The Interstate Medical Licensure Compact offers a pathway to make it easier for physicians already licensed in one state to also practice in another. While the Compact is relevant to any physician along the career spectrum who is seeking to practice in more than one state, it is especially important for residents and fellows to understand how it works as they navigate where and how to make their transition to practice.
After all, to practice medicine in a state, you must be licensed there. First, some history and fast facts on the Interstate Medical Licensure Compact. The Federation of State Medical Boards finalized the Compact in 2014, and the AMA was an early advocate, adopting policy to support it.
The Interstate Medical Licensure Compact “makes it easier for physicians to obtain licenses to practice in multiple states and strengthens public protection by facilitating state medical board sharing of investigative and disciplinary information that they cannot share now,” says a 2025 AMA issue brief (PDF).
The AMA “supports state adoption of the Compact as a way to help modernize the state licensure system and promote uniformity in requirements for state licensure. With the proliferation of telehealth, the Compact has been instrumental in providing physicians interested in caring for patients across state lines via telehealth a pathway to obtain licensure in other states.”
The latest figures from the Interstate Medical Licensure Compact Commission (IMLCC) bear that out.
The first license issued under the Compact was processed April 20, 2017. It involved a Wisconsin physician obtaining a Colorado license. A total of three licenses were issued that month. By comparison, a whopping 3,633 licenses were issued under the Compact in March 2026. Forty-four states are members of the Compact, as are the District of Columbia and Guam. Participation is voluntary and maintenance of certification is not required. Overall, more than 200,000 licenses have been issued.
For the most recent year of IMLCC data, the top five states issuing the most licenses under the Compact were:
- Texas—1,462.
- Florida—1,105
- Illinois—1,013.
- Georgia—966.
- Indiana—963.
Nearly 11,000 applications for an IMLCC “letter of qualification” were completed in the most recent 12-month period, running from April 1, 2025–March 31, 2026. On average, applicants obtained four licenses, with 62% getting one or two licenses and another 38% in the three-plus bucket. In only 7% of applications it was determined that the applying doctor did not meet the eligibility requirements—a figure that has stayed stable for the last three years.
So now let’s dive into how the process works, and what residents, fellows and other physicians should know about it.
Which physicians are eligible to take part in the Compact?
To qualify, the IMLCC’s FAQ webpage says that physicians must hold a full, unrestricted medical license in a Compact member state which qualifies as their state of principal license. The physician must meet at least one of these criteria:
- Have their primary residence in the state of principal license or use it as their state of residence for federal tax purposes.
- Have at least 25% of their practice of medicine in the state of principal license.
- Be employed to practice medicine by person, business or organization in the state of principal license.
Among other criteria, to qualify for multistate licensure under the Compact doctors also must have:
- Graduated from an accredited medical school, or a school listed in the International Medical Education Directory.
- Successfully completed Accreditation Council for Graduate Medical Education- or American Osteopathic Association-accredited graduate medical education.
- Passed each component of the United States Medical Licensing Exam, Comprehensive Osteopathic Medical Licensing Examination of the United States, or equivalent predecessor exam accepted by the state medical board in no more than three attempts for each component.
- A current specialty certification or time-unlimited certification by a member board of the American Board of Medical Specialties or American Osteopathic Association Bureau of Osteopathic Specialties.
In addition, physicians who apply must not have:
- Any history of disciplinary actions toward their medical license.
- Any criminal history.
- Any history of controlled substance actions toward their medical license.
- Any current investigation underway.
How do physicians apply to participate in the Compact?
Apply at the IMLCC website. The cost is $700.
What happens when physicians apply?
The state where you have your principal license will look over your application and qualifications and conduct a criminal background check. If you meet all the requirements, a “letter of qualification” is issued by the state indicating that you can take part in the Compact. This takes 38 days on average, though 55% of letters of qualification are obtained in less than a month.
You then pick the states where you want to be licensed. Those states, upon receiving the letter of qualification, will issue a license. Sometimes, the other states will ask for additional information and you will be obliged to provide it in order to maintain your license there.
What if physicians want to become licensed in more states later?
Your letter of qualification is valid for a year, and at any time during that 365-day period you can request licensure from additional Compact member states. Additional fees apply. After the letter of qualification expires, then the physician must reapply.
Get further details and answers to other questions at the IMLCC website.
Also, learn more with the AMA about medical licensing requirements, what residents should know about board certification, and how resident physicians can speed up their transition to practice.
