Interstate Medical Licensure Compact (IMLC): The 2026 State-by-State Guide

Getting a medical license in a new state used to mean filling out a full application, paying fees ranging from $400 to $1,300, and waiting 3 to 6 months for that state's medical board to complete its primary source verification. For a physician wanting licenses in three or four states, that meant six months to a year of overlapping paperwork with four separate boards, each with their own forms, processing queues, and verification requirements.

The Interstate Medical Licensure Compact (IMLC) exists to replace that process with a faster, centralized one. A physician with a qualifying primary license can use the compact to obtain additional state licenses in any of the 40+ participating states through a single expedited process, often in 7 to 21 days per state instead of months.

This guide covers what the compact does, who qualifies, how to apply in 2026, what it costs, how long it takes, and how it compares to other licensure compacts like PSYPACT for psychologists, the Nurse Licensure Compact (NLC), and the emerging Physical Therapy Compact.

Key Takeaways

• IMLC lets qualified physicians obtain additional state medical licenses through an expedited process. Each state still issues its own license, but the compact streamlines verification.
• 40+ states, DC, and Guam participate as of 2026. A short list of states (California, New York, Oregon, among others) have not joined.
• Eligibility requires a valid unrestricted license as a physician (MD or DO), board certification or equivalent, no discipline history, and a State of Principal License (SPL) in an IMLC member state.
• Typical timeline from application to first compact license is 4 to 8 weeks total. Additional licenses after the first are typically 7 to 21 days each.
• Cost is $700 application fee to IMLC plus each state's license fee (usually $300 to $800 per state).
• IMLC does not give you one license that works in all states. You still get a separate license per state. The compact expedites verification, not the concept of a license.
• The compact is aimed primarily at telemedicine and locum tenens practice. Both use cases have seen significant growth since 2020.

Table of Contents

• What the compact actually does
• Which states are in IMLC as of 2026
• Eligibility requirements
• The application process step by step
• Timeline from application to active license
• Cost breakdown
• Compact licenses vs regular licenses: what is the same and different
• Renewal and maintenance
• IMLC vs PSYPACT vs NLC: how it compares
• Who benefits most from IMLC
• Frequently Asked Questions

What the compact actually does

The Interstate Medical Licensure Compact is a legal agreement between state medical boards. Each participating state agrees to issue medical licenses through an expedited process for physicians who qualify through the compact.

The mechanics: a qualifying physician designates one state as their State of Principal License (SPL). The SPL board verifies the physician meets all compact requirements once. When the physician then wants a license in another compact state, they submit a compact application. The second state's medical board uses the verified information from the SPL instead of running its own primary source verification from scratch. The second state still issues its own license under its own authority.

What the compact does:

• Eliminates duplicate primary source verification across states
• Provides a single portal to apply for licenses in multiple states
• Standardizes eligibility requirements for the expedited track
• Typically cuts per-state timelines from 3 to 6 months down to 2 to 4 weeks

What the compact does not do:

• It does not create a single license valid in multiple states. You still get a separate license per state.
• It does not waive any state's license fees or renewal requirements.
• It does not eliminate the requirement to maintain CE credits in each state, where applicable.
• It does not reduce the professional liability exposure of practicing across state lines.

Most of the confusion about the compact comes from people expecting it to be a single universal license. It is not. It is an expedited administrative process for getting multiple individual state licenses.

Which states are in IMLC as of 2026

40+ states, the District of Columbia, and Guam participate as of 2026. The list is stable but occasionally adds members as state legislatures pass compact legislation.

States currently participating (as of early 2026):

Alabama, Arizona, Colorado, Delaware, Georgia, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Dakota, Tennessee, Texas (limited), Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming. Plus DC and Guam.

States not currently participating:

California, New York, Oregon, Florida (pending legislation has not passed), Massachusetts (limited), and a handful of others. Legislation has been introduced in several of these over the past few years without passage.

The non-participating states are strategically significant because they include several of the largest by population (California, New York, Florida) and several with high telehealth demand. Telehealth practices serving patients in California or New York cannot use IMLC to obtain those licenses; they must go through each state's traditional medical board process separately.

Check the IMLC Commission website (imlcc.org) for the current list of member states before planning a multi-state strategy. Membership changes occasionally as legislation passes in more states.

Eligibility requirements

To use the compact, a physician must meet all of the following:

1. Hold a valid, unrestricted medical license (MD or DO). The license must be issued by an IMLC member state, and it must be in good standing with no current restrictions, limitations, or conditions.

