IMLC License: How the Compact Works for Physicians

Published 2026-09-13. Last verified 2026-10-27 by the TelehealthHiring editorial team. Sources are linked at the bottom; salary figures inside are labeled as benchmarks or observed ranges, never mixed.

Telehealth work creates a licensing problem that does not exist for a single-site clinic: your patients can be in several states in one week. The Interstate Medical Licensure Compact (IMLC) is the mechanism most U.S. physicians use to solve it, but it is widely described inaccurately — often as a "national license." It is not. It is an expedited pathway that still ends with a separate license issued by each state board you choose. The roles it unlocks are grouped on the physician telehealth jobs hub.

Here is how the process actually works, according to the Interstate Medical Licensure Compact Commission's own published guidance.

What the Compact does and does not do

The Commission describes the IMLC as a voluntary, expedited pathway to state licensure for physicians who want to practice in multiple states. Eligible physicians complete one application inside the Compact and receive separate licenses from each state they select. The Commission records that the model compact was introduced publicly in the fall of 2014, that state legislatures then began adopting it, and that it became operational in early 2017. Its site reports that more than half of U.S. states, the District of Columbia and the Territory of Guam are participating, with other states at various stages of introducing legislation.

What it does not do: license you nationally, replace state board authority, or let you skip state law. The Commission states that a physician is bound to comply with the statutes, rules and regulations of each compact state where they choose to practice medicine.

Eligibility: the license you already hold decides the rest

The starting condition is a full, unrestricted medical license in a compact member state. That state becomes your State of Principal License (SPL). Separately, at least one of these four must also be true:

• your primary residence is in the SPL;
• at least 25% of your practice of medicine occurs in the SPL;
• you are employed to practice medicine by a person, business or organization

located in the SPL;

• you use the SPL as your state of residence for U.S. federal income tax purposes.

The Commission notes that SPL status must be maintained at all times, and that the SPL can be updated after you receive a letter of qualification (explained below). Because the SPL is defined by tangible ties rather than convenience, a physician whose license, home, tax residency and employer sit in four different states should work out which state can actually serve as the SPL before paying any fees.

On top of the SPL requirement, the Commission lists these eligibility criteria:

• graduation from an accredited medical school, or a school listed in the

International Medical Education Directory;

• successful completion of ACGME- or AOA-accredited graduate medical education;
• passing each component of the USMLE, COMLEX-USA or an accepted equivalent

predecessor exam in no more than three attempts per component (the Commission states specifically that passing the Canadian LMCC does not satisfy this);

• current specialty certification, or time-unlimited certification, from an ABMS

or AOABOS board.

Then the disqualifiers, which the Commission describes as absolute for compact participation: any history of disciplinary action against your medical license, any criminal history, any history of controlled substance actions against your license, or being currently under investigation.

The Commission estimates that approximately 80% of U.S. physicians meet the criteria. Each physician is responsible for making that self-determination before applying, and for confirming they understand the compact rules.

The process, in order

1. Confirm SPL status and eligibility yourself before spending money. The

Commission is explicit that physicians should verify eligibility first, because fees are non-refundable even if the application fails.

1. Apply through the Commission's online application. The SPL board reviews and

issues a Letter of Qualification (LOQ).

1. Select the compact states where you want licenses. The Commission notifies those

states that you are eligible for licensure, and each state board issues its own license through its normal process.

A detail that matters for planning: the LOQ is valid for 365 days from issuance, and the Commission states there are no waivers of that limit. If you want a fresh LOQ after it expires, you may apply again after 365 days from the original issuance — and the Commission notes that a physician requesting a new LOQ will not be required to re-demonstrate current specialty board certification.

Fees

The Commission's FAQ states the cost to participate is $700 plus the cost of a license in each compact state where you want to practice. Adding states later costs an additional $100 request fee per state, on top of that state's licensing fee. All fees are non-refundable.

The practical implication for telehealth work: budget the compact fee plus the per-state license fees plus the additional-state request fees as one package, then compare that against the actual number of states your patient panel requires. If a role touches two states, the compact may be hard to justify on its own. If it touches ten, the arithmetic changes completely.

What the Compact does not require

Maintenance of Certification is not a compact requirement. The Commission states that the Compact does not require a physician to participate in MOC at any stage, and that board certification functions only as an eligibility factor at the initial entry point of the process.

Verification and the telehealth checklist

Compact membership is a moving target: states join, and implementation stages differ. Before you rely on a state's participation, check the current compact map and jurisdiction status on the Commission's site rather than any third-party list, including lists like this one.

For telehealth specifically, compact licensure answers the question of which state licenses you hold, not which state rules you follow. Work through these before accepting a multistate panel:

• Confirm participation status for every state where a patient may be located.
• Ask the state medical board directly: does that state impose telehealth-specific

practice standards, registration requirements or documentation rules beyond holding a license?

• Confirm the malpractice policy covers every state in which you practice. A policy

written for one state's scope and consent rules may not cover another.

• Confirm prescribing rules — including any controlled-substance telehealth limits —

with the state where the patient is located, since federal registration alone does not settle state requirements.

For scale, and labeled as a benchmark rather than any employer's pay: BLS Occupational Outlook Handbook lists a May 2025 median annual wage of $275,930 for physicians and surgeons, with 862,800 jobs and about 22,100 openings per year projected over 2025–2035. Candidly, that benchmark says nothing about what a multistate telehealth contract pays — it is the occupation-wide median, and telehealth contract terms vary by state mix, panel type and payer.

The bottom line

The IMLC is a licensure accelerator, not a license. If you hold an unrestricted license in a compact state and can tie yourself to that state through residence, practice volume, employment or tax residency, you can expect one application, a 365-day LOQ, and per-state licenses issued for a $700 compact fee plus state fees. What it will not do is make you eligible in a state that has not joined, or excuse you from the practice rules of any state where your patient sits. Confirm both before you sign a contract that assumes coverage.

Working the numbers for your state footprint? Use our IMLC cost calculator — the $700 LOQ fee, per-state fees, and a running total for any state list.

Sources

• https://www.imlcc.com/faqs
• https://www.imlcc.com/
• https://imlcc.com/participating-states
• https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm