What to do when papers keep getting denied

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voxveritatisetlucis

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How common is it for a paper to be rejected at 3+ journals before being accepted? Wrote up an internal medicine manuscript and it had now been denied in 3 journals. I go to a low tier school in which most faculty are not funded (ie no real incentive to publish). How should I proceed?

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VERY common.

Aim lower in where you're submitting.

Also, are you getting decent feedback from the reviewers? If so, incorporate their comments into your manuscript.

Contact the editor of the journals you want to apply to and ask if the subject matter is of interest to the journal.
 
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Well it depends what the subject matter is and your target journal. But if you're trying to write a paper with a faculty mentor who doesn't write, that's not going to work--with all due respect, your paper probably sucks (like my med student papers sucked) and need to be polished by someone who knows how to get a paper accepted. Surely there are some research faculty at your school, so find them and follow their lead.

If these are case reports, those are becoming increasingly difficult to publish and you really need to be thoughtful about what a single case can add to the literature. If it's a review then those are pretty rarely accepted if not invited.

Finally, as @Goro if you received reviewer feedback listen to the feedback. If they criticized you for your analysis, correct the problem. If it isn't something you can fix, then address it as a limitation. Finally, if you got desk-rejected because your paper is out of scope for the journal, then you're unlikely to get any additional useful feedback, but perhaps reflect on why that might be and consider if you need to aim for a different kind of journal.
 
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Are you getting desk rejected or rejected by reviewers? I have found incredible success at publishing in higher tier journals than my work deserves by

1) Making the paper very polished/pretty. Diagrams/Illustrator skills are high yield for high impact pubs.

2) Reaching out to editors before sending the manuscript. They might even give you a sense of what sort of material they're trying to publish (i.e., there's an upcoming issue focusing on [topic], and your manuscript will fit better if you emphasize that aspect of the project).

Make sure you're aiming appropriately, but overall I'd say getting rejected 3+ times is better than getting accepted on the first go-around. If you're consistently getting accepted to the first place, you're aiming too low.
 
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Go to a lower tier journal. Many of the open access journals have generous acceptance rates.

You can also consider submitting to a pre-print server.
 
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Unfortunately in many cases.
I mean, medical literature generally provides few enlightenments and >99% is relevant garbage. The “high impact” papers boil down to epidemiology research that demonstrate cancer IS bad, poverty IS bad and being hospitalized IS bad. The other “high impact” papers then end up being review articles that surmise the epidemiology studies that being sick and poor IS bad and there are future studies to be done. None of that is earth shattering. Then of course, within my field, all the “high impact” trials are studies that either test a terrible hypothesis AND are negative or studies that test the hypothesis that most physicians don’t know jack **** about illness by testing the two most common treatments and find… they are the same.

From an actual translational science perspective, two seminal papers that both launched incredibly successful NIH research careers had a combined impact factor of 4.

Basically, it’s all nonsense. But if you enjoy doing it, who gives AF.
 
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I mean, medical literature generally provides few enlightenments and >99% is relevant garbage. The “high impact” papers boil down to epidemiology research that demonstrate cancer IS bad, poverty IS bad and being hospitalized IS bad. The other “high impact” papers then end up being review articles that surmise the epidemiology studies that being sick and poor IS bad and there are future studies to be done. None of that is earth shattering. Then of course, within my field, all the “high impact” trials are studies that either test a terrible hypothesis AND are negative or studies that test the hypothesis that most physicians don’t know jack **** about illness by testing the two most common treatments and find… they are the same.

From an actual translational science perspective, two seminal papers that both launched incredibly successful NIH research careers had a combined impact factor of 4.

Basically, it’s all nonsense. But if you enjoy doing it, who gives AF.
I have never felt more validated in my utter disdain for research.
 
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I have never felt more validated in my utter disdain for research.
I mean, research itself is fun. Asking and answering questions is fun. It’s better than doing the >90% of medicine which is routine and protocol based.

