Background: Family physicians in primary healthcare (PHC) settings frequently encounter emergency cases of varying severity. Managing such cases effectively requires structured protocols, proper training, and adequate equipment. This study aimed to identify the barriers faced by primary care physicians (PCPs) in managing emergency cases in Al Ahsa, Saudi Arabia. Methods: A cross-sectional study was conducted among PCPs working under the Ministry of Health (MOH) and National Guard Health Affairs (NGHA) in Al Ahsa. Data were collected using a self-administered electronic questionnaire distributed via official email and social media platforms. The instrument included sections on socio-demographic characteristics, a 10-item competency scale, a 12-item satisfaction scale, and the frequency of emergency cases encountered over the past 12 months. Results: Of the 414 respondents, 81.1% were female and 83.5% were aged between 25 and 34 years. Attendance at BLS, ACLS, and ATLS courses within the last 1–2 years was reported by 45.8%, 58.5%, and 50.4% of participants, respectively. Low competency levels were reported by 15.6% of physicians, and 18.9% expressed dissatisfaction in handling emergency cases. Higher competency and satisfaction scores were significantly associated with younger age, female gender, Saudi nationality, and possession of a bachelor’s degree. A positive correlation was observed between competency and satisfaction scores. Conclusion: The findings reveal moderate levels of competency and satisfaction among PCPs in managing emergency cases. Notably, older, male, and non-Saudi physicians demonstrated lower levels in both domains. Targeted training and continuous professional development are essential to enhance emergency preparedness in PHC settings.