Interstate Medical Licensure Compact (IMLC/IMLCC) for Locum Tenens Doctors: The Complete Guide
/Interstate Medical Licensure Compact (IMLC/IMLCC) for Locum Tenens Doctors: The Complete Guide
Locum tenens rewards flexibility and speed. The faster you can obtain (and maintain) multiple state licenses, the faster you can say “yes” to high-quality assignments—and the more negotiating power you have with rates, schedules, and locations.
The Interstate Medical Licensure Compact (IMLC)—administered by the Interstate Medical Licensure Compact Commission (IMLCC)—is designed to expedite the path to getting licensed in multiple states. It does not create a single “multi-state” license. Instead, it provides an accelerated process where you submit one core application through the Compact, receive a Letter of Qualification (LOQ) from your State of Principal License (SPL), and then obtain separate, full licenses from the Compact states you choose.
This guide explains how the IMLC works, who qualifies, timelines and costs, how to use it strategically for locums, and the most common pitfalls that slow physicians down. A large FAQ section follows.
1) What the IMLC is (and what it is not)
What it is
The IMLC is an expedited licensure pathway for MDs and DOs to obtain medical licenses in multiple participating states/territories.
The key idea:
You establish eligibility through an SPL and receive an LOQ.
You then select additional Compact states and apply for expedited licenses there through the Compact portal.
Each state issues its own license, and you must follow that state’s rules.
What it is not
The IMLC is not:
A single “compact license” that automatically lets you practice everywhere
A workaround for the rule that the practice of medicine occurs where the patient is located
A replacement for state authority—each state board still issues the license and retains jurisdiction
For locums, that last point matters: if you’re doing telehealth locums or covering multiple states remotely, you still need the license in the patient’s state at the time of care.
2) Why the IMLC is a big deal for locum tenens
The classic locums licensing pain points are:
repeated applications and primary-source verification
slow board processing
waiting on background checks/fingerprints
missing a start date because licensing drags
The IMLC doesn’t eliminate state licensing, but it can dramatically reduce the friction of expanding from one state to many.
Where it helps most
IMLC is especially valuable if you:
plan to do locums across multiple states over the next few years
want the option to accept assignments on shorter notice
do telehealth or multi-state call coverage where licensing footprint = opportunity
Where it won’t help
IMLC won’t solve:
facility credentialing and privileging timelines
payer enrollment timelines (if relevant)
a state that isn’t participating (or isn’t fully “go-live” yet)
3) The high-level IMLC process (how it actually works)
Think of the IMLC as two phases:
Phase 1: LOQ (Letter of Qualification) through your SPL
You designate a State of Principal License (SPL). That board evaluates your eligibility and issues a Letter of Qualification (LOQ) that gets transmitted to the Commission.
The Commission’s handout notes that the LOQ is valid for 365 days.
Phase-1 timing varies by board. The Commission handout describes an average of 30–45 days (controlled by the member board, not the Commission).
Phase 2: Select states and obtain expedited licenses
Once you have the LOQ, you use the Compact process to request licenses from other member states. The Commission handout describes Average ~20 days for the expedited part, and emphasizes that individual state boards issue the licenses.
Critical nuance: You are not getting permission to practice “through the Compact.” You are getting actual state medical licenses, just faster.
4) State of Principal License (SPL): the anchor decision
What is an SPL?
Your SPL is the Compact member state that serves as your “home base” for IMLC eligibility and LOQ issuance. The SPL issues the LOQ that allows you to pursue expedited licenses elsewhere.
Not every member state can serve as an SPL
Some states are Compact members but may not serve as SPLs (or may have limited participation status). This is why you’ll see references to “SPL states” vs other member/participating states in Compact materials.
The Commission publishes an SPL/member board list PDF updated 1/1/2026 that’s useful for verifying which boards are active and “go-live.”
