Interstate Medical Licensure Compact: 2025 Workflow & How Assured Automates It

Expanding medical practice across state lines has never been easier—at least in theory. The Interstate Medical Licensure Compact (IMLC) provides a solution to this. 

The agreement offers a process for physicians to obtain licenses in multiple states, making it an attractive option for those in telemedicine, multi-state practices, or mobile healthcare services. 

However, IMLC isn’t always a one-size-fits-all solution. It comes with costs, eligibility restrictions, and limitations that can make the traditional licensing process a better choice.

This guide breaks down everything you need to know:

• What IMLC is
• When it provides a clear return on investment (ROI)
• And when traditional licensing is the smarter move

Let’s get right in.

What is IMLC?

The Interstate Medical Licensure Compact (IMLC) is an agreement between participating U.S. states that allows qualified physicians to obtain licenses in multiple states through a streamlined process. 

Instead of applying separately to each state’s medical board, eligible physicians can apply for a single expedited process, significantly reducing administrative burden and approval times.

As of February 2025, participating states include:

Source: Compact State Map | Interstate Medical Licensure Compact

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List of Interstate Medical Licensure Compact (IMLC) participating states

1. Alabama
2. Arizona
3. Arkansas
4. Colorado
5. Connecticut
6. Delaware
7. District of Columbia
8. Georgia
9. Guam
10. Idaho
11. Illinois
12. Indiana
13. Iowa
14. Kansas
15. Kentucky
16. Louisiana
17. Maine
18. Maryland
19. Michigan
20. Minnesota
21. Mississippi
22. Missouri
23. Montana
24. Nebraska
25. Nevada
26. New Hampshire
27. New Jersey
28. North Dakota
29. Ohio
30. Oklahoma
31. Pennsylvania
32. South Dakota
33. Tennessee
34. Texas
35. Utah
36. Vermont
37. Washington
38. West Virginia
39. Wisconsin
40. Wyoming
41. Florida‍
42. Hawaii

• States issuing licenses but not serving as States of Principal Licensure (SPL): Connecticut, Pennsylvania, Vermont
• States with legislation passed but implementation pending or delayed: Arkansas, Massachusetts, New Mexico, New York, Rhode Island

Note that 42 states, the District of Columbia, and Guam are part of the compact. Some states (e.g., Connecticut, Pennsylvania, Vermont) can issue licenses through IMLC but cannot serve as an SPL for entry into the compact. Others have introduced or passed legislation to join but are not yet fully operational

IMLC core eligibility requirements

Not all physicians qualify for the IMLC. To be eligible, you must meet these criteria:

• Hold a full, unrestricted medical license in a Compact member state eligible to serve as a State of Principal License (SPL)
• The SPL must be the physician’s primary residence, or at least 25% of their medical practice must occur there
• Physicians can qualify if employed by an organization based in the SPL
• The SPL must be used as the physician’s state of residence for U.S. federal income tax purposes
• SPL status must be maintained at all times, but it can be updated after receiving a letter of qualification
• Must have graduated from an accredited medical school or one listed in the International Medical Education Directory
• Must have completed an ACGME or AOA-accredited graduate medical education program
• Must have passed the United States Medical Licensing Examination (USMLE), Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA), or an accepted predecessor exam within three attempts per component (LMCC is not accepted)
• Must hold a current or time-unlimited specialty certification from an American Board of Medical Specialities (ABMS) or American Osteopathic Board of Orthopedic Surgery (AOABOS) board
• Must have no history of disciplinary actions against their medical license
• Must have no criminal history
• Must have no history of controlled substance-related actions against their medical license
• Must not be under investigation at the time of application

The Complete 10-Step IMLC Workflow Process

Here's the definitive step-by-step process for obtaining licenses through IMLC:

Step 1: Eligibility Verification and Documentation Gathering

Timeline: 1-2 weeks
Key Actions:

• Verify you meet all IMLC eligibility requirements
• Confirm your State of Principal License (SPL) qualifies
• Gather required documents: medical school diploma, board certification, background check results

🤖 Assured Automation: Our eligibility checker instantly verifies your qualifications against IMLC requirements and identifies any potential issues before you apply.

