Interstate Medical Licensure Compact: The 2026 Guide to Multi State Licensing

In This Article

• The Multi-State Licensing Problem Every Physician Faces
• What Is the Interstate Medical Licensure Compact?
• How the IMLC Works: Letters of Qualification and the Expedited Process
• Which States Are in the Compact?
• States Not in the Compact and What That Means
• IMLC Eligibility Requirements
• Step-by-Step Application Process
• Cost Breakdown: IMLC Fees Plus State Fees
• How Fast Is Expedited? Real Timeline Expectations
• Telemedicine Implications: Prescribing and Practicing Across State Lines
• How the IMLC Interacts with Payer Credentialing
• Common Misconceptions About the IMLC
• IMLC Compared to Other Professional Licensing Compacts
• What This Means for Your Practice in 2026

Key Takeaways

• The Interstate Medical Licensure Compact (IMLC) is not a national license. It is an expedited pathway that allows eligible physicians to obtain full, individual state medical licenses in 41 states, Washington D.C., and Guam without repeating the full application process in each state.
• Physicians can typically receive new state licenses in 2 to 4 weeks through the Compact, compared to 8 to 16 weeks (and sometimes longer) through traditional state board applications.
• Total cost per state ranges from $75 to $800+ in state fees, plus a one-time IMLC processing fee, making multi-state expansion significantly more affordable than hiring separate licensing agents for each state.
• Having a medical license in a state is only the first step. Physicians must still complete payer credentialing and enrollment separately for every insurance network they want to join in each new state.
• The IMLC requires physicians to designate a State of Principal License (SPL) and meet eligibility criteria including active board certification, no disciplinary actions, and no criminal history.
• California, New York, and Florida are the three most notable states still outside the Compact, and each requires a traditional full application.

Dr. Marcus Webb, a psychiatrist based in Nashville, Tennessee, built a thriving telepsychiatry practice during 2023 and 2024. By early 2025, his patient waitlist had grown to over 200 names, with more than half of those patients located in neighboring states: Kentucky, Alabama, Georgia, and Virginia. The demand was obvious. The barrier was licensing.

When Dr. Webb contacted each state medical board individually, the timelines he received ranged from 10 weeks in Kentucky to nearly 20 weeks in Georgia. The paperwork for each state was different. Every board wanted its own set of primary source verifications, its own application fee, its own set of reference letters. His office manager, Rebecca, estimated they would spend over 60 hours compiling and submitting four separate applications, at a total cost exceeding $3,200 in application and processing fees alone.

Then Rebecca discovered the Interstate Medical Licensure Compact. Within six weeks, Dr. Webb held active medical licenses in all four states. The total administrative time was closer to 12 hours. The total cost was under $1,800.

That difference is not a minor convenience. For Dr. Webb's practice, those four new state licenses translated into approximately $38,000 in additional monthly revenue within the first quarter. And the time his staff saved on licensing paperwork was redirected toward the far more complex process of getting credentialed with payers in each of those new states.

This guide covers everything physicians and practice administrators need to know about the IMLC in 2026: eligibility, process, costs, timelines, and the critical steps that come after the license is in hand.

The Multi-State Licensing Problem Every Physician Faces

Medical licensure in the United States is governed at the state level. There is no federal medical license. Every state and territory operates its own medical board, sets its own requirements, collects its own fees, and processes applications on its own timeline. This system dates back to the 19th century, and while it has served important public safety functions, it creates significant friction for physicians who want or need to practice across state borders.

This friction has grown dramatically since 2020. The expansion of telemedicine turned state borders from a logistical nuisance into a daily operational bottleneck. A dermatologist in Arizona who wants to see a patient in New Mexico via video call needs a New Mexico medical license. A radiologist reading imaging studies from a hospital system that spans three states needs a license in each state. A locum tenens surgeon covering weekend call at a rural hospital across the state line needs a license in that state, even if the assignment is only for 48 hours.

Before the Compact existed, physicians had two options. They could apply individually to each state medical board, repeating essentially the same verification process over and over, waiting months for each license, and paying separate fees. Or they could hire a licensing service to manage the process, which typically added $500 to $1,500 per state on top of the board's own fees.