Practical locums advice: choose an SPL that reduces friction
Most physicians choose an SPL where they already:
hold a full, unrestricted license
live or primarily practice
have clean/straightforward documentation history
If you have multiple options, prioritize the SPL whose board is:
operationally responsive
familiar to you
less likely to create administrative delays for LOQ processing
(You can still get expedited licenses in other states regardless—your SPL is mainly about Phase 1.)
5) Eligibility: who qualifies for the Compact?
IMLC eligibility has two buckets:
SPL eligibility (your SPL must be eligible to serve as your SPL, and you must meet SPL requirements)
general eligibility (your overall physician profile must meet Compact standards)
State boards often publish a checklist distinguishing SPL eligibility vs general eligibility (Texas does this explicitly).
While the specific criteria and proofs can vary, common themes include:
holding a full, unrestricted license in your SPL
meeting Compact’s requirements for professional standing
completing required criminal background check steps (fingerprinting may vary by state)
If you suspect any complexity—past board action, malpractice issues, gaps in training documentation—assume eligibility and processing will be more involved.
6) Background checks and fingerprinting: don’t underestimate this
The Compact application process requires a background check for LOQ applications, and fingerprint requirements vary by state.
For locums, this matters because:
fingerprint scheduling can create delays
some states require specific vendors or processes
background check results can become time-sensitive
Best practice: treat fingerprints like a critical path item (do it early, not after you’ve picked an assignment).
7) Timelines: what to expect (and what controls the clock)
You can think of timeline as:
LOQ processing: often the longest and most variable, because it depends on SPL review, primary source verification norms, and background check workflow. The Commission handout cites an average 30–45 days for Phase 1.
Expedited licensure: faster and more standardized, cited around ~20 days average in Commission material.
State license issuance & post-licensure steps: still state-controlled. Even after issuance, you may need to finalize controlled substance registration, hospital credentialing, etc.
Locums reality check
If you’re trying to start an assignment “in a few weeks” and you don’t already have multi-state licensure, the IMLC may still not be fast enough—especially if LOQ is not already in place.
Locums power move: establish IMLC eligibility during your “off-season,” so Phase 1 is done before you urgently need licenses.
8) Costs and fees: what to budget for IMLC
IMLC costs are a combination of:
Compact/Commission fees
state license fees (each state sets its own)
background check/fingerprint fees (variable)
The Compact’s cost page states the initial cost to participate is $700 PLUS the cost of the license(s) in Compact stateswhere you want to practice.
The Commission’s Rule on Fees (amended May 13, 2025) also describes administrative/service fee structures, including a $25 service fee per license renewed through the Compact.
What this means for locums budgeting
For a realistic “IMLC year-1 budget,” estimate:
~$700 initial IMLC cost
state license fees for each state you add (often several hundred per state)
fingerprint/background fees
later renewal fees (including service fees)
If you plan to add 3–6 states, the IMLC can still be a good ROI because it reduces time and admin hassle—but it’s not “cheap.”
9) IMLC vs “fast licensing”: what to clarify with recruiters and agencies
Some recruiters say “IMLC state” as shorthand. In practice, you want to clarify:
Is the assignment in a state that is fully implemented and issuing expedited licenses through the Compact?
Can your current license serve as an SPL? (Some states are member but may not be SPL states in the way you need.)
Do you already have an LOQ? If not, your start date should reflect the Phase-1 timeline.
10) Facility credentialing: your second bottleneck (after licensing)
Even with fast IMLC licensing, hospitals and groups still require:
credentialing and privileging
references
malpractice history documentation
immunizations, TB testing, etc.
possibly payer enrollment
So: IMLC is a licensing accelerator, not a complete locums onboarding solution.
Best practice: once you initiate IMLC for a new state, start facility credentialing intake in parallel.
11) Telehealth + locums: the “patient location” rule
States emphasize that you must be licensed where the patient is located at the time of care. Louisiana’s board communication states you cannot see patients in another state without being licensed where the patient is located, even with the IMLC pathway.
North Carolina’s medical board similarly notes the IMLC is an expedited pathway but does not automatically grant authority in other states; you still need a North Carolina license before seeing patients located in NC.