Step 2: State of Principal License (SPL) Selection and Validation

Timeline: 2-3 days
Key Actions:

• Confirm SPL meets residency or practice percentage requirements (25% minimum)
• Validate SPL status for federal tax purposes
• Ensure SPL can serve as primary license for IMLC entry

🤖 Assured Automation: Automated SPL validation cross-references your practice locations, residency, and tax status to recommend the optimal SPL.

Step 3: Primary Source Verification Initiation

Timeline: 1-2 weeks
Key Actions:

• Request verification from medical school
• Obtain board certification verification
• Secure residency program confirmation
• Order background checks and fingerprinting

🤖 Assured Automation: We automatically request all primary source verifications simultaneously and track their completion status in real-time.

Step 4: IMLC Application Submission

Timeline: 1-2 days
Key Actions:

• Complete IMLC online application
• Upload all required documentation
• Pay IMLC application fee ($700)
• Submit to SPL medical board

🤖 Assured Automation: Our platform pre-fills applications using your stored data and automatically uploads documents in the correct formats.

Step 5: SPL Review and Letter of Qualification (LOQ) Processing

Timeline: 2-4 weeks
Key Actions:

• SPL medical board reviews application
• Board verifies credentials and eligibility
• LOQ issued if approved, or rejection notice if denied

🤖 Assured Automation: Real-time status tracking with automated follow-ups to expedite review. We alert you immediately when LOQ is issued.

Step 6: Target State Selection and Fee Planning

Timeline: 1-2 days
Key Actions:

• Select states where you need licenses
• Calculate total licensing fees
• Plan application priority based on processing times

🤖 Assured Automation: Our cost calculator provides instant fee estimates, and our state analyzer recommends optimal application sequencing.

Step 7: Multi-State License Applications

Timeline: 1 week
Key Actions:

• Submit license applications to selected states
• Pay individual state fees
• Upload state-specific requirements
• Provide additional documentation if requested

🤖 Assured Automation: Bulk application submission to multiple states simultaneously with automated fee payments and document routing.

Step 8: State Board Reviews and Follow-ups

Timeline: 2-8 weeks per state
Key Actions:

• Monitor application status across all states
• Respond to additional document requests
• Provide clarifications if needed
• Track processing timelines

🤖 Assured Automation: Centralized dashboard tracks all applications with automated status updates and proactive follow-ups with state boards.

Step 9: License Issuance and Activation

Timeline: 1-2 days per state
Key Actions:

• Receive license approval notifications
• Download official license documents
• Verify license details for accuracy
• Activate licenses for practice

🤖 Assured Automation: Instant notifications when licenses are issued, with automatic license verification and secure digital storage.

Step 10: Renewal Setup and Ongoing Compliance

Timeline: Ongoing
Key Actions:

• Set up renewal reminders for each state
• Track continuing education requirements
• Monitor compliance deadlines
• Plan for future license additions

🤖 Assured Automation: Automated renewal tracking with customized reminder schedules and CE requirement monitoring across all licensed states.

Interstate Medical Licensure Compact process overview 

The IMLC process can be simplified into three key steps:

1. Establish Your State of Principal License (SPL): This is the state where you primarily practice medicine or hold your primary residence.
2. Submit Your IMLC Application: Apply through the IMLC website, designating the states where you seek licensure.
3. Undergo Expedited Review: The IMLC verifies your credentials and facilitates communication with the selected state medical boards, leading to faster licensure.

Cost-benefit analysis: Hard numbers

Is the IMLC truly a cost-effective solution? Let's examine the financial implications. 

Additional Costs to Consider:

• IMLC Application Fee: $700 (paid to SPL)
• Background Check: $50-100 per state
• Primary Source Verification: $20-50 per verification
• Fingerprinting: $25-75 per state

Direct cost comparison table: IMLC vs. traditional for 1, 3, 5, and 10 states

True timeline comparison

One of the biggest selling points of IMLC is speed. Here’s how the timelines compare:

• IMLC Average Approval Time: 4 – 8 weeks after your application is complete and accepted
• Traditional Licensing: 3 – 6 months

Some states still take longer through IMLC due to internal delays. If speed is a priority, check each state’s average processing time before applying.

