Multi-State Licensing Made Simple: Using the IMLC for Telehealth and Locums Work

Why Multi-State Licensure Matters More Than Ever

Telehealth and locum tenens work have permanently changed how clinicians build careers. A physician in one state can now see patients in a dozen others, and a locums assignment might mean working in a new state every few months. The catch: medicine is still licensed at the state level. There is no federal medical license, and practicing across state lines almost always requires holding an active license in the state where the patient is physically located at the time of the visit.

That reality makes multi-state licensure strategy a core career skill for anyone doing telehealth, locums, or both. Fortunately, licensure compacts have made the process meaningfully faster than it used to be — if you understand how to use them.

The Interstate Medical Licensure Compact (IMLC): The Big One for Physicians

The IMLC is the primary tool MD/DO physicians should know about. It does not create a single "multi-state license." Instead, it creates an expedited pathway for an already-licensed physician to obtain full, separate licenses in other participating states.

How it works

1. Establish a State of Principal Licensure (SPL). This is typically a state where you live, work, or hold your primary license, and it must be an IMLC member state.
2. Apply through the Compact. You submit one application and one set of verified credentials to the IMLC Commission rather than re-submitting the same documents to every state medical board.
3. Receive a Letter of Qualification. Once the Commission verifies your eligibility, this letter allows you to apply for licensure in any other member state you choose.
4. Pay state-specific fees and receive individual licenses. You still end up with a distinct license number and renewal cycle in each state — the Compact just removes the duplicated credentialing work.

Who qualifies

General eligibility criteria include:

• An unrestricted medical license in a compact member state
• Board certification (or eligibility, depending on the state)
• Completion of an accredited residency program
• No history of disciplinary action, malpractice issues, or controlled substance violations
• Passage of licensing exams within a defined attempt limit

Most participating states have joined the Compact, and the list continues to grow, so it's worth checking current membership before you plan a licensing strategy around a specific state.

Why it's a great avenue for telehealth and locums

• Speed: Turnaround for additional state licenses is often significantly faster than applying cold to each board.
• Efficiency: Credential verification happens once, not repeatedly.
• Scalability: It's designed for physicians who need licenses in several states at once — exactly the profile of a telehealth or locums physician.
• Predictability: Because the process is standardized, you can plan expansion into new states around case volume or contract needs rather than being at the mercy of each board's individual backlog.

Limitations to keep in mind

• The IMLC is physician-only (MD/DO); it does not cover NPs, PAs, or CRNAs.
• You still pay separate licensing fees per state and must track separate renewal dates, CME requirements, and state-specific rules (e.g., controlled substance registration, telehealth informed consent laws).
• Some states have licensing requirements outside the Compact process (like state-specific jurisprudence exams) that still apply.
• Disciplinary actions in any state can affect your standing across all your licenses, so compliance matters more, not less, once you're multi-licensed.

Options for Advanced Practice Providers

APPs have their own — less unified — landscape:

• Nurse Licensure Compact (NLC): Covers RN and LPN/VN scope of practice and allows a multistate license for direct patient care, but it does not automatically extend to advanced practice authority.
• APRN Compact: A newer compact aimed at nurse practitioners and other APRNs is in various stages of state adoption. Coverage is expanding, but it is not yet universal, so confirm current status before relying on it for a telehealth build-out.
• PA Licensure Compact: Physician assistants have a growing but still limited compact footprint. Many PAs still need to apply for licensure state-by-state.
• CRNAs: Typically licensed through state boards of nursing and may benefit from NLC depending on scope, but anesthesia-specific privileges are usually facility-credentialed separately.

Because compact coverage for APPs changes frequently, always verify current state participation directly with the relevant compact commission before building a multi-state practice plan around it.

Building a Practical Multi-State Strategy

1. Pick your SPL strategically. Choose a state where you already have strong ties and where renewal requirements are manageable, since it anchors your entire compact eligibility.
2. Sequence your applications around contracts, not curiosity. Apply for new state licenses when you have a confirmed telehealth panel or locums assignment lined up — licenses have renewal costs even when unused.
3. Track everything in one system. A spreadsheet or credentialing service should log license numbers, expiration dates, CME cycles, and controlled substance registrations per state.
4. Confirm malpractice coverage extends state-by-state. Your policy needs to explicitly cover the states where you're treating patients, including telehealth encounters.
5. Understand telehealth-specific rules per state. Some states require an in-person visit before telehealth prescribing, restrict certain visit types, or have unique informed consent language — licensure is necessary but not sufficient for compliant telehealth practice.
6. Budget for credentialing lag, even with the Compact. Facility credentialing and payer enrollment can take longer than the license itself, so start those processes early.

The Bottom Line

The IMLC doesn't eliminate state-by-state licensing, but it removes the most painful part — redundant paperwork and slow verification — for physicians who want to practice across multiple states. For APPs, compact coverage is improving but still uneven, making it essential to check current state participation before committing to a multi-state telehealth or locums plan. Either way, treating multi-state licensure as an ongoing career infrastructure project, rather than a one-time hurdle, is what lets clinicians actually capture the flexibility that telehealth and locums work promise.