The process by which ACEP Councillors are selected from Chapters varies from state to state, with each chapter customizing its approach based on its size, structure, and governance style. Each ACEP Chapter is awarded one Councillor. An additional Councillor is awarded for every 100 members. California is ACEP’s largest Chapter with nearly 3,500 members. The smallest Chapters are Montana, Wyoming, and the Dakotas, which typically report 100 members or fewer.

The variations in Councillor elections reflect the diversity of ACEP Chapters.

Pennsylvania, for example, is ACEP’s sixth-largest Chapter with about 1,850 members. Its selection of Councillors is a coordinated and deliberate effort overseen primarily by the immediate past president with input from other Chapter leaders. The selection process begins with volunteers or nominees who express interest in serving. Pennsylvania College of Emergency Physicians (PACEP) intentionally builds its delegation from a diverse mix of past Chapter presidents and leaders, current board members, and rising leaders within the organization.

This includes early-career physicians and residents, many of whom are involved in the chapter’s leadership fellowship or serve as resident board members.

Mentorship plays a central role in how PACEP engages members in the Council process. The Chapter integrates new voices by pairing junior faculty or residents with seasoned delegates. Additionally, the Chapter has created its own internal Reference Committee structure, mirroring the national Council’s process. A designated Reference Committee Chair is assigned to follow the progress of resolutions within a specific Reference Committee, review materials in advance, and represent the Chapter in both asynchronous and live testimony.

This chair mentors a vice chair who will take on the role the next year, ensuring institutional continuity and building leadership capacity. This internal preparation allows PACEP to develop informed positions on Council resolutions and provides members with meaningful advocacy and governance experience.

PACEP also invests in resolution writing and grassroots engagement. In the months leading up to the Council meeting, the chapter hosts resolution writing workshops and actively solicits ideas from members. Chapter leaders work directly with interested members to mentor them in crafting resolutions. This collaborative approach ensures that PACEP’s contributions to ACEP policy are grounded in member experience and reflective of state-specific concerns.

In contrast to PACEP’s mentorship-focused appointment process, several other chapters take a more formal electoral approach.

In Oklahoma, Councillors are elected by the Chapter’s membership during its annual meeting. Arizona follows a similar procedure, holding elections each April; however, the incoming president automatically receives a Councillor slot if they were not already elected. Georgia uses a nominating committee to select a slate of candidates for both Councillor and Alternate positions, which are then voted on by the membership at the Annual Meeting. These roles are described as competitive and highly sought after within the Chapter.

South Carolina uses an inclusive ballot system. The Chapter sends out a call for interest, and all who respond are placed on the ballot. Councillors are elected by membership vote at the annual meeting. Those who do not secure a Councillor role but receive a significant number of votes are assigned as Alternates if space allows.

Some Chapters rely on appointments rather than election. In Minnesota, the Chapter’s officers appoint eight Councillors annually, prioritizing existing board members. These appointments are made in the Spring and serve for one year. California takes an even more structured approach: its Board of Directors appoints Councillors based on a ranking policy approved by the Board of Directors. This vote occurs in July, after new board members are seated, ensuring that newly elected leaders are considered in the process.

Missouri combines electoral structure with term continuity. The Chapter has seven Councillors who serve staggered three-year terms. Elections are held annually at the Missouri Emergency Medicine Symposium each spring, allowing only a portion of Councillor positions to turn over at one time, which supports long-term strategy and institutional memory.

These varying methods, ranging from elections to board appointments to mentorship-driven selection, demonstrate the flexibility ACEP offers its Chapters in structuring their Council delegations. Although some prioritize member voting, others like PACEP emphasize continuity, leadership development, and active engagement in shaping the College’s future.

Mr. Scheid is ACEP’s Communications Director.