Hidden costs and fees and administrative overhead

Be aware of these potential hidden costs:

• Application Fees: Both the IMLC and individual state boards charge application fees
• Fingerprinting and Background Checks: These are standard requirements and can add to the overall expense. Typically costing $50-$100 per state
• Primary Source Verification: You may need to pay to verify your credentials with medical schools and other institutions. This can range from $20 to $50 per verification

Both IMLC and traditional licensing require administrative effort. The IMLC aims to reduce the burden, but you'll still need to:

• Gather necessary documents
• Complete online applications
• Respond to inquiries from the IMLC and state boards
• Spend communicating with different state boards to follow up on the application status

Where IMLC delivers clear ROI

In what scenarios does the IMLC truly excel?

Specific scenarios with quantified savings (telemedicine expansion, multi-state needs):

Telemedicine expansion

If you plan to offer virtual consultations to patients in multiple states, the IMLC can streamline the licensing process, saving you time and money. 

For example, a psychiatrist seeking to expand their telemedicine practice to five states—Colorado, Nevada, Arizona, Utah, and New Mexico—could potentially save several months of processing time and thousands of dollars in application fees by using the IMLC.

The cost savings could be in the range of $1,000-$3,000, and the time savings could be 3-6 months.

Multi-state needs

If your practice involves frequent travel or providing services in multiple states, maintaining multiple licenses is easier with IMLC. 

Traveling physicians who cover multiple rural hospitals in states like Iowa, Nebraska, and South Dakota could benefit most.

Physician specialties that benefit most from IMLC

Certain specialties benefit disproportionately from the IMLC:

• Radiologists and Pathologists: Often provide interpretations across state lines
• Hospitalists and Psychiatrists: Often cover multiple facilities that span across state lines in bordering areas
• Telemedicine doctors: Can quickly scale across states
• Emergency medicine physicians: Often need licenses in multiple locations
• Specialists with niche expertise: If demand exists in various states, IMLC makes expansion seamless

Break-even analysis: How many states justify IMLC?

Let's assume a telemedicine doctor wants to expand their practice to five states: Tennessee, Kentucky, Ohio, Indiana, and Illinois. 

Using IMLC’s efficiency will save:

• 3–4 months in licensing time
• $2,000–$3,000 in administrative costs
• Lost revenue from a delayed start

While traditional licensing might take 3-6 months per state, costing $750-$2,000 per license. The IMLC could potentially reduce the timeline to 3-6 months total and lower the overall cost by 20-30%.

A good rule of thumb: If you need licenses in three or more IMLC participating states, the compact is likely the more cost-effective and time-efficient option.

When traditional licensing is better than IMLC

Despite its advantages, the IMLC isn't always the optimal choice.

Single-state scenarios

If you only need a license in one state, traditional licensing is generally faster and cheaper. For example, if you plan on practicing in California, going through the California Medical Board directly will likely be more straightforward, as California is not part of the IMLC.

States where IMLC processing is slow

Some states have slower IMLC processing times than others. States like Pennsylvania have been known to have slower processing times within the IMLC framework compared to states like Utah or Nebraska.

Eligibility barriers

Physicians with:

• Disciplinary history
• Substance-related actions
• Lack of board certification

…are ineligible for IMLC and must use traditional licensing.

Strategic decision framework

Below are the decision points you should consider:

• How many states do you need to be licensed in? If only one, consider traditional licensing
• Are all states IMLC participants? If not, you'll need a mix of approaches
• Do you meet all IMLC eligibility requirements? Disciplinary actions or lack of a full, unrestricted license will disqualify you
• What are the processing times for each state? Research IMLC vs. traditional processing times for your target states
• Cost Comparison: Get estimates for both IMLC and traditional licensing fees in your target states

Hybrid approach options that maximize efficiency

While the Interstate Medical Licensure Compact (IMLC) simplifies multi-state licensing, it does not cover all states, nor is it always the most cost-effective option. 

Many physicians find that a hybrid approach (using a mix of IMLC and traditional licensing) can optimize both cost and efficiency.

