Interstate Medical Licensure Compact: 2026 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.