Interstate Medical Licensure Compact Explained: How Healthcare Licensure Compacts Are Changing Hiring and Careers

Healthcare Licensure Compacts at a Glance

• The Interstate Medical Licensure Compact (IMLC) helps eligible physicians more quickly obtain licenses in participating states.
• The Nurse Licensure Compact (NLC) allows eligible nurses to practice across participating states using one multistate license.
• The PA Licensure Compact is expanding interstate mobility opportunities for physician assistants/associates (PAs).
• The APRN Compact aims to support multistate licensure for advanced practice registered nurses (APRNs), though it is not yet operational nationwide.
• Healthcare licensure compacts are helping support clinician mobility, telehealth expansion, workforce flexibility, and faster hiring across state lines.
• As provider shortages continue growing nationwide, many healthcare organizations view interstate mobility as an increasingly important workforce strategy.

Understanding the Licensure Landscape

A rural hospital is struggling to recruit specialists. Patients are waiting months for behavioral healthcare appointments. 

Meanwhile, qualified clinicians may be available just across state lines.

That disconnect has become one of the defining workforce challenges in modern healthcare.

As physician shortages grow, telehealth expands, and care delivery becomes increasingly regional rather than local, healthcare organizations are looking for faster, more flexible ways to deploy talent across state lines. Interstate licensure compacts have emerged as one of the industry’s most significant responses.

The IMLC is one of the most recognized examples, helping physicians more quickly obtain licensure in participating states. But it’s far from the only compact reshaping the healthcare workforce. Similar frameworks exist for Registered Nurses (RNs), Physician Assistants/Associates (PAs), and Advanced Practice Registered Nurses (APRNs), each with different levels of adoption and impact.

For healthcare leaders, these changes are influencing recruitment strategy, staffing flexibility, telehealth expansion, and access to care. For healthcare professionals, they may create broader career mobility and new opportunities to practice across state lines.

Here’s what to know about healthcare licensure compacts—and why they matter more than ever.

What Are Healthcare Licensure Compacts?

Healthcare licensure compacts are agreements between participating states that streamline the process for clinicians to practice in different states.

Traditionally, healthcare professionals needed to apply for and maintain separate licenses in every state where they wanted to practice. That process could be time-consuming, expensive, and administratively complex—particularly for those interested in telehealth, travel assignments, or regional health systems operating across multiple states.

Licensure compacts were designed to reduce some of those barriers while still allowing states to maintain oversight of professional standards and discipline.

The goals are straightforward:

• Improve access to care
• Support workforce mobility
• Address medical provider shortages
• Expand telehealth capabilities
• Reduce administrative delays

However, not all compacts function the same way. Some allow providers to hold a single multistate license, while others simply accelerate the process of obtaining licenses in additional states.

That distinction is especially important when comparing the Interstate Medical Licensure Compact to nursing and advanced practice compacts.

The timing of these compacts is not accidental.

Healthcare organizations are navigating multiple workforce pressures simultaneously: rising patient demand, an aging population requiring more complex care, and large numbers of medical professionals approaching retirement themselves. At the same time, many rural hospitals and underserved communities continue facing provider access challenges, often compounded by financial strain and evolving Medicare and Medicaid reimbursement pressures.

Telehealth has helped expand access in some areas, but licensing barriers have historically limited how easily clinicians can practice across state lines. Licensure compacts aim to reduce some of that friction by making multi-state practice more realistic for physicians, nurses, and Advanced Practice Providers (APPs).

They also reflect a broader shift in care delivery itself. As healthcare organizations increasingly rely on team-based models and APPs to help meet patient demand, interstate mobility is becoming more strategically important across multiple disciplines—not just for physicians.

The result is a healthcare landscape increasingly shaped by interstate practice models, flexible staffing strategies, and expanding multistate care delivery networks. Several licensure compacts are helping drive that transformation.

Interstate Medical Licensure Compact (IMLC)

The Interstate Medical Licensure Compact is an agreement that streamlines physician licensure for eligible doctors seeking to practice in multiple states.

Importantly, the IMLC does not create one universal physician license. Instead, it offers an expedited pathway for physicians to obtain licenses in participating states more efficiently than through traditional application processes.

To qualify for the IMLC pathway, physicians must meet specific eligibility requirements, including holding a full and unrestricted medical license in a participating state and meeting certain board certification, disciplinary, and practice standards.

The compact has grown significantly since its launch and now includes the majority of U.S. states, though participation is not yet nationwide.

For physicians, the IMLC can reduce delays associated with:

• Expanding telehealth services
• Accepting locum tenens assignments
• Practicing across regional health systems
• Relocating or pursuing flexible career models

For healthcare organizations, the impact can be even broader.

Faster physician licensure may help reduce time-to-fill for hard-to-staff specialties, improve responsiveness to patient demand, and support multi-state care delivery strategies. In competitive hiring markets, organizations that can onboard physicians more efficiently may gain a meaningful advantage.

