- OnCall Solutions Editorial Team
- Published:
- Updated: August 2026
If you’re a physician or advanced practice clinician lining up locum tenens work, the licensing question comes down to one thing: which path gets you credentialed before the assignment starts.
The Interstate Medical Licensure Compact now covers 44 member states plus two U.S. territories, and it can put a license in your hand in weeks instead of months. But it isn’t the right answer for everyone, and the states it doesn’t cover are exactly the ones clinicians ask about most.
Here’s how the two paths compare on speed, cost, and eligibility, plus the details that trip people up.
The short answer
The Compact is faster when you need licenses in more than one state. It covers 44 member states plus two U.S. territories, and physicians see an average processing time of roughly 19 days once a Letter of Qualification is issued. Traditional state licensing still makes sense if you only need one license, or if your target state is California, New York, Oregon, South Carolina, or Virginia. None of those are compact members.
How the Interstate Medical Licensure Compact actually works
The Compact isn’t a national license. It’s a shared verification process that lets one state board vouch for you so the others don’t have to start from scratch.
Since 2017, the Commission reports 227,966 licenses issued through the Compact, a figure current as of August 6, 2026. That’s licenses, not physicians, since most participants pick up several.
Here’s the sequence. You designate a State of Principal License, or SPL, based on one of four qualifying bases: your primary residence, your primary practice location, your employer’s location, or the state you use for federal tax filing. Your SPL board reviews your credentials once and issues a Letter of Qualification.
That LOQ is the key that opens the rest of the door. With it in hand, you request licenses in other compact states through a single portal instead of filing a fresh application with every board.
One thing the marketing around the Compact tends to skip: getting the LOQ is the slow part. Depending on your SPL board, it takes anywhere from a couple of weeks to several months. The fast part is everything after.
Not every member state can be your SPL
This is the detail that derails plans. A state can issue licenses through the Compact without being eligible to serve as your State of Principal License. Hawaii and Vermont fall into that category: you can get licensed there through the Compact, but you can’t use either as your home base for it.
Pennsylvania used to be a common point of confusion here. That’s resolved. The Pennsylvania Department of State confirms the Commonwealth fully implemented the Compact on July 7, 2025, and physicians can now designate Pennsylvania as their SPL.
Check your own state’s status before you build a timeline around it.
How traditional state licensing works
Every state medical board runs its own review, and each one wants its own copy of everything: medical education records, exam scores, professional references, an FSMB report, fingerprints, and a background check.
There’s no shortcut and no shared file. Apply in three states the traditional way and you assemble the same packet three times, on three different clocks.
Timelines vary enough that a single national average isn’t meaningful. The FSMB’s state by state requirements are the honest reference point here. Two to six months is a reasonable planning range for most boards, and a few run longer during renewal season.
IMLC vs traditional licensing at a glance
| Feature | IMLC | Traditional State Licensing |
|---|---|---|
| Jurisdictions covered | 44 member states plus two U.S. territories | One state per application |
| Who qualifies | Physicians (MD and DO) only | Physicians and APCs through their own board processes |
| Time to Letter of Qualification | Two weeks to several months, depending on your SPL board | Not applicable |
| Time to license after LOQ | About 19 days on average | Varies by board, commonly two to six months |
| Upfront cost | $700 Compact fee plus each state’s license fee | Each state’s application fee |
| Per state license fee range | $35 (Pennsylvania M.D.) to $895 (Texas) | Set independently by each board |
| Renewal | Tracked through the Compact portal | Tracked separately with every board |
| Best for | Multi-state assignments, telehealth panels, building optionality | One license, especially in a non-compact state |
Note: CME requirements and renewal fees still apply for each state.
Which states aren’t in the Compact
If your target state is on this list, the Compact can’t help you there and you file directly with the board.
Not members: California, New York, Oregon, South Carolina, and Virginia, plus Puerto Rico and the U.S. Virgin Islands.
Passed but not yet operational: Alaska, Arkansas, New Mexico, and Rhode Island have enacted legislation to join the Interstate Medical Licensure Compact, but their implementation is still delayed or underway. Massachusetts has introduced Compact legislation but has not yet joined. Check the IMLC’s official participating-state map for the current status before advising a physician on licensing.
One important correction: Florida is an active IMLC member state. Eligible physicians can apply for a Florida licence through the Compact’s expedited process, as confirmed by the IMLC’s Florida application guidance. Florida should not be grouped with non-member states such as California and New York, as some older articles, including several of ours, still do.