But medical literature and publishing is just a game. And impact factors are intentionally fudged to make journals get better advertisers. Actually advertising, just like Facebook, is how journals make their money. “High impact” actually translates into getting into a journal with the most advertisers. Groundbreaking.
 
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The reasons are many and multifaceted. It might be that your paper's message isn't broad enough for the audience of the paper, the editors simply don't like the message, the novelty is just not there, etc. If you're getting rejected for the same things, then it's worth looking into those criticisms to see if you can address some of them before submitting to another journal. Otherwise you'll just keep making the same error.

At the end of the day, it could just be an issue with the science and the level of analysis that the journals want isn't there.
 
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I mean, research itself is fun. Asking and answering questions is fun. It’s better than doing the >90% of medicine which is routine and protocol based.

But medical literature and publishing is just a game. And impact factors are intentionally fudged to make journals get better advertisers. Actually advertising, just like Facebook, is how journals make their money. “High impact” actually translates into getting into a journal with the most advertisers. Groundbreaking.
Oh don’t get me wrong, I agree. I actually enjoyed the investigation process of my required research as a trainee. It was really cool to look into a question I genuinely had and maybe even get to answer it. But then the IRB had their hoops to jump through. And the PhD research consultant gave about 30 minutes of input that they demanded second author status for. And the journals have their asinine standards for submission. And endless other annoyances. Basically everything from your post. Again, I agree lol
 
My PI has told us that he once had a manuscript rejected >10 times, but eventually got it published. I've had a publication that took 3 submissions before we could get it published.

It's common.
 
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Every journal has an audience, so your writing needs to reflect a significant interest from that audience.

One indicator is to see frequent mentions of journals in your reference list. This should tell you the ballpark/league your paper likely belongs to. Then write for that audience.
 
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Well it depends what the subject matter is and your target journal. But if you're trying to write a paper with a faculty mentor who doesn't write, that's not going to work--with all due respect, your paper probably sucks (like my med student papers sucked) and need to be polished by someone who knows how to get a paper accepted. Surely there are some research faculty at your school, so find them and follow their lead.

This is why all my drafts I send to my PI who's been publishing for 20 years come back covered in red ink
 
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I have never felt more validated in my utter disdain for research.
Research in general is fine, wonderful even. Aim your disdain towards the MDs who dip their toes in the water and then claim to be experts for the sake of ego or career advancement. For most medical students, this is the research you are exposed to the most, and I don't blame you for hating it. Working with engineers and basic scientists is an absolute breath of fresh air compared to clinical folks. In my experience, purely clinical researchers suffer massively from the Dunning-Kruger effect, especially surgeons. Last year I listened to an orthopedic surgeon give an impassioned speech to a room of ~50 scientists during a PhD thesis defense about how one cannot draw a conclusion from N = 5. It was a plate assay with an absurdly tight distribution for all groups and p < 0.0001. The man, who is full professor at an elite medical school, genuinely thought he was educating everyone. If you're wondering, yes, his publication record is filled with 10+ articles/year titled things like, "Bones and Moans: Pain in the Era of Minimally Invasive Joint Distraction Arthroscopy" (fake title, but you get it). I'd love to say that the "cerebral" physicians (e.g., ID, Heme/Onc, Nephro, etc...)do a better job, but they generally don't unless they actually run a lab.

No one seeing patients for 80% of their working hours with no formal research training should be publishing more than 1 article per year. We need tenure committees, NIH study sections, journal reviewers, and program directors to recognize this and place a major emphasis on quality over quantity. It would help not only in terms of quality of research, but also in terms of quality of review.
 
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Research in general is fine, wonderful even. Aim your disdain towards the MDs who dip their toes in the water and then claim to be experts for the sake of ego or career advancement. For most medical students, this is the research you are exposed to the most, and I don't blame you for hating it. Working with engineers and basic scientists is an absolute breath of fresh air compared to clinical folks. In my experience, purely clinical researchers suffer massively from the Dunning-Kruger effect, especially surgeons. Last year I listened to an orthopedic surgeon give an impassioned speech to a room of ~50 scientists during a PhD thesis defense about how one cannot draw a conclusion from N = 5. It was a plate assay with an absurdly tight distribution for all groups and p < 0.0001. The man, who is full professor at an elite medical school, genuinely thought he was educating everyone. If you're wondering, yes, his publication record is filled with 10+ articles/year titled things like, "Bones and Moans: Pain in the Era of Minimally Invasive Joint Distraction Arthroscopy" (fake title, but you get it). I'd love to say that the "cerebral" physicians (e.g., ID, Heme/Onc, Nephro, etc...)do a better job, but they generally don't unless they actually run a lab.

