These compacts allow physicians to apply for and secure licenses from each state they wish to practice in, using a single application process. This not only conserves time and resources but also circumvents the tediousness associated with conventional licensing procedures. Moreover, the compacts bolster public protection by improving states’ capacity to exchange investigative and disciplinary information.
As of now, six compacts cater to various health professions: the Interstate Medical Licensure Compact (IMLC), the Nurses Licensure Compact (NLC), the Physical Therapy Compact (PTC), the Psychology Interjurisdictional Compact (PSYPACT), the Audiology and Speech-Language Pathology Interstate Compact (ASLP-IC), and the Emergency Medical Services Personnel Licensure Interstate Compact (REPLICA). By July 2023, the IMLC, being the most dynamic and extensive compact, had enlisted 39 states, the District of Columbia, and the Territory of Guam. Other states are currently instituting legislation to adopt the IMLC or other compacts.
This article aims to shed light on how medical licensing compacts operate, the eligibility criteria, the benefits physicians stand to gain, and the process of license application through a compact.
Demystifying Medical Licensing Compacts
Medical licensing compacts are agreements that bind participating U.S. states and territories to collaboratively streamline the licensing process for physicians aiming to practice in multiple states. The compacts offer a voluntary, accelerated licensure route for qualifying physicians, fostering interstate telehealth practice by setting a uniform care standard. They do not alter a state’s existing Medical Practice Act or its jurisdiction over medical practice in any way but simply offer an additional, more efficient avenue for physicians seeking licenses in multiple states.
The underlying aim of medical licensing compacts in improving healthcare delivery across state lines is to enhance access to healthcare, particularly for underserved or rural patient populations. These compacts pave the way for broadening the scope of physicians, enhancing accessibility to medical specialists, and capitalizing on advanced medical technologies such as telemedicine. Furthermore, they amplify public protection by augmenting states’ ability to exchange investigative and disciplinary information.
The federal government can play a vital role in state licensure by persuading state legislatures to adopt reciprocal licensure compacts and ensuring they function as intended. Amid the COVID-19 pandemic, federal and state policymakers provisionally waived specific licensure prerequisites to facilitate more clinicians in delivering telehealth services across state boundaries.
However, the expiration of state-level public health emergency declarations may lead to some clinicians losing the interstate licensure flexibility available during the pandemic waiver period. Consequently, permanent legislation permitting physicians not licensed in the state to register and provide telehealth services to in-state patients is crucial for maintaining and expanding patient access to care.
Presenting Medical Licensing Compacts: A Detailed Guide for Healthcare Providers
Today, six medical licensing compacts cater to diverse health professions, each with unique eligibility prerequisites, benefits, and application procedures for aspiring participants. This section provides an overview of each compact and its current status.
The Interstate Medical Licensure Compact (IMLC)
This compact brings together participating U.S. states and territories with the mission to substantially simplify the licensing process for physicians keen on practicing across multiple states. It provides a voluntary, expedited route to licensure for qualifying physicians. The primary objective of this compact is to enhance healthcare access, particularly for patients in underserved or rural regions. It achieves this by broadening the reach of physicians, improving access to medical specialists, and leveraging advanced medical technologies such as telemedicine. Additionally, it bolsters public safety by improving states’ capacity to exchange investigative and disciplinary data.
Read more about the IMLC
States participating in the Interstate Medical Licensure Compact:
- Alabama
- Arizona
- Colorado
- Connecticut
- Delaware
- District of Columbia
- Georgia
- Guam
- Hawaii
- Idaho
- Illinois
- Indiana
- Iowa
- Kansas
- Kentucky
- Louisiana
- Maine
- Maryland
- Michigan
- Minnesota
- Mississippi
- Missouri
- Montana
- Nebraska
- Nevada
- New Hampshire
- New Jersey
- North Dakota
- Ohio
- Oklahoma
- Pennsylvania
- Rhode Island
- South Dakota
- Tennessee
- Texas
- Utah
- Vermont
- Washington
- West Virginia
- Wisconsin
- Wyoming
The Nurse Licensure Compact (NLC)
This compact facilitates the mutual recognition (reciprocity) of a nursing license between member U.S. states (“compact states”). It allows nurses to possess a multistate license, permitting them to practice in other member states, subject to each state’s practice laws. The compact aims to enhance access to nursing services, strengthen public safety, and promote state cooperation.