If you do:
tele-ICU coverage
remote consults
multi-state call
direct-to-consumer telehealth shifts
…your licensing footprint is your ceiling. IMLC can help raise that ceiling faster.
12) The “locums licensing strategy” using IMLC
Here’s a practical approach many locums physicians use:
Step 1: Build your base
Choose an SPL you clearly qualify for
Complete LOQ process
Keep LOQ status current (remember LOQ validity window)
Step 2: Add “anchor states”
Pick 2–4 states that:
consistently have demand in your specialty
are geographically/logistically acceptable
have favorable pay trends and assignment volume
Step 3: Add “opportunity states” on demand
When an assignment pops up in a new state:
initiate expedited license through IMLC immediately
simultaneously begin facility credentialing paperwork
align start date expectations to realistic licensing + credentialing timelines
Step 4: Maintain a credential vault
Keep updated PDFs of:
CV (chronology consistent)
all licenses and DEA
board certifications
CME summaries
malpractice certificates + claims history letters
references list
This keeps the “non-IMLC” friction from becoming your bottleneck.
13) Common pitfalls (and how to avoid them)
Pitfall 1: Waiting until you have a job offer
If you start IMLC only after signing an assignment, you may miss the desired start date. The LOQ stage can take weeks and is board-controlled.
Pitfall 2: SPL confusion
Not every member state functions as an SPL in the way you expect. Use the Commission’s SPL/member board list to confirm.
Pitfall 3: Underestimating fingerprints/background checks
Background checks are required and fingerprint requirements vary—start these early.
Pitfall 4: Thinking “Compact = practice anywhere”
You still need a license in the patient’s state.
Pitfall 5: Treating “IMLC license” as a single renewal
You’re managing multiple state licenses with their own renewal cycles (even if the Compact streamlines some renewal mechanics/fees).
Interstate Medical Licensure Compact (IMLC) FAQ for Locum Tenens Doctors (Deep Dive)
A) Core concepts
1) Is the IMLC the same as “one license for all states”?
No. You receive separate state licenses issued by each member board; the Compact is a pathway to obtain them more efficiently.
2) Can I practice in a Compact state without applying there?
No. You must hold that state’s license before treating patients located there.
3) What is an LOQ?
A Letter of Qualification is issued by your SPL’s board confirming you meet IMLC requirements and enabling you to seek expedited licenses in other Compact states.
4) How long is the LOQ valid?
Commission material states the LOQ is valid for 365 days.
5) What is an SPL?
Your State of Principal License is the Compact member state that verifies your eligibility and issues your LOQ.
B) Eligibility
6) Who can use the IMLC?
The IMLC is available for MDs and DOs seeking an expedited pathway to full medical licenses in participating states.
7) Are eligibility rules identical in every state?
No—boards often discuss SPL eligibility and general eligibility requirements, and they may publish their own checklists (Texas does).
8) What if I’ve had prior disciplinary action?
That can affect eligibility and timelines. If you have any history that might be reviewed, plan on a more complex process and verify specifics with your SPL board.
9) Can residents/fellows use IMLC?
Typically you need a full, unrestricted license in your SPL and to meet IMLC requirements. If you’re still training, you’ll usually wait until you hold an unrestricted license.
10) Do I need board certification?
Requirements can vary by the Compact’s standards and your SPL board’s evaluation; always verify your SPL’s criteria and any published checklists (again, state boards outline these).
C) Participating states and SPL states
11) How many states participate?
Staffing-industry summaries in January 2026 note 42 states plus Washington, D.C. and Guam have joined the compact (status can vary by implementation).
12) Are all member states “fully implemented”?
Not always. Some states may have joined but have different implementation status; confirm on official Commission/board resources.
13) How do I know if my state can be an SPL?
Use the Commission’s published SPL/member boards list (updated 1/1/2026).
14) If my home state isn’t an SPL state, can I still use IMLC?
