Rejection hurts. And having your work rejected from medical journals or other academic journals can especially sting. After all, you’ve poured your knowledge, experience, and passion onto the page expecting to see it in print. But while that rejection can feel personal, it represents a great learning experience and opportunity to make your current and future work even better.

This article will help you understand why submissions get rejected from medical journals, how you can avoid a rejection, and what to do after you get that fateful decision letter.

How Common is Rejection from Medical Journals?

Rejection from academic journals is very common. Most journals reject more submissions than they accept; scientific journals often have rejection rates ranging from 50-70%. Some are even higher.

And it’s not just the most prominent journals that are picky. These selective acceptance rates persist regardless of a journal’s size, age, fame, or impact factor.

Even niche journals often have low acceptance rates. When my colleagues and I examined JAAPA’s original research acceptance rate, we found that our rejection rate was on par with much larger and more broadly read journals.

These high rejection rates shouldn’t discourage authors from submitting their work, but should guide you in setting realistic expectations. Authors will often need to submit a single manuscript to multiple journals before acceptance. Success comes from a combination of quality work and gritty persistence.

Oh course, the real #1 reason for rejection is never included in these statistics. I discuss more about that in the video below:

When Do Rejections Occur in the Editorial Process?

Submissions to medical journals can get rejected at various stages of the editorial process. The three most common places a manuscript will be rejected are: (1) upon initial review by a senior editor (often called a “desk rejection”), (2) after the article has been sent to peer reviewers for feedback, and (3) after revisions have been made by the author(s). The timing of your rejection can often give you hints as to the issues your submission might have had in the eyes of editors.

Desk Rejection

This rejection often occurs because the article has some fundamental or foundational flaw that can be detected by an experienced editor relatively easily. While the editor might not have deep expertise in the article’s specific subject matter, they can tell the submission won’t work for the journal. This might be because the article does not fit the scope or audience of the journal (more on that here), because the article has some major flaw with the methods or thesis, or because the quality of the work is very low.

A desk rejection usually occurs early in the review process and may or may not come with a letter of explanation from the journal editors.

Rejection After Peer Review

Articles rejected after peer review often have issues with the article content that were apparent to those with expert subject matter insight. This might mean that the information contained in the article was not accurate or up to the standards of the field, or it might mean that the methodology of the research was not rigorous enough to pass the eye of experienced researchers.

The good news: if your article makes it to peer review, you will often get detailed feedback from peer reviewers so you can improve the article for your next submission.

Rejection After Revision

Rejection after initial peer review, revision by the author, and resubmission is relatively rare (only 1.8% of rejections in our study of JAAPA rejections). Often, this occurs because authors receive an initial decision from journal editors to “revise the work and resubmit” and then either fail to resubmit the manuscript or resubmit but fail to make the requested changes or revisions. It is almost unheard of that authors make their best attempts at revision, complete all the requested changes, resubmit, and still face a rejection. Often, persistence and diligence are all it takes to avoid this form of rejection.

Common Reasons for Rejection from Medical Journals

Journals reject manuscripts for a variety of reasons, however the most common reasons typically occur again and again. We can break down the most common reasons for rejection into two broad categories: editorial reasons and technical reasons.

Editorial Reasons for Rejection

Lack of Novelty

This is a fancy way of saying the article has been done before. Maybe this article topic has been covered in the same journal, or maybe it has been covered in the broader academic literature and is not worth replicating yet again. Journal editors don’t want to waste their reader’s time with redundant information and extraneous articles are less likely to be cited than fresh material.

How to avoid it: Research your topic in the target publication and the broader literature before you begin working. If the topic has been covered, consider approaching from a different perspective, narrowing the topic for a deeper dive, and/or including new and updated information. A great way to narrow your topic is to download and follow this guide:

Outside the Journal’s Scope or Audience

Editors will immediately reject an article if it is not within the scope of the journal or is not appropriate for the journal’s audience. Essentially, this means the material is not appropriate for the journal’s focus or is not written for the journal’s core readership.

