Purpose and History of the Compact
The genesis of the Interstate Medical Licensure Compact (“Compact” or “IMLC”) started in 2013, when the Federation of State Medical Boards worked with its member state boards to study the feasibility of an interstate compact to support medical license portability.1 The final model legislative language was released in September 2014.2 On February 27, 2015, the State of Wyoming was the first state to pass legislation, followed by South Dakota, Utah, Idaho, West Virginia, and Montana.3 With Florida recently joining the Compact, the Compact now has 42 member jurisdictions, including 40 states, the District of Columbia and the territory of Guam.4 IMLC legislation is pending in Massachusetts, New York, and North Carolina.5
The Compact is of high importance for individual medical staffs because each medical staff in a participating jurisdiction must rely on the State of Principal License to correctly and thoroughly determine a physician's eligibility. Therefore, each medical staff is prone to the risk of relying on any false or incomplete information provided through the IMLC licensing procedure.
How Does Medical Licensure Work Under the Compact?
To participate in the Compact, a state's legislature must introduce and enact a bill authorizing the state to join.6 While the licensing process may be expedited under the Compact, the physicians are licensed by individual state's medical and osteopathic boards, and the state retains the full authority in administering its duties of oversight.7
To participate in the Compact, physicians must:8
- Hold a full, unrestricted medical license in a Compact member-state;
- Graduated from an accredited medical school or a school listed in the International Medical Education Directory;
- Successfully completed ACGME- or AOA-accredited graduate medical education;
- Passed each component of the USMLE, COMLEX-USA, or equivalent in no more than three attempts for each component;
- Hold a current specialty certification or time-unlimited certification by an ABMS or AOABOS board;
- Not have any history of disciplinary actions toward their medical license;
- Not have any criminal history;
- Not have any history of controlled substance actions toward their medical license; and
- Not currently be under investigation.
Once a physician applies, the State of Principal License reviews the application and conducts primary-source verification including criminal background check to determine eligibility. If all requirements are met, the State of Principal License issues a formal Letter of Qualification, which is valid for 365 days to obtain licenses from multiple states through the Compact.9
What Are the Risks and Benefits?
Benefits
Streamlining/Reduction of Administrative Burden. The Interstate Medical Licensure Compact Commission (“IMLCC”) noted that since operations, more than 25,000 physicians secured more than 100,000 licenses in IMLCC member states through April 2024.10 Texas, Illinois and Ohio were the top three states with the most Letters of Qualification applications, and Texas, Wisconsin, and Arizona issued the most licenses.11
Recent annual study by the IMLCC showed that nearly 30% of all new licenses issued to physicians in 2022 were done via the IMLCC process.12 The study also showed a steady increase in number of requests from 654 applications in April 2017 to 7,142 in April 2024, yet showed that the processing times have remained fairly consistent.13 In April 2024, the study noted that it took on average 43 days from application to Letter of Qualification issuance, then 20 days from qualification to license issuance.14
Because the Compact makes it easier and quicker for physicians to obtain and renew licenses to practice in multiple states, this expedited process reduces administrative burdens, which includes those for individual medical staffs.
Information Sharing/Disciplinary Information Reporting. All state boards participating in the Compact are required to share investigative and disciplinary information with each other.15 According to the Compact Rules, any reported disciplinary action may be a basis for discipline by other member boards.16 In comparison, when a physician's license in a state is “revoked, surrendered, suspended or relinquished,” all other state licenses of that physician shall be automatically suspended for 90 days to permit each member board to investigate the matter.17
Therefore, a medical staff in a participating state could find out about a state board investigative/ disciplinary action against a physician in any state where the physician has a license. This free flow of information may help identify quality concerns early on that could adversely affect patient care and help promote quality care.
Access to Care. The Compact's streamlined licensing procedure may also help enhance the portability of a medical license, which may enhance access to and continuity of care. Further, the number of physicians licensed via IMLC may increase the availability of out-of-state disaster-response providers who do not need emergency waiver, which may make it easier for physicians to reach areas in urgent need of care.18 As a result, individual medical staffs could promptly provide physicians emergency privileges to cover the patient care needs. Additionally, the Compact could facilitate the provision of telemedicine, which can help reach more patients, including those in rural areas.
