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Introduction: An emergency physician (EP) at triage may improve waiting times, emergency department (ED) length of stay and staff satisfaction, while reducing left without being seen (LWBS) rates. Different staffing models have been described, however the optimal model is unknown. We assessed whether having a 4-hour EP at triage shift would reduce length of stay and LWBS rates. Methods: The study was conducted in an urban ED (60 000 visits annually). 4-hour shifts were scheduled during peak afternoon hours over a 6-week period, divided into 3 control weeks (no triage EP) alternating with 3 intervention weeks (triage EP present). All patient visits were included. The triage EP managed patients clinically, and assisted with triage and administration. Prospective temporal data and visit rates were extracted from the Emergency Department Information System. Staff satisfaction was recorded on project-specific surveys. Results: 5020 visits were included. Groups were similar for age, gender, CTAS score, and daily ED volumes. A triage EP did not reduce mean ED length of stay (triage EP 396 min v. no EP 409 min, p = 0.32) or mean time to see a physician (triage EP 111min v. 112 min, p = 0.61). Overall LWBS rates were reduced (triage EP 5.7% v. 6.3%, ARR 0.6%, RRR 10%, NNT 17). Subgroup analysis of the 4-hour triage EP period demonstrated a very significant reduction in LWBS rates (triage EP 3.1% v. 7.6%, ARR 4.5%, RRR 59%, NNT 3). The majority of physicians surveyed enjoyed the triage shifts, however 46% felt that these shifts should not continue after the study period. The nurses responded more favorably, with 65% preferring the shifts to continue. Conclusion: 4-hour shifts at triage are not sufficient to reduce overall ED length of stay, although they reduce the number of patients who leave without being seen. Longer shifts may be required to significantly impact ED length of stay. Keywords: emergency physician in triage, ED crowding, LWBS