Nature Medicine 'Under Consideration': What Each Status Means and When to Expect a Decision
If your Nature Medicine submission shows Under Consideration, 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.
Next step
Choose the next useful decision step first.
Use the guide or checklist that matches this page's intent before you ask for a manuscript-level diagnostic.
Decision cue: Nature Medicine uses the same manuscript tracking system as other Nature journals. "Under Consideration" is the default status during both editorial assessment and active peer review. If your paper has been Under Consideration for more than 10 days without a rejection, the editors are likely still evaluating it or have sent it to reviewers. The desk rejection rate is roughly 70 to 80%.
Quick answer
Nature Medicine is one of the most selective clinical research journals. The desk rejection rate is 70 to 80%, with most desk rejections arriving within 1 to 2 weeks. Papers that pass the desk screen go to 2 to 3 reviewers, with first decisions typically arriving 30 to 45 days after submission.
If your paper shows "Under Consideration" past the 10-day mark, it has very likely survived the editorial screen. That is a strong position, but the review is rigorous and revision requests at Nature Medicine typically require new experiments or analyses.
Nature Medicine's review pipeline
Status | What is happening | Typical duration |
|---|---|---|
Received | Administrative processing | 1 to 2 days |
Under Consideration | Editor evaluating, consulting team, possibly inviting reviewers | Days to weeks |
Under Review (if shown) | Sent to external reviewers | 4 to 8 weeks |
Decision in Process | Editor reviewing reports, preparing decision | 3 to 7 days |
Decision Made | Accept, revise, or reject | Check email |
Like Nature, the Nature Medicine tracking system is not highly granular. "Under Consideration" may cover everything from initial editorial read to active reviewer search. The most reliable signal is elapsed time.
The desk screen (~70 to 80% rejected)
Nature Medicine editors screen every submission before peer review. The desk filter is aggressive because the journal publishes work that changes clinical practice or clinical understanding in a broad way.
Editors are evaluating:
- does the study change how clinicians think about a disease, treatment, or diagnostic approach?
- is the clinical relevance direct and immediate, or is the translational distance too large?
- is the study design strong enough for the claims (adequately powered, properly controlled, appropriate endpoints)?
- will the finding interest the journal's broad clinical and translational readership?
- is this an advance that matters beyond one clinical specialty?
The most common desk rejection reasons:
- the study is translational or preclinical rather than clinical (Nature Medicine wants direct clinical relevance)
- the finding is clinically relevant but too narrow for one specialty audience
- the design cannot support the clinical claims (underpowered, retrospective when prospective is needed)
- the work is strong but fits better in a specialty journal or in Nature Communications
Desk rejections typically arrive within 5 to 10 days. If the editors suggest a different Nature journal, take the suggestion seriously. Nature editors have good judgment about where work will be best received.
What "Under Consideration" means at each time point
Days 1 to 3: Administrative processing
Files are checked for completeness. No editorial judgment is happening yet.
Days 3 to 10: Editor reading and team discussion
A primary editor reads the manuscript and discusses it with the editorial team. This is when the desk decision happens. If you receive a rejection, it will likely come during this window.
Days 10 to 14: Reviewer invitation
If the paper passes the desk, editors begin searching for reviewers. Nature Medicine needs reviewers who can evaluate both the clinical significance and the scientific rigor, which can make the search more difficult than for a pure clinical or pure basic science journal.
Days 14 to 45: Active peer review
Reviewers evaluate the manuscript. Nature Medicine sends papers to 2 to 3 reviewers and asks for reports within 2 to 3 weeks. The actual timeline depends on reviewer availability and responsiveness.
Beyond 45 days: Consider following up
If your status has not changed after 6 weeks, a polite inquiry to the editorial office is reasonable. The delay is usually caused by a slow reviewer.
What each decision means
Reject
The most common outcome even after review. A post-review rejection at Nature Medicine means the reviewers or editors concluded the clinical advance was not substantial enough, the evidence was not definitive enough, or the concerns could not be addressed within a reasonable revision.
Revise
A revision request from Nature Medicine is a strong signal. The paper has a good chance of eventual acceptance if the revision is thorough. Expect the revision to require new experiments, additional clinical data, extended follow-up, or independent validation. This is normal for Nature-family journals and the timeline for revision may be months.
Accept
Very rare on first round. Almost all acceptances follow at least one revision round.
When to worry and when to wait
Situation | What it likely means | Action |
|---|---|---|
Under Consideration, day 3 | Editor has not read it yet | Wait |
Under Consideration, day 7 | Editor is reading or discussing | Wait |
Under Consideration, day 10 | Either decision is coming or passed desk | Wait |
Under Consideration, day 14+ | Likely passed desk, reviewers being invited | Good sign. Wait. |
Under Consideration, day 30+ | Active review underway | Normal. Wait. |
Under Consideration, day 45+ | Possible reviewer delay | Polite inquiry is reasonable |
Decision in Process | Editor has reports, deliberating | Decision within days |
What to do while waiting
- do not contact the editorial office during the first 30 days
- use the time to prepare supplementary analyses that reviewers might request
- if new clinical data becomes available (longer follow-up, additional cohort), note it for potential inclusion in a revision
- do not submit elsewhere while the paper is under consideration
- prepare for the reality that a Nature Medicine revision typically requires new experiments, not just rewriting
How Nature Medicine compares
Feature | Nature Medicine | |||
|---|---|---|---|---|
Scope | Clinical research + translational medicine | All science, broadest | Clinical medicine, practice-changing | Clinical + global health |
Desk rejection | ~70 to 80% | ~60% | ~90% | ~80% |
Desk speed | 5 to 10 days | 5 to 7 days | 1 to 2 weeks | 1 to 2 weeks |
Review time | 4 to 8 weeks | 4 to 8 weeks | 3 to 4 weeks | 3 to 4 weeks |
Status system | Nature portfolio (Under Consideration) | Nature portfolio | ScholarOne | Similar |
Best for | Studies changing clinical understanding | Broadest-impact science | Practice-changing clinical trials | Global health + policy |
Check whether your paper is ready to submit with a free readiness scan. It takes about 60 seconds.
Sources
On this page
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.
Before you upload
Choose the next useful decision step first.
Move from this article into the next decision-support step. The scan works best once the journal and submission plan are clearer.
Use the scan once the manuscript and target journal are concrete enough to evaluate.
Anthropic Privacy Partner. Zero-retention manuscript processing.
Where to go next
Start here
Same journal, next question
Conversion step
Choose the next useful decision step first.
Use the scan once the manuscript and target journal are concrete enough to evaluate.