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MEDICAL YEAR
IN REVIEW

The Interstate

Medical

Licensure

Compact:

Balancing Licensure

Portability and
State Autonomy

By Lori H. Kels, MD, MPH and Charles G. Kels, JD

2022 marked Texas’s first year as a member state of the Interstate streamlining physician mobility and preserving state regulation of med-
Medical Licensure Compact (IMLC). On June 7, 2021, Texas became icine, which is a key tenet of federalism under US constitutional gov-
the 33rd state to join the IMLC when Governor Greg Abbott signed ernance. Medical licensing is a quintessential exercise of states’ inherent
House Bill 1616 into law. On March 1, 2022, Texas compact licensing authority to protect the health, safety and welfare of their inhabitants.
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became operational, with Texas physicians able to apply for out-of-state Yet licensure barriers to cross-state practice can pose problems of in-
licenses and out-of-state physicians able to apply for Texas licenses via equity, complexity and perceived obsolescence in an increasingly inter-
the IMLC mechanism. connected world, especially since pandemics and other disasters do not
The IMLC facilitates interstate practice, whether through telemed- respect artificial boundaries. These challenges have led to growing calls
icine or in-person care such as locum tenens arrangements, by simpli- for upending the current state-based system through national or federal
fying and easing the licensure application process between member licensure, or alternatively through defining the telemedicine site of care
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states. The compact is also designed to enhance patient protection as where the physician, rather than the patient, is located. Either op-
through additional layers of physician vetting, beginning with a re- tion would inevitably erode state primacy in verifying the competency,
quirement for the applicant’s home state to verify their qualifications qualifications and character of physicians delivering care to the local
for IMLC participation. Additional state licenses obtained via the population.
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IMLC are neither special purpose licenses (such as limited telemedi- In addition to advances in telemedicine technology, one of the im-
cine licenses), nor new national or multistate licenses. They are unre- petuses for the Federation of State Medical Boards (FSMB) to steer
stricted state licenses identical to the traditional (and historically more the development of the IMLC a decade ago was its recognition that
onerous) process of applying for multiple licenses directly. Accordingly, an innovative state-based solution was essential to maintaining states’
a physician’s practice in another state – whether in-person or virtual – historical and constitutional role in regulating the professions and
remains subject to the oversight and regulation of the relevant state protecting the public. Previous efforts, such as the Federation Cre-
medical board based on the patient’s location. For qualifying physi- dentials Verification Service and uniform licensure application,
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cians already licensed in a member state, the IMLC offers an additional proved helpful but ultimately insufficient to meet the emerging chal-
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pathway for multistate licensure that seeks to minimize redundancies lenge. The ingenuity and enduring promise of the IMLC is that it
and centralize administrative functions; more conventional licensure provides an expedited pathway for physicians to obtain multiple li-
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avenues remain available and in place. censes while keeping the traditional regulatory authority of state
Arguably the greatest strength of the IMLC is its balance between medical boards intact.

28 SAN ANTONIO MEDICINE • December 2022