Neither option was efficient. And for physicians in time-sensitive situations, such as accepting a new position, expanding a telehealth practice, or responding to workforce shortages, the traditional process was often too slow to be practical.

The Interstate Medical Licensure Compact was designed to solve exactly this problem.

What Is the Interstate Medical Licensure Compact?

The Interstate Medical Licensure Compact (IMLC) is a formal agreement among participating U.S. states, territories, and the District of Columbia that creates an expedited pathway for physicians to obtain medical licenses in multiple member states. The Compact is administered by the Interstate Medical Licensure Compact Commission, which operates under federal legislation and interstate compact law.

The IMLC was first authorized in 2015, and the Commission began accepting applications in 2017. It was created through a collaborative effort led by the Federation of State Medical Boards (FSMB) in response to growing demand for physician mobility, particularly in telehealth, locum tenens, and rural healthcare.

What the IMLC Is

The Compact is a process, not a license type. Physicians who use the IMLC receive full, individual state medical licenses in each member state they select. These licenses are identical in legal authority to licenses obtained through the traditional application process. The IMLC simply provides a faster and more efficient administrative pathway to obtain them.

Think of it this way: instead of sending separate, complete applications to five different state medical boards and having each one independently verify your medical school, residency, board certification, and disciplinary history, the IMLC performs a single comprehensive verification through what it calls a Letter of Qualification (LOQ). That LOQ is then accepted by each participating state as the verification foundation for issuing your license.

What the IMLC Is Not

The IMLC is not a national medical license. It does not override state medical board authority. Each state that issues a license through the Compact retains full regulatory jurisdiction over that license, including the authority to investigate complaints, impose discipline, and revoke or suspend the license. The Compact does not exempt physicians from state-specific requirements like jurisprudence exams where applicable.

This is a critical distinction that gets lost in casual conversation. When someone says they "got their Compact license," what they actually mean is they used the Compact process to obtain individual state licenses more quickly.

How the IMLC Works: Letters of Qualification and the Expedited Process

The mechanical process of the IMLC centers on two key concepts: the State of Principal License (SPL) and the Letter of Qualification (LOQ).

The State of Principal License

Every physician applying through the Compact must designate one state as their State of Principal License. This is the state where the physician meets at least one of the following criteria:

1. The state is the physician's primary residence
2. The state is where at least 25% of the physician's medical practice occurs
3. The state is where the physician's employer is located
4. If the physician is serving in the U.S. military, the state is the physician's legal domicile

The SPL serves as the physician's "home base" within the Compact system. The medical board of the SPL state is responsible for initiating the verification process and confirming the physician's eligibility.

The Letter of Qualification

Once a physician submits their application through the IMLC portal, the Commission coordinates with the SPL state medical board to verify the applicant's credentials. If the physician meets all eligibility criteria, the Commission issues a Letter of Qualification.

The LOQ is essentially a pre-verified credential package that tells each member state: "This physician has been verified against all Compact eligibility requirements. Their education, training, board certification, licensure history, and disciplinary record have been confirmed through primary sources."

Each member state the physician selects then reviews the LOQ and issues a full state medical license. Because the heavy verification work has already been completed, the state board's review is dramatically shorter than it would be for a traditional application.

Ongoing Obligations

Licenses obtained through the Compact carry the same renewal requirements as traditionally obtained licenses. Physicians must renew each state license according to that state's cycle, pay that state's renewal fees, and complete that state's continuing medical education (CME) requirements. The Compact does not consolidate renewals.

Additionally, if a physician's SPL state license is revoked, surrendered, or otherwise terminated, all licenses obtained through the Compact can be affected. Disciplinary actions in one member state are reported to all other member states where the physician holds a Compact license.

Which States Are in the Compact?

As of 2026, 41 states, the District of Columbia, and the territory of Guam have enacted IMLC legislation. The Compact's membership has grown steadily since its launch, with several states joining between 2023 and 2025.

The current member states and territories are:

Alabama, Arizona, Colorado, Connecticut, Delaware, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, the District of Columbia, and Guam.

