Traditional Medical Licensing vs. the IMLC: A Physician’s Guide

Traditional State Medical Licensing vs. the Interstate Medical Licensure Compact

Physicians planning to practice in multiple states generally have two licensing pathways: applying directly to each state medical board or using the Interstate Medical Licensure Compact, commonly called the IMLC.

Both pathways ultimately result in individual state medical licenses. The Compact does not create one national license that allows a physician to practice anywhere in the country. Instead, it offers an expedited application pathway for eligible physicians seeking licenses from participating states.

Understanding the differences can help physicians choose the most appropriate approach based on their qualifications, target states, timeline, and intended practice model.

How does traditional state medical licensing work?

Under the traditional process, a physician applies separately to the medical or osteopathic board in every state where they intend to practice.

Each board establishes its own application requirements, fees, documentation standards, processing procedures, and renewal rules. State requirements can differ regarding postgraduate training, examination attempts, background checks, supporting documentation, and other licensing criteria.

A typical state application may require verification of:

• Medical school education
• Graduate medical education
• USMLE or COMLEX-USA results
• Existing and previous licenses
• Professional work history
• Hospital privileges
• Board actions or disciplinary history
• Identity and background information

The state medical board reviews the physician’s credentials, licensing history, examination results, and application responses before deciding whether to issue a license. In certain cases, a board may request additional documentation or an interview.

Can physicians simplify traditional state applications?

Physicians applying directly to state boards may be able to use services offered by the Federation of State Medical Boards.

The Uniform Application, or UA, allows physicians to reuse a standardized core application when applying to participating boards. However, physicians must still complete any state-specific requirements.

The Federation Credentials Verification Service, or FCVS, creates a permanent profile containing primary-source verification of core credentials such as medical education, postgraduate training, examination history, identity, and board certification. Some boards accept FCVS, while others require it.

These services can reduce repeated data entry and credential collection, but they do not replace the state medical license application.

What is the Interstate Medical Licensure Compact?

The Interstate Medical Licensure Compact is a voluntary, expedited pathway for qualified physicians who want to obtain licenses in multiple participating states.

A physician begins by applying through a qualifying State of Principal License, or SPL. That state reviews the physician’s eligibility and conducts the required background and credential checks. An approved physician receives a Letter of Qualification and can then select participating states from which they want licenses.

The selected state boards—not the Compact Commission—issue the actual medical licenses. Physicians must follow the laws, regulations, renewal requirements, and continuing obligations of every state in which they become licensed.

As of June 30, 2026, the Compact reported 44 member states, two U.S. territories, 59 participating licensing boards, and more than 221,000 licenses issued. Participation and implementation status can change, so physicians should check the current Compact map before choosing this pathway.

Who qualifies for the IMLC?

Compact eligibility is narrower than general eligibility for a traditional state medical license.

A physician must hold a full, unrestricted license in a participating state that can serve as their State of Principal License. At least one of the following must also apply:

• The physician’s primary residence is in the SPL.
• At least 25% of the physician’s medical practice occurs in the SPL.
• The physician’s employer is located in the SPL.
• The physician uses the SPL as their state of residence for federal income-tax purposes.

Additional requirements include qualifying medical education and graduate medical training, acceptable examination history, qualifying specialty board certification, and an eligible professional and legal history. Physicians generally cannot have prior medical-license discipline, criminal history, controlled-substance actions against a license, or an active investigation.

Because the Compact application fee is nonrefundable, physicians should carefully review the complete eligibility requirements before applying.

Traditional Medical Licensing vs. the IMLC

Eligibility

Traditional State Licensing:

Eligibility is determined by the individual requirements of each state medical board.

Interstate Medical Licensure Compact:

Physicians must meet the licensing requirements of the selected states as well as the Compact’s additional eligibility standards.

Available States

Traditional State Licensing:

Physicians may apply directly to any state or jurisdiction where they meet the licensing requirements.

Interstate Medical Licensure Compact:

The expedited process is only available for participating and operational Compact states and territories.

Application Process

Traditional State Licensing:

The physician submits a separate application directly to each state medical board.

Interstate Medical Licensure Compact:

The physician first applies through a qualifying State of Principal License. After receiving a Letter of Qualification, the physician can select additional participating states.

Licenses Issued

Traditional State Licensing:

Each state medical board issues a separate medical license.

Interstate Medical Licensure Compact:

Each selected state still issues its own separate medical license. The Compact does not provide a national medical license.

