Healthcare licensing compacts make it easier to practice in multiple states, but they don't all work the same way.
Explore how each compact works, who qualifies, and how Barton helps clinicians navigate the licensing process.
The IMLC and the NLC are both interstate licensing compacts — agreements among member states designed to make multi-state practice easier. But they cover different clinician types, work differently, and are governed by entirely different organizations. Confusing the two is common and leads to real misunderstandings about what’s available to you.
| Feature | IMLC | NLC |
|---|---|---|
| Full Name | Interstate Medical Licensure Compact | Nurse Licensure Compact |
| Who It Covers | Physicians (MD/DO) | RNs and LPN/VNs (NPs: RN layer only) |
| Governing Body | IMLCC (Interstate Medical Licensure Compact Commission) | NCSBN / ICNLCA |
| Established | 2017 | 2000 (25th anniversary in 2025) |
| Member Jurisdictions | 44 (42 states + DC + Guam) | 42 jurisdictions enacted as of FY2024 |
| How It Works | Physician applies for a Letter of Qualification (LOQ), then uses it to obtain expedited individual state licenses in member states | Nurse holds one multistate license from home state — covers practice in all NLC member states |
| License Model | Individual full state licenses — one per state, obtained faster through the compact process | Single multistate license — one license covers all compact states |
| Qualification Document | Letter of Qualification (LOQ) — valid 1 year, renewable | Multistate license from home state — standard renewal cycle |
| Covers PAs? | No — PA Compact enacted in 19 states, operational 2027 |
Important: the sequence is always state license first, then CSR, then DEA. None of these can be obtained out of order.
The IMLC is an agreement among 44 member jurisdictions — 42 states, DC, and Guam — that gives eligible physicians an expedited pathway to licensure in multiple states without starting from scratch in each one. It is not a separate national license. Physicians who use the IMLC still receive full, unrestricted individual state licenses from each state’s medical board. The compact simply makes the process significantly faster.
Physicians currently use the IMLC process
Member jurisdictions — newest: Arkansas (March 2025) and North Carolina (July 2025)
Licensing boards participating
Letters of Qualification issued since inception
Licenses issued since inception
of physicians obtain their LOQ in 30 days or less
Receive all requested compact state licenses within 7 days of LOQ issuance
of physicians find the process beneficial
of all new physician licenses in member states were issued through IMLC in 2024
of IMLC physicians intend to use their licenses in rural or underserved areas
Source: IMLCC FY2025 Annual Report
To use the IMLC, a physician first obtains a Letter of Qualification (LOQ) from their State of Principal License (SPL) — the state where they hold their primary license and practice most. The LOQ confirms eligibility and unlocks the expedited pathway to licenses in other compact states.
Apply once. One LOQ application through your SPL medical board.
Qualify once. The LOQ confirms you meet the compact’s eligibility criteria.
License in days. Once the LOQ is issued, compact state licenses typically arrive in days to weeks — not months.
Valid for one year — and renewable. The LOQ must be renewed annually. Renewal requires repeating certain steps, including fingerprinting.
No IMLCC license. There is no separate “IMLCC license.” Physicians receive full, unrestricted individual state licenses — the compact is a technology and process pathway, not a credential.
Eligibility is based on your State of Principal License (SPL). To qualify, you must:
Hold a full, unrestricted medical license in your SPL
Have passed USMLE or COMLEX within three attempts
Have completed graduate medical education
Have no history of disciplinary actions, criminal convictions, or controlled substance violations
Be in active practice or military service
Your Barton licensor will walk you through eligibility and manage the LOQ application if you qualify.
The NLC is an agreement among member jurisdictions that allows nurses whose home state is a compact member to hold one multistate license — covering practice in person or via telehealth in their home state and all other NLC states. Unlike the IMLC, which expedites individual state licenses, the NLC replaces the need for separate state licenses entirely within the compact.
The NLC celebrated its 25th anniversary in 2025. It has earned formal endorsement from the U.S. Department of Defense — in part for the mobility it provides to military spouse nurses who face repeated licensure delays when relocating. It has also proven essential in emergencies, enabling rapid deployment of vetted nurses during the COVID-19 pandemic.
Jurisdictions enacted as of FY2024
Fully implemented July 7, 2025
In 2025 — the model that informed and inspired the health care
Department of Defense endorsement
Strong nurse support: 90% of Massachusetts nurses surveyed support the NLC
Source: Nurse Licensure Compact Commission Annual Report, FY2024
Source: NCSBN FY25 Annual Report
If your home state is an NLC member, you already hold a multistate license — which covers practice in all other NLC member states without additional applications, fees, or waiting periods. The multistate license is issued by your home state board of nursing and follows the standard renewal cycle for that state.
You can only hold an NLC multistate license if your primary state of residence is an NLC member state.
No separate applications in each compact state — your home state license covers you everywhere the NLC operates.
Nurses can provide telehealth nursing services to patients in NLC states without additional licenses.
All multistate license applicants undergo federal and state criminal background checks under aligned NLC standards.
The NLC multistate license is an RN-level license. As an NP, you still need a separate APRN license in each state where you practice as a nurse practitioner. The NLC does not automatically extend to NP scope of practice. Barton manages both layers — the NLC-covered RN license and the separate APRN license — as one coordinated process.