Frustrations With Hospitalist Care: Need to Improve Transitions and Communication This issue includes several letters that comment on“Three Degrees of Separation ” (1), Howard Beckman’s

sobering essay about hospitalist care. Dr. Beckman’s per-sonal recounting of adverse changes in hospital-based care over the past 2 decades raised several concerns about the burgeoning hospitalist movement in the United States. With great nostalgia, he described his early days as a gen-eralist who managed both outpatient and inpatient care. The flow of information across these settings was relatively seamless, in part because the same physician cared for the patient. But Beckman encountered multiple logistical chal-lenges that, over time, impeded his ability to meet the needs of his hospitalized patients: traveling from practice to hospital, competing responsibilities, less interaction with other physi-cians caring for mutual patients, and keeping up with the fast-changing protocols and technology of inpatient medicine. Recognizing these limitations, he reluctantly relinquished hi