Here’s how to combine both:

Using IMLC for fast-processing states and traditional licensing for others

Some states process IMLC applications more quickly than others. Physicians can use IMLC to secure licenses in fast-processing states while applying traditionally in states where IMLC is slow or unavailable (e.g., California, New York, and Florida).

This strategy helps avoid unnecessary delays and additional fees while still benefiting from IMLC’s streamlined approach.

Prioritizing telemedicine expansion with IMLC, local practice with traditional licensing

Telemedicine doctors often need multi-state licenses for virtual patient care, making IMLC an ideal solution for fast expansion.

Meanwhile, physicians practicing in only one or two physical locations may find traditional licensing more affordable for their primary state(s).

This hybrid approach allows physicians to expand strategically without unnecessary costs.

Combining IMLC for initial licensing and traditional licensing for renewals

IMLC requires physicians to renew each state license separately, which can become costly over time.

Some physicians initially use IMLC for quick access to multiple licenses but later transition to traditional renewals in states where it is more cost-effective.

Using IMLC for primary states and Locum Tenens registration for temporary work

Locum tenens physicians who work across multiple states may use IMLC for their primary work locations while applying for temporary practice permits in non-IMLC states.

This minimizes administrative overhead and allows greater flexibility without committing to full state licenses where short-term work is required.

Critical application mistakes that cause delays (Specific to IMLC)

Even though IMLC is designed to expedite multi-state licensing, mistakes in the application process can lead to delays. 

Here are some of the most common errors and how to avoid them:

1. Failing to verify eligibility before applying

• Mistake: Many physicians assume they qualify without reviewing IMLC’s strict eligibility criteria (e.g., board certification, disciplinary history, criminal record)
• Fix: Check all eligibility requirements before starting the application process

2. Choosing the wrong state of principal license (SPL)

• Mistake: Some applicants select an SPL where they do not meet the residency or practice percentage requirements, leading to rejection
• Fix: Make sure your SPL is either your primary residence, where 25% of your practice occurs or where you are employed

3. Submitting incomplete or inaccurate documentation

• Mistake: Missing documents, incorrect forms, or incomplete information cause delays in verification
• Fix: Double-check that all licenses, board certifications, proof of employment, and background check documents are accurate and up to date

4. Assuming all IMLC states process at the same speed

• Mistake: Some physicians expect uniform processing times, but each state has its processing speed
• Fix: Research individual state processing timelines and prioritize applications accordingly

5. Not accounting for renewal and administrative costs

• Mistake: Physicians underestimate renewal fees and administrative costs for each licensed state
• Fix: Consider the long-term financial implications and evaluate whether IMLC or traditional licensing is more sustainable for your needs

IMLC implementation timeline planning guide

Proper planning ensures a smooth and timely licensing process through IMLC. Below is a step-by-step timeline to help you navigate the process efficiently.

Step 1: Pre-Application Preparation (1–2 Weeks)

• Verify IMLC eligibility (SPL status, board certification, clean disciplinary record)
• Gather necessary documentation (medical school diploma, board certification, background check)
• Research state-specific processing times to prioritize applications

Step 2: Application Submission (1 Week)

• Apply for IMLC through your State of Principal License (SPL)
• Pay the IMLC application fee ($700)
• Submit all required documents accurately to prevent rejections

Step 3: Letter of Qualification (LOQ) Approval (2–4 Weeks)

• Your SPL verifies credentials and issues an LOQ if approved
• If denied, resolve any eligibility issues before reapplying

Step 4: Multi-State Licensing Requests (2–6 Weeks Per State)

• Once LOQ is received, apply for licenses in participating states
• Pay each state’s licensing fees ($75–$805 per state)
• Track applications and respond promptly to any additional document requests

Step 5: Final Licensing Approval & Activation (Ongoing)

• Once approved, ensure all state licenses are properly registered
• Set renewal reminders—IMLC states require separate renewals per state

By following this structured timeline, physicians can avoid unnecessary delays, minimize errors, and optimize their multi-state licensing process.

Frequently Asked Questions (FAQ)

General IMLC Questions

1. What is the Interstate Medical Licensure Compact (IMLC)?‍

The IMLC is an agreement between participating U.S. states that allows qualified physicians to obtain licenses in multiple states through a streamlined, expedited process instead of applying separately to each state medical board.

