How Long Peer Review Takes in Medical Journals

A status that has not changed for weeks feels like nothing is happening. Usually something is, and knowing which stage you are at tells you whether to wait or ask.

Explainer · 9 min read · Directive Publications Editorial Team

The short answer: plan in months

There is no single answer to how long peer review takes, and any figure a journal publishes describes a median or average across many papers, not yours. The time depends on the journal, the article type, how quickly suitable reviewers agree, and how many rounds of revision the paper needs.

For a rough benchmark, a pilot survey of corresponding authors of clinical research studies in MEDLINE-indexed journals, published by Wallach and colleagues in 2018, reported a median of 5 months from first submission to acceptance (interquartile range 3 to 8) and 7 months to publication (5 to 12). Those intervals start at the first journal the authors tried, so they include any earlier rejections. Only 21% of eligible authors responded, so treat the figures as an order of magnitude rather than a standard.

The planning rule: for a reviewed original research article, plan in months. If a grant report, thesis deadline or promotion file depends on acceptance, count backwards from the deadline and build at least one round of revision into the plan.

An estimate for one journal

A specific journal's own dates tell you more than any survey, and they are often printed on its articles.

1. Open about ten recent articles of the same type as yours in the target journal.
2. Note the received, revised and accepted dates on each. In PubMed, the PubMed display format shows them as PHST lines tagged received, revised and accepted, where the publisher has supplied them.
3. Work out the days from received to accepted, and look at the spread as well as the middle.

Two cautions apply. These dates describe only papers that were accepted, and each interval includes the time the authors spent revising.

What happens at each stage

Peer review is a series of hand-offs, and most of the waiting happens between them.

Acceptance ends peer review. Copyediting, proofs and online publication come afterwards and run on the journal's production schedule.

What your submission status tells you

Status labels differ between submission systems, and between journals using the same system, so check your journal's help pages before reading meaning into a word. Elsevier's explanation of submission statuses in Editorial Manager shows how a typical set works:

• Submitted to Journal: the editorial team will check the submission and either send it back to you or assign it to an editor.
• With Editor: an editor has been assigned but has not yet taken an action that changes the status, usually inviting reviewers.
• Under Review: reviewers have been invited and review is underway. Elsevier notes that this status "encompasses many steps".
• Required Reviews Completed: the target number of reviews is in and the handling editor is considering them.
• Decision in Process: an editor has begun entering a decision, which some journals require more than one editor to confirm.

Statuses can also move backwards. The same page explains that editors considering the reviews may invite more reviewers or assign another editor, returning the submission to an earlier status. A backward step means the editor is seeking another review or another editor's input, which is not in itself a sign that the paper is in trouble.

Journals on ScholarOne often use different labels for the same steps. There, Awaiting Reviewer Assignment typically means invitations are out and the journal is waiting for replies, and Awaiting Reviewer Scores typically means at least one reviewer has agreed and the journal is waiting for the report.

What to do: keep a dated log of every status change. It turns a vague sense that nothing is happening into a fact you can use if you need to ask.

Why medical manuscripts stall

Elsevier's status page names the availability of reviewers as the most notable factor in review time. Most delays come from people, not systems.

• Reviewers decline or do not answer. Each decline restarts part of the search, and an unanswered invitation holds a place until the editor gives up on it.
• The topic is narrow. A rare condition or an unusual method leaves few qualified reviewers, and some of them will have conflicts of interest with your group.
• The reports disagree. An editor holding one favourable and one unfavourable report may invite another reviewer before deciding.
• A statistical review is added. Some biomedical journals send some or all research articles to a specialist statistical reviewer as well as to subject experts, which adds a step.
• The submission is incomplete. A missing trial registration number, reporting checklist, ethics approval statement or disclosure form can send the paper back before review starts. Check the journal's instructions for what it requires, and use our first manuscript submission checklist to assemble the statements and files before you click Submit.

You control two of these. Send a complete package the first time, and when a revision request arrives, return it by the deadline or ask for an extension at the start rather than at the end. Our guide to responding to peer review comments shows how to size up a revision quickly enough to make that call.

When to contact the editor, and what to write

Asking about status is legitimate. The ICMJE Recommendations state that "Journals should respond to authors' requests about the status of their manuscript in a timely manner," and that editors "should do all they can to ensure timely processing of manuscripts with the resources available to them."

Decide on timing this way:

1. Find the journal's benchmark. Use any timeline in its author instructions, or the received-to-accepted intervals you found on its recent articles.
2. Check whether the status has moved. A recent change means the paper is progressing, even if slowly.
3. Write when the status has been static for clearly longer than the benchmark. If you can find no benchmark at all, asking the editorial office what timeline to expect is a reasonable question in itself.

Contact the journal sooner, whatever the status, if something the editor needs to know has changed: you have found an error in the data or analysis, the author list or corresponding author has to change, or you have posted a preprint since submitting.

A short inquiry is all you need:

Subject: Status inquiry, manuscript [number]

Dear Editorial Office,

I am writing about manuscript [number], "[title]", submitted on [date]. The submission system has shown the status "[status]" since [date]. Could you let me know whether there is an expected timeline for a decision?

Thank you for your help.

[Name], corresponding author, [affiliation], [institutional email]

Send it through the submission system or to the address the journal lists for its editorial office. Do not argue for the importance of the work, and never contact anyone you suspect is reviewing your paper. If there is no reply after a reasonable interval, one polite follow-up is fine.

What a very quick decision usually means

A decision within days usually means the paper did not go to external review, because inviting reviewers and waiting for reports takes longer than that. It is usually one of three things:

• a desk rejection on scope, fit or quality
• a request to supply missing items before review can start
• an offer to transfer the paper to another journal, which Editorial Manager shows as Transfer Pending

A fast rejection is the process working as intended. The ICMJE Recommendations say that if a journal has no intention of proceeding, editors "should endeavor to reject the manuscript as soon as possible to allow authors to submit to a different journal." Read the letter for the reason, check the next journal's scope against it, and reformat while the paper is fresh in your mind.

The quick decision to worry about is an acceptance. Acceptance within days with no substantive reviewer comments suggests the paper was not properly reviewed, and it is one of the warning signs in our 12 red flags for predatory journals.

While you wait: withdraw, never double-submit

However long the wait, do not send the same manuscript to a second journal. The ICMJE Recommendations are plain: "Authors should not submit the same manuscript, in the same or different languages, simultaneously to more than one journal."

If you decide to move on:

1. Agree the decision with your co-authors first.
2. Send a written withdrawal request from the corresponding author, giving the manuscript number and title.
3. Ask for confirmation and keep a copy of your request. The ICMJE Recommendations add that authors who request withdrawal in good faith "should consider the manuscript withdrawn even if they don't receive a confirmation from the journal."
4. Only then submit elsewhere.

Weigh what you would give up before withdrawing. A paper at Required Reviews Completed is close to a decision, and the reports can improve your next version whatever the outcome. Withdrawing at that point discards reviewers' work and the time already spent.

If you want the findings visible while you wait, check the journal's preprint policy first. The ICMJE Recommendations ask authors to tell the journal and provide a link if they post a preprint during peer review, and not to post interim versions that incorporate revisions based on journal feedback.

Judge the wait by the stage, not the calendar

The useful question is not how long peer review takes in general but which stage your paper is at and whether it has sat there longer than this journal normally takes. Answer that, and you know whether to wait, ask, or move on.

Directive Publications sets out each stage of its peer review process, from editorial checks and desk assessment to revision and re-review, and its guidance for authors covers what to prepare before you submit.