Interstate Medical Licensure Compact (IMLC: State List, Eligibility, and Benefits

The Interstate Medical Licensure Compact (IMLC) provides eligible physicians with a voluntary, expedited pathway to obtain medical licenses in multiple participating states. It can be especially useful for physicians working in locum tenens, telemedicine, rural healthcare, and other settings where practice may cross state lines.

As of June 30, 2026, the IMLC includes 44 member states plus the District of Columbia and Guam, representing 59 licensing boards. The Compact has issued more than 221,000 licenses since becoming operational.

What Is the Interstate Medical Licensure Compact?

The IMLC is an agreement among participating states that streamlines the process of obtaining additional medical licenses.

One important distinction: the IMLC does not issue a single multistate medical license. Instead, eligible physicians complete the Compact process once and can then request separate licenses from participating states where they want to practice. Each license is issued and regulated by the individual state medical board.

The Compact became operational in early 2017 and was created in response to the growing need for more efficient physician licensing, including opportunities created by telemedicine and interstate practice.

IMLC States in 2026

The IMLC currently has 44 member states plus Washington, DC, and Guam. However, membership does not mean every jurisdiction has the same operational status.

According to the IMLCC's July 2026 snapshot:

• 38 states, DC, and Guam are serving as State of Principal License (SPL) jurisdictions and processing applications and issuing licenses.
• Hawaii and Vermont are member jurisdictions that issue licenses but do not currently serve as SPL jurisdictions.
• Alaska, Arkansas, New Mexico, and Rhode Island have passed Compact legislation, with implementation in process.
• Massachusetts has introduced Compact legislation but has not yet enacted it.

Recent additions and implementation milestones include New Mexico joining in February 2026, North Carolina completing its technical integration in January 2026, Connecticut going live as an SPL in March 2026, and Alaska becoming the 44th state member in June 2026.

Because state participation and implementation can change, physicians should verify the current status with the official IMLCC before applying.

Who Is Eligible for the IMLC?

Not every physician qualifies for Compact licensure. Eligibility includes both State of Principal License (SPL) requirements and general professional requirements.

State of Principal License requirements

A physician must hold a full, unrestricted medical license in a participating state that can serve as the SPL.

At least one of these conditions 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 U.S. federal income tax purposes.

Physicians must maintain their SPL status while participating in the Compact, although the SPL can be redesignated under the Compact's rules.

General eligibility requirements

Physicians must also:

• Graduate from an accredited medical school or an eligible school listed in the International Medical Education Directory or equivalent.
• Successfully complete ACGME- or AOA-accredited graduate medical education.
• Pass each component of USMLE, COMLEX-USA, or an accepted equivalent predecessor examination in no more than three attempts per component.
• Hold current specialty certification or time-unlimited certification from an ABMS or AOABOS board.
• Have no history of disciplinary action against a medical license.
• Have no criminal history.
• Have no history of controlled-substance action against a medical license.
• Not currently be under investigation.

The Compact also requires a criminal background check, with fingerprint requirements handled through the designated process in the physician's SPL.

Physicians should confirm their eligibility before applying because the application fee is non-refundable.

How Does the IMLC Application Process Work?

The process generally follows these steps:

1. Confirm eligibility: Determine whether you meet the SPL and general Compact requirements.
2. Submit the application: Complete the IMLC application and provide the required professional and personal information.
3. Complete background screening: The SPL reviews credentials and conducts the required criminal background check.
4. Receive a Letter of Qualification: If the requirements are satisfied, the SPL issues an LOQ.
5. Select additional states: Use the LOQ to request licenses in participating states where you intend to practice.
6. Complete state-specific requirements: Individual medical boards may request additional information, such as a jurisprudence examination or documentation of legal authorization to work in the United States.

A Letter of Qualification is valid for 365 days from its date of issuance.

How Much Does IMLC Licensure Cost?

The current IMLC participation fee is $700, plus the licensing fees charged by each state where the physician requests a license. Fees are non-refundable. State licensing fees vary considerably, so physicians should review the applicable state fee before requesting a license.

The Compact therefore does not necessarily reduce the total cost of obtaining multiple licenses. Its primary advantage is reducing duplicative administrative work and streamlining the licensing process.

How Fast Is IMLC Licensure?

The IMLC has demonstrated significant efficiency compared with traditional multistate licensing processes.

The IMLCC's Year 9 Data Study, covering applications completed from April 1, 2025 through March 31, 2026, found:

• 38 days average from application receipt to issuance of the Letter of Qualification.
• 22 days average from qualification to issuance of requested licenses.
• 55% of LOQs were issued within 30 days or less.

These are averages, not guaranteed processing times. Actual timelines can vary by physician, state, documentation, background check, and state-specific requirements.

Benefits of the IMLC for Physicians

Faster access to multiple state licenses

The Compact can substantially shorten the time and administrative effort involved in obtaining licenses in multiple participating states.

Greater career flexibility

For locum tenens physicians, the IMLC can make it easier to pursue assignments across participating states without completing a completely separate traditional licensing process for every state.

Support for telemedicine

The Compact can simplify obtaining the state licenses needed for interstate telemedicine. However, it does not eliminate state-specific telemedicine requirements.

Under the Compact, the location of medical practice is generally considered to be the state where the patient is located. Physicians must therefore comply with the laws, regulations, scope-of-practice requirements, prescribing rules, and other requirements of the patient's state.

Expanded access to care

By making interstate licensure more efficient, the Compact can help physicians serve rural and underserved communities and expand access to specialized care.

What Physicians Should Know Before Applying

The IMLC is not available in every state, and member-state implementation can change. A physician should verify that the intended practice states are currently participating and operational before beginning the process.

Physicians should also remember that receiving an IMLC license does not exempt them from the laws of the state where they practice. Each state retains authority over medical practice, licensing, renewal, and discipline.

Individual state licenses also have their own expiration dates and renewal requirements.

IMLC Licensing Support for Physicians

Navigating multistate medical licensing can involve eligibility reviews, credential verification, background checks, state-specific requirements, renewals, and ongoing compliance.

DirectShifts helps physicians navigate the licensing process and manage multistate licensure requirements. Whether you are pursuing locum tenens opportunities, telemedicine practice, or expansion into additional states, professional licensing support can help reduce administrative complexity and keep your applications moving efficiently.

Visit our Healthcare Licensing Services page to learn more about how we can help you simplify the licensing process and expand your practice.

State participation, eligibility rules, fees, and implementation status can change. Physicians should confirm current requirements directly with the Interstate Medical Licensure Compact Commission and the applicable state medical boards before applying.