Expanding medical practice across state lines has never been easier—at least in theory. The Interstate Medical Licensure Compact (IMLC) provides a solution to this.
The agreement offers a process for physicians to obtain licenses in multiple states, making it an attractive option for those in telemedicine, multi-state practices, or mobile healthcare services.
However, IMLC isn’t always a one-size-fits-all solution. It comes with costs, eligibility restrictions, and limitations that can make the traditional licensing process a better choice.
This guide breaks down everything you need to know:
- What IMLC is
- When it provides a clear return on investment (ROI)
- And when traditional licensing is the smarter move
Let’s get right in.
What is IMLC?
The Interstate Medical Licensure Compact (IMLC) is an agreement between participating U.S. states that allows qualified physicians to obtain licenses in multiple states through a streamlined process.
Instead of applying separately to each state’s medical board, eligible physicians can apply for a single expedited process, significantly reducing administrative burden and approval times.
As of February 2025, participating states include:
Source: Compact State Map | Interstate Medical Licensure Compact
List of IMLC participating states
- Alabama
- Arizona
- Arkansas
- Colorado
- Connecticut
- Delaware
- District of Columbia
- Georgia
- Guam
- Idaho
- Illinois
- Indiana
- Iowa
- Kansas
- Kentucky
- Louisiana
- Maine
- Maryland
- Michigan
- Minnesota
- Mississippi
- Missouri
- Montana
- Nebraska
- Nevada
- New Hampshire
- New Jersey
- North Dakota
- Ohio
- Oklahoma
- Pennsylvania
- South Dakota
- Tennessee
- Texas
- Utah
- Vermont
- Washington
- West Virginia
- Wisconsin
- Wyoming
- Florida
- Hawaii
- States issuing licenses but not serving as States of Principal Licensure (SPL): Connecticut, Pennsylvania, Vermont
- States with legislation passed but implementation pending or delayed: Arkansas, Massachusetts, New Mexico, New York, Rhode Island
Note that 42 states, the District of Columbia, and Guam are part of the compact. Some states (e.g., Connecticut, Pennsylvania, Vermont) can issue licenses through IMLC but cannot serve as an SPL for entry into the compact. Others have introduced or passed legislation to join but are not yet fully operational
IMLC core eligibility requirements
Not all physicians qualify for the IMLC. To be eligible, you must meet these criteria:
- Hold a full, unrestricted medical license in a Compact member state eligible to serve as a State of Principal License (SPL)
- The SPL must be the physician’s primary residence, or at least 25% of their medical practice must occur there
- Physicians can qualify if employed by an organization based in the SPL
- The SPL must be used as the physician’s state of residence for U.S. federal income tax purposes
- SPL status must be maintained at all times, but it can be updated after receiving a letter of qualification
- Must have graduated from an accredited medical school or one listed in the International Medical Education Directory
- Must have completed an ACGME or AOA-accredited graduate medical education program
- Must have passed the United States Medical Licensing Examination (USMLE), Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA), or an accepted predecessor exam within three attempts per component (LMCC is not accepted)
- Must hold a current or time-unlimited specialty certification from an American Board of Medical Specialities (ABMS) or American Osteopathic Board of Orthopedic Surgery (AOABOS) board
- Must have no history of disciplinary actions against their medical license
- Must have no criminal history
- Must have no history of controlled substance-related actions against their medical license
- Must not be under investigation at the time of application
Interstate Medical Licensure Compact process overview
The IMLC process can be simplified into three key steps:
- Establish Your State of Principal License (SPL): This is the state where you primarily practice medicine or hold your primary residence.
- Submit Your IMLC Application: Apply through the IMLC website, designating the states where you seek licensure.
- Undergo Expedited Review: The IMLC verifies your credentials and facilitates communication with the selected state medical boards, leading to faster licensure.
Cost-benefit analysis: Hard numbers
Is the IMLC truly a cost-effective solution? Let's examine the financial implications.
Direct cost comparison table: IMLC vs. traditional for 1, 3, 5, and 10 states
True timeline comparison
One of the biggest selling points of IMLC is speed. Here’s how the timelines compare:
- IMLC Average Approval Time: 4 – 8 weeks after your application is complete and accepted
- Traditional Licensing: 3 – 6 months
Some states still take longer through IMLC due to internal delays. If speed is a priority, check each state’s average processing time before applying.
