INTRODUCTION: The problem of emergency department (ED) overcrowding is an issue of some concern and staffing profile has been identified as a contributing factor. The aim of this study was to assess the effect of having an emergency physician on-site at night in a rural base hospital ED in terms of the ED length of stay, waiting times, admissions, specialist consultations, the use of diagnostic tests, and ED representations within 7 days. METHODS: A retrospective analysis was performed of the ED database at Tamworth Base Hospital in rural New South Wales, Australia. A comparison was made between 125 patients seen when an emergency physician was in the department (Group A) and 117 patients seen when an emergency physician was not on site (Group B). RESULTS: The mean ED length of stay was 48 min for Group A and 96 min for Group B. There were 15 admissions from Group A and 27 from Group B. There were significantly less pathology tests and consultations for the patients in Group A compared with Group B. There was no significant difference in waiting times or in the re-presentation rate between the two groups. CONCLUSIONS: The presence of an on-site emergency physician resulted in a significantly shorter ED length of stay, lower admission rate, less initial pathology tests, and fewer telephone consultations.