Risks/Considerations
Risk of Reliance on Information. All medical staffs in participating states must rely on the State of Principal License to correctly and thoroughly review, verify, and determine a physician's eligibility. Therefore, the IMLC licensing procedure can create risk of reliance on false or incomplete information for individual medical staffs as they no longer conduct their own primary-source verification. Accordingly, such reliance may result in approval of membership/ privileges for a physician who fall short of the medical staff's standards, which in turn may subject the organization to patient safety issues, declining reputation, as well as liabilities such negligent credentialing.
State Laws. Each physician with license through the Compact is required to abide by all requirements of each licensed state's laws and medical board. Some areas of laws and requirements to be mindful of include record retention, patient-provider relationship, abortion, informed consent, minor consent, unprofessional conduct, reporting requirements, prescribing practices, scope of practice, and telemedicine. Accordingly, individual physicians should be mindful of differing standards and requirements of each state to ensure compliance with state statues, rules, and regulations that can change.19
Further, insurers may have territorial restrictions and limitations on coverage based on how lawsuits are handled in each state.20 As such, medical staffs and physicians should carefully verify professional liability coverage afforded in each state to avoid any gap in coverage.
Conclusion
Individual medical staffs should use extra caution and appropriate review processes when making a membership/privileging decision on a physician licensed via the IMLCC process. As stated, while the Compact supports an expedited licensing process, medical staffs of member states must rely on primary-source verification of the State of Principal License. Accordingly, to avoid granting membership/ privileges to ineligible physicians, medical staffs should engage in complete and thorough review process with clear eligibility criteria. For example, such process may include primary-source verification of malpractice claims, current/prior affiliations, and peer references from peers in the same specialty. As we have seen a steady increase in the number of licenses issued via the IMLCC process, these types of measures by medical staffs will be valuable for ensuring patient safety and quality care.
Footnotes
1. Rick Masters, Creating the Interstate Medical Licensure Compact(IMLC), INTERSTATE MEDICAL LICENSURE COMPACTS (Apr. 2022), https://www.imlcc. org/wp-content/uploads/2022/04/IMLCC_Newsletter_5Anniv_April2022_Web-1.pdf.
2. Id.
3. Strategic Planning Background, INTERSTATE MEDICAL LICENSURE COMPACT, https://www.imlcc.org/wp-content/uploads/2020/02/Strategic-Planning-IMLCC-History.pdf (last accessed Jun. 20, 2024).
4. Compact State Map, INTERSTATE MEDICAL LICENSURE COMPACTS, https://www.imlcc.org/participating-states/ (last accessed Jun. 20, 2024).
5. Id.
6. General FAQs, INTERSTATE MEDICAL LICENSURE COMPACT, https://www.imlcc.org/faqs/ (last accessed Jun. 20, 2024).
7. Id.
8. LOQ Re-Apply, INTERSTATE MEDICAL LICENSURE COMPACTS, https://www.imlcc.org/loq-reapply/ (last accessed Jun. 20, 2024).
9. Id.
10. IMLCC Data Study Year 7, INTERSTATE MEDICAL LICENSURE COMPACT (Jun. 15, 2024), https://www.imlcc.org/wp-content/uploads/2024/06/IMLCC-Data-Study-April-2024-6-2024-Final-1.pdf.
11. Id.
12. Id.
13. Id.
14. Id.
15. General FAQs, INTERSTATE MEDICAL LICENSURE COMPACT, https://www.imlcc.org/faqs/ (last accessed Apr. 12, 2024); see also Issue Brief: Interstate Medical Licensure Compact, AMA, https://www.ama-assn.org/system/files/fsmb-interstate-medical-licensure-compact-issue-brief.pdf (last accessed Jun. 20, 2024).
16. IMLCC Rule 6.5.
17. Id.
18. Interstate Medical Licensure Compact, ABPS, https://www.abpsus.org/medical-licensure-compact/ (last accessed Jun. 20, 2024).
19. MedPro Group, Risk Considerations: Interstate Professional Licensure Compacts, LINKEDIN (Aug. 10, 2023), https://www.linkedin.com/pulse/risk-considerations-interstate-professional-licensure-compacts/?trk=article-ssr-frontend-pulse_more-articles_related-content-card.
20. Chad Anguilm et al., Interstate Licensure for Telehealth Can Fuel Medical Practice Growth, MICHIGAN STATE MEDICAL SOCIETY (Jan. 28, 2021), https:// www.msms.org/About-MSMS/News-Media/interstate-licensure-for-telehealth-can-fuel-medical-practice-growth.
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