This list covers the vast majority of the U.S. population and represents most of the states where telemedicine demand is highest. For physicians focused on provider licensing for multi-state practice, the Compact's membership now includes many of the states that were historically the most difficult and time-consuming for licensure.

Several states that were previously absent have joined in recent years. New Jersey's entry in 2024 was particularly significant for physicians in the Northeast corridor. Pennsylvania's participation has opened new options for large health systems operating across the Mid-Atlantic region.

States Not in the Compact and What That Means

The most notable absences from the Compact are California, New York, and Florida, three of the largest states by physician population and patient volume.

California

California has not joined the Compact and has shown limited legislative movement toward doing so. The Medical Board of California operates one of the most independent and stringent licensing processes in the country. California's application process typically takes 12 to 16 weeks, sometimes longer, and the state requires a California-specific jurisprudence component. Physicians seeking to practice in California, whether in person or via telehealth, must apply directly through the Medical Board of California.

New York

New York has also remained outside the Compact. The New York State Education Department, which oversees physician licensing through the Office of the Professions, has historically maintained its own verification standards. The New York application process typically takes 10 to 14 weeks and requires submission of documentation directly to the state.

Florida

Florida's absence is particularly notable given the state's large and growing physician workforce. The Florida Board of Medicine processes a high volume of applications, and the typical timeline ranges from 8 to 12 weeks. There have been periodic discussions in the Florida legislature about joining the Compact, but as of early 2026, no legislation has been enacted.

What Non-Compact States Mean for Your Practice

If your practice involves patients in California, New York, or Florida, the IMLC will not help you with those states. You will need to submit traditional applications to each non-member state board, which means longer timelines, separate verification processes, and additional costs. For a physician building a nationwide telehealth practice, these three states often represent the most time-consuming licensing bottlenecks.

The practical approach is to use the IMLC for all eligible member states while simultaneously beginning traditional applications for non-member states. This parallel strategy can shave weeks off the total time to full multi-state licensure.

IMLC Eligibility Requirements

Not every physician qualifies for the Compact. The eligibility requirements are specific and strictly enforced. If you do not meet all of the following criteria, you will need to apply through traditional state board processes.

Degree and Training

The physician must hold a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree from an accredited medical school. Graduates of international medical schools must have completed an accredited U.S. residency program and hold a valid ECFMG (Educational Commission for Foreign Medical Graduates) certificate.

Board Certification

The physician must hold an active, current board certification from an ABMS (American Board of Medical Specialties) or AOBMS (American Osteopathic Board of Medical Specialties) member board. This is one of the most common disqualifying factors. Physicians who are board-eligible but not yet board-certified cannot use the Compact. Physicians whose board certification has lapsed must renew it before applying.

Active License in SPL State

The physician must hold a full and unrestricted medical license in their designated State of Principal License. Training permits, temporary licenses, and restricted licenses do not qualify.

No Disciplinary History

The physician must have no history of disciplinary actions against any medical license, including letters of reprimand, consent agreements, license suspensions, or license revocations. Any prior disciplinary action, regardless of how minor or how long ago, will disqualify the physician from the Compact process.

No Criminal History

The physician must have no criminal convictions. This includes felony convictions and, in many cases, certain misdemeanor convictions depending on the nature of the offense. The Commission conducts an FBI background check as part of the application process.

No DEA Restrictions

The physician must not have any controlled substance prescribing restrictions or DEA registration issues.

Examination History

The physician must have passed USMLE or COMLEX within three attempts. Physicians who required more than three attempts to pass any step are ineligible.

These requirements are strict by design. The Compact's premise is that the expedited process is justified because only physicians with clean records and verified credentials are eligible. If any of these criteria present a concern, it is worth reviewing the detailed eligibility guidelines on the IMLC website before beginning an application.

Step-by-Step Application Process

The IMLC application is submitted entirely online through the Commission's portal. Here is what the process looks like from start to finish.

Step 1: Create an Account

Visit the IMLC portal at imlcc.org and create a physician account. You will need your basic demographic information, NPI number, and current license details. If you need to verify your NPI first, you can use our NPI lookup tool to confirm your information is current.