No one seeing patients for 80% of their working hours with no formal research training should be publishing more than 1 article per year. We need tenure committees, NIH study sections, journal reviewers, and program directors to recognize this and place a major emphasis on quality over quantity. It would help not only in terms of quality of research, but also in terms of quality of review.
Writing is writing. Not all people view publishing in journals as hard science. Some people like writing editorial pieces, etc. If you're a basic science kind of guy with an IQ through the roof, more power to you. But don't fault people for pursuing their interests.
 
Writing is writing. Not all people view publishing in journals as hard science. Some people like writing editorial pieces, etc. If you're a basic science kind of guy with an IQ through the roof, more power to you. But don't fault people for pursuing their interests.
I'm fine with writing, but there are better venues. If these articles need to exist that's fine, but we shouldn't index them the same way we index a breakthrough study in the NEJM or a novel mechanistic finding in Nature. These articles are mostly ego fluff. No one is actually sitting down in their office and opening up Academic Medicine to read "Moving Fast by Thinking Slow: Lessons from the ED" by Dr. Needsapub.

Then there are the needless reviews. If you want to write an "expert opinion" article that will actually be used in clinical practice, try UTD, Dynamed, or another journal. We don't need 65 separate review articles every year on the latest developments in Diamond Blackfan Anemia diagnosis. These again serve as CV fluff that also clog up peer review with vanity articles.

Finally, the biggest issue is the poor quality of most clinical research journal articles. There's a reason people say to stay away from basic science and RCTs if you want to publish a lot and publish fast. Most authors and peer reviewers are not even remotely qualified to evaluate published work quantitatively, and the ones who are don't bother for these types of submissions. The result is tons of unreliable findings in the literature.
 
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I'm fine with writing, but there are better venues. If these articles need to exist that's fine, but we shouldn't index them the same way we index a breakthrough study in the NEJM or a novel mechanistic finding in Nature. These articles are mostly ego fluff. No one is actually sitting down in their office and opening up Academic Medicine to read "Moving Fast by Thinking Slow: Lessons from the ED" by Dr. Needsapub.

Then there are the needless reviews. If you want to write an "expert opinion" article that will actually be used in clinical practice, try UTD, Dynamed, or another journal. We don't need 65 separate review articles every year on the latest developments in Diamond Blackfan Anemia diagnosis. These again serve as CV fluff that also clog up peer review with vanity articles.

Finally, the biggest issue is the poor quality of most clinical research journal articles. There's a reason people say to stay away from basic science and RCTs if you want to publish a lot and publish fast. Most authors and peer reviewers are not even remotely qualified to evaluate published work quantitatively, and the ones who are don't bother for these types of submissions. The result is tons of unreliable findings in the literature.

Yeah, I mean I kinda disagree with this whole perspective. Science is already restrictive enough to those who aren't like all-into a hard research career. The fact that editorials and opinions pieces are published in the highest tier journals like JAMA is a good thing IMO.

If you're like really into the whole science/research thing, differentiating what is truly a breakthrough piece vs. "fluff" isn't difficult. There is also a reason why top journals exist, because this is where all the submissions that you would likely approve of go. But to further separate those entrenched in the sciences from the real world isn't healthy imo
 
Yeah, I mean I kinda disagree with this whole perspective. Science is already restrictive enough to those who aren't like all-into a hard research career. The fact that editorials and opinions pieces are published in the highest tier journals like JAMA is a good thing IMO.