Read more about the eNLC
States participating in the Nurse Licensure Compact:
- Alabama
- Arizona
- Arkansas
- Colorado
- Delaware
- Florida
- Georgia
- Guam
- Idaho
- Indiana
- Iowa
- Kansas
- Kentucky
- Louisiana (Registered Nurse and Practical Nurse)
- Maine
- Maryland
- Mississippi
- Missouri
- Montana
- Nebraska
- New Hampshire
- New Jersey
- New Mexico
- North Carolina
- North Dakota
- Ohio
- Oklahoma
- Pennsylvania (Law passed and awaiting implementation)
- South Carolina
- South Dakota
- Tennessee
- Texas
- Utah
- Vermont
- Virginia
- Virgin Islands (Law passed and awaiting implementation)
- Washington
- West Virginia (Registered Nurse and Practical Nurse)
- Wisconsin
- Wyoming
The Physical Therapy Compact (PTC)
This agreement among member states aims to improve public access to physical therapy services by enhancing the mobility of eligible physical therapy providers to practice across multiple states. The compact offers a voluntary, expedited pathway to licensure for physical therapists and physical therapist assistants who qualify. Like its counterparts, this compact supports interstate telehealth practice by establishing a uniform care standard. The compact does not alter a state’s existing Physical Therapy Practice Act or its jurisdiction over physical therapy practice but merely provides an additional, faster licensing option for providers.
States participating in the Physical Therapy Compact:
- Arizona
- Arkansas
- Colorado
- Delaware
- Georgia
- Iowa
- Kentucky
- Louisiana
- Maryland
- Mississippi
- Missouri
- Montana
- Nebraska
- New Hampshire
- North Carolina
- North Dakota
- Ohio
- Oklahoma
- Oregon
- South Dakota
- Tennessee
- Texas
- Utah
- Virginia
- Washington
- West Virginia
- Wisconsin
The Psychology Interjurisdictional Compact (PSYPACT)
This agreement between member states facilitates both telehealth and temporary in-person psychology practice across state boundaries. It allows psychologists, licensed in one PSYPACT state, to offer psychological services in another PSYPACT state without the need for an additional license.
The compact’s goal is to enhance public access to psychological services, especially for underserved populations and regions. It also ensures the continuity of care when a patient relocates or travels, and fosters cooperation among states in regulating and enforcing psychology practice laws.
States participating in the Psychology Interjurisdictional Compact (PSYPACT):
- Alabama
- Arizona
- Arkansas
- Colorado
- Commonwealth of the Northern Mariana Islands
- Connecticut
- Delaware
- District of Columbia
- Florida
- Georgia
- Idaho
- Illinois
- Indiana
- Kansas
- Kentucky
- Maine
- Maryland
- Michigan
- Minnesota
- Missouri
- Nebraska
- Nevada
- New Hampshire
- New Jersey
- North Carolina
- Ohio
- Oklahoma
- Pennsylvania
- Rhode Island
- South Carolina
- Tennessee
- Texas
- Utah
- Virginia
- Washington
- West Virginia
- Wisconsin
- Wyoming
The Audiology and Speech-Language Pathology Interstate Compact (ASLP-IC)
This compact allows audiologists and speech-language pathologists licensed in one ASLP-IC state to provide services in another ASLP-IC state without obtaining an additional license. The goal of the compact is to improve public access to audiology and speech-language pathology services, especially for rural and underserved areas. It also enhances cooperation among states in regulating and enforcing audiology and speech-language pathology practice laws.
States participating in the Audiology and Speech-Language Pathology Interstate Compact (ASLP-IC):
- Alabama
- Arkansas
- Colorado
- Delaware
- Georgia
- Idaho
- Indiana
- Iowa
- Kansas
- Kentucky
- Louisiana
- Maryland
- Mississippi
- Missouri
- Nebraska
- New Hampshire
- North Carolina
- Ohio
- Oklahoma
- South Carolina
- Tennessee
- Utah
- Virginia
- West Virginia
- Wyoming
The Emergency Medical Services Personnel Licensure Interstate Compact (REPLICA)
This agreement recognizes the EMS personnel licenses of other member states, allowing EMS personnel licensed in one REPLICA state to provide emergency medical services in another REPLICA state without obtaining an additional license.
The compact aims to enhance public access to emergency medical services, especially during disasters and emergencies. It also promotes public safety and accountability by facilitating the exchange of licensure, investigative, and disciplinary information among states.
States participating in the Emergency Medical Service Personnel Licensure Interstate Compact (REPLICA):
- Colorado
- Texas
- Virginia
- Idaho
- Utah
- Kansas
- Tennessee
- Wyoming
- Georgia
- Alabama
- Delaware
- Iowa
- Mississippi
- Missouri
- Nebraska
- South Dakota
- North Dakota
- South Carolina
- West Virginia
- Indiana
Advantages of Medical Licensing Compacts for Healthcare Providers
Medical licensing compacts present a host of benefits for healthcare providers intending to practice across various states.