When traditional licensing is the better call
The Compact isn’t automatically the answer. Three situations where filing directly wins:
You only need one license. You pay the $700 Compact fee on top of the state license fee either way. For a single state, the traditional route is usually cheaper.
Your target state isn’t a member. No Compact path exists. File with the board.
You can’t use your home state as an SPL. If your state isn’t a member or can’t serve as an SPL, the Compact route gets complicated fast, and a direct application may be quicker.
The hybrid approach most multi state clinicians end up using
These paths aren’t exclusive, and in practice a lot of clinicians run both at once.
Take a Wisconsin based hospitalist who holds an LOQ through Wisconsin. She uses the Compact to pick up Minnesota, Iowa, and Illinois for weekend and week long coverage, and files a traditional application in Indiana for a longer, better paying assignment.
One process handles breadth. The other handles the specific opportunity worth waiting for. Running them in parallel means the wait on one doesn’t idle the other.
What the Compact doesn’t do
It shortens the license, not the privileging.
Your hospital’s credentialing committee still runs on its own clock, and that process is separate from state licensure. We see this gap catch clinicians constantly: the license arrives in two weeks, the start date is still eight weeks out, and nobody explained why. If you want the employer side of that problem, we’ve written about why physician credentialing delays slow hospital operations and what shortens them.
For a fuller walkthrough of the Compact itself, including eligibility requirements, see our guide to IMLC licenses.
What to do before your next assignment
Map your states 6 to 12 months out.
Licensing rewards planning and punishes urgency. If you know a market you want to work, start before the assignment exists.
Watch your LOQ window.
Your Letter of Qualification is valid for 365 days from its issue date to request expedited licences through the Compact. Apply early enough to support your anticipated assignment timeline, but not so early that the LOQ expires before you need to add a state. The Commission does not waive this deadline.
Track renewal cycles per state.
Compact licenses renew through the portal, but each state sets its own cycle. Miss one and you lose coverage in that state regardless of the rest.
Confirm your malpractice coverage travels.
A license in five states doesn’t mean coverage in five states, and the gap tends to show up after an assignment ends rather than during it. This is where tail coverage matters for locums and moonlighters.
Frequently asked questions
Q: Which states aren’t in the Interstate Medical Licensure Compact?
A: California, New York, Oregon, South Carolina, and Virginia, plus Puerto Rico and the U.S. Virgin Islands. Alaska, Arkansas, New Mexico, and Rhode Island have passed the Compact but are still implementing it.
Q: Can I use any compact state as my State of Principal License?
A: No. Hawaii and Vermont issue licenses through the Compact but can’t serve as an SPL. Pennsylvania can, as of July 7, 2025.
Q: Does an IMLC license speed up hospital credentialing?
A: No. Licensure and privileging are separate processes with separate reviewers. The Compact gets you licensed faster. Your hospital’s credentialing committee sets its own pace.
Q: Is the Compact cheaper than applying to each state directly?
A: Not always. The $700 Compact fee sits on top of each state’s license fee, so a single license is usually cheaper the traditional way. The Compact wins on speed, and on volume.
Q: Do nurse practitioners and physician assistants have a compact of their own?
A: Not an operational one yet. The PA Licensure Compact is enacted in 29 states but the commission isn’t issuing compact privileges. The APRN Compact activates only once seven states enact it. For now, APCs license state by state.
Q: What happens if I move?
A: Designate a new SPL that reflects your updated residence, practice location, employer, or tax filing state.
Get the licensing piece off your plate
Applying for a new license shouldn’t decide which assignments you can take.
Our team files LOQ applications, tracks each state board, and confirms your privileging paperwork is complete before your first shift, so the paperwork moves while you’re still working. If you’re weighing an agency to handle this, here’s what to look for.
Ready to sort out your SPL and target states? Connect with an OnCall licensing coordinator today, or browse current openings for physicians and clinicians.
Sources
- Interstate Medical Licensure Compact Commission
- IMLCC participating-state map
- IMLCC FAQs, including LOQ validity
- IMLCC fee schedule
- IMLCC Florida expedited-licence application guidance
- Massachusetts Legislature, bill H.2393
- Pennsylvania Department of State, Interstate Medical Licensure Compact
- FSMB, State Specific Requirements for Initial Medical Licensure
- AAPA, PA Licensure Compact
- AACN, Compact Licensure for APRNs