Hidden costs and fees and administrative overhead
Be aware of these potential hidden costs:
- Application Fees: Both the IMLC and individual state boards charge application fees
- Fingerprinting and Background Checks: These are standard requirements and can add to the overall expense. Typically costing $50-$100 per state
- Primary Source Verification: You may need to pay to verify your credentials with medical schools and other institutions. This can range from $20 to $50 per verification
Both IMLC and traditional licensing require administrative effort. The IMLC aims to reduce the burden, but you'll still need to:
- Gather necessary documents
- Complete online applications
- Respond to inquiries from the IMLC and state boards
- Spend communicating with different state boards to follow up on the application status
Where IMLC delivers clear ROI
In what scenarios does the IMLC truly excel?
Specific scenarios with quantified savings (telemedicine expansion, multi-state needs):
Telemedicine expansion
If you plan to offer virtual consultations to patients in multiple states, the IMLC can streamline the licensing process, saving you time and money.
For example, a psychiatrist seeking to expand their telemedicine practice to five states—Colorado, Nevada, Arizona, Utah, and New Mexico—could potentially save several months of processing time and thousands of dollars in application fees by using the IMLC.
The cost savings could be in the range of $1,000-$3,000, and the time savings could be 3-6 months.
Multi-state needs
If your practice involves frequent travel or providing services in multiple states, maintaining multiple licenses is easier with IMLC.
Traveling physicians who cover multiple rural hospitals in states like Iowa, Nebraska, and South Dakota could benefit most.
Physician specialties that benefit most from IMLC
Certain specialties benefit disproportionately from the IMLC:
- Radiologists and Pathologists: Often provide interpretations across state lines
- Hospitalists and Psychiatrists: Often cover multiple facilities that span across state lines in bordering areas
- Telemedicine doctors: Can quickly scale across states
- Emergency medicine physicians: Often need licenses in multiple locations
- Specialists with niche expertise: If demand exists in various states, IMLC makes expansion seamless
Break-even analysis: How many states justify IMLC?
Let's assume a telemedicine doctor wants to expand their practice to five states: Tennessee, Kentucky, Ohio, Indiana, and Illinois.
Using IMLC’s efficiency will save:
- 3–4 months in licensing time
- $2,000–$3,000 in administrative costs
- Lost revenue from a delayed start
While traditional licensing might take 3-6 months per state, costing $750-$2,000 per license. The IMLC could potentially reduce the timeline to 3-6 months total and lower the overall cost by 20-30%.
A good rule of thumb: If you need licenses in three or more IMLC participating states, the compact is likely the more cost-effective and time-efficient option.
When traditional licensing is better than IMLC
Despite its advantages, the IMLC isn't always the optimal choice.
Single-state scenarios
If you only need a license in one state, traditional licensing is generally faster and cheaper. For example, if you plan on practicing in California, going through the California Medical Board directly will likely be more straightforward, as California is not part of the IMLC.
States where IMLC processing is slow
Some states have slower IMLC processing times than others. States like Pennsylvania have been known to have slower processing times within the IMLC framework compared to states like Utah or Nebraska.
Eligibility barriers
Physicians with:
- Disciplinary history
- Substance-related actions
- Lack of board certification
…are ineligible for IMLC and must use traditional licensing.
Strategic decision framework
Below are the decision points you should consider:
- How many states do you need to be licensed in? If only one, consider traditional licensing
- Are all states IMLC participants? If not, you'll need a mix of approaches
- Do you meet all IMLC eligibility requirements? Disciplinary actions or lack of a full, unrestricted license will disqualify you
- What are the processing times for each state? Research IMLC vs. traditional processing times for your target states
- Cost Comparison: Get estimates for both IMLC and traditional licensing fees in your target states
Hybrid approach options that maximize efficiency
While the Interstate Medical Licensure Compact (IMLC) simplifies multi-state licensing, it does not cover all states, nor is it always the most cost-effective option.
Many physicians find that a hybrid approach (using a mix of IMLC and traditional licensing) can optimize both cost and efficiency.
Here’s how to combine both:
Using IMLC for fast-processing states and traditional licensing for others
Some states process IMLC applications more quickly than others. Physicians can use IMLC to secure licenses in fast-processing states while applying traditionally in states where IMLC is slow or unavailable (e.g., California, New York, and Florida).
This strategy helps avoid unnecessary delays and additional fees while still benefiting from IMLC’s streamlined approach.
Prioritizing telemedicine expansion with IMLC, local practice with traditional licensing
Telemedicine doctors often need multi-state licenses for virtual patient care, making IMLC an ideal solution for fast expansion.
