Nature Medicine 'Under Consideration': What Each Status Means and Realistic Timelines

Nature Medicine uses the same manuscript tracking platform as other Nature Portfolio journals. The status labels are deliberately vague, which means you can't read too much into any single update. Here's what the system typically shows:

The frustrating reality: "Under Consideration" and "Under Review" aren't always distinct in the system. Some authors report seeing "Under Review" appear when reviewers are assigned; others never see it at all and go straight from "Under Consideration" to "Decision in Process." Don't assume the absence of "Under Review" means anything negative.

Nature Medicine's desk rejection rate is among the highest in biomedical publishing. About 85% of submissions don't make it past the editors. That's not a typo, and it's not a reflection of the quality of science being submitted. It's a reflection of how narrow the journal's sweet spot actually is.

The editors are professional (not practicing academics), and they're looking for a very specific combination:

• Direct clinical relevance. The paper must speak to something that matters for patient care, diagnostics, or treatment. A beautiful mechanistic study that might someday have clinical implications isn't enough.
• Mechanistic depth. This is what separates Nature Medicine from purely clinical journals like NEJM or The Lancet. You can't just show that a treatment works; you need to show why it works at a biological level.
• Broad readership appeal. A finding that matters deeply to pediatric endocrinologists but wouldn't interest anyone outside that subspecialty probably won't clear the desk, no matter how strong the evidence is.
• Study design that matches the claims. Underpowered studies, retrospective analyses presented as though they were prospective, single-center findings generalized to broad populations: these are desk rejection triggers.

Here's a specific failure pattern I've seen repeatedly: a paper with excellent basic science data and a final paragraph saying "these findings may have clinical implications." That last paragraph doesn't make a basic science paper clinical. Nature Medicine editors can spot that framing from the abstract alone, and they'll reject it before reading the Methods section.

What desk rejection emails look like

They're short. Usually two to three sentences. Something along the lines of: "We've considered your manuscript carefully and concluded it isn't suitable for Nature Medicine. We suggest you consider [other journal]." Don't expect detailed feedback. With the volume they handle, they can't provide it.

If the rejection letter suggests a specific Nature Portfolio journal (Nature Communications, Nature Immunology, Nature Cancer, etc.), pay attention. The editors have a good sense of where work fits across the portfolio, and that suggestion is genuine.

Days 1 to 3: Nobody's reading it yet

Your files are being checked for completeness. Ethics statements, conflict of interest forms, cover letter, figure quality. This is administrative, not editorial. Don't refresh the portal.

Days 3 to 7: The editor is reading

A primary editor picks up your manuscript and reads it against those four criteria above. They'll often discuss it with other editors on the team, especially if the paper sits at the boundary between clinical and translational. This is the most consequential 48 to 72 hours of your submission.

Days 7 to 10: Decision zone

If you're going to be desk rejected, it almost always happens in this window. The editor has read the paper, possibly consulted a colleague, and made a call. If your status still shows "Under Consideration" on day 10, that's encouraging.

Days 10 to 14: Reviewer search

The editor is now looking for 2 to 3 reviewers who can evaluate both the clinical significance and the scientific rigor. This is harder than it sounds. Nature Medicine papers often sit at the intersection of clinical medicine and basic biology, which means the editor needs reviewers who are comfortable in both domains. It's not unusual for the first round of reviewer invitations to be declined.

Days 14 to 45: Active peer review

Reviewers typically get 2 to 3 weeks to submit reports. In practice, at least one reviewer is usually late. The editor sends reminders but won't rush the process. If all three reviewers respond on time, you might hear back by day 35. If one reviewer is slow, it could stretch to day 50 or beyond.

Days 45 to 60: Getting long but not unusual

Some Nature Medicine reviews take 8 weeks from the time the paper reaches reviewers. If your status hasn't changed after 6 weeks, something might be stuck (a reviewer dropped out, a replacement was invited), but it's still within normal range.

Beyond 60 days: Follow up

At this point, a polite inquiry is reasonable and even expected. More on how to write that email below.

This is the thing that trips up the most experienced researchers. Nature Medicine isn't just a clinical journal, and it isn't just a basic science journal. It demands both, and the bar for each is high.

I've seen two common mismatches:

The clinical researcher's mistake: A well-designed trial with clear endpoints and statistically strong outcomes, but no mechanistic insight into why the intervention works. This paper belongs at NEJM, The Lancet, or JAMA, not Nature Medicine. If you can't explain the biology, Nature Medicine's reviewers will ask for it, and the editors will agree with them.