You may still be able to participate if you hold an unrestricted license in another SPL-eligible member state and meet SPL requirements—but this becomes a planning exercise. Confirm via the SPL list and your board guidance.
D) Timeline and speed
15) How fast is IMLC, realistically?
Commission material describes:
Phase 1 (LOQ): average 30–45 days
Phase 2 (expedited): average ~20 days
but emphasizes Phase 1 is controlled by the member board.
16) What slows Phase 1 down?
Common bottlenecks:
background checks
fingerprint scheduling
SPL board review volume
documentation inconsistencies
17) Can I start Phase 2 before LOQ is complete?
Generally, no. LOQ is what enables the expedited pathway.
18) If I’m trying to start locums in 3 weeks, should I rely on IMLC?
Usually not, unless you already have LOQ completed and you’re adding a state with predictable processing. Otherwise, build in buffer.
E) Background checks and fingerprints
19) Are background checks required?
Yes—Compact materials state background checks are required for LOQ applications, and fingerprint requirements vary by state.
20) Will I need to fingerprint for every state I add?
It depends. Some steps occur at the LOQ stage; states may still have their own requirements. Expect variability.
21) What’s the best way to avoid fingerprint delays?
Schedule early, follow the SPL board’s instructions precisely, and keep copies/receipts.
F) Costs, fees, renewals
22) What does it cost to start?
The IMLC cost page states initial participation cost is $700 plus the cost of licenses in the states you select.
23) Do states charge their own license fees?
Yes. Each state sets its license fee. The Compact streamlines the pathway, not the underlying state fee structure.
24) Are there renewal-related Compact fees?
The Commission’s fees rule includes a $25 service fee assessed per license renewed through the Compact.
25) Is IMLC worth it for locums financially?
If you will add multiple states over time, the ROI is often strong because it reduces admin burden and can accelerate start dates (opportunity cost). If you only need one additional state once, ROI depends on your situation.
G) Locums workflow and “what recruiters forget to mention”
26) Does IMLC speed up hospital credentialing?
No. Hospital credentialing/privileging is separate and can be the longer bottleneck.
27) Can I accept an assignment contingent on licensing?
Yes—many locums contracts are contingent on license issuance. Just be careful with start-date promises and travel plans.
28) Should I get licenses before I have an assignment?
If you’re serious about locums, having a small set of “ready” licenses (or being LOQ-ready) increases your ability to move fast and negotiate.
29) What are “anchor states” and why do they matter?
Anchor states are 2–4 states you keep active because they reliably produce assignments for your specialty. IMLC makes adding them more manageable.
H) Telehealth + multi-state coverage
30) If I do telehealth, can I use one license?
No. Boards emphasize you need the license where the patient is located.
31) What if I’m covering call for a hospital system in another state?
If you’re practicing medicine for patients in that state, you generally need that state’s license. IMLC can help you get it faster, but it doesn’t waive the requirement.
I) Practical checklists
32) IMLC readiness checklist (locums-friendly)
Choose SPL that you clearly qualify for
Start LOQ early (budget 30–45 days average)
Schedule fingerprints / background check steps immediately
Keep LOQ window in mind (365 days)
Add anchor states first, then opportunistic states
33) “Credential vault” checklist (so licensing isn’t your only bottleneck)
Updated CV with consistent chronology
Copies of all current licenses + DEA
Board certification documents
CME summary
Malpractice face sheet + claims history (or no-claims letter)
References list with updated contact info
Immunization/TB/occupational health documents
J) Quick one-liners
34) Does IMLC guarantee I’ll be approved in every state?
No—states still issue licenses and retain authority, though the LOQ is a key eligibility step and the process is designed to streamline issuance.
35) What’s the biggest reason locums docs “feel stuck” with IMLC?
They start after signing an assignment, discover LOQ + background check timelines, and the start date becomes unrealistic.
36) What’s the best time to set up IMLC?
When you’re not urgently chasing a start date—so you can clear Phase 1 calmly and be ready to add states quickly.