Step 2: Designate Your State of Principal License

Select the state that qualifies as your SPL based on the criteria described above (primary residence, primary practice location, employer location, or military domicile). This designation is important because your SPL state's medical board will be involved in the initial verification.

Step 3: Select Your Target States

Choose which member states you want to obtain licenses in. You can select as many member states as you need. Each state selection will incur that state's individual licensing fee, so consider your actual practice needs carefully before selecting every available state.

Step 4: Complete the Application

The application collects information about your medical education, postgraduate training, examination history, practice history, malpractice claims history, and any legal or disciplinary matters. Much of this will be familiar if you have ever completed a state licensing application or a credentialing application.

Step 5: Pay Fees

You will pay the IMLC processing fee and the individual state licensing fees for each state you selected. The IMLC fee and state fees are collected at the time of application. A full cost breakdown is provided in the next section.

Step 6: Background Check

The Commission will initiate an FBI criminal background check. You will receive instructions for completing the fingerprinting process through an approved channeler. This step must be completed promptly, as delays in fingerprinting are one of the most common causes of application processing delays.

Step 7: SPL State Verification

Your State of Principal License board reviews your application and confirms your eligibility. This includes verifying that your SPL license is active and unrestricted.

Step 8: Letter of Qualification Issued

If all eligibility criteria are met and verifications are complete, the Commission issues your Letter of Qualification. The LOQ is transmitted electronically to each state you selected.

Step 9: State Licenses Issued

Each selected member state reviews the LOQ and issues your license. Some states may have additional requirements, such as a jurisprudence exam (a short online test about that state's medical practice laws). Once issued, your license is active and you can begin practicing in that state.

Cost Breakdown: IMLC Fees Plus State Fees

Understanding the total cost of multi-state licensing through the Compact requires accounting for two separate categories of fees.

IMLC Processing Fee

The Commission charges a processing fee of $700 for the Letter of Qualification. This is a one-time fee per application cycle. If you are applying for licenses in three states or ten states, the LOQ fee remains the same.

Individual State Licensing Fees

Each member state charges its own licensing fee, which is collected through the IMLC portal at the time of application. These fees vary significantly by state:

Lower-cost states ($75 to $200): States like Mississippi, South Dakota, and Montana tend to have lower initial licensing fees. These states often also have lower renewal fees.

Mid-range states ($200 to $500): The majority of member states fall in this range. Texas charges approximately $370, Ohio is around $305, and Virginia is approximately $311. These fees are comparable to what you would pay applying directly through the state board.

Higher-cost states ($500 to $800+): Some states have licensing fees at the upper end. Connecticut and certain other Northeastern states charge fees in the $500 to $800 range.

Total Cost Example

Here is a realistic example for a physician obtaining licenses in five states through the Compact:

Compare that to the cost of hiring a licensing service at $500 to $1,500 per state on top of application fees, plus the opportunity cost of 8 to 16 weeks of processing time per state, and the Compact becomes the clear financial winner for any physician seeking three or more state licenses.

For a detailed analysis of how licensing timelines affect your credentialing and enrollment schedule, our credentialing timeline estimator can help you map out the full process from licensure through payer enrollment.

How Fast Is Expedited? Real Timeline Expectations

The IMLC markets its process as "expedited," and compared to traditional licensing, that description is accurate. But physicians should set realistic expectations about what expedited actually looks like in practice.

IMLC Processing: 2 to 4 Weeks

The typical timeline from completed application submission to license issuance is 2 to 4 weeks. This assumes all of the following go smoothly:

1. The application is complete with no missing information
2. Fingerprinting is completed within a few days of the request
3. The FBI background check returns clean results without delays
4. The SPL state board responds promptly to the verification request
5. No selected state has additional requirements that add processing time

What Causes Delays

The most common causes of IMLC application delays include:

Fingerprinting backlogs. The FBI background check requires fingerprinting through an approved channeler. During high-volume periods, scheduling fingerprinting appointments can add 1 to 2 weeks. Some locations have walk-in availability; others require appointments booked days in advance.

