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MEDICAL YEAR
IN REVIEW

The IMLC addresses an identified barrier to Table
access to care by leveraging, rather than enervat-
Interstate Medical Licensure Nurse Licensure Compact (NLC)
ing, a physician’s home state license through a
Compact (IMLC)
clearinghouse function that streamlines multi-
Participation 37 states, District of Columbia, 35 states (awating implementation in
state licensure while adding appropriate safe- Guam OH and PA)
guards. The resulting licenses obtained by
Texas Yes Yes
physicians seeking to expand their virtual or membership
physical reach are full and separate medical li-
Mechanism Expedited pathway through IMLC Multistate license / Automatic
censes, reaffirming states’ jurisdiction over the Commission reciprocity
conditions of practice impacting their communi-
Process (1) Confirm eligibility Obtain multistate (compact) license
ties but reducing unnecessary duplication and (2) Apply through IMLC portal from primary state of residence
delay. Promulgated under the auspices of the (3) Receive letter of qualification (PSOR) in a compact state
(LOQ) from state of principal
FSMB and endorsed by the American Medical
license (SPL)
Association, the IMLC was designed to achieve
(4) Select additional member
license portability through voluntary mecha- states and pay state fees"
nisms compatible with state prerogatives and Result Additional state license(s) Multistate (compact) license
physician self-policing through medical boards.
3
The Texas Medical Association (TMA) had advocated for Texas to join Engl J Med. 2015;372(17):1581-1583.
the compact for multiple legislative sessions before the efforts came to 5. Dent v W Va, 129 US 114 (1889).
fruition last year. 6. Slomski A. Telehealth success spurs a call for greater post-COVID-
Although the IMLC model of expedited licensure is less robust than 19 license portability. JAMA. 2020;324(11):1021-1022.
an automatic reciprocity system such as the Nurse Licensure Compact, 7 7. National Council of State Boards of Nursing. Nurse Licensure Com-
its careful construction to obtain widespread buy-in among state capi- pact. https://www.ncsbn.org/nurse-licensure-compact.htm.
tals remains integral to the venture’s lasting success (Table). Adoption 8. Federation of State Medical Boards. Interstate Medical Licensure
of the IMLC by remaining US states and territories is both a test of the Compact. https://www.imlcc.org.
flexibility of time-honored licensure mechanisms to meet emerging
needs and an imperative to address geographical physician shortages, Lori Kels, MD, MPH is a board-certified psychiatrist and an
both during and outside of crises such as the COVID-19 pandemic. 2 Associate Professor at the University of the Incarnate Word
Since Texas adopted the compact last year, it has been joined by four School of Osteopathic Medicine, where she serves as the Psychi-
more states, bringing the current total to 37 states, the District of Co- atry Clerkship Director. She is also a member of the Bexar County Medical
lumbia and Guam. 8 Society (BCMS) and serves as the UIWSOM representative on the
BCMS Board of Directors.
Disclaimer: The views expressed are those of the authors and do not
necessarily reflect those of the Department of Defense or any of its compo- Lieutenant Colonel Charlie Kels is an associate general coun-
nents. sel for the Defense Health Agency and a judge advocate (JAG)
in the U.S. Air Force Reserve.
References:
1. Tex Occ Code Ann § 171.
2. Adashi EY, Cohen IG, McCormick WL. The Interstate Medical Li-
censure Compact: attending to the underserved. JAMA.
2021;325(16):1607-1608.
3. Steinbrook R. Interstate medical licensure: major reform of licensing
to encourage medical practice in multiple states. JAMA.
2014;312(7):695-696.
4. Chaudry HJ, Robin LA, Fish EM, Polk DH, Gifford JD. Improving
access and mobility: the Interstate Medical Licensure Compact. N

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