Heading into her final meeting as ACEP’s Council Speaker this fall, Melissa Costello, MD, FACEP, has one goal in mind.

“When the meeting is over, I want to make sure everybody’s voice has been heard,” said Dr. Costello, who has led the group for three years.

That’s not an easy goal to accomplish.

Dr. Costello

Dr. Costello, who will lead ACEP’s Council on Sept. 5-6 in Salt Lake City before ACEP’s 2025 Scientific Assembly (ACEP25), has more than 450 Councillors in the room for two days. But when you consider elections and other scheduled events during the Council meeting, she really has about 12 hours. Things move fast, and debate must be free and fair, she said. When it’s all over, dozens of resolutions will be amended, some rejected, and some adopted before moving ahead to ACEP’s Board of Directors for approval.

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All in a day’s work for the Council Speaker.

“The thing that attracts people to this process is that people who make a living working in chaotic, uncontrolled environments can come into a place—even one with 400 people from all over the country, with all different political views, backgrounds, experiences—[and] agree on a method for forming policy that serves our specialty,” she said. “For me, it has been a privilege to be an arbiter of the process. The shared sense of purpose is what makes the ACEP Council not just functional, but exceptional.”

Genuine Discourse

The ACEP Council is the representative body of the College, composed of Councillors elected by state Chapters, Sections, and other partner organizations such as the Emergency Medicine Residents Association (EMRA). The Council drives policy through Resolutions, chooses members to the Board of Directors, and selects the next Council Speaker. By the time the event is over, the Council will have debated and decided nearly 100 resolutions dealing with everything from clinical guidelines to health policy.

“People are always surprised at how efficient and civil it is,” Dr. Costello said. “We do it with real discussion and genuine discourse, not yelling, not posturing. It’s deliberate, collaborative, and professional.”

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That professionalism stems from the rules of order and the culture of preparation instilled in the Council delegates. Dr. Costello noted that the Council functions under a version of parliamentary procedure designed specifically for ACEP, and that the structure “isn’t meant to limit people—it’s meant to ensure that everyone has a chance to be heard, and that we can still get things done.”