Introduction
For physicians, the Interstate Medical Licensure Compact (IMLC) offers a streamlined path to multi-state practice. It’s designed to reduce paperwork, shorten licensing timelines, and open new opportunities — particularly for telemedicine and locum tenens work.
But is it truly worth the investment? With fees for the Letter of Qualification (LOQ) and individual state licenses, the IMLC isn’t free, and the return on investment varies depending on your practice goals. This guide breaks down the benefits, hidden costs, and considerations every clinician should know before applying in 2025.
The Benefits: Speed, Access, and Flexibility
Faster Licensing Across States
The primary benefit of the IMLC is time savings. Traditional multi-state licensure often takes months of back-and-forth with state boards. With the IMLC, physicians can hold multiple active licenses in weeks instead of months.
This speed is particularly valuable for clinicians who:
- Work telemedicine and need cross-state coverage
- Take locum tenens assignments that require quick start dates
- Want to expand their practice into multiple states without lengthy credentialing delays
By reducing the verification process, the IMLC allows you to move faster and take advantage of high-demand assignments that might otherwise be off-limits.
Broader Practice Opportunities
IMLC membership isn’t just about speed — it opens doors to new patient populations. Clinicians can practice in states where demand is high, often commanding higher reimbursement rates for telehealth or locum contracts.
For example, a physician in Iowa may use the IMLC to quickly practice in Colorado, Arizona, or Maryland, significantly expanding both income potential and professional reach.
Streamlined Documentation
The IMLC eliminates the need for repeating credential verification for each state. Once your LOQ is approved by your State of Principal License (SPL), additional compact states issue licenses without redundant background checks, making multi-state practice much smoother.
Platforms like DirectShifts can further simplify this process, tracking your LOQ, coordinating submissions, and ensuring no steps are missed — allowing you to focus on patient care rather than paperwork.
The Costs: What to Expect
While the benefits are clear, the IMLC does come with financial and administrative costs:
Letter of Qualification Fee
The LOQ is required to use the compact process. As of 2025, this fee is approximately $700–$800, depending on your SPL.
Individual State License Fees
Once your LOQ is approved, you must pay for each additional state license, typically ranging from $75–$350 per state.
Renewal Costs
Each state license is renewed annually, meaning ongoing fees and administrative effort. Failure to track renewal dates can result in lapsed licenses, which delay practice opportunities.
Hidden Costs
Some additional costs may include:
- Background check or fingerprinting fees
- CME or board certification maintenance per state
- DEA registration if prescribing controlled substances across multiple states
It’s important to factor these into your total cost of multi-state practice.
When the IMLC Might Not Be Worth It
Despite its advantages, the IMLC may not be the best fit for every physician. Consider avoiding it if:
- You only plan to practice in one or two states. The time savings may not justify the expense.
- Your home state is not yet a member of the IMLC. You’ll have to apply through traditional channels anyway.
- You’re only doing limited telehealth or locum work. In these cases, a single state license may suffice.
In short, the IMLC is most valuable for clinicians who plan to practice in 3+ states, especially if telemedicine or travel assignments are a key part of their workflow.
How DirectShifts Maximizes the ROI of IMLC
The value of the IMLC increases dramatically when you align licensing with job opportunities. DirectShifts helps clinicians:
- Match with contracts across compact states while the LOQ is being processed
- Track deadlines for additional state applications and renewals
- Pre-verify documents to prevent delays
By combining licensing efficiency with immediate placement opportunities, DirectShifts ensures the cost of the IMLC translates into faster revenue generation, rather than idle paperwork.
Practical Example
Consider Dr. Patel, a physician based in Colorado:
- Without IMLC: Applying directly to three states takes 3–4 months, with separate verification and delays.
- With IMLC: LOQ obtained in 2 weeks, additional states approved in another 1–2 weeks, allowing Dr. Patel to start telehealth contracts 6–8 weeks earlier.
The financial benefit of starting assignments earlier easily offsets the initial LOQ and state fees, making the IMLC a clear win for multi-state practice.
FAQs
1. Can I use one IMLC license across all states?
No. You receive a separate license for each state, but the compact process eliminates redundant verification.
2. Is the IMLC cheaper than applying directly to each state?
Not necessarily in total cost, but it saves significant time and administrative effort.
3. Can I practice telemedicine with one license?
No. You need an active license in each patient’s state. IMLC simply streamlines multi-state licensure.
4. How much does the process cost?
LOQ: ~$700–$800. Additional state licenses: $75–$350 each. Renewals: annual fees per state.
5. What happens if my LOQ is delayed?
Delays often result from missing documents or incomplete background checks. Platforms like DirectShifts help prevent this by pre-verifying submissions.
6. Can I apply if my primary state isn’t a compact member yet?
No. Your SPL must be part of the IMLC. If your state joins later, you can apply retroactively.
7. How quickly can I start practicing in additional states?
Once your LOQ is approved, additional states usually issue licenses in 3–7 days each.
Conclusion
The IMLC is a powerful tool for physicians seeking multi-state practice, particularly in telehealth and locum assignments. While it comes with upfront costs, the time savings, broader opportunities, and simplified documentation make it worth it for many clinicians — especially those planning to work in three or more states.
Platforms like DirectShifts can further maximize the benefits by coordinating licensing, tracking applications, and connecting physicians to immediate job opportunities.
In 2025, with proper preparation and support, the IMLC can transform how physicians expand their practice, increase income, and streamline multi-state work.
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