Aims: To determine if primary contact physiotherapists (PCPs) in the emergency department (ED) improve patient flow while providing management comparable to doctors for musculoskeletal patients. Methodology: Prospective observational design comparing PCPs to doctor treatment of musculoskeletal patients. Participants: 559 ED patients--275 patients treated by a PCP and 284 by a doctor. Measures: The primary outcome measure was wait time. Secondary outcomes were total length of stay, patient satisfaction, recovery and follow-up, re-presentations and adverse events. Results: The median wait time for patients managed by a PCP was statistically significantly shorter than for patients managed by a doctor, with a median of 22 minutes compared with 63 minutes (P<0.001). The median total time spent in the ED for patients managed by a PCP was also statistically significantly shorter than for patients managed by a doctor, 120 minutes compared with 201 minutes (P<0.001). Conclusion: PCP services in ED improve patient flow for musculoskeletal patients.