If you're like really into the whole science/research thing, differentiating what is truly a breakthrough piece vs. "fluff" isn't difficult. There is also a reason why top journals exist, because this is where all the submissions that you would likely approve of go. But to further separate those entrenched in the sciences from the real world isn't healthy imo
Out of curiosity, what do you think is the purpose of research? Is it to get "pubs" to get into residency (or other academic advancement/etc), or is it to advance our understanding of the world around us and improve patient care? The problem with all the fluff and garbage stuff created by people with the first approach is that it actually harms the efforts of the people with the second approach.

Just as a thought exercise, I've tweaked your previous post to apply to a different setting:

Yeah, I mean I kinda disagree with this whole perspective. Medicine is already restrictive enough to those who aren't like all-into a hard clinical career. The fact that NPs and PAs are practicing independently in the highest tier hospitals like MGH is a good thing IMO.

If you're like really into the whole medicine/patient care thing, differentiating what is truly quality care vs. "malpractice" isn't difficult. There is also a reason why top hospitals exist, because this is where all the clinicians that you would likely approve of go. But to further separate those entrenched in medicine from the real world isn't healthy imo
 
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Are you getting desk rejected or rejected by reviewers? I have found incredible success at publishing in higher tier journals than my work deserves by

1) Making the paper very polished/pretty. Diagrams/Illustrator skills are high yield for high impact pubs.

2) Reaching out to editors before sending the manuscript. They might even give you a sense of what sort of material they're trying to publish (i.e., there's an upcoming issue focusing on [topic], and your manuscript will fit better if you emphasize that aspect of the project).

Make sure you're aiming appropriately, but overall I'd say getting rejected 3+ times is better than getting accepted on the first go-around. If you're consistently getting accepted to the first place, you're aiming too low.
How do you go about asking editors if they may have interest in your manuscript? Do you email them with the title alone, do you provide the abstract, or some other method?
 
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How do you go about asking editors if they may have interest in your manuscript? Do you email them with the title alone, do you provide the abstract, or something other method?
You can email them. That being said, editors are busy and many journals have editorial reviews just for this purpose. This is one of the “metrics” that journals love to publish and highlight. “Time to first decision” is usually a reflection of that. If the acceptance rate is <10-15% and the time to first decision is ~1 week, that’s because 85% of the articles underwent an editorial review and were told to move on within a couple of days. My personal best was 12 hours from clicking the “submit” button to get a letter to get lost.

In general, an editor should not be sending out a manuscript for peer review if it has no hope of being published in the journal (though that does happen).
 
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You can email them. That being said, editors are busy and many journals have editorial reviews just for this purpose. This is one of the “metrics” that journals love to publish and highlight. “Time to first decision” is usually a reflection of that. If the acceptance rate is <10-15% and the time to first decision is ~1 week, that’s because 85% of the articles underwent an editorial review and were told to move on within a couple of days. My personal best was 12 hours from clicking the “submit” button to get a letter to get lost.

In general, an editor should not be sending out a manuscript for peer review if it has no hope of being published in the journal (though that does happen).
How many times do you usually have a paper rejected before just letting it die?
 
How many times do you usually have a paper rejected before just letting it die?
Depends. If you ran out of funds/time and the story is complete, I never let it die.

I might let go back and rework it if I can or it needs to be, but generally if I had an idea and did the work, I find a home for it somewhere.
 
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Depends. If you ran out of funds/time and the story is complete, I never let it die.

I might let go back and rework it if I can or it needs to be, but generally if I had an idea and did the work, I find a home for it somewhere.
The Moscow International Journal of Informative Pediatrics
 
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The Moscow International Journal of Informative Pediatrics
Couldn't find that one in JCR. But there is "Medical Hypotheses", the journal where you can just write whatever the f-ck you feel. It's impact factor isn't that bad (4.7). This is was also the journal that published masks during COVID were harmful because they caused CO2 retention and hypoxemia, so you can literally publish anything in it.

Yahtzee!
 
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Couldn't find that one in JCR. But there is "Medical Hypotheses", the journal where you can just write whatever the f-ck you feel. It's impact factor isn't that bad (4.7). This is was also the journal that published masks during COVID were harmful because they caused CO2 retention and hypoxemia, so you can literally publish anything in it.