How to avoid it: Make sure to read and understand the purpose and mission of a journal before you submit a manuscript. You can read an entire article on journal scope and audience here.

Weak or Missing Central Thesis

No matter the topic or format, every article should address one key central idea or question. Articles without a core central idea lack purpose. Articles with multiple central ideas lack focus. If you cannot identify and support a central thesis, you may need to revisit the purpose and construction of your manuscript.

How to avoid it: Ensure your article focuses on one central idea. If you are conducting research, make sure your methods support this idea. If this is a non-research paper, make sure the entire article is written to support your main idea.

Inappropriate Format or Style

Journal’s typically present material in recurring departments or sections that follow a standard format or approach. Journal editors expect submissions to conform to the format of the department to which a manuscript is submitted. Sometimes editors will recommend shuffling a submission to a different department, however if the manuscript doesn’t fit any of the department formats, it will often face rejection.

How to avoid it: Read example articles from a variety of journal departments and decide which one best suits your topic and perspective BEFORE you start writing.

Major Quality Problems

This broad category includes any major issues with the quality of the work. We aren’t talking about a misplaced comma; these are foundational errors that are unlikely to be fixed by editing. This might include major issues with writing quality or organization, work that does not meet a high academic standard, inadequate literature review, or the use of low-quality references. In short, these are good ideas with very poor execution.

How to avoid it: Carefully research your topic and use high-quality, primary resources. Plan your manuscript with an outline to ensure organization and logical flow. Partner with a writing mentor or colleague to help with writing and editing prior to submission.

Ethical Issues

While some ethical violations are malicious, most are the result of carelessness or lack of awareness. Ethical issues can include those having to do with the consent process (missing consent for research or case reports), research methods (unethical study design or lack of IRB approval), or the writing or publication itself (plagiarism or authorship issues).

How to avoid it: Address consent and IRB approval in the study design phase. Follow standardized policies for consent when writing case reports or case series. Cite borrowed ideas, create original writing, and discuss author contributions and authorship criteria prior to beginning a project.

Failure to Make Revisions

Most articles experience a request for revision prior to acceptance. Authors should incorporate peer review and editorial feedback into manuscript changes and then resubmit the manuscript to the same journal. Some authors are either unwilling or unable to make changes and find their manuscripts ultimately rejected.

How to avoid it: Make the requested changes and resubmit. Consider including a letter to explain the changes you made and address any change requests that you wish to clarify or challenge. Persistence usually wins the day.

Technical Reasons for Rejection

Flawed Research Question

This rejection of research papers occurs when a research question is inappropriate, incomplete, or simply missing from the paper. Research papers should start with a central question that can be reasonably addressed my scientific methods, is appropriate for the journal, and is important for its audience.

How to avoid it: Carefully plan your research question before you begin working on a study. Perform a thorough literature review to see if this question has already been addressed and to ensure that it is of scientific importance.

Flaws with Methodology

Most technical rejection relates to the methodology used to conduct a study or literature analysis. Some common methodological issues are listed below:

• Hypothesis is weak, missing, or not scientifically valid
• Study methods are not appropriate to answer the research question
• Issues with sample size or sampling method
• Methods of gathering data are not scientifically sound or are flawed
• Methods of statistical analysis are not appropriate, are flawed, or are not used at all

How to avoid it: Most of the time, flaws with data gathering or analysis must be solved in the planning stage before the actual research study has taken place. Researchers with less experience or training should consider partnering with more experienced researchers for help with methodology.

Conclusions Not Supported by the Research

Sometimes researchers misinterpret their own data or overreach when drawing conclusions from it. If the author’s conclusions are not supported by the research methodology and the data it collects, a manuscript might be rejected.

How to avoid it: Present responsible conclusions from your data and analysis and be sure to understand the limitations of your own methodology when making general statements about the implications of your work.

