Multi-state licensing and the Interstate Medical Licensure Compact.

A practice seeing patients across state lines — in person or by telehealth — runs into a fact that surprises a lot of first-time multi-state practices: there is no such thing as one license that works everywhere. The Interstate Medical Licensure Compact exists to make getting several licenses faster, not to make one license do the work of several. Understanding exactly what it speeds up, and what it leaves untouched, is what keeps a multi-state expansion plan realistic.

Why multi-state practice needs multiple licenses in the first place

The general rule is that a physician needs a full, separate medical license in every state where the patient is physically located at the time of the encounter — not where the provider happens to be sitting. This applies just as much to telehealth as to in-person care: a physician licensed only in State A who sees a telehealth patient physically located in State B is generally practicing medicine in State B without a license there, regardless of how the visit was delivered. This single fact is what makes multi-state and telehealth-heavy practices treat licensing as an ongoing operational function rather than a one-time setup step.

How the IMLC's expedited pathway actually works

The Interstate Medical Licensure Compact, at imlcc.com, exists specifically to speed up this process for eligible physicians. Instead of submitting a full, independent application — including a fresh round of primary-source verification — to every state, an eligible physician's state of principal license issues a Letter of Qualification. Participating states in the compact use that letter to expedite issuing their own license to the physician, avoiding much of the redundant verification work a cold application in each state would otherwise require.

The physician still ends up holding a genuinely separate license, issued by each individual compact state's board, subject to that state's own renewal cycle and CME requirements described in our state medical board licensing guide. What changes is how fast those separate licenses can be obtained, not whether they're required.

Current membership: confirm it, don't quote a fixed number

As of 2026, IMLC membership is commonly cited in the 40-plus states range, but the exact figure moves as states join, and different sources report slightly different counts depending on when they were last updated. Rather than treating any specific number as a fixed fact, the reliable approach is to confirm current membership directly at imlcc.com before telling a physician or practice which states are covered — this is one of the few pieces of information in practice licensing that's genuinely a moving target, and quoting a stale number to a client can set the wrong expectation for a state that either joined or hasn't joined since the number was last checked.

Eligibility is also not universal even within member states. The compact has historically applied to physicians specifically, not automatically to every other licensed provider type, and not every physician meets the compact's eligibility criteria for a Letter of Qualification (which generally depends on their state of principal license and the standing of that license). Confirm both state membership and individual eligibility before building a timeline around the compact.

Multi-state licensing outside the compact

For a state that isn't a compact member, or a provider type the compact doesn't cover, there's no shortcut — the standard full state licensing process applies, with its own primary-source verification of medical school, residency, prior licenses, and disciplinary history, run independently in that state. This is the same process covered in full in our state medical board licensing guide, and the same caution applies: the timeline is usually gated by how quickly outside institutions respond to verification requests, not by anything the applicant controls directly.

This is worth planning for explicitly rather than assuming the compact will eventually cover every state a practice wants to expand into. A practice building a multi-state telehealth footprint should map its target states against current IMLC membership early, and budget realistic timelines for the states that fall outside it — treating those as full applications from day one rather than discovering partway through an expansion that a state was never a compact member to begin with.

Licensing obligations beyond the license itself

Holding an active license in a state — whether obtained through the compact or the standard process — is the floor, not the whole picture. Each state where a physician is licensed and practicing generally expects that physician to also meet that state's own telehealth-specific practice rules where they exist, its CME and renewal cycle described in our state medical board licensing guide, and often its own controlled substance registration if the physician prescribes controlled substances to patients in that state, on top of the DEA registration covered in our DEA registration guide. A multi-state practice is effectively running several parallel sets of these obligations at once, one per state, and none of them collapse into a single combined requirement just because the underlying license was obtained through an expedited pathway.

Step by step: expanding into a new state

1. Confirm the target state's current IMLC membership at imlcc.comDon't rely on a previously checked number — membership changes.
2. Confirm the physician's individual eligibility for the compact pathwayDepends on the standing of their state of principal license; not every physician qualifies.
3. If eligible and the state is a member, obtain the Letter of QualificationIssued by the physician's state of principal license.
4. Submit the expedited application to the target stateFaster than a cold application, but still results in a separate, distinct license.
5. If ineligible or the state isn't a member, run the full state applicationSame primary-source verification process as any first-time state license application.
6. Diarise the new license's renewal date and CME cycleEach state license runs on its own schedule from this point forward.

Frequently asked questions

Related resources

• Our complete practice licensing guide
• Entity formation and EIN
• State medical board licensing
• DEA registration and the MATE Act
• NPI registration: Type 1 vs Type 2
• CLIA waivers and facility licenses
• Practice management service
• Practice management operations