AOA president: ABIM policy about internal medicine program directors is unlawful, disruptive

Patients, physicians and U.S. health care will be hurt by a policy that shuts osteopathic physicians out of program directorships in internal medicine, said the leader of the American Osteopathic Association (AOA).

A federal lawsuit filed in December 2025 was a public step in the dispute between AOA and the American Board of Internal Medicine (ABIM). The organizations are sparring over and ABIM policy that deals with the medical certifications of residence and fellowship program directors. AOA alleges ABIM will not honor program attestations of completion from program directors certified by the American Osteopathic Board of Internal Medicine (AOBIM), despite a decade-old agreement that unified medical education in the United States.

AOA President Robert G.G. Piccinini, DO, D.FACN, spoke with Medical Economics about the ramifications of this policy, the lawsuit, and what they mean for patients and doctors in a health care system already short of physicians. Of note: Osteopathic medicine has boomed in recent years in U.S. health care.

This transcript has been edited for style and clarity.

Medical Economics: We're going to talk about a pending court case that the association has gotten involved in. But I wanted to preface that with context and ask you to discuss some of the recent facts, figures, and findings that indicate the growth of osteopathic medical schools and osteopathic physicians, their numbers across the United States.

Robert G.G. Piccinini, DO, D.FACN: It's a great question, it's a great topic, I love talking about it because it's such a great story. Currently, we're over 207,000 osteopathic physicians and osteopathic medical students. We’ve grown about 300% in the last 10 years. So we've just been keeping on moving forward in our growth is seeming to be doing wonderfully. The majority of our physicians are in primary care. The other thing to note about is that the osteopathic profession, 70% of our membership is under the age of 45. So, even though we've been around for quite a long time, with the explosive growth that we've had in medical schools our numbers are a very youthful workforce, and we're here to answer the long-term goals of the position shortages.

Medical Economics: Recently, the AOA filed a lawsuit against the American Board of internal medicine. Can you explain that lawsuit and why it had it had to be filed?

Robert G.G. Piccinini, DO, D.FACN: I think some history is good in this, in that in 2015, even prior to that, the AOA and the ACGME (the Accreditation Council for Graduate Medical Education) entered into negotiations about streamlining graduate medical education. And in 2015, we had a unified system whereas all the osteopathic-only residency programs entered into the ACGME system for a single unified system. At the time all the ABMS (American Board of Medical Specialties) member boards agreed to allow AOA board-certified physicians function as program directors to attest to the certification and completion of residents, and that happened without problems for approximately seven years. Then all of a sudden ABIM on their own decided that this was no longer adequate, that their program directors in ABIM programs and sub-specialties had to be ABIM certified. So, after we engaged in substantive and direct discussions with the American Board of Internal Medicine representatives, and despite good-faith conversations between AOA leaders and the ABIM representatives, they refused to eliminate this unlawful policy. Following a comprehensive evaluation of available options, the AOA leadership reached the unanimous decision that legal action was necessary to protect osteopathic physicians and residency programs. So that’s why we entered into the lawsuit, to really change this unlawful action that ABIM has and, being of note, that of the ABMS boards, ABIM is the only one that has this policy.

Medical Economics: Back in 2015, when you touched on that history at the time, it sounded like this policy to really streamline the program recognition and completion, that sounds like a move that AOA supported. Is that accurate?

Robert G.G. Piccinini, DO, D.FACN: Correct. We, at our house of delegates that year voted as an association to enter into this unified system. So it was a decision made at the house of delegates for all our membership.

Medical Economics: Now, what has been the effect for osteopathic physicians working as program directors in training programs for internal medicine?

Robert G.G. Piccinini, DO, D.FACN: Thank you for that question. It's been quite drastic. I mean, we've seen a 93% decrease in AOBIM-certified program directors and internal medicine residency program since 2015. We’ve seen an 82% decrease in AOBIM certified program directors in internal medicine subspecialties. So there has been a significant damage to people taking the boards, but also it's been disruptive to physicians’ individual lifestyles, autonomy. It is forced people who were AOBIM-certified to go back and take ABIM certification. It's not something in the second half, or even in the middle career of your life, that you want to suddenly go back and take us a certifying board. It upended lifestyles. And you know, part of our lawsuit is actually, it's not just the AOA, but there are members that have entered into this that their lives were harmed because of this policy. This has been disruptive to those physicians in their lifestyle, their autonomy, their career paths. It has been up upending and uprooting to these physicians.