IMLC Guide for Physicians: States, Costs, and How to Apply in 2026

Every state requires physicians to hold a valid license before treating patients there. That has always been true. What has changed is how painful it is to get licensed in more than one state.

The traditional route means a separate application, separate fees, separate document requests, and separate waiting periods for every single state board. Weeks turn into months. If you want licenses in four states, you go through it four times.

The Interstate Medical Licensure Compact exists to fix that problem. One application, one background check, and a qualification letter that unlocks expedited licenses in dozens of states at once.

The compact has also grown much faster than most physicians realize. If you looked into the IMLC a few years ago and decided it didn’t cover enough states to matter, it’s worth another look. The map looks very different now.

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What is IMLC?

IMLC stands for Interstate Medical Licensure Compact, an agreement among member states that gives qualified physicians an expedited pathway to licensure in multiple states.

The compact was drafted in 2014 by state medical board leaders who wanted to cut the redundancy out of multistate licensing. It’s administered by the Interstate Medical Licensure Compact Commission, which is its own body, not a state or federal agency.

One point trips people up constantly, so let’s settle it early. The IMLC does not issue a “compact license” or any kind of national license. You receive a full, individual medical license from each state you select, issued by that state’s board, and you practice under that board’s jurisdiction. The compact only speeds up how you get there.

The scale at this point is significant. As of mid-2026, more than 62,000 physicians have used the compact, and member states have issued over 215,000 licenses through it. This isn’t a niche program anymore.

The original goal was patient access, particularly in rural and underserved communities that struggle to recruit physicians. In practice, the biggest beneficiaries have been physicians building locum tenens careers and those expanding into telemedicine, where a patient in another state legally requires a license in that state.

Related: The Pros and Cons of Physician Locum Tenens.

Which States Participate in IMLC?

The compact now includes 44 member states, plus the District of Columbia and Guam. That’s 46 jurisdictions in total. Alaska became the newest member in June 2026.

For comparison, only 28 states belonged to the compact in 2024. The growth over the past two years has been fast, driven largely by physician shortages and the continued expansion of telehealth.

U.S. State Participation in the Compact

The following states and territories are currently accepting applications and issuing licenses through the IMLC:

*Hawaii and Vermont participate on a limited basis. They will issue you a license through the compact, but you cannot use a Hawaii or Vermont license to enter the compact in the first place. More on that distinction below.

Four more states have passed IMLC legislation and are working through implementation. If you live in one of these states, contact the state medical board directly for the current status before making plans around the compact:

Massachusetts has introduced legislation but hasn’t passed it yet.

That leaves just five states with no active path into the compact: California, New York, Oregon, South Carolina, and Virginia. Physicians who need licenses in those states still go through the traditional application process with each board.

Membership changes often enough that the IMLC’s participation map is worth checking before you apply.

How Does IMLC Work?

Everything starts with your State of Principal License, or SPL. This is the member state whose board reviews your application, runs your background check, and vouches for your qualifications to every other compact state.

To designate a state as your SPL, you must hold a full, unrestricted medical license there, and at least one of the following must be true:

1. Your primary residence is in that state
2. At least 25% of your practice of medicine occurs in that state
3. Your employer is located in that state
4. You use that state as your state of residence for federal income tax purposes

Notice the “at least one” language. You don’t have to live in your SPL. A physician who lives in Iowa but works for a hospital system in Nebraska can use Nebraska as their SPL through the employer criterion.

This is also where Hawaii and Vermont’s limited status matters. Neither state currently serves as an SPL, so a license from Hawaii or Vermont can’t get you into the compact. You’d need to qualify through another member state first, after which the compact will happily issue you a Hawaii or Vermont license.

If your SPL confirms you qualify, it issues a formal Letter of Qualification, or LOQ. The LOQ is your ticket. It stays valid for 365 days, and during that window you can request licenses from as many compact states as you want.

Each state you select still issues its own license and charges its own fee. But there’s no separate application, no repeated document gathering, and no starting over. Every state you pick begins processing at the same time.

Who Is Eligible for the IMLC?