The basic scientist's mistake: Elegant mechanistic work in disease-relevant models, with a concluding paragraph arguing for clinical translation. Unless you have actual patient data, clinical samples, or a clear bridge to human disease, this paper belongs at Nature Cell Biology, Nature Immunology, or a similar mechanistic journal.

Nature Medicine lives in the overlap. The papers that succeed here typically include both patient-derived data and mechanistic experiments, or they present clinical trial results alongside translational biology that explains the observed effects.

Reject after review

This is the most common outcome even for papers that made it past the desk. The reviewers found problems that can't be fixed in revision, or they concluded the clinical advance wasn't substantial enough. A post-review rejection from Nature Medicine is still a strong signal about your work. It means professional editors thought the paper was worth sending out, which isn't nothing.

Major revision

Good news, despite the intimidating label. A major revision request from Nature Medicine means the editors believe the paper could be publishable if you address the reviewers' concerns. But "address" at this journal usually means new experiments, additional patient cohorts, extended follow-up data, or independent validation. It doesn't mean rewriting a few paragraphs.

You'll typically get 3 to 6 months for a major revision. Use all of it if you need to. Rushing a revision and leaving gaps is worse than taking the full timeline and doing it thoroughly.

Minor revision

Rare on first round. If you get one, you're almost certainly going to be accepted. The reviewers are asking for clarifications, additional statistical analyses, or minor experiments. Don't get careless though. Address every point systematically.

Accept

Almost never happens without at least one round of revision. If it does, congratulations. You've written what the editors and reviewers consider a nearly perfect manuscript.

Here's exactly what to write:

"Dear [Editor name or Editorial Team], I'm writing to inquire about the status of manuscript NMED-XXXXXXX, submitted on [date]. I would appreciate any update on the expected timeline for a decision. Thank you for your time."

That's it. Don't attach new data. Don't summarize the paper. Don't explain why it's urgent. Just ask for a timeline.

An 85% desk rejection rate means most submissions to Nature Medicine end up somewhere else. That's fine. The question is where to redirect.

If the clinical data is strong but mechanism is thin:

• NEJM or The Lancet for practice-changing trials
• JAMA for strong observational or trial data
• Disease-specific top journals (Journal of Clinical Oncology, Circulation, Gastroenterology) for specialty-relevant findings

If the mechanism is strong but clinical data is limited:

• Nature if the finding is broad enough
• Nature sub-journals (Nature Immunology, Nature Cancer, Nature Genetics) for mechanistic work in specific domains
• Cell or Cell sub-journals for deep mechanistic biology

If the paper is solid but not broad enough:

• Nature Communications is the natural landing spot for many Nature Medicine desk rejections. The editors often suggest it explicitly, and it's a strong journal in its own right (IF ~16).
• Science Translational Medicine sits in a similar translational space and may be a good fit if the paper bridges basic and clinical.

Don't treat a desk rejection as a comment on your science. The journal receives thousands of submissions per year and publishes a tiny fraction. Most rejected papers find good homes elsewhere.

If you receive a revision request, you're in a small minority of submissions. Treat it seriously. Nature Medicine revisions aren't cosmetic. Here's what the process looks like:

The revision letter will be detailed. Expect 3 to 5 pages of reviewer comments, often with specific requests for new experiments, additional cohorts, or reanalysis of existing data. The editor will also add their own guidance, flagging which reviewer concerns are mandatory and which are suggestions.

You'll typically get 3 to 6 months. This is generous compared to most journals, and it reflects the expectation that you'll generate new data, not just revise text. If you need more time, ask. Editors are usually willing to grant extensions if you explain what you're working on.

Your point-by-point response matters as much as the revised manuscript. Don't underestimate this document. Address every single comment, even the ones you disagree with. When you disagree, explain why with data, not opinions. Reviewers remember when their concerns are dismissed without evidence.

The revised paper usually goes back to the same reviewers. This means your response needs to satisfy the specific people who raised the concerns. Don't assume a new reviewer will see things differently. Occasionally the editor will add a fourth reviewer if the revision introduced new methods or data that the original reviewers aren't qualified to evaluate.

Second revision requests happen but aren't common. If the editor asks for a second revision, it usually means one reviewer is still unsatisfied with a specific point. These second revisions are typically narrower in scope and faster to complete.

Acceptance after revision isn't guaranteed. Roughly 60 to 70% of papers invited to revise at Nature Medicine eventually get accepted. That's a high conversion rate, but it means a meaningful fraction of revised papers still get rejected. The most common reason: the revision didn't fully address the reviewers' core concern, or new data weakened rather than strengthened the original claims.