2. How many states participate in IMLC as of 2025?‍

As of February 2025, 42 states, the District of Columbia, and Guam participate in the IMLC. Notable non-participants include California, Florida, and New York.

3. What is a State of Principal License (SPL)?‍

Your SPL is the state where you hold your primary medical license and either maintain primary residence or conduct at least 25% of your medical practice. It serves as your entry point into the IMLC system.

Eligibility and Requirements

1. What are the main eligibility requirements for IMLC?‍

Key requirements include: holding a full, unrestricted license in an SPL-eligible state, board certification, clean disciplinary record, no criminal history, graduation from an accredited medical school, and completion of ACGME/AOA residency.

2. Can I use IMLC if I have a history of disciplinary action?‍

No, any history of disciplinary actions against your medical license disqualifies you from IMLC. You would need to pursue traditional licensing in each state.

3. Do I need to be board certified to qualify for IMLC?‍

Yes, you must hold current or time-unlimited specialty certification from an ABMS or AOABOS board.

Process and Timeline

1. How long does the IMLC process typically take?‍

The process usually takes 4-8 weeks after application completion and acceptance, compared to 3-6 months for traditional licensing in each state.

2. Can I apply for licenses in multiple states simultaneously?‍

Yes, once you receive your Letter of Qualification (LOQ), you can apply for licenses in multiple IMLC states at the same time.

3. What happens if my LOQ application is denied?‍

If denied, you'll receive specific reasons and may be able to address issues and reapply. Alternatively, you can pursue traditional licensing in individual states.

Costs and Fees

1. What is the total cost for IMLC licensing?‍

Costs vary by state but typically include a $700 IMLC application fee plus individual state fees ranging from $300-$805 per state, plus additional costs for background checks and verifications.

2. Is IMLC more cost-effective than traditional licensing?‍

IMLC becomes more cost-effective when seeking licenses in 3 or more states, potentially saving $2,000-$5,000 and several months of processing time.

3. Do I need to pay renewal fees for each state separately?‍

Yes, each state license obtained through IMLC must be renewed separately according to that state's renewal schedule and requirements.

Practice and Compliance

1. Can I practice telemedicine in any IMLC state once licensed?‍

Yes, but you must still comply with each state's telemedicine regulations, which may have additional requirements beyond holding a license.

2. What happens if I change my primary residence or SPL?‍

You can update your SPL after receiving an LOQ, but you must maintain SPL status at all times and notify the IMLC of changes.

3. Do IMLC licenses have the same privileges as traditional state licenses?‍

Yes, IMLC licenses provide the same practice privileges and scope as traditional licenses in each respective state.

Automation and Technology

1. How does Assured automate the IMLC process?‍

Assured automates eligibility verification, document collection, application submission, status tracking, renewal reminders, and provides real-time updates across all states.

2. Can I track my application status in real-time?‍

With Assured's platform, yes. We provide a centralized dashboard showing the status of all your applications across different states with automated updates.

3. What happens if additional documentation is requested?‍

Assured's system automatically alerts you to any additional document requests and facilitates quick submission to prevent delays.

Conclusion

The Interstate Medical Licensure Compact (IMLC) offers a faster, more streamlined way for physicians to secure multiple state licenses, making it a valuable tool for those in telemedicine, multi-state practices, or locum tenens work. However, it’s not a one-size-fits-all solution. 

The costs, renewal complexities, and eligibility restrictions mean that, in some cases, traditional licensing is the better option—especially for physicians practicing in only one state or those ineligible for IMLC.

Before deciding, carefully evaluate your practice needs, long-term goals, and financial considerations. If speed and multi-state access are priorities, IMLC may be the right fit. But if simplicity matters more, traditional licensing could be the smarter move.

However, if you’re unsure which path to take, Assured can help. We make the IMLC process easier and stress-free, guiding you through every step—from checking your eligibility to handling the paperwork and ensuring everything moves smoothly. 

If IMLC isn’t the best fit for you, we’ll help you explore other licensing options so you can get the approvals you need without unnecessary delays.

Want to get started? Book a Demo with us