Meanwhile, physicians practicing in only one or two physical locations may find traditional licensing more affordable for their primary state(s).
This hybrid approach allows physicians to expand strategically without unnecessary costs.
Combining IMLC for initial licensing and traditional licensing for renewals
IMLC requires physicians to renew each state license separately, which can become costly over time.
Some physicians initially use IMLC for quick access to multiple licenses but later transition to traditional renewals in states where it is more cost-effective.
Using IMLC for primary states and Locum Tenens registration for temporary work
Locum tenens physicians who work across multiple states may use IMLC for their primary work locations while applying for temporary practice permits in non-IMLC states.
This minimizes administrative overhead and allows greater flexibility without committing to full state licenses where short-term work is required.
Critical application mistakes that cause delays (Specific to IMLC)
Even though IMLC is designed to expedite multi-state licensing, mistakes in the application process can lead to delays.
Here are some of the most common errors and how to avoid them:
1. Failing to verify eligibility before applying
- Mistake: Many physicians assume they qualify without reviewing IMLC’s strict eligibility criteria (e.g., board certification, disciplinary history, criminal record)
- Fix: Check all eligibility requirements before starting the application process
2. Choosing the wrong state of principal license (SPL)
- Mistake: Some applicants select an SPL where they do not meet the residency or practice percentage requirements, leading to rejection
- Fix: Make sure your SPL is either your primary residence, where 25% of your practice occurs or where you are employed
3. Submitting incomplete or inaccurate documentation
- Mistake: Missing documents, incorrect forms, or incomplete information cause delays in verification
- Fix: Double-check that all licenses, board certifications, proof of employment, and background check documents are accurate and up to date
4. Assuming all IMLC states process at the same speed
- Mistake: Some physicians expect uniform processing times, but each state has its processing speed
- Fix: Research individual state processing timelines and prioritize applications accordingly
5. Not accounting for renewal and administrative costs
- Mistake: Physicians underestimate renewal fees and administrative costs for each licensed state
- Fix: Consider the long-term financial implications and evaluate whether IMLC or traditional licensing is more sustainable for your needs
IMLC implementation timeline planning guide
Proper planning ensures a smooth and timely licensing process through IMLC. Below is a step-by-step timeline to help you navigate the process efficiently.
Step 1: Pre-Application Preparation (1–2 Weeks)
- Verify IMLC eligibility (SPL status, board certification, clean disciplinary record)
- Gather necessary documentation (medical school diploma, board certification, background check)
- Research state-specific processing times to prioritize applications
Step 2: Application Submission (1 Week)
- Apply for IMLC through your State of Principal License (SPL)
- Pay the IMLC application fee ($700)
- Submit all required documents accurately to prevent rejections
Step 3: Letter of Qualification (LOQ) Approval (2–4 Weeks)
- Your SPL verifies credentials and issues an LOQ if approved
- If denied, resolve any eligibility issues before reapplying
Step 4: Multi-State Licensing Requests (2–6 Weeks Per State)
- Once LOQ is received, apply for licenses in participating states
- Pay each state’s licensing fees ($75–$805 per state)
- Track applications and respond promptly to any additional document requests
Step 5: Final Licensing Approval & Activation (Ongoing)
- Once approved, ensure all state licenses are properly registered
- Set renewal reminders—IMLC states require separate renewals per state
By following this structured timeline, physicians can avoid unnecessary delays, minimize errors, and optimize their multi-state licensing process.
Conclusion
The Interstate Medical Licensure Compact (IMLC) offers a faster, more streamlined way for physicians to secure multiple state licenses, making it a valuable tool for those in telemedicine, multi-state practices, or locum tenens work. However, it’s not a one-size-fits-all solution.
The costs, renewal complexities, and eligibility restrictions mean that, in some cases, traditional licensing is the better option—especially for physicians practicing in only one state or those ineligible for IMLC.
Before deciding, carefully evaluate your practice needs, long-term goals, and financial considerations. If speed and multi-state access are priorities, IMLC may be the right fit. But if simplicity matters more, traditional licensing could be the smarter move.
However, if you’re unsure which path to take, Assured can help. We make the IMLC process easier and stress-free, guiding you through every step—from checking your eligibility to handling the paperwork and ensuring everything moves smoothly.
If IMLC isn’t the best fit for you, we’ll help you explore other licensing options so you can get the approvals you need without unnecessary delays.
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