2. Qualify for a State of Principal License (SPL). The SPL is the state where the physician meets at least one of these conditions: primary residence, practice at least 25 percent of time, employer based in that state, or the state where the physician files state income taxes as a primary resident.

3. Hold or be eligible for full board certification. MBoard certification by one of the 24 member boards of the American Board of Medical Specialties (ABMS) or the 15 member boards of the American Osteopathic Association (AOA). Recertification boards like ABMS-MOC count.

4. Have completed graduate medical education (residency). In the United States, Canada (LCME), or another recognized pathway. Foreign medical graduates need ECFMG certification plus US/Canadian residency completion.

5. Passed all components of USMLE, COMLEX-USA, or equivalent. In a cumulative attempt profile acceptable to the SPL.

6. No discipline history that disqualifies. Specifically, no felony convictions, no prior license revocations or suspensions, no current investigations for professional misconduct, no controlled substance actions, no fraudulent credentialing history.

7. Passed a criminal background check. The compact application triggers a federal and state background check through the FBI.

Physicians who do not meet the SPL requirements or who have discipline history cannot use the compact and must apply to additional state licenses through each state's traditional process.

Roughly 75 to 80 percent of actively practicing physicians in IMLC member states qualify for the compact. The main disqualifiers are lack of board certification (more common for older practitioners who completed residency before board certification became standard) and discipline history.

The application process step by step

Step 1: Confirm your SPL eligibility. Identify the state that qualifies as your State of Principal License based on residency, practice, employer, or tax filing. The SPL must be an IMLC member state. If your primary state is not a member (for example, California), you cannot use IMLC even if the states you want licenses in are members.

Step 2: Apply for a Letter of Qualification (LOQ) through your SPL board. This is done through the IMLC Commission website (imlcc.org). The application asks for identification, education, training, board certification, license history, work history, and disclosure responses. You pay a $700 application fee to the IMLC Commission at this step.

Step 3: SPL verification. Your SPL board reviews your application, runs primary source verification on your credentials, and either issues a Letter of Qualification or denies the application. This step takes 2 to 4 weeks typically.

Step 4: Select the states where you want compact licenses. Once your LOQ is issued, you can select any IMLC member state (or multiple states) where you want to apply for a compact-expedited medical license. You complete a state-specific online application, pay that state's license fee, and submit.

Step 5: State review and issuance. The selected state's medical board receives the application along with your LOQ, reviews any state-specific requirements (for example, state controlled substance registration, state jurisprudence exam, state fingerprinting), and issues the license. This step takes 7 to 21 days in most states.

Step 6: Additional state licenses. You can request licenses in additional compact states at any time while your LOQ is active (the LOQ is valid for 365 days from issuance). Each additional state license is a separate application with its own fee and its own state-specific requirements.

Step 7: Renewal. Each state license has its own renewal cycle (usually every 2 years). Renewal is handled with each state directly, not through the compact. Your compact eligibility may also need to be renewed annually.

Timeline from application to active license

Typical 2026 timelines:

From submitting your compact application to receiving your Letter of Qualification from the SPL: 2 to 4 weeks for most clean applications. The SPL board is running primary source verification from scratch for the first time, so this step is roughly as slow as a traditional license application.

From LOQ issuance to first compact state license: 1 to 3 weeks typically. The second state's board uses the SPL-verified information and runs only state-specific requirements (state-specific exams, fingerprinting, etc.).

Additional compact licenses after the first: 1 to 3 weeks each. Generally the fastest part of the process.

Cumulative timeline for 3 compact licenses starting from zero: 4 to 10 weeks. Compare to 9 to 18 months if you were applying to the same three state boards through their traditional processes.

Factors that slow timelines:

• Incomplete or disputed disclosure responses. Any "yes" answer on the disclosure section (malpractice claims, board actions, criminal history) requires explanation and documentation.
• Multiple medical licenses with complex status histories. If you hold 5+ licenses, expect extra review.
• Fingerprinting delays. State fingerprinting requirements vary. Some states accept cards from any FBI-authorized provider; others require specific vendors or in-state fingerprinting.
• State-specific exams. A small number of states require a state jurisprudence exam or medical history exam even on the compact track.

Cost breakdown

IMLC is not free. Real 2026 costs:

IMLC Commission application fee: $700 per LOQ application. Required once to establish compact eligibility. The LOQ is valid for 365 days; you can request multiple state licenses during that window without paying the $700 again.

