New England Journal of Medicine
Difficulty 99Massachusetts Medical Society
NEJM is an extreme clinical filter focused on practice-changing consequence. Most competent clinical studies are rejected before full review.
Primary fit signal
the manuscript changes clinical practice rather than adding incremental evidence
OA model
Hybrid
Acceptance posture
<5%
Desk decision
~21 days
First decision after review
6–10 weeks
Desk reject posture
>90%
Sources reviewed
4
Open full journal recordReviewed Mar 30, 2026
What gets in
- the manuscript changes clinical practice rather than adding incremental evidence
- methods and interpretation can survive intense clinical scrutiny
Common rejection reasons
- important specialty result without broad practice consequence
- claims of clinical importance outrun the trial or cohort evidence
Submission package constraints
Main text
~3,000
Abstract
Structured · 250
Figures
5 total
References
70
Data provenance
Publisher
Massachusetts Medical Society
Version
2026.03.30-mvp1
Sources reviewed
4 public sources
Desk reject posture
>90% (estimated)