Study objective: To compare emergency physician (EP) credentialing characteristics in two metropolitan areas of Missouri: Kansas City, which has had an emergency medicine (EM) residency program since 1973, and St Louis, which is without a program approved by the Accreditation Council for Graduate Medical Education. Methods: A cross-sectional, descriptive survey concerning EP training, certification, and practice characteristics was administered by standardized telephone interviews. Participants were all emergency department directors in Kansas City and St Louis general hospital EDs serving more than 10,000 patients annually. Results: Twenty Kansas City EDs, with an annual census of 20,250±7,200; and 30 St Louis EDs, with an annual census of 27,100±13,800, were surveyed. In Kansas City, 68% of practicing EPs were EM trained, versus 10% in St. Louis (P<.0005). The percentage of board-certified EPs was also greater in Kansas City than in St Louis (82% versus 42%, P<.0005). Eighty-six percent of ED directors in St Louis, compared with 30% in Kansas City, reported that they did not attempt to recruit EM-trained staff or that recruitment was difficult (P<.0005). Conclusion: The presence of an EM residency training program is associated with favorable EP credentialing characteristics in the Kansas City metropolitan area. This information may prove useful to institutions attempting to establish EM training programs in areas where none currently exist.