State license fees: Vary by state. Typical range: $300 to $800 per state. Examples:

• Alabama: approximately $400
• Arizona: approximately $500
• Colorado: approximately $500
• Georgia: approximately $250 initial, $500 renewal
• Illinois: approximately $750
• Kentucky: approximately $300
• Maryland: approximately $800
• Nevada: approximately $800
• Texas (limited IMLC): approximately $900 initial
• Washington: approximately $700
• Wyoming: approximately $350

Ongoing maintenance:

• State license renewals (usually every 2 years): same fees as initial in most states
• IMLC eligibility renewal (if required by your SPL): some SPLs renew annually at $300 to $600
• State controlled substance registrations (where applicable): $100 to $300 per state per year

Total first year cost for a physician pursuing compact licenses in 3 additional states:

• IMLC Commission application: $700
• 3 state licenses at $500 average: $1,500
• State controlled substance registrations: $450
• Fingerprinting and background checks: $100 to $200
• Total: approximately $2,750 to $2,850

Compare to the same 3 licenses through traditional state processes:

• 3 state licenses: $1,500
• Duplicated primary source verification fees where applicable: $200 to $600
• Cost of time (6 to 18 months of application management): substantial in opportunity cost
• Total: approximately $1,700 to $2,100

The direct financial cost of IMLC is slightly higher than traditional licensing in most cases. The compact's value is in time compression, not direct cost savings. For a physician who wants to be able to see telehealth patients in three new states within 2 months instead of a year, the compact is obviously worth the $700 premium.

Compact licenses vs regular licenses: what is the same and different

An important clarification that trips up many physicians: a compact license is not a different kind of license. It is a regular state medical license obtained through an expedited application process.

What is the same:

• The license is issued by the state medical board under the state's full medical practice act
• The scope of practice is identical to any other license in that state
• The legal authority to practice is identical
• Renewal requirements are identical
• Continuing medical education requirements are identical
• Board disciplinary authority is identical
• Prescribing authority is identical

What is different:

• The application process used the compact expedited pathway
• Verification was routed through the SPL board rather than done from scratch
• The timeline was faster

A compact license in Nevada looks exactly like a non-compact Nevada license once issued. The patient you treat under that license, the billing you submit, the CME you complete, all operate under standard Nevada rules.

Renewal and maintenance

Each state license obtained through IMLC has its own renewal cycle, which is generally 2 years. Renewal is handled with each state directly through that state's online portal or paper application. The compact does not manage renewal.

State-specific CME requirements apply. A physician licensed in 5 states through IMLC may need to meet CME requirements in all 5, though most CME credits can be applied to multiple states (check each state's specific rules about category 1 vs category 2 requirements).

Some SPLs require annual compact eligibility renewal. Check with your SPL about whether this applies to you.

License lapse on any single state license does not affect other state licenses. A physician who lets their Ohio license lapse still holds their Kentucky, Tennessee, and Wisconsin licenses. However, any disciplinary action in one state is generally reported to all states where the physician holds licenses, and can trigger review or action in those other states.

Pro tip: set a centralized calendar tracking renewal deadlines and CME requirements for every state where you hold a license. A missed state license renewal can mean 30 to 90 days of practice disruption in that state. For telehealth practices, that can translate to significant lost revenue. Our compliance monitoring solution tracks state license expiration deadlines with 90, 60, and 30 day alerts.

IMLC vs PSYPACT vs NLC: how it compares

Several licensure compacts exist for different provider types. They share general concepts but differ in details.

IMLC (physicians). Covers MDs and DOs. Expedited application through one SPL. Each member state issues its own license. 40+ states as of 2026.

PSYPACT (psychologists). Covers PhD and PsyD licensed psychologists. Works differently from IMLC: PSYPACT lets a psychologist practice telehealth into any PSYPACT member state without obtaining a separate license in that state. Very different mechanism. 40+ states as of 2026.

Nurse Licensure Compact (NLC). Covers RNs and LPNs. Works like PSYPACT in that one multistate license permits practice in all compact member states without separate licensing. 41 states as of 2026, mostly in the south and midwest.

Advanced Practice Registered Nurse Compact (APRN Compact). Similar mechanism to NLC but for nurse practitioners. Adopted slowly, small number of states implementing as of 2026.

Physical Therapy Compact (PT Compact). Covers PTs and PTAs. Works through a compact privilege concept similar to PSYPACT. 30+ states as of 2026.