The compact holds applicants to a uniform standard, and it’s a strict one. To qualify, you must:

1. Hold a full, unrestricted license in a state that can serve as your SPL
2. Have graduated from an accredited medical school, or an international school certified through ECFMG
3. Have completed accredited graduate medical education
4. Have passed each component of the USMLE or COMLEX-USA in no more than three attempts
5. Hold a current specialty certification, or a time-unlimited certification, from an ABMS or AOA board

The background requirements are just as firm. A criminal history disqualifies you. So does any history of disciplinary action against a medical license, any controlled substance action, and any pending investigation by a licensing agency or law enforcement.

Roughly 90% of applicants are approved, so the bar is high but most established physicians clear it.

If your record has complications, it’s worth an honest self-assessment before you apply, because the $700 application fee is non-refundable even when the application is rejected.

What Does the IMLC Cost?

Plan on two layers of fees.

The compact itself charges a $700 non-refundable application fee. That covers your qualification review, the background check coordination, and your LOQ.

Then each state charges its normal licensing fee on top. Current state fees range from $35 for a Pennsylvania MD license up to $895 for Texas, with most states falling somewhere between $300 and $500. The IMLC publishes a full fee table that’s updated as boards adjust their rates.

One cost-saving note from the compact’s own fee structure: it’s cheaper to request all the states you want at once. Adding states later, while your LOQ is still valid, means paying an additional $100 service fee on top of the state fees. If you’re deciding between three states now and maybe two more next spring, price that out before you submit.

For physicians running their own practice or working locums as independent contractors, licensing fees across multiple states are a legitimate business expense worth tracking. A good tax planning strategy accounts for these costs along with the rest of your multistate income picture, which gets complicated quickly once you’re earning in several states.

How Fast Is It?

This is where the compact earns its fee. The average IMLC license is issued in about 19 days, and nearly half of all licenses come through within a week of qualification.

Compare that to traditional licensing, where a single state application routinely takes 60 to 90 days, sometimes longer. Physicians who use the compact obtain an average of four licenses, and they get all of them in roughly the time one traditional application would take.

According to AMA reporting on interstate licensing, about 15.5% of U.S. physicians hold licenses in two states and 6.6% hold licenses in three or more. Multistate practice is no longer unusual. The compact is simply the fastest route to it for physicians who qualify.

Renewing Licenses Obtained Through the Compact

Licenses obtained through the IMLC renew on each state’s normal schedule, at each state’s normal renewal fee. The boards will contact you directly as renewal dates approach.

If you obtained the license through the compact, you renew it through the compact’s renewal process as well. Budget for these recurring fees when deciding how many state licenses you actually need. Four licenses are great for flexibility, but if you’re only ever practicing in two states, you’re paying renewal fees on shelf space.

Should You Join, and in How Many States?

The compact makes the most sense for three groups.

Locum tenens physicians benefit most obviously. More licenses mean more assignments to choose from and faster starts. If you’re weighing that path, our breakdowns of locum tenens pay and locum tenens insurance coverage are good companions to this guide, and working with a physician recruiter can help you match new licenses to actual openings.

Telemedicine physicians are the second group. The practice of medicine legally occurs where the patient is located, so every state your virtual patients live in is a state where you need a license. The compact is the practical way to build that footprint.

The third group is physicians planning a move or weighing offers across state lines. If you’re comparing opportunities in a few of the best states to practice medicine, holding licenses in each lets you negotiate from a position of readiness rather than telling an employer you’ll be credentialed in three months.

A few financial threads run through all three situations, and they’re easy to overlook while you’re focused on the licensing itself. Practicing in multiple states raises real questions about malpractice insurance, since coverage requirements and claim environments vary significantly by state, and about whether your disability insurance still fits an income that now comes from several sources. And every new locum or telemedicine agreement you sign in a new state is still a contract, with its own compensation terms, restrictive covenants, and tail coverage provisions. A professional contract review before you sign, and contract negotiation support when terms need work, protect the earning power all those new licenses just created.

Get More From Your Multistate Career

If you’re ready to start, visit the IMLC website to confirm your SPL eligibility and begin your application. With a valid LOQ in hand, you can be licensed in a handful of new states within weeks.

And once the licenses arrive, make sure the contracts, insurance, and tax strategy behind them are working as hard as you are. Contact Physicians Thrive to talk through the financial side of practicing across state lines.

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