Incomplete applications. Missing information about prior malpractice claims, gaps in practice history, or incorrect NPI data will trigger a request for additional information from the Commission, adding days or weeks to the process.

SPL state board processing. Some state medical boards respond to IMLC verification requests within 48 hours. Others take 5 to 10 business days. The speed of your SPL state's response is largely outside your control.

State-specific requirements. A small number of member states require completion of a jurisprudence exam after the LOQ is received. These exams are typically short online assessments, but they add a step that must be completed before the license is issued.

Traditional Licensing: 8 to 16 Weeks

For comparison, traditional state medical license applications typically take 8 to 16 weeks from submission to license issuance. Some states are faster, and some are significantly slower. States with large application backlogs, such as California (a non-Compact state), can take 16 to 24 weeks or longer.

The time savings from the Compact are most significant when licensing in multiple states simultaneously. A physician who would spend 12 weeks per state licensing in four states traditionally (with some overlap) might spend 8 to 10 months achieving what the IMLC can accomplish in under a month.

Telemedicine Implications: Prescribing and Practicing Across State Lines

The intersection of multi-state licensure, telemedicine, and prescribing regulations is where physicians most often run into compliance trouble. Having a medical license in a state is necessary but not sufficient for providing telehealth services to patients in that state.

The Basic Rule

The general rule in the United States is that a physician must hold an active medical license in the state where the patient is physically located at the time of the encounter. This applies regardless of the physician's location. If Dr. Webb in Nashville is providing a telepsychiatry session to a patient sitting in their home in Lexington, Kentucky, Dr. Webb needs a Kentucky medical license for that encounter.

The IMLC makes obtaining that license faster, but it does not change the underlying requirement.

The Ryan Haight Act and Controlled Substance Prescribing

Physicians who prescribe controlled substances across state lines face additional regulatory requirements under the Ryan Haight Online Pharmacy Consumer Protection Act. This federal law generally requires at least one in-person medical evaluation before prescribing controlled substances online, with certain exceptions.

The Ryan Haight Act's requirements interact with state-specific telehealth prescribing rules, which vary considerably. Some states have enacted exceptions or modifications to the in-person requirement for established patients. Others have maintained strict interpretation of the federal standard.

For psychiatrists, pain management physicians, and other specialties that frequently prescribe Schedule II through V controlled substances, understanding both the federal requirement and each state's specific telehealth prescribing rules is essential before expanding into new states. The IMLC does not address prescribing regulations; it only addresses licensure.

State-Specific Telehealth Rules

Beyond licensure and prescribing, each state may have its own telehealth practice requirements, including:

Informed consent. Many states require specific informed consent for telehealth encounters, separate from general medical consent.

Technology standards. Some states specify minimum technology requirements for telehealth platforms, including encryption standards and the types of modalities permitted (video, audio-only, asynchronous store-and-forward).

Documentation requirements. Several states have telehealth-specific documentation standards that exceed their in-person encounter requirements.

Billing and reimbursement. State-specific parity laws, billing codes, and reimbursement policies for telehealth services vary significantly. What CMS allows for Medicare telehealth billing may differ from what a state Medicaid program or commercial payer covers.

The practical takeaway: obtaining a license through the IMLC is the first step. Understanding and complying with each state's telehealth regulatory framework is the second. And getting credentialed with payers in each state to actually receive payment for those services is the third.

How the IMLC Interacts with Payer Credentialing

This is where many physicians and practice managers are caught off guard. Obtaining a medical license in a new state is only the beginning. To bill insurance companies and receive reimbursement for patient care in that state, you must also be credentialed and enrolled with each payer in that state's market.

Licensing and Credentialing Are Separate Processes

A medical license authorizes you to practice medicine in a state. Payer credentialing authorizes you to bill a specific insurance company and receive payment as a participating provider. These are entirely separate administrative processes with separate timelines, separate applications, and separate approval criteria.

A physician who obtains a medical license in Georgia through the IMLC in three weeks will still need to spend an additional 60 to 120 days (or more) getting credentialed with each insurance payer they want to participate with in Georgia. For major commercial payers like Aetna, Blue Cross Blue Shield, Cigna, and UnitedHealthcare, the credentialing process requires submitting a full application with each payer, primary source verification (often duplicating verification the state board and IMLC already performed), and committee review.

