How long does it take for a peer-reviewed journal article to be published? 5 tips to speed up the process for digital health companies.
One of the most frequently asked questions I get in my consultancy practice is “How long does it take to publish a paper?”
Obviously, it varies a lot! Out of some ~150 publications I’ve published my fastest time from submitted to published was 25 days, my longest was 453 days. What that doesn’t tell you though is how many journals rejected a paper without sending it for peer review, what sort of article it was, my relationship with the journal, how good the data was, or how active I was in chasing down the journal. All of these are important factors that can make the difference between a quick and timely publication and you getting so bored with the process that your work ends up in the filing cabinet.
For commercial clients relying on the timely publishing of evidence to support investment, sales, and regulatory filings, I see too many good studies that took a long time to design, fund, and execute disappear off in to the void when it’s time to publish. If the company is unfamiliar with the arcane rituals of publishing they often leave it up to academic collaborators to manage the process, but the issue there is that there are misaligned incentives. A digital health startup wants to get evidence out there quickly and make as much impact as possible for their audience, whether that’s clinicians, investors, or the press. By contrast an academic has typically got longer-term aspirations in mind and can invest more time shopping around for a journal with a higher “journal impact factor”.
Here are some quick tips, written from the perspective of someone in clinical medicine and/or digital health:
1.) Pick your target journals carefully. Mega journals like BMJ Open or PLOS Medicine are reputable, have good peer review, and are widely read, but are aiming for quality, not “impact”. Too many papers are rejected for being “well designed but with no new / surprising information”. If you’re in an innovative space like digital health then it often makes sense to get started with digital-health-focussed journals like the Journal of Medical Internet Research (JMIR) family of journals, npj Digital Medicine, or Lancet Digital Health. These are much more open to receiving work conducted online, as opposed to traditional medical society journals which might harbour concerns about any work not done in a hospital setting by physicians. Note that if it’s impact factor you’re after (e.g. for academic tenure) then JMIR’s flagship journal has an impact factor of 5.0, whereas the “Nature” and “Lancet” digital health journals don’t have impact factors yet. However it is strikingly commonplace when describing your “nature partner journal (NPJ) digital medicine” paper to mumble all of the words except “NATURE PAPER”
2.) Get early feedback from editors. Line up 3 target journals by impact factor, acceptance rate, and how many similar studies they’ve published before. Use pre-submission enquiries to the 3 editors and ask for advice on what sort of article type might be appropriate for what you’re thinking of submitting, and whether they agree that (from a brief description of the work) their readership might find it interesting. If they say “no” that’s great — you’ve just saved yourself about a month or two. If they come back to you promptly with suggestions of article formats for your work (e.g. a short report) or to alert you to a forthcoming special issue on your topic of interest (e.g. AI in medical imaging) then bump them up the queue and make sure this is the first place you submit.
3.) Propose peer reviewers that will engage in your work. As an editor one of the hardest things to do is find good peer reviewers. Increasingly an editor might have to invite 10, 20, or more prospective peer reviewers before they get a positive acceptance and a good review. There’s lots of good reasons for this; people are busy, peer review is unpaid, COVID has got everyone overworked and juggling too many demands, and if you’ve never heard of a journal before then it’s much easier to turn down a review request when you’ve got other things going on. Never propose a peer reviewer with a conflict of interest, but do look for people who have recently written systematic reviews in your space, or published similar studies, particularly if their work was published in one of your target journals of interest. That will mean they are sure to be on the lookout for emails from that journal and might be more willing to review similar work (it never hurts if you cite them). Don’t just look for the corresponding author of such work, but look down the author list, google the other co-authors, and put them in the mix too — they might have a different perspective of special expertise in different aspects of your work. But always know that Reviewer #2 will be challenging.
4.) Preprints are your friend. One of the most striking things about the COVID-19 pandemic has been the medical research community’s rapid embrace of preprints, particularly through the medRxiv service run by Yale, the BMJ, and Cold Spring Harbour Laboratory. If you remember hearing back in April 2020 that loss of sense of smell (anosmia) was a potential symptom of COVID-19, that came from a preprint. In fact as of today there are 5,000 preprints about COVID-19 on medRxiv, which allows researchers to submit their work quickly with just a quick check for some red flags before being made available with their own digital object identifier (DOI). For most peer-reviewed journals, a preprint does not preclude submission or publication at a later date; in fact some journals like JMIR and BMJ make it very easy to submit a preprint while you’re in the process of submitting to them. That paper on anosmia in COVID-19 was published a month later in Nature Medicine.
5.) Internalize that your “final” submission is really only 70% done. You’ve done the study, you’ve submitted the paper, three months have elapsed, and you finally have your reviewer comments back. Ugh. Your 3,200 word paper has got 8,000 words of reviewer comments to address from 5 peer-reviewers, some of them contradict one another, and you’re going to have to work with your team of co-authors (some of whom have moved on to other projects or changed jobs) to figure out how to respond. Sometimes this can be so demotivating that people give up, or procrastinate, or hold a tribal war meeting on how they’re going to angrily rebuff all of Reviewer #2’s requests and assertions. This is fruitless. The frustration comes from the false impression that because your internal processes leading up to this point included dozens of rounds of internal review, the paper was 100% perfect at the point of submission and basically just needed a stamp of approval and a pat on the back for all your hard work. But I bet when you peer-review the work of others you’ve probably never seen a perfect paper sail through merrily with just a couple of typos. There are some great articles online about how to respond to reviwers point-by-point, but the biggest tip here is to change your perspective — your “final” version was only ever rough marble and it needed a polish and maybe even a few blows of the chisel to reveal its final form.
Do you have a publication backlog you’d like to clear down? Any other tips to share? Feel free to get in touch, paul@wicksdigitalhealth.com
Disclosures: PW is an associate editor at the Journal of Medical Internet Research and is on the editorial advisory boards of The BMJ, BMC Medicine, The Patient, and Digital Biomarkers. PW is employed by Wicks Digital Health Ltd, which has received funding from Ada Health, Baillie Gifford, Bold Health, Camoni, Compass Pathways, Coronna, EIT, Happify, HealthUnlocked, Inbeeo, Sano Genetics, Self Care Catalysts, The Learning Corp, The Wellcome Trust, and Woebot.
