- Background: Despite the evidence that the patient gender is an important component in the intensive care unit (ICU) admission decision, the role of physician gender and the interaction between the two remain unclear. Objective: To investigate the association of both the patient and the physician gender with ICU admission rate of critically-ill emergency department (ED) medical patients in a hospital with restricted ICU bed capacity operates with "closed door" policy. Methods: A retrospective population based cohort analysis. We included patients above 18 admitted to an ED resuscitation room (RR) of a tertiary hospital during 2011-2012. Data on medical, laboratory, and clinical characteristics were obtained. We used an adjusted multivariable logistic regression to analyze the association between both the patient and the physician gender to the ICU admission decision. Results: We included 831 RR admissions, 388 (46.7%) were female patients and 188 (22.6%) were treated by a female physicians. In adjusted multivariable analysis (adjusted for age, diabetes, mode of hospital transportation, first pH, and patients who were treated with definitive airway and vasso-pressors in the resuscitation room), female-female combination (patient-physician, respectively) showed the lowest likelihood to be admitted to ICU (adjusted OR 0.21, 95% CI 0.09-0.51) compared to male-male combination, in addition to a smaller decrease among female-male (adjusted OR 0.53, 95% CI 0.32-0.86) and male-female (adjusted OR 0.43, 95% CI 0.21-0.89) combinations. Conclusion: We demonstrated the existence of the possible gender bias where female gender of the patient and treating physician diminish the likelihood of the restricted health resource use.