The Credentialing Timeline After IMLC Licensure

Here is a realistic timeline for a physician expanding into a new state using the IMLC:

The total timeline from "I want to practice in State X" to "I can bill patients in State X" is typically 4 to 6 months, even with the IMLC cutting the licensing portion down to weeks. Understanding this full timeline is essential for financial planning and patient scheduling.

Strategies for Faster Payer Enrollment

Physicians and practice managers can take several steps to accelerate the post-licensing credentialing process:

Update CAQH ProView immediately. As soon as your new state license is issued, add it to your CAQH profile. Most payers reference CAQH during credentialing, and an up-to-date profile prevents delays. Our guide on state-specific payer enrollment covers the major payers in each region.

Submit credentialing applications before the license is issued. Some payers will accept a credentialing application with a pending license and begin processing, completing the final verification step once the license is active. This can overlap weeks of processing time.

Prioritize high-volume payers. Identify which payers cover the majority of patients in your new state's market. In many states, two or three payers cover 60% to 70% of the commercially insured population. Prioritize those applications.

Consider delegated credentialing. If you are joining a hospital or health system in the new state, ask whether they have delegated credentialing authority with any payers. Delegated arrangements can significantly reduce the timeline for employed or affiliated physicians.

Common Misconceptions About the IMLC

Despite being operational for nearly a decade, the IMLC is surrounded by persistent myths and misunderstandings that lead physicians to make planning errors.

Misconception 1: "The IMLC Issues a National Medical License"

This is the most widespread misconception. The IMLC does not issue any license at all. It issues a Letter of Qualification that participating states accept as the basis for issuing their own individual state licenses. You end up with multiple state licenses, each governed by that state's laws and regulations.

Misconception 2: "Once I Have a Compact License, I'm Done"

Obtaining the license is step one. You still need to register your DEA number in the new state (if you prescribe controlled substances), update your CAQH profile, apply for credentialing with payers, comply with state-specific telehealth regulations, and meet any state-specific CME requirements. The license is necessary but not sufficient for a functioning multi-state practice.

Misconception 3: "The IMLC Replaces State Medical Boards"

State medical boards retain full authority over licenses issued through the Compact. If a patient files a complaint in Georgia about a physician who obtained their Georgia license through the IMLC, the Georgia Board of Medicine investigates and adjudicates that complaint under Georgia law. The Compact process has no bearing on the state's regulatory authority.

Misconception 4: "Disciplinary Actions Won't Follow Me Through the Compact"

The opposite is true. One of the Compact's design principles is enhanced information sharing among member states. If you receive a disciplinary action in one member state, all other member states where you hold a Compact license are notified. Those states may independently take action against your license based on the original state's findings. The Compact actually increases transparency regarding disciplinary history, not decreases it.

Misconception 5: "I Can Choose Any State as My SPL"

The State of Principal License must meet specific criteria. You cannot simply pick the state with the lowest fees or fastest processing time. Your SPL must be your primary residence, the state where at least 25% of your practice occurs, or where your employer is located. Misrepresenting your SPL qualifications could result in application denial and potential sanctions.

Misconception 6: "The IMLC Saves Money on State Licensing Fees"

The IMLC adds the $700 LOQ processing fee on top of each state's regular licensing fee. The per-state fee you pay through the Compact is typically the same as (or very close to) what you would pay applying directly. The savings come from reduced administrative time, eliminated need for separate verification processes, and the dramatically compressed timeline, not from reduced state fees.

IMLC Compared to Other Professional Licensing Compacts

The IMLC is not the only professional licensing compact in healthcare. Understanding how it compares to similar compacts for other professions provides useful context, particularly for multi-specialty practices and organizations that employ multiple provider types.

Psychology Interjurisdictional Compact (PSYPACT)

PSYPACT allows psychologists to practice telepsychology and conduct temporary in-person practice across member state lines. As of 2026, PSYPACT includes over 40 member states. The key differences from the IMLC:

PSYPACT creates an Authority to Practice Interjurisdictional Telepsychology (APIT) rather than issuing new state licenses. Psychologists practicing under PSYPACT do not hold a separate license in each state; they practice under the authority of their home state license. This is a fundamentally different model from the IMLC, where physicians receive individual state licenses.