Occupational Therapy Compact (OT Compact). Newer, fewer states as of 2026, early implementation phase.

Counseling Compact. For licensed professional counselors. In adoption phase as of 2026, approximately 25 states passed the compact into law but implementation still rolling out.

Social Work Compact. For LCSWs and related licenses. In earliest stages of development as of 2026.

Key difference: IMLC results in separate state licenses. PSYPACT, NLC, and PT Compact use a "compact privilege" model where you hold one multistate license and practice across member states without separate licensing. Physicians do not have the compact privilege option; they must obtain separate state licenses through every state where they practice.

The compact privilege model is operationally simpler but requires more state-level legislation. Physicians' compact takes a more conservative approach that was politically easier to pass in more states.

Who benefits most from IMLC

Three physician profiles get the most value from the compact:

1. Telemedicine practitioners. The clearest use case. Telemedicine platforms serving patients nationally need physicians licensed in every state where patients live. A single telemedicine physician often needs 10 to 30 state licenses. Doing this through traditional state-by-state processes is impractical; IMLC cuts cumulative licensure time from years to months.

2. Locum tenens physicians. Physicians who travel between hospitals and practices often need licenses in multiple states on short notice. Locum tenens placement agencies work with IMLC-licensed physicians more frequently because the expedited timeline matches staffing needs.

3. Multi-state group practices. Medical groups with clinics in multiple states benefit from physicians who can cross-cover between sites. IMLC makes it feasible to maintain licenses in neighboring states without each physician going through separate multi-month applications per state.

Physicians who probably do not benefit from IMLC:

• Physicians practicing in a single state with no plans for telemedicine or multi-state work
• Physicians whose SPL is not an IMLC member state (California, New York, Oregon, etc.)
• Physicians with discipline history that makes them ineligible for compact expedited review

For physicians considering telehealth, IMLC is usually the right place to start. Our telehealth solutions page covers the full credentialing and licensing workflow for multi-state telemedicine practices.

Frequently Asked Questions

Is IMLC a single license that works in all states?

No. Each state still issues its own medical license. IMLC is an expedited process for obtaining separate licenses in multiple compact states faster than going through each state's traditional process.

How much does IMLC cost in 2026?

The IMLC Commission charges $700 for the initial Letter of Qualification. Each state license costs an additional $300 to $800 depending on the state. For a physician pursuing compact licenses in 3 additional states, total first year cost is typically $2,500 to $3,000.

How long does it take to get a license through IMLC?

The Letter of Qualification from your State of Principal License takes 2 to 4 weeks. Each additional state license after that takes 1 to 3 weeks typically. Total time to have active licenses in 3 additional states through IMLC is 4 to 10 weeks, compared to 9 to 18 months through traditional state-by-state applications.

Which states are in IMLC?

40+ states, DC, and Guam participate as of 2026. The full list changes as state legislatures pass or repeal compact legislation. Check imlcc.org for the current roster before planning a multi-state licensure strategy.

Why is California not in IMLC?

California has not passed the required compact legislation. Similar arguments have been raised in state legislative sessions but have not resulted in adoption. Physicians who want California licenses must apply through the Medical Board of California's standard process.

Do I need to choose a State of Principal License?

Yes. Every compact applicant must designate one state as their SPL. Qualifying factors include primary residence, work location (at least 25 percent of time), employer location, or state of primary tax filing. The SPL must be a compact member state.

Can I use IMLC if I have a restricted or probationary license?

Generally no. IMLC requires a fully unrestricted license in good standing in your SPL. Probationary status, active investigation, or restrictions that limit practice typically disqualify you from the expedited track.

Does IMLC cover DEA or state controlled substance registration?

No. DEA registration is federal and is not affected by IMLC. State controlled substance registrations (where required) are separate state-level processes. After obtaining a compact license, you still need to apply for that state's CS registration separately if you prescribe controlled substances.

Does IMLC count toward board certification or CME?

No. Board certification and CME requirements are separate from licensure. A compact license does not change your board certification status or CME obligations. Each state's CME rules apply to your license in that state.

Can I practice in any compact state with just one compact license?

No. You need a license in each specific state where you practice. A compact license in Kentucky does not authorize practice in Ohio. The compact only speeds up how you obtain each individual state license.

If you are a physician pursuing multi-state telemedicine licensure and want help managing the IMLC application process along with the credentialing and payer enrollment in each state, our telehealth credentialing service handles the full workflow from license application to first billable claim.