Carter Lee|7/25/2023|3 min read

Multi-State Licensing and Licensure Compacts — What You Need to Know

How compacts streamline the licensing process and what you should know about them

Physician filling out licensure application

The demand continues to grow for accessible healthcare, shifting the landscape of medical practice towards care options like telemedicine. Telemedicine significantly increases the accessibility of care by eliminating most geographic barriers and allowing clinicians to see patients nationwide. However, this means telemedicine often requires clinicians to hold multiple states licenses. 

Obtaining multi-state licensure can be very time consuming as each state’s licensing requirements, application processes and scope of practices vary. And depending on the state, this could mean a 60-day to 4 month waiting period for each state license. This is where a licensing compact comes in.

Interstate Medical Licensure Compact (IMLC)

Knowing that multi-state licensing can easily become an overwhelming process, many states have attempted to streamline licensing through interstate medical licensure compacts. These interstate compacts are created when multiple states decide upon a uniform standard of care and create state laws to support that standard. 

Brief compact history:

In the United States, states can participate in the Interstate Medical Licensure Compact (IMLC or the Compact). The IMLC’s mission is to increase access to healthcare, especially for patients in rural and underserved areas. 

U.S. state medical boards developed the IMLC in 2013, with the thought that as telehealth grows - more and more clinicians will need multiple states licenses to effectively deliver care. The Compact was publicly announced in 2014 and was fully operational by April of 2017. Currently the IMLC includes 37 states, the District of Columbia and the Territory of Guam. 


How the Compact works:

The Compact uses an expedited information sharing system, allowing participating states to easily access any IMLC clinician’s license application information. Thanks to this information sharing, a clinician only has to submit one application to quickly be approved and granted licensure in any Compact state - allowing care providers to receive multiple state licenses at once. It is important to note that the Individual licenses are still issued by the state, the process is just streamlined through the Compact. 

Clinician eligibility requirements for IMLC

Before a care provider can participate in the IMLC they are required to meet certain qualifications. The first of which is that they must hold a full, unrestricted medical license in a Compact member state. The clinician must then declare that state as their State of Principal License (SPL). A clinician can declare a state their SPL if one of the following applies:

  • The state is their primary residence

  • The state is where at least 25% of the clinician’s practice occurs 

  • The clinician is employed by a person, business or organization located in the state

  • The clinician uses the state as his/her state of residence for Federal Income State purpose

After declaring a SPL, the clinician also needs to meet the following criteria in order to participate in the compact: 

The physician must 

  • Have graduated from an accredited medical school or a school on the International Medical Education Directory

  • Have successfully completed ACGME- or AOA-accredited graduate medical education

  • Passed each part of the USMLE, COMPLEX-USA or equivalent in no more than three attempts for each component

  • Hold a current specialty certification or time-unlimited certification by an ABMS or AOABOS board

Additionally, the physician cannot have any criminal or disciplinary action history. They also can not be under investigation or have a history of controlled substance actions toward their medical license to be eligible for the Compact.

After a clinician determines their eligibility and designates an SPL, they can apply to join the Compact. If the clinician meets the Compact’s requirements and standards, they will receive a formal Letter of Qualification. Once qualified, their SPL will share the application information with all the other Compact states. 

Benefits of the IMLC

Simplified process

The IMLC significantly reduces the licensing process timeline and decreases the amount of duplicate paperwork. What is typically a 60-day to 4-month wait without the IMLC becomes, on average, a 19-day wait with the IMLC. This saves both time and administrative burdens that come with multi-state licensing.  

Expanded patient reach

Whether a clinician solely practices telemedicine or not, the IMLC’s expedited licensing process makes it significantly easier to expand their patient reach. It also allows clinicians to respond to healthcare needs beyond their primary state (both for in person care and telemedicine), creating greater access to care providers. 

Powering multi-state clinician licensure

Looking for more ways to streamline licensing? By joining the OpenLoop clinician network, you can take advantage of our licensing and credentialing services. With 6,000+ providers already in our clinician network, you can not only streamline licensing and credentialing but also tap into other OpenLoop benefits such as:

  • Nationwide connections

  • Sync & async options

  • Flexible scheduling

  • Competitive pay

  • Dedicated provider support

Interested in streamlining licensing and credentialing? Apply to our clinician network!