Prior to the COVID-19 pandemic, a major force in supporting telehealth expansion was the Interstate Medical Licensure Compact (IMLC), which was designed to preserve state regulation of medical practice while making it easier for physicians to provide care remotely  and in person to patients in other states. Physicians can apply now.

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The use of the compact has grown by 47% during the pandemic, even as most states and the Centers for Medicare & Medicaid Services temporarily waived the requirement that physicians need to be licensed in the state where the patient they are treating is located.

As states and Congress shape telehealth’s future, it appears physicians are taking advantage of the existing process formalized eight years ago by the Federation of State Medical Boards (FSMB) and launched two years later with the support of AMA policy.

Big boom during pandemic

Since a Wisconsin physician was issued a license from the Colorado Medical Board using the IMLC in 2017, there have been more than 17,000 other physician licenses issued under the compact through February. Almost half of that total was issued during the pandemic.

Of those, 8,126 licenses were issued through the compact between March 2020 and March 2021, according to the Interstate Medical License Compact Commission (IMLCC). In comparison, 3,877 were issued during the previous 12-month period.

“The compact is no longer just an idea or a test,” wrote Timothy E. Terranova, immediate past chair of the IMLCC and assistant executive director of Maine’s Board of Licensure in Medicine, in the commission’s December newsletter. “It continues to mature into a full-fledged organization with a proven track record.”

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IMLCC is classified under Internal Revenue Service code as a “governmental instrumentality,” according to an essay by Marschall S. Smith published last fall in the FSMB’s Journal of Medical Regulation. So when states join the compact, the commission becomes a regulatory authority of the state government “with the authority to collect fees and issue rules,” wrote Smith, the commission’s executive director.

Louisiana became the compact’s 32nd member in October, joining 29 other states, Guam and the District of Columbia. Legislation to join the compact has been introduced this year in Missouri, New Jersey, New York, North Carolina, Ohio, Oregon, Rhode Island, and Texas.

According to 2019–2020 data from the commission:

  • The average number of state licenses obtained per applicant was 1.6, down from three in the previous period.
  • 80% of applicants use the compact to obtain one or two licenses, up from 64%.
  • 20% of applicants obtain three or more, down from 36%.
  • 6% obtained seven or more, down from 13%.

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A total of 4,805 licenses were issued through the compact during the 12-month period studied. The states issuing the most licenses were:

  • Wisconsin—330.
  • Arizona—324.
  • Illinois—303.
  • Colorado—299.
  • Nevada—283.
  • Washington—272.
  • Minnesota—245.
  • Iowa—232.
  • Idaho—226.
  • Tennessee—225.
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