After efforts to eliminate unreasonable barriers, the AOA takes legal action to ensure all qualified physicians can lead and mentor the next generation of doctors.
CHICAGO—The American Osteopathic Association (AOA) has filed a lawsuit challenging a restrictive American Board of Internal Medicine (ABIM) policy that unfairly limits opportunities for both internal medicine physicians and residency and fellowship training programs.
At issue is an ABIM rule that blocks qualified residents and fellows from taking its board certification exams—not because of their competence, but because their program directors are certified by the American Osteopathic Board of Internal Medicine (AOBIM) rather than ABIM. This rule sidelines well-trained, accomplished osteopathic physicians who are fully approved by the Accreditation Council for Graduate Medical Education to lead residency and fellowship programs.
“When DOs are excluded, patients lose,” said AOA President Robert G.G. Piccinini, DO, D.FACN. “This policy removes skilled program directors from leadership, disrupts career paths and limits mentorship for young physicians. At a time when the nation faces a growing physician shortage, ABIM’s actions close essential training pathways that ultimately hurt patient care. We will continue to defend osteopathic physicians and stand up for a medical education system that recognizes excellence.”
These obstacles and unnecessary barriers to bringing Americans quality healthcare occur at a time of ongoing physician burnout and the projected shortage of more than 86,000 physicians by 2026 identified by the Association of American Medical Colleges (AAMC).
In addition, osteopathic medicine is experiencing remarkable growth. The AOA reports that the profession is comprised of more than 207,000 DOs and medical students, the largest number in its 150-year history. Almost 40,000 students are training at osteopathic medical schools, representing over 25% of all U.S. medical students. With a young workforce—nearly 70% of practicing DOs are under the age of 45—the profession is well positioned to help address the nation’s projected physician shortfall. DOs also hold influential roles across government, the military, NASA, major sports organizations and the past three U.S. presidential administrations.
The AOA’s legal action aims to restore fairness and ensure that all qualified program directors—whether certified by AOBIM or ABIM—can continue guiding residents and fellows toward the certification of their choice.
“Legal action was our last resort. We filed this lawsuit only after exhaustive efforts to resolve the issue collaboratively,” said AOA CEO Kathleen S. Creason, MBA. “Our goal is to ensure fairness, protect our members, and preserve the integrity of graduate medical education.”
The American College of Osteopathic Internists (ACOI), one of the plaintiffs in the lawsuit, notes that when program directors are pushed aside for reasons unrelated to competence, patients lose access to the physicians they need. The organization believes internal medicine residents deserve fair, evidence-based pathways to board certification.
“We did not arrive at this decision lightly,” said ACOI President Damon Baker, DO, MACOI. “We joined this lawsuit because the current policy creates unnecessary barriers for program directors and residents alike. We believe in a collaborative approach to graduate medical education—one that values all qualified physicians and maintains a fair path to certification.”
The American Osteopathic Association represents more than 207,000 osteopathic physicians (DOs) and medical students, advocating for the distinct philosophy of osteopathic medicine: treating the whole person, not just the symptoms. The AOA supports excellence in education, research and patient care across all medical disciplines.
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Frequently asked questions
The American Board of Internal Medicine (ABIM) maintains a policy that blocks highly trained, qualified osteopathic physicians from educating residents and fellow physicians in training who wish to sit for ABIM examinations. No other American Board of Medical Specialties (ABMS) has such a policy or limitation. The ABIM policy unfairly limits the board certification options for qualified residents and fellows and eliminates career opportunities as program directors for physicians certified by the American Osteopathic Association’s (AOA) internal medicine certifying board, the American Osteopathic Board of Internal Medicine (AOBIM).
The current ABIM policy prohibits AOBIM board-certified program directors from attesting to the training of residents and fellows; attestation of training is a prerequisite for all ABIM board certification exams. This policy is not based on the qualifications of the residents, fellows or program directors, but on outdated and inaccurate assumptions about the ability and expertise of osteopathic program directors—physicians whose qualifications are universally recognized throughout the healthcare community, including hospitals, insurers and the Accreditation Council for Graduate Medical Education (ACGME), the accrediting body that accredits most allopathic and osteopathic residency and fellowship programs in the U.S.
The AOA made the decision to litigate only after careful analysis, having exhausted all other options to bring the matter to a productive resolution. Numerous conversations with ABIM, both by AOA and others, made it clear that, for the protection of residents, fellows and AOBIM board-certified physicians, a legal challenge was the only remaining option. With this lawsuit, the AOA is seeking to have a court declare the ABIM policy unlawful and enjoin its continued enforcement. The effect of such an injunction would be to give residents and fellows who complete training under AOBIM-certified program directors a choice in their board certification exams.
This lawsuit is important to protect the autonomy of residents and fellows to choose their board certification pathways. This lawsuit also works to defend qualified program directors, maintain open career pathways and honor AOBIM-certified program directors’ contributions to graduate medical education. It is essential to preserve osteopathic training and the tenets that are valued by patients and the entire healthcare community.
Internal Medicine (IM) is AOA’s second largest certifying board and practice specialty. More DOs currently enter IM than any other specialty.
No, the ABIM is the only ABMS board that does not accept an attestation of program completion from an AOA board-certified program director.
AOA had significant discussions with stakeholder groups and ABIM. Specifically, AOA leadership and other stakeholders engaged in dialogue directly with ABIM, seeking modifications to this policy. Despite these collective efforts, ABIM was unwilling to adequately modify or eliminate the policy. After an extensive review, AOA leadership unanimously agreed that legal action was necessary.
Please read AOA’s prior statement. AOA’s current lawsuit asserts new claims for antitrust violations that continued to occur since the resolution of the prior lawsuit.
Key pillars of the AOA’s strategic plan include advocacy for the profession, support of affiliate organizations, enhancement of AOA board certification and growth of the profession.
AOA is seeking to have the ABIM policy declared unlawful and enjoined. We understand that the legal process takes time, and we are fully committed to vigorously pursuing this process through to successful resolution. Throughout the process, we will continue to advocate for osteopathic physicians to have the opportunity to obtain the board certification pathway of their choice.
Updated information will be maintained on the AOA website.
Additional information about the American Osteopathic Board of Internal Medicine can be found on the AOBIM website.
AOA board certification, established in 1939, currently provides board certification in 73 primary, subspecialty and conjoint certifications in addition to Certificates of Added Qualification (CAQs) and professional designations in osteopathic manipulative treatment (OMT). More information on AOA board certification can be found on certification.osteopathic.org.
If you have been negatively impacted by the ABIM policy and would like to share your story with us, please contact [email protected].