Yahtzee!
Lol I made it up facetiously
 
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Research in general is fine, wonderful even. Aim your disdain towards the MDs who dip their toes in the water and then claim to be experts for the sake of ego or career advancement. For most medical students, this is the research you are exposed to the most, and I don't blame you for hating it. Working with engineers and basic scientists is an absolute breath of fresh air compared to clinical folks. In my experience, purely clinical researchers suffer massively from the Dunning-Kruger effect, especially surgeons. Last year I listened to an orthopedic surgeon give an impassioned speech to a room of ~50 scientists during a PhD thesis defense about how one cannot draw a conclusion from N = 5. It was a plate assay with an absurdly tight distribution for all groups and p < 0.0001. The man, who is full professor at an elite medical school, genuinely thought he was educating everyone. If you're wondering, yes, his publication record is filled with 10+ articles/year titled things like, "Bones and Moans: Pain in the Era of Minimally Invasive Joint Distraction Arthroscopy" (fake title, but you get it). I'd love to say that the "cerebral" physicians (e.g., ID, Heme/Onc, Nephro, etc...)do a better job, but they generally don't unless they actually run a lab.

No one seeing patients for 80% of their working hours with no formal research training should be publishing more than 1 article per year. We need tenure committees, NIH study sections, journal reviewers, and program directors to recognize this and place a major emphasis on quality over quantity. It would help not only in terms of quality of research, but also in terms of quality of review.
This is all so perfect that I wish I had written it. MDs are not PhDs and need to stop pretending to be them.

The only thing I would add is that the worst part about this culture is that the "Full Professor" Ortho that publishes 20+ articles per year in the "Martian Journal of Bones and Joints" also expects every resident that matches at his program to already have 20 published articles in similar negative impact factor journals. The cycle continues.
 
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Research in general is fine, wonderful even. Aim your disdain towards the MDs who dip their toes in the water and then claim to be experts for the sake of ego or career advancement. For most medical students, this is the research you are exposed to the most, and I don't blame you for hating it. Working with engineers and basic scientists is an absolute breath of fresh air compared to clinical folks. In my experience, purely clinical researchers suffer massively from the Dunning-Kruger effect, especially surgeons. Last year I listened to an orthopedic surgeon give an impassioned speech to a room of ~50 scientists during a PhD thesis defense about how one cannot draw a conclusion from N = 5. It was a plate assay with an absurdly tight distribution for all groups and p < 0.0001. The man, who is full professor at an elite medical school, genuinely thought he was educating everyone. If you're wondering, yes, his publication record is filled with 10+ articles/year titled things like, "Bones and Moans: Pain in the Era of Minimally Invasive Joint Distraction Arthroscopy" (fake title, but you get it). I'd love to say that the "cerebral" physicians (e.g., ID, Heme/Onc, Nephro, etc...)do a better job, but they generally don't unless they actually run a lab.

No one seeing patients for 80% of their working hours with no formal research training should be publishing more than 1 article per year. We need tenure committees, NIH study sections, journal reviewers, and program directors to recognize this and place a major emphasis on quality over quantity. It would help not only in terms of quality of research, but also in terms of quality of review.
I love this so much. Most of us have zero formal training in research and get taught how to do it by people who also have no formal training in research. I hate that this is a requirement and there’s so much fluff out there that doesn’t even say anything .
 
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Couldn't find that one in JCR. But there is "Medical Hypotheses", the journal where you can just write whatever the f-ck you feel. It's impact factor isn't that bad (4.7). This is was also the journal that published masks during COVID were harmful because they caused CO2 retention and hypoxemia, so you can literally publish anything in it.

Yahtzee!
Gotta wonder how much of that impact factor is people citing papers to prove them incorrect, essentially the academic version of "Cunningham's Law."
 
I found out earlier this week that it was accepted. Thanks for the advice everybody! For future people reading this, just keep submitting after revising based on reviewer feedback
 
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