The Interstate Medical Licensure Compact is an agreement among participating U.S. states to work together to significantly streamline the licensing process for physicians who want to practice in multiple states. It offers a voluntary, expedited pathway to licensure for physicians who qualify.
The mission of the Compact is to increase access to health care for patients in underserved or rural areas and allow them to more easily connect with medical experts through the use of telemedicine technologies. While making it easier for physicians to obtain licenses to practice in multiple states, the Compact strengthens public protection by enhancing the ability of states to share investigative and disciplinary information.
The Compact currently includes 37 states, the District of Columbia and the Territory of Guam. In these jurisdictions, physicians are licensed by 50 different medical and osteopathic boards. The Compact became operational in April 2017.
Eligible physicians can qualify to practice medicine across state lines within the Compact if they meet the Compact’s agreed-upon eligibility requirements. Physicians who are eligible can qualify to practice medicine in multiple states by completing just one application within the Compact, receiving separate licenses from each state in which they intend to practice.
These licenses are still issued by the individual states – just as they would be using the standard licensing process – but because the application for licensure in these states is routed through the Compact, the overall process of gaining a license is significantly streamlined. Physicians receive their licenses much faster and with fewer burdens.
The licensing is all state-based. Physicians do not receive a “Compact license” or a nationally recognized medical license through their participation in the Compact.
Approximately 80% of U.S. physicians meet the criteria for licensure through the Compact.
Only states that have formally joined the Compact can participate in this streamlined licensure process. In order to participate in the Compact, states must pass legislation authorizing it. (More details about this process are provided below.)
This section provides information your state may need in order to participate in the Compact. You may also visit the FAQs on our homepage.
How does the Compact expedite licensure?
States that participate in the Compact are able to streamline licensure by using an expedited process to share information that physicians have previously submitted in their State of Principal License (SPL) -- the state in which a physician holds a full and unrestricted medical license.
Physicians apply through the Compact to receive a Letter of Qualification from their SPL. Physicians cannot obtain licenses through the compact unless they have an SPL and are issued a Letter of Qualification.
The SPL reviews the physician’s background and verifies his or her eligibility for the Compact, sharing this information with additional states where the physician wants to practice medicine. Once qualified, physicians may select any number of Compact states in which they want to practice, receiving licensure from these states much more quickly than using traditional licensure processes.
What are the SPL Requirements?
Designating an SPL is an important part of the Compact process for physicians. In order to designate a state as an SPL, physicians must ensure that at least ONE of the following apply:
- The physician’s primary residence is in the SPL
- At least 25% of the physician’s practice of medicine occurs in the SPL
- The physician is employed to practice medicine by a person, business or organization located in the SPL
- The physician uses the SPL as his or her state of residence for U.S. Federal Income Tax purposes.
The SPL has the authority to determine if a physician meets any or all of the qualifications listed above.
How do physicians participate in the Compact?
The Compact treats all physicians equally without preference for specialty. Any physician from a Compact state who meets the qualifications of the Compact is eligible for licensure in any other Compact state and responsible for obeying all statutory laws and administrative rules of the state.
The first step for physicians interested in participating in the Compact is to make sure they meet all of the Compact’s eligibility requirements. Key details are provided below and additional information can be found at the Apply tab on the Compact homepage.
Physicians who want to use the Compact to acquire licenses must apply for participation using this website. They will be asked for demographic and professional information and to select a State of Principal License where the physician already has a license. The State of Principal License must be a state currently participating in the Compact.
Physicians are charged a non-refundable $700 fee when applying to participate in the Compact. Payment is made online by credit card. Physicians must also submit fingerprints to the designated criminal justice agency in their State of Principal License, so that a criminal background check can be conducted.
In order to qualify for Compact participation, physicians must:
- Hold a full, unrestricted medical license in a Compact member-state that can serve as a State of Principal License (SPL), and meet the SPL requirements. See the Compact map on our homepage to see the states that are currently participating. (Note: Physicians must maintain their SPL status at all times. Physicians may change the location of their SPL – through a process known as redesignation – after they receive a Letter of Qualification to participate in the Compact.)
