Nature Medicine reaches a first editorial decision in a median of 4 days.
Acceptance takes far longer — a median of 117 days from submission — and the gap between those two numbers is the shape of the process: a fast editorial screen, then a long review and revision cycle for the papers that clear it.
Key numbers before you submit to Nature Medicine
| What you are planning around | Nature Medicine |
|---|---|
| Journal Impact Factor (2025 JIF, 2026 JCR release) | 52.5 |
| Median submission to first editorial decision | 4 days |
| Median submission to acceptance | 117 days |
| Article main text | 4,000 words |
| Display items per Article | up to 6 items |
| Gold open access APC | $12,850 (£9,390 / €10,850) |
| Initial submission formatting | none required |
How to submit to Nature Medicine, step by step
- Check scope and content type first. Confirm the work fits the journal's aims, and that your format exists there — Article, Brief Communication, Resource, and Comment all carry different limits.
- Consider a presubmission enquiry. Nature Medicine accepts them, and they are the cheapest way to find out whether a borderline paper is worth a full submission.
- Do not format the manuscript. Your initial submission does not need to be specially formatted, as long as the study is described in a way suitable for editorial assessment and peer review. PDF, Word or TeX/LaTeX are all accepted at this stage; LaTeX users submit compiled PDFs.
- Write the cover letter for editors, not reviewers. It should explain why the work matters and why it suits the journal's readership. Reviewers do not see it. If you are opting into double-anonymized peer review, author names and affiliations go here rather than in the manuscript.
- Decide the publishing route. Subscription or gold open access — the choice affects budget, not editorial handling.
- Submit through the journal's online system, reachable from the Nature Medicine submission guidelines; the journal's Contact page carries the editorial office addresses for anything the system cannot answer.
- Expect real formatting work only after acceptance in principle. That is when the figure specification in the Nature Medicine formatting guide takes effect.
What happens after you upload: the timeline
Editorial assessment — median 4 days. Editors judge scope, significance, and fit before any reviewer is approached. Most submissions conclude here.
Peer review. Papers that pass are sent to referees. Nature Medicine offers double-anonymized peer review as an option, chosen at submission.
Revision. Included in the published medians rather than counted separately.
Accepted in principle (AIP). The editor is satisfied that reviewer concerns are addressed and sends detailed formatting instructions. This is the point where widths, resolutions, and file formats start to matter, and where a flattened figure turns into a delay.
Acceptance — median 117 days from submission. Then production.
If you ask the editors to reconsider a rejection, that is an appeal, and the journal states that appeals take second place to consideration of normal submissions.
What does each submission status actually mean?
Nature Medicine does not publish a table mapping the status labels in its manuscript system to editorial stages, and we do not import status names from other publishers' platforms — identical wording means different things in different systems.
Read elapsed time against the two published medians instead. A decision inside the first few days is the editorial screen doing its 4 days median work. A submission still open after a couple of weeks has most likely gone to referees, and the relevant horizon becomes the 117 days median to acceptance rather than anything the status field is telling you. Beyond that, the journal's Contact page is the route to ask.
Acceptance rate and desk rejection at Nature Medicine
Nature Medicine does not publish an acceptance rate, and we do not substitute a number from a metrics aggregator for one — those figures are recomputed from different denominators and are frequently wrong for this journal's family.
What the journal does publish answers the underlying question well enough to plan with. A median first editorial decision of 4 days means the large majority of submissions are assessed and returned before peer review begins; that is what a desk-rejection rate would be measuring. And the 117 days median to acceptance tells you what the surviving path costs in time.
Practically: assume the editorial screen is the real gate, put your strongest framing of significance in the cover letter and abstract, and decide in advance which journal is next if the answer comes back inside a week.
APC, open access, and waivers
Two publishing routes are available.
Subscription. No article processing charge. This is the default route, and the only route for non-primary research articles — Reviews, Comments, and News & Views are explicitly not eligible for gold open access.
Gold open access. The APC to publish gold open access in Nature Medicine is $12,850, or £9,390 / €10,850. The final version is then free to read for everyone under a Creative Commons licence, with publishing costs covered by the author's institution or funder.
Check institutional agreements before assuming you will pay list price — Springer Nature has transformative agreements with many institutions and consortia, and Nature Medicine maintains an open-access funding page for exactly this question. If your funder mandates immediate open access and no agreement covers you, that constraint belongs in your journal choice, not in a discussion after acceptance.
Pre-submission checklist
- Content type identified, and its limits checked — an Article is 4,000 words with up to 6 items
- Presubmission enquiry sent, if the fit is uncertain
- Manuscript readable for assessment; no journal formatting applied yet
- Cover letter written for editors, explaining significance and fit
- Double-anonymized peer review decided, with author details moved to the cover letter if you opt in
- Reporting standards and data, code, and protocol availability statements prepared
- Any LLM use documented in the Methods — an LLM cannot be an author
- Publishing route chosen, and institutional open-access agreement checked
- Figures drafted so labels and scale bars stay editable, ready for the AIP stage
What the official pages don't answer
An acceptance rate. Not published. The 4 days editorial-decision median is the closest available proxy, and it is a better planning input than a third-party percentage.
A JCR quartile. Not on the metrics page; the journal leads with its DORA position instead. The Impact Factor of 52.5 is published, and the quartile field lives in the Journal Citation Reports record — see the Nature Medicine impact factor guide for how to cite it.
A minimum line width for figures. The guidelines set resolution, width, and type size but not line weight. Keep strokes at 0.25 pt or heavier, which is where print-grade line art stops holding together at these column widths.
Does Nature Medicine allow AI-generated figures?
Nature Portfolio governs AI use by risk level rather than by tool type, in a Green / Amber / Red framework, and the current policy carries no blanket ban on AI-generated figures — the only image-specific entry in the Red band is creating photorealistic images such as deepfakes.
Two things carry over to any figure you submit: accountability stays human, and AI use is disclosed. The full wording and what it means for artwork is in the Nature Medicine formatting guide.
For figures you already have, Vector Canvas makes every shape, label, and colour editable and exports layered SVG.
Figure Enhancer refines the text, improves clarity, and upscales an existing figure to 8K without starting over.
The same scientific figure usually also has to serve grants, posters, defense slides, and lab pages; where a target setting allows AI-generated content for that task, you can also explore Text-to-Figure for a new generated draft.
Have the figures ready for the AIP request
Formatting starts at acceptance in principle. Editable labels and 300 dpi panels turn that request into a formality.
Explore the ToolFrequently asked questions / Sources
Start the figures before the manuscript is finished
Six display items is the whole budget for an Article. Plan what each one carries while the text is still moving.
Try Free- Nature Medicine — Submission Guidelines — the full submission path and its sections
- Nature Medicine — Editorial Process & Peer Review — assessment, review, and appeals
- Nature Medicine — Journal Metrics — Impact Factor and the decision and acceptance medians
- Nature Medicine — Publishing options — subscription and gold open access, and the APC
- Nature Medicine — Formatting your initial submission — what the first submission needs
- Nature Medicine — Preparing your material — cover letter, author information, LLM documentation
See our editorial standards for how these guides are researched and corrected.