Practicing across multiple states: Medical licensing compacts provide physicians with the capacity to apply for and secure separate licenses for each state they wish to practice in, using a single application within the compact. This leads to time, cost, and effort savings, as opposed to the traditional licensing process that necessitates separate license applications for each state.
For instance, the Interstate Medical Licensure Compact Commission (IMLCC) reports an average 30-day licensing time via the IMLC, contrasted with 121 days for a traditional license. The average IMLC license costs $1,560, as compared to a traditional license at $3,000. The IMLC also streamlines the renewal process, permitting physicians to renew all their licenses through one online portal.
Facilitating telehealth and virtual care: Medical licensing compacts empower physicians to deliver telehealth and virtual care services to patients across state lines, subject to each state’s practice laws. This enhances healthcare access, especially for underserved or rural areas patients who may struggle to locate or reach a local provider.
Telehealth and virtual care can also bolster patient outcomes by minimizing wait times, improving adherence, and boosting patient satisfaction.
Aiding in emergency and disaster response: Medical licensing compacts allow physicians to promptly and effectively respond to emergencies and disasters occurring in other states, without needing an additional license for that state. This can save lives and alleviate suffering by delivering timely and sufficient medical care to victims of natural disasters, pandemics, terrorist attacks, or mass shootings.
For instance, during the COVID-19 pandemic, many states temporarily waived certain licensure requirements to allow more clinicians to provide telehealth services across state lines. However, once state-level public health emergency declarations expire, some clinicians will no longer benefit from the interstate licensure flexibilities available during the pandemic waiver period.
Thus, there’s a need for permanent legislation that enables non-state-licensed physicians to register and provide telehealth services to in-state patients, ensuring continued and expanded patient care access.
Enhancing job mobility and opportunities: Medical licensing compacts offer physicians the chance to pursue more career opportunities and explore varied practice settings across multiple states. This can assist physicians in finding the best fit for their skills, interests, and goals. It can also diversify their income sources, increase their earning potential, and prevent burnout by introducing more variety and flexibility in their work. Moreover, medical licensing compacts can help physicians meet the demand for certain specialties or services in diverse regions or markets.
Understanding the Application and Membership Process
If you’re interested in joining a medical licensing compact, it’s essential to comprehend the eligibility requirements, the application process, and the cost and maintenance of licensure through a compact. Here, we explain these aspects in detail.
Eligibility requirements for healthcare providers: Each medical licensing compact presents unique eligibility criteria for healthcare providers keen on participating. However, several common prerequisites across most compacts include:
- Full, unrestricted medical license in a compact-member state that can serve as your State of Principal License (SPL).
This is the state where you primarily reside, where at least 25% of your medical practice takes place, where your employer is located, or where you declare it as your residence for U.S. federal income tax purposes.
- Diploma from an accredited medical school or a school listed in the International Medical Education Directory or its equivalent.
- Successful completion of ACGME- or AOA-accredited graduate medical education (GME).
- USMLE, COMLEX-USA, or an equivalent predecessor exam accepted by the state medical board in no more than three attempts for each part.
- Current specialty certification or time-unlimited certification by an ABMS or AOABOS board.
- No history of disciplinary actions, criminal history, controlled substance actions, or investigations related to your medical license.
You can check your eligibility for each compact by visiting their respective websites or contacting their representatives.
To maintain your licenses through a compact, you need to:
- Renew your SPL and other state licenses based on their expiration dates and renewal prerequisites.
- Renew your compact participation by paying the renewal fee to the compact every two years.
- Maintain your compact eligibility by complying with its rules and requirements.
- Report any changes in your personal or professional data, like your name, address, contact details, education, training, certification, licensure, or practice history to the compact and the states where you hold licenses.
- Report any adverse actions, criminal history, controlled substance actions, or investigations regarding your medical license to the compact and the states where you hold licenses.
Pitfalls and Doubts Surrounding Medical Licensing Compacts
Though medical licensing compacts deliver many benefits, they also face their fair share of objections and challenges. Some of the key concerns are:
Potential Compromise on Quality and Patient Safety
Detractors of medical licensing compacts argue that these agreements could risk the safety and quality of healthcare. They fear that enabling physicians to practice in various states without necessarily complying with local regulations or standards could undermine the local health system. The concern is that these compacts might set off a “race to the bottom,” diminishing the licensure standards and weakening the oversight and accountability mechanisms of the state. Critics also voice concerns about how such compacts could disrupt the authority and autonomy of state medical boards to shield the public from unethical or incompetent physicians.
Diverse State Participation and Legislation
Another hurdle for medical licensing compacts is the uneven adoption and legislative enactments across states. Since not every state has opted to join or pass legislation to adopt these compacts, their influence and reach are inevitably limited. In some states, bills aiming to join these compacts have faced resistance or delays from various stakeholders, including medical associations, consumer groups, and legislators. Some states have also added amendments to the compact legislation, potentially creating inconsistencies or conflicts with the rules or requirements of the compacts.
