As medicine is getting more and more complex and (bio) technology-driven, it is seeing a considerable increase in subspecialisation. This is not only true for traditionally 'broad' disciplines, such as internal medicine, surgery, or paediatrics, but in virtually all medical specialisms there is increasing sub-specialisation. We now see interventional cardiologists or cardio-electrophysiologists, fertility specialists, immuno-dermatologists, ophthalmologists who entirely focus on the anterior chamber of the eye, and ear-nose-throat specialists who only want to hear about the ear ossicles. It seems that the subspecialisation of all medical disciplines is evolving every year and is not going to stop for a while. Even more than in clinical practice, research is usually carried out in a small area of medicine and is subspecialised in itself. Hence, an increasing number of subspecialist journals are coming to press, whereas the number of general journals has been stable for decades. Nevertheless, most physicians, including subspecialists, still see patients with 'general' problems or problems belonging to a neighbouring subspecialism, or patients who also have problems other than those that fit in their subspecialisation. In view of that, it may be expected that the interest in medical journals that encompass more than subspecialised information and are not held by the boundaries of subspecialisation will remain. Indeed, journals such as the New England Journal of Medicine, the Lancet, the British Medical Journal and JAMA are widely distributed and read by a diverse readership on a weekly basis. National journals of medicine have a fixed position in the ranking list of medical journals in the Journal Citation Report and show an increasing impact factor.
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