- Have graduated from an accredited medical school, or a school listed in the International Medical Education Directory
- Have successfully completed ACGME- or AOA-accredited graduate medical education
- Passed each component of the USMLE, COMLEX-USA, or equivalent in no more than three attempts for each component
- Hold a current specialty certification or time-unlimited certification by an ABMS or AOABOS board
In addition, physicians must:
- Not have any history of disciplinary actions toward their medical license
- Not have any criminal history
- Not have any history of controlled substance actions toward their medical license
- Not currently be under investigation
Each physician is responsible for making a self-determination of eligibility prior to applying to participate in the Compact, and they must confirm that they understand the Compact rules.
For further clarification, please refer to our Compact Policies, Rules and Laws section.
What happens after a physician applies?
The SPL reviews the physician’s application and qualifications, including conducting a criminal background check. If the physician meets all requirements, a formal Letter of Qualification is issued by the SPL, indicating that the physician may participate in the Compact. The physician then may select the states within the Compact where he or she wishes to be licensed. These states, upon receiving the physician’s formal Letter of Qualification, then issue a license.
After issuing a license to a physician who has received a Letter of Qualification for the Compact, the medical board that has issued the license may ask for additional, ancillary information to fulfill the requirements of their respective medical practice act and their operational requirements. The license holder is required to comply with these requests, and failure to do so may result in action against the license by the issuing medical board.
Physicians who apply but do not meet the requirements of the Compact may not participate and are duly notified by the SPL.
Who administers the Compact?
The Compact is an agreement among sovereign states, with the Interstate Medical Licensure Commission serving as an independent coordinating organization that administers the Compact on the states’ behalf. The Commission is made up of representatives from each participating Compact state.
It is important to note that while the Commission oversees the work of coordinating multi-state licensing activity within the Compact, it does not actually issue individual medical licenses. Licenses are issued by the states that participate in the Compact – not by the Commission itself.
Each participating Compact state sends two representatives to the Commission. These commissioners must be either a physician member of a medical or osteopathic physician licensing board, a public member of such a board, or an executive director or administrator of such a board.
If a state has only one medical board, then both commissioners must come from that board. But if it has two boards -- a medical board and an osteopathic board -- then each board gets one seat.
The Commission is the sole entity administering the Compact’s bylaws, rules, policies, and advisory opinions. No other governmental agency or private entity has control over how the Compact is administered.
The Commission is governed by the terms of the Compact, which provides the authority for the Commission to create bylaws, rules, and policies for self-governance. Commissioners must function within the terms and limitations of the Compact and the bylaws, rules, and policies which the Commission approves.
The Commission meets regularly and information about its meetings, activities and policies are posted in this website’s About the Interstate Medical Licensure Compact Commission section.
How can my state join?
To participate in the Compact, a state’s legislature must introduce and enact a bill authorizing the state to join. The language of the compact must be consistent in each state that joins.
States participating in the Compact make an affirmative and informed choice to accept the Compact’s terms – made possible by the formal legislation, adopted and signed into law.
You can visit the Compact map on our homepage, where you will find links to the legislation each of the currently participating states passed in order to join the Compact.
Which states are members of the Compact now?
37 states, the Territory of Guam and the District of Columbia have joined the Compact to date, and more than 45,000 medical licenses have been issued to date by states participating in the Compact. You can see participating states by visiting the Compact map.
What are the responsibilities of the State of Principal License?
The SPL conducts the primary-source verification and background check of physicians interested in participating in the Compact. Additionally, the SPL communicates with physicians and with the Compact Commission about the status of license applications.
What are the responsibilities of licensing states?
After a physician has been approved for licensure with a Letter of Qualification (LOQ) from the SPL and selects states in which he or she wishes to be licensed, those “licensing states” – all of which must be participants in the Compact -- receive notification.
When a Compact licensing-state receives an LOQ for a physician seeking licensure, the state is expected to process the LOQ and issue the license promptly. It must also report the licensure to the Interstate Medical Licensure Commission.
Each licensing state must notify the licensee 90 days in advance when a license issued via the Compact is due to expire. Licensing states also are expected to work with the Commission to facilitate timely renewal of licenses granted via the Compact.
Because information exchange between individual Compact states and the Commission is vital to the successful operation of the Compact, each licensing state must have procedures and processes in place to share information associated with Letters of Qualification and to compile various other Compact-related information in its database of physicians.
For more information
Compact staff is available to assist states in the process of developing administrative procedures after joining the Compact. For more information, call 303-997-9842 or 720-621-9464.