Administrative Challenges and Misunderstandings
Medical licensing compacts also grapple with administrative obstacles and misunderstandings that can impede their implementation and adoption. Administrative issues often involve creating the infrastructure and processes necessary to facilitate the operations of the compacts, such as the development of commissions, databases, websites, fee structures, and verification systems. Misunderstandings often revolve around misrepresentation or misunderstanding the purpose, benefits, or implications of the compacts. For example, some confuse them with national licensure, federal preemption, or loss of state sovereignty.
Despite these concerns and critiques, medical licensing compacts have received a fair share of support from various stakeholders, including physicians, patients, policymakers, health organizations, and telehealth providers. Supporters argue that these compacts provide an effective solution to the emerging needs of cross-state healthcare delivery, enhancing access to healthcare, facilitating telehealth, aiding in emergency and disaster responses, and boosting job mobility and opportunities.
Future Trajectories of Medical Licensing Compacts
Currently, six medical licensing compacts exist. However, several other medical professions could reap benefits from creating their compacts or joining existing ones. Professions like dentists, pharmacists, optometrists, podiatrists, chiropractors, occupational therapists, social workers, and counselors face similar challenges as the existing compact professions regarding interstate practice, telehealth, and mobility.
On the legislative front, the federal government can encourage state legislatures to adopt reciprocal licensure compacts and ensure their effective functioning. During the COVID-19 pandemic, policymakers waived certain licensure requirements temporarily, enabling more clinicians to deliver telehealth services across state lines. As these temporary measures expire, a need arises for permanent legislation that allows out-of-state physicians to register and provide telehealth services.
MedicalLicensing.com: Streamlining the Medical License Application Process
Medical licensing compacts allow for a streamlined application process for obtaining licenses across multiple states. Yet, even this streamlined process can seem daunting, requiring the applicant to meet eligibility criteria, complete various forms, and stay updated with state boards. This is where we come in. We take the burden of the complex application process off healthcare professionals, enabling you to focus on your practice.
We are familiar with the various state requirements, procedures, and deadlines, thereby avoiding common errors or delays. Additionally, our team of experts can help find the best deals on fees and other expenses, reducing the overhead costs associated with applying for multiple licenses. Forget about all the paperwork, communication, and follow-up, we eliminate the stress involved in the process.
Utilizing a medical licensing service can greatly simplify the licensing process, making your medical practice more successful and your life much easier.
Frequently Asked Questions About Medical Licensing Compacts
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What exactly are Medical Licensing Compacts?
Medical Licensing Compacts are collective agreements between participating U.S. states and territories designed to streamline the process for physicians seeking to practice in multiple states. These compacts provide an expedited licensure pathway for eligible physicians and play a pivotal role in standardizing care by supporting interstate telehealth practices. -
How do Medical Licensing Compacts operate?
Medical Licensing Compacts simplify the licensing process for physicians wishing to practice in multiple states. If a physician holds a full, unrestricted license in one of the compact-member states, they can apply for and receive separate licenses from each state they intend to practice in, via a single compact application. It’s important to note that these compacts don’t alter a state’s existing Medical Practice Act or the state’s authority over the practice of medicine; they simply provide a quicker alternative for obtaining multiple licenses. -
Who qualifies to participate in Medical Licensing Compacts?
Eligibility to participate in Medical Licensing Compacts depends on each compact’s specific criteria. Generally, physicians must hold a full, unrestricted medical license in a compact-member state, and this state must be available to serve as the State of Principal License (SPL). Other common requirements include graduation from an accredited medical school, completion of accredited graduate medical education (GME), successful completion of USMLE, COMLEX-USA, or an equivalent exam, current specialty certification or time-unlimited certification by an ABMS or AOABOS board, and no disciplinary actions, criminal history, or controlled substance actions against their medical license. -
What are the costs associated with participating in Medical Licensing Compacts?
The costs involved in obtaining and maintaining a license through a Medical Licensing Compact vary, based on factors such as the application fee charged by the compact, the state fees for each license, and the costs of fingerprinting and background checks. Fees also apply for renewing licenses held through a compact. All fees are non-refundable, and participants are responsible for all associated costs. -
What benefits do Medical Licensing Compacts offer healthcare providers and patients?
Medical Licensing Compacts offer numerous advantages to healthcare providers and patients alike. For healthcare providers, compacts simplify the process of practicing in multiple states and provide a platform for delivering telehealth and virtual care services across state lines. In addition, they enable swift response during emergencies or disasters in other states, and they present a broader spectrum of career opportunities and practice settings. For patients, particularly those in underserved or rural areas, these compacts increase access to healthcare services.
