editor | Editor assessing for desk decision | 3 to 7 days |
Under Review | Sent to external reviewers + statistical reviewer | 1 to 3 weeks |
Awaiting Decision | Editor reviewing reports | 2 to 5 days |
Decision Made | Check email | Same day |
The desk screen (~85% rejected)
JAMA receives thousands of submissions per year and accepts only 5 to 7%. The desk rejection rate is approximately 85%, making it one of the most aggressive editorial filters among top medical journals.
Editors are evaluating:
- does the study directly change clinical practice in the United States and internationally?
- is the study design appropriate and strong enough for the claims?
- is the topic of interest to JAMA's broad physician readership across all specialties?
- does the result add something genuinely new to clinical medicine?
Most desk rejections arrive within 5 to 10 days. The feedback is typically brief. JAMA may suggest a JAMA Network journal (JAMA Internal Medicine, JAMA Cardiology, JAMA Oncology, etc.) as a more appropriate venue.
If your paper has passed this screen and shows "Under Review," you have cleared the hardest filter.
What happens during peer review
Papers that pass the desk go to 2 to 3 clinical expert reviewers plus an independent statistical reviewer. JAMA's statistical review is rigorous and evaluates the analytical methods independently from the clinical reviewers.
Reviewers evaluate:
- originality and clinical significance
- study design, methodology, and execution
- appropriateness and correctness of statistical analysis
- whether conclusions are supported by the data
- relevance to JAMA's general medical readership
JAMA asks reviewers to return reports quickly, which is why the total decision time is so short. Most reviewers respond within 1 to 2 weeks.
Understanding the decision
- Accept: very rare on first round. Almost all JAMA acceptances follow revision.
- Minor revision: specific changes needed. Typically formatting, clarification, or minor analytical adjustments. Strong signal of eventual acceptance.
- Major revision: substantive concerns. The statistical review results are included. May require additional analyses or extended discussion of limitations.
- Reject after review: the reviewers or statistical reviewer identified problems that cannot be adequately addressed. The decision letter includes detailed feedback.
When to follow up
Situation | Action |
|---|---|
With Editor for 7 to 10 days | Normal desk review. Wait. |
Under Review for 14 days | Normal. JAMA is fast. |
Under Review for 21+ days | Slightly slower than typical. Polite inquiry reasonable. |
No status change for 14+ days | Contact the editorial office. |
What makes JAMA's process distinctive
The statistical review
JAMA sends every research manuscript to an independent statistical reviewer in addition to clinical peer reviewers. This is more rigorous than most journals. The statistical reviewer evaluates sample size calculations, analytical methods, missing data handling, and whether the statistical reporting meets JAMA's standards.
Authors should prepare for statistical questions that their clinical reviewers might not raise. Common statistical review feedback includes: requests for confidence intervals instead of (or in addition to) p-values, questions about multiple comparisons corrections, concerns about sensitivity analyses for missing data, and requests for effect size reporting.
The JAMA Network transfer option
If JAMA editors reject the paper, they may suggest transfer to a JAMA Network specialty journal. The JAMA Network includes JAMA Internal Medicine, JAMA Cardiology, JAMA Oncology, JAMA Neurology, JAMA Psychiatry, JAMA Surgery, JAMA Dermatology, JAMA Ophthalmology, JAMA Otolaryngology, and JAMA Pediatrics.
A transfer preserves the manuscript context and sometimes reviewer reports. This is often a better path than starting fresh at a completely new journal. The specialty JAMA journals carry strong impact factors and are well-regarded within their respective fields.
How JAMA compares for status tracking
Feature | JAMA | |||
|---|---|---|---|---|
Desk rejection | ~85% | ~90% | ~70% | ~80% |
Median first decision | ~14 days | ~21 days | ~17 days | ~21 to 28 days |
Statistical review | Yes, independent | Yes | Yes | Yes |
Transfer network | JAMA Network (10+ specialty journals) | No formal network | BMJ family journals | Lancet specialty journals |
Best for | US and international clinical practice | Highest-impact clinical trials | International clinical practice | Global health + clinical |
What to do while waiting
- JAMA's process is fast enough that long waits are unusual
- prepare for statistical review feedback that may require additional analyses
- if JAMA suggests a JAMA Network transfer, evaluate the suggestion seriously
- do not submit elsewhere while under review
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Sources
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Reference library
Use the core publishing datasets alongside this guide
This article answers one part of the publishing decision. The reference library covers the recurring questions that usually come next: how selective journals are, how long review takes, and what the submission requirements look like across journals.
Dataset / reference guide
Peer Review Timelines by Journal
Reference-grade journal timeline data that authors, labs, and writing centers can cite when discussing realistic review timing.
Dataset / benchmark
Biomedical Journal Acceptance Rates
A field-organized acceptance-rate guide that works as a neutral benchmark when authors are deciding how selective to target.
Reference table
Journal Submission Specs
A high-utility submission table covering word limits, figure caps, reference limits, and formatting expectations.
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