PSYPACT also includes a Temporary Authorization to Practice (TAP) for short-term in-person practice across state lines, limited to 30 days per year per state. The IMLC has no equivalent temporary provision because physicians receive full state licenses.

Nurse Licensure Compact (NLC)

The Nurse Licensure Compact is the oldest and largest healthcare professional licensing compact, with nearly all 50 states participating. The NLC operates on a multi-state license model, where a nurse licensed in their home state can practice in any other member state without obtaining additional licenses.

This is markedly different from the IMLC's approach. Under the NLC, a nurse holds one license that authorizes practice in all member states. Under the IMLC, a physician obtains separate licenses in each state. The NLC model is simpler but grants less individual state regulatory control.

Physical Therapy Compact

The Physical Therapy Compact allows physical therapists and physical therapy assistants to practice in member states through a Compact Privilege, which is similar to PSYPACT's approach. The compact member can practice in other states without obtaining a separate state license, though they must declare their intent and pay applicable fees.

What These Differences Mean for Multi-Specialty Practices

Organizations that employ physicians, psychologists, nurses, and physical therapists will navigate different compact structures for different provider types. The administrative implications are significant:

Nurses can practice across state lines with their existing license under the NLC. Psychologists can provide telehealth across state lines under PSYPACT without new licenses. But physicians must obtain individual licenses through the IMLC. This means that for a multi-specialty telehealth organization, the physician licensing component will always be the most complex and expensive part of multi-state expansion.

What This Means for Your Practice in 2026

The IMLC has matured significantly since its launch and now represents the standard pathway for physicians seeking multi-state licensure. With 41 states, D.C., and Guam in the Compact, the vast majority of potential patient markets are accessible through the expedited process.

If You Are a Solo Practitioner Expanding via Telehealth

The IMLC is almost certainly the right path for adding state licenses. The $700 LOQ fee is a worthwhile investment if you are licensing in two or more new states. Start the process early, ideally three to four months before you want to begin seeing patients in new states, to account for both the licensing timeline and the subsequent payer credentialing timeline.

If You Are a Practice Manager at a Multi-Provider Group

Coordinate IMLC applications across your physician staff. Multiple physicians from the same practice can apply through the Compact simultaneously. Build your credentialing applications in parallel so that payer enrollment submissions can go out within days of license issuance.

If You Are an Organization Expanding Into New States

Factor the IMLC into your expansion timeline, but recognize that licensing is the short phase. Payer credentialing, network adequacy, and operational setup will consume the majority of your timeline. Use the weeks saved by the IMLC to get ahead on credentialing paperwork and CAQH profile updates.

The Ongoing Cost of Multi-State Licensure

Do not overlook the long-term costs. Each state license obtained through the IMLC carries its own renewal fees and CME requirements. A physician licensed in 10 states will pay 10 separate renewal fees on 10 different renewal cycles. Annual renewal costs across multiple states can add up to $2,000 to $5,000 per year. Build this into your financial projections before selecting states.

Start With Licensing, But Plan for Credentialing

The single most important thing practice managers can do when planning multi-state expansion is to view licensing and credentialing as two phases of one project, not two separate projects. The IMLC handles phase one. Phase two, payer credentialing and enrollment, requires its own dedicated timeline, staffing, and budget.

If you are managing credentialing for multiple providers across multiple states, the complexity scales rapidly. PayerReady's provider licensing and credentialing tools are built to help practices track the full lifecycle from initial license application through payer enrollment and ongoing maintenance.

The Interstate Medical Licensure Compact has made multi-state medical practice more accessible than at any point in American healthcare history. For physicians willing to meet its eligibility standards and practices prepared to follow through with payer credentialing, the Compact turns what was once a year-long bureaucratic ordeal into a process measured in weeks. The opportunity is real. The process is straightforward. And for most physicians practicing across state lines in 2026, the IMLC is no longer optional. It is the expected standard.

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