Heading into her final meeting as ACEP’s Council Speaker this fall, Melissa Costello, MD, FACEP, has one goal in mind.
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ACEP Now: July 2025“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.”
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.”
As Speaker, Dr. Costello manages the flow of business to ensure procedural integrity, and that work isn’t done in isolation. She describes the rhythm of ACEP’s Council as predictable but energized: Reference committees hear testimony on resolutions ahead of time, and these comments help shape the debate on the floor.
“By the time we get to the floor for voting, people have heard the arguments,” she said. “They’ve thought deeply about the issues. That makes the discussion richer and more meaningful.”
Policy in Action
This policy creation process doesn’t end at the close of the Council meeting. Once a resolution is adopted, it moves along to the ACEP Board of Directors for consideration and implementation. In most cases, the Board affirms the Council’s actions and incorporates them into ACEP’s advocacy or clinical priorities. Over the years, Council-originated resolutions have influenced national policy stances on workplace violence, pain management protocols, and boarding in the emergency department, among many others.
Dr. Costello sees this evolution of ideas as a testament to the Council’s value.
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“You don’t need to be a policy expert to bring something to Council,” she says. “You just need to be someone with a perspective, an idea, and the willingness to do the work to turn that idea into policy.”
In fact, she encourages more members, especially younger physicians and those who’ve never attended, to consider participating.
“If there’s something you think ACEP should be doing, this is how you make that happen,” she said. “My advice to any physician attending Council for the first time, get up and speak. Go to the microphone. Once you’ve done that for the first time, it will be much easier the next time you come.”
ACEP’s Council is where complex issues such as workplace violence, boarding, and reimbursement challenges continue to be discussed, and where policy moves forward.
“This is one of the best things ACEP does,” Dr. Costello said.
Mr. Scheid is ACEP’s Communications Director.
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