The advancement of radiology was the first thing that came to mind for Dr. Clarke when discussing how technology has advanced emergency medicine. Today, physicians can utilize MRIs, CT, and ultrasound, with the latter often available at the point of care. Expedited lab work has also improved care, Dr. Clarke said.
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ACEP Now: Jan 01“We can order a CBC or a [comprehensive metabolic panel] and make a faster diagnosis,” Dr. Clarke said.
From an economic viewpoint, emergency physicians today are faced with an increasing number of patients who use the ED as a source of primary care, Dr. Clarke said, although perceived issues around the “misuse” of the ED date back to the 1970s.2
Parked Los Angeles Fire Department rescue ambulance in 1978. (Click to enlarge.)
“Even in my smaller hospital, we see a lot of patients who come in if they’d had a cold for several days, and when we ask them why they haven’t gone to a doctor or urgent care, they tell us that they don’t want to have to pay up front,” Dr. Clarke said. He is also familiar with the delayed care and crowding, including boarding issues, that occur.
The economics of emergency medicine has also evolved. Dr. Clarke recalled issues with payment and salary in his earlier years, especially those related to contract management groups like the ones detailed in the 1992 book The Rape of Emergency Medicine.
“The groups would hire physicians and pay them a certain salary and then have a contract with a hospital where the group would be making a lot more money,” Dr. Clarke said. “It was almost like a pyramid scheme. That has changed, even within the group I work for, because ER physicians are learning more about businesses and contracts.”
Same Beating Heart
Throughout all these changes over the decades, Dr. Clarke is still in love with the specialty.
“I am not one to sit down and look at an ECG or sodium potassium in the ICU,” Dr. Clarke said. “I like the excitement.”
Emergency medicine allows physicians to be wanderers, Dr. Clarke said. They can be ship doctors, go on mountain treks, work in forensics, or be a part of a S.W.A.T. team.
“You can do so many things, and I think a lot of the physicians in emergency medicine still do it because they like the excitement,” Dr. Clarke said.
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3 Responses to “Dr. Elsburgh Clarke Was Among First to Specialize in Emergency Medicine”
January 16, 2025
Charles Boursier, MDElsburgh continues to be a remarkable man, excellent photographer and hard working physician, putting in the hours few much younger would be willing to do. He continues to be a fine doctor and compassionate patient advocate.
February 2, 2025
Neil Shocket MDI was a fellow resident with Elsburgh back when we started at LAC/USC in 1980. Technology has come a long way since those early years when we used to do our own basic tests in the tiny lab in the back behind C booth. I’m still Board Certified.
After a long and satisfying career as an Emergency Physician, I now teach the “introduction to clinical medicine” course to new medical students at Keck School of Medicine at USC.
The old hospital is now a historical landmark and kept in its original condition although no longer used to treat acute patients. As a special treat I take my students on a private tour of the old ER. You can definitely still feel the ghosts of patients and staff members roaming the halls.
May 30, 2025
Terrence L. Jones MDI worked with Dr. Clark when I was a paramedic in Pomona in the mid-1980’s. It was his influence, as well as his colleagues at Pomona Valley Hospital that encouraged me to go to medical school. After nearly 30 years on the Big Island of Hawaii, in single coverage ERs and as EMS Medical Director for the Department of Health, the seed planted found favorable soil.