The IMLC has also become increasingly relevant as telehealth continues to evolve. Many health systems and digital health organizations now operate across multiple states, making streamlined physician licensing crucial.

Still, participation gaps remain, and physicians must continue monitoring state-specific requirements, renewal processes, and eligibility criteria.

View current IMLC participating states here.

Nurse Licensure Compact (NLC)

The Nurse Licensure Compact (NLC) is one of the most established and widely adopted healthcare licensure compacts in the country.

Unlike the IMLC, the NLC allows eligible Registered Nurses (RNs) and Licensed Practical/Vocational Nurses (LPN/VNs) to hold one multistate license that grants practice privileges in participating states.

Under the NLC, nurses can practice physically, electronically, or telephonically in participating states using a single multistate license issued by their primary state of residence.

The compact has played a major role in increasing nursing mobility, particularly for:

• Travel nursing
• Regional staffing models
• Telehealth nursing roles
• Emergency response staffing
• Float pool flexibility
  

During the COVID-19 pandemic, the value of nursing mobility became especially clear as healthcare organizations rapidly deployed clinicians to areas experiencing staffing shortages.

For employers, the NLC has helped simplify recruitment across state lines and expand access to qualified nursing talent. For nurses, it’s created greater flexibility and career mobility without requiring multiple separate licenses.

Explore the current NLC map here.

The success of the NLC has also influenced conversations around broader interstate mobility for other healthcare professions.

PA Licensure Compact: An Expanding Framework

The PA Licensure Compact is one of the newest healthcare licensure compacts, designed to support greater mobility for PAs across participating states.

Momentum around the compact has accelerated in recent years as more states adopt legislation and healthcare organizations continue embracing team-based care models. The compact officially moved closer toward implementation after reaching the threshold of enacted participating states required to operationalize the agreement.

Like the Interstate Medical Licensure Compact, the PA Compact is intended to streamline multi-state practice while maintaining state-level licensure oversight.

For healthcare employers, expanded PA mobility could help support:

• Faster staffing deployment
• Rural and underserved care access
• Flexible specialty coverage
• Telehealth growth
• More scalable workforce planning

As physician shortages continue, many healthcare organizations are increasingly relying on PAs and other APPs to help expand primary care access and support collaborative care models.

For PAs themselves, the compact may create greater flexibility to pursue opportunities across multiple states without navigating entirely separate licensure pathways each time.

View current PA Compact legislation and participating states here.

APRN Compact: Why Adoption Has Been Slower

APRNs—including Nurse Practitioners, Certified Registered Nurse Anesthetists (CRNAs), Clinical Nurse Specialists, and Nurse Midwives—continue to play an increasingly important role in healthcare delivery. But unlike registered nurses and physicians, APRNs still face significant barriers to interstate mobility.

The APRN Compact was adopted by the National Council of State Boards of Nursing (NCSBN) in 2020 as a framework for multistate APRN licensure. However, the compact is not yet operational nationwide.

Before implementation can begin, at least seven states must enact APRN Compact legislation. While several states have introduced bills and a small number have enacted the compact, the threshold has not yet been reached.

One ongoing challenge is that APRN scope-of-practice laws vary significantly from state to state, creating additional regulatory complexity compared to other healthcare compacts. In some states, APRNs practice independently, while others still require varying levels of physician collaboration or supervision.

Those differences have made broad compact alignment more difficult.

Even so, momentum continues building.

As healthcare organizations increasingly rely on NPs to address physician shortages and expand patient access, interstate APRN mobility will likely remain a major workforce conversation in the coming years.

Learn more about the APRN Compact and legislative progress here.

Comparing Today’s Major Healthcare Licensure Compacts

Are Licensure Compacts the Future of Healthcare Hiring?

Healthcare licensure compacts alone can’t solve every workforce challenge facing the industry. Provider shortages, burnout, rural access disparities, reimbursement pressures, and growing patient demand will continue shaping healthcare hiring for years to come.

But compacts represent an important shift toward a more flexible and connected healthcare workforce.

By making it easier for physicians, nurses, PAs, and APPs to practice across state lines, these agreements enable healthcare organizations to respond more quickly to staffing shortages, expand telehealth capabilities, and improve access to care in underserved communities.

Additional interstate licensure compacts exist across behavioral and allied healthcare. Compacts like PSYPACT, ASLP-IC, the PT Compact, and even the developing Dietitian Licensure Compact reflect a broader industry push toward improving workforce mobility and expanding patient access across settings and specialties.

At the same time, healthcare organizations are increasingly relying on multiple strategies to close workforce gaps—including technology, flexible care models, and strategic staffing partnerships.

At Medix, we work closely with healthcare organizations and talent navigating these workforce changes every day. Whether supporting nursing recruitment or physician and APP staffing, our goal is helping connect healthcare professionals with the environments where they can make the greatest impact.