How to Avoid Rejection from Medical Journals

As you can see from the solutions to individual problems listed above, most solutions to avoid rejection from medical journals occur in the planning phase. Fully understanding your target journal, audience, and article type before you start writing will help you avoid many editorial pitfalls. Similarly, many methodological flaws must be corrected prior to data collection, which means research questions and methods must be carefully planned before data is gathered and analyzed. In many cases, it helps to engage colleagues and mentors (research mentors, writing coaches, academic librarians, etc.) at the beginning of a project to address any blind spots you may have and to ensure your work meets a high academic standard.

What to Do After You Are Rejected from a Medical Journal

Academic publication is very competitive and even good work will be rejected. Across the biomedical and medical fields, rejection rates for academic journals often approach 70%. Even a smaller, more niche journal like JAAPA accepts less than 30% of its research submissions. Authors should mentally prepare themselves for the possibility of rejection and have a plan in place to bounce back from this outcome.

(Side Note: Revision is NOT rejection. Most accepted manuscripts will undergo some form of revision prior to publication. Do not mistake a “Revision” decision for a rejection. If a journal asks you to revise and resubmit, you are well on your way to acceptance, so make the necessary changes and resubmit your manuscript!)

1. Avoid Emotional Self-critique

It is natural to view rejection as a form of failure, but the emotions associated with rejection can work against your ultimate plan for success. There is a time for realistic assessment (and improvement) of your work, but that is most productive after the initial sting of rejection has worn off. Take a moment to digest this temporary outcome, allow the initial disappointment to subside, and remind yourself that rejection is normal and that your ideas and abilities are still valuable.

2. Read and Digest Editorial/Reviewer Feedback

One of the benefits of the peer review process is that authors typically receive feedback from editors and/or peer reviews, regardless of the journal’s decision to publish a submission. Read and consider the feedback you receive after a rejection; it may guide you along a path to improving your manuscript and finding acceptance in another journal. Of course, take feedback with a grain of salt, as it is often subjective and imperfect.

3. Consider Making Minor Changes

Even rejected manuscripts are often salvageable. But they might need a little more work. Armed with the passage of time, a new perspective, and/or feedback from editors and reviewers, you can likely make improvements to your manuscript. Focus on the main flaw that led to the rejection decision before you move on to polishing the smaller details. This is a good time to recruit some help to address your weaknesses.

4. Look for a New Journal

There are plenty of other peer-reviewed fish in the sea. When you and your manuscript are ready, search for another journal to submit your article. You may look for a journal that has a slightly higher acceptance rate, or you might look for a journal that is a better fit for your subject matter or the audience you hope to reach. (If you haven’t already, now is a good time to brush up on this article on scope and audience).

5. Consider Overhauling your Manuscript

If you have been rejected multiple times or you have some other indication that your work suffers from larger issues, your manuscript might need major changes. Maybe your central idea is good, but it is presented in a format that most journals don’t accept. Or maybe your topic is important, but your approach to the material is broad and has been published 1,000 times before. You may need to take the core of your work—the thesis, the raw data, the literature review, etc—and present it in a radically new way. Break your work down into its basic parts and recycle them for something better.

6. Shelve Your Manuscript (for Now)

Your manuscript might not be ready for primetime. If your progress has completely stalled, you face a stream of rejections, or you have some other evidence that the manuscript is unlikely to find acceptance anywhere, you might want to put it back on the shelf. There is no value in destroying your work; you can digitally store it forever. Who knows? Maybe one day inspiration will strike and you will find a new way to package and publish your ideas.

Conclusion

Rejection from medical journals is scary because it seems mysterious and personal. By understanding the reasons behind an editor’s decision to reject a submission, we can separate our emotions from the result and add transparency to the editorial decision process. When we review the most common reasons for rejection from medical journals, we find that many are solved by (1) obtaining a strong understanding of our target journal, (2) deliberately planning our work’s thesis and methods, and (3) collaborating with others to address our weaknesses. We also realize that, to a degree, successful publication is a “numbers game” and, given journals’ low acceptance rates, it might require multiple submissions to ultimately find success.

Feeling stuck and want to go back to the drawing board for your next article? Download my free guide below. The download will also place you on my mailing list so you can get my hand-picked writing advice and resources. I promise not to flood your inbox or waste your time.

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