The American Osteopathic Association (AOA) has filed a lawsuit challenging a restrictive American Board of Internal Medicine (ABIM) policy that reportedly 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 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, according to AOA.

“When DOs are excluded, patients lose,” AOA President Robert G.G. Piccinini dsif. “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 to bringing Americans quality healthcare occur as physicians are burning out at alarming rates; the Association of American Medical Colleges estimates a projected shortage of more than 86,000 physicians by 2026.

At the same time, osteopathic medicine is experiencing remarkable growth. The AOA reports 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 more than 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,” AOA CEO Kathleen S. Creason stated. “Our goal is to ensure fairness, protect our members, and preserve the integrity of graduate medical education.”

The American College of Osteopathic Internists (ACOI), a plaintiff in the lawsuit, argues that patients lose access to physicians when program directors are pushed aside for reasons unrelated to competence. The organization believes internal medicine residents deserve fair, evidence-based pathways to board certification.

“We did not arrive at this decision lightly,” ACOI President Damon Baker noted. “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 philosophy of osteopathic medicine: treating the whole person rather than the symptoms. The AOA supports excellence in education, research, and patient care across all medical disciplines.