AOA files lawsuit to protect fair opportunities for physicians and residents

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, Dec. 4, 2025 /PRNewswire/ -- 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."

• ABIM's policy restricts opportunity: It unfairly blocks qualified residents and fellows from pursuing board certification based on bias, not ability.
  
  
• Qualified directors are being sidelined: AOBIM-certified physicians, trained and approved under the same ACGME standards as their peers, are being stripped of their authority to verify residents' and fellows' training.
  
  
• Patients ultimately pay the price: By excluding DOs from key leadership roles, the policy exacerbates the nation's physician shortage and reduces care access—especially in underserved areas where DOs have long played a vital role.

SOURCE American Osteopathic Association