Shortage of doctors in emergency departments (EDs) is a root issue in maintaining ED-based residency programs. This study describes the efficiency of emergency practice according to board certification; 3 board-certified physicians versus a pediatric resident. Of 342 children, we found no differences as per the board certification in the ED length of stay, acuity, and return visits with more frequent hospitalization by the board-certified physicians. This result suggests that with a proper residency program, both board-certified physicians and residents can make a decision on hospitalization.