Credential Review

Traditional State Licensing:

Each state board reviews the physician’s application, credentials, examination history, professional background, and supporting documents.

Interstate Medical Licensure Compact:

The State of Principal License completes the initial Compact eligibility review before the physician requests licenses from additional participating states.

State-Specific Requirements

Traditional State Licensing:

Physicians must satisfy the application, renewal, continuing education, and professional requirements of each state.

Interstate Medical Licensure Compact:

Physicians must still follow the laws, renewal requirements, continuing education rules, and professional standards of every state in which they receive a license.

Best Suited For

Traditional State Licensing may be appropriate for physicians who:

• Need a license in only one additional state
• Are applying to a state that does not participate in the Compact
• Do not meet the Compact’s eligibility standards
• Need to reinstate a previous state license
• Prefer to apply directly through the state board

The Interstate Medical Licensure Compact may be appropriate for physicians who:

• Meet all Compact eligibility requirements
• Need licenses in several participating states
• Practice telemedicine across state lines
• Accept multi-state locum tenens assignments
• Work for a healthcare organization operating in multiple states
• Expect to add more state licenses in the future

• How much does the IMLC cost?

The initial Compact application fee is $700, and it is nonrefundable. Physicians must also pay the licensing fee charged by every state they select. State fees vary considerably and remain separate from the Compact application fee.

A physician adding states while an existing Letter of Qualification remains valid is also charged a Compact handling fee in addition to the applicable state licensing fees.

Traditional applications do not have one standardized total cost. Expenses depend on the state board and may include application fees, license-verification charges, fingerprinting, transcripts, FCVS services, or other supporting requirements.

Is the IMLC always faster?

The Compact is designed to expedite multi-state licensing, but the full timeline includes two stages:

1. The State of Principal License reviews the physician and issues the Letter of Qualification.
2. The physician selects participating states, which then issue individual licenses.

After a valid Letter of Qualification has been received and state fees have been paid, participating boards generally issue licenses within a relatively short period, although individual boards may request additional information.

Traditional licensing timelines vary by board, application completeness, verification speed, and the physician’s professional history. Physicians should not make employment or start-date commitments until the required license has actually been issued.

When might traditional licensing be the better option?

Applying directly to a state board may make more sense when:

• The physician only needs one additional license.
• The target state does not participate in the Compact.
• The physician does not meet the Compact’s eligibility requirements.
• The physician previously held a license in the target state and must use its reinstatement process.
• The board offers a direct pathway that fits the physician’s circumstances.
• The additional Compact fee would not provide enough value for the number of licenses needed.

The Compact specifically advises physicians with a previously expired or lapsed license in a target state to contact that state board because reinstatement may be required.

When might the IMLC be the better option?

The Compact may be especially useful for eligible physicians who:

• Plan to practice in several participating states
• Provide telemedicine services across state lines
• Accept locum tenens assignments
• Work for multi-state healthcare organizations
• Need to expand into additional states over time
• Want a more centralized pathway for obtaining multiple licenses

A Letter of Qualification remains valid for 365 days. During that period, the physician may request licenses from additional participating states, subject to applicable fees and requirements.

DoesIMLC replace individual state requirements?

No. Every license obtained through the Compact remains under the authority of the issuing state medical board.

Physicians must maintain each license, satisfy renewal requirements, comply with state practice laws, and respond to requests for additional information from individual boards. License expiration dates and renewal requirements are determined by each state.

The Compact changes the pathway used to obtain licenses. It does not eliminate state regulation of medical practice.

Choosing the right multi-state licensing pathway

The best option depends on the physician’s eligibility, target states, number of licenses, desired start dates, and professional history.

Before applying, physicians should:

• Confirm whether each target state participates in the Compact.
• Review the complete Compact eligibility standards.
• Compare Compact and direct-application costs.
• Determine whether any prior licenses require reinstatement.
• Review state-specific application and renewal requirements.
• Build enough time into employment and credentialing schedules.
• Get help with multi-state medical licensing

Managing several state applications can involve extensive credential collection, board communication, document tracking, and deadline management.

MedLicense can help physicians evaluate their target states and organize the medical licensing process. Contact MedLicense to discuss whether traditional state applications, the Interstate Medical Licensure Compact, or a combination of both may be appropriate for your licensing goals.

_This article is provided for general informational purposes and does not constitute legal advice. Requirements, fees, participation status, and processing procedures may change. Physicians should verify current information with the appropriate medical board and the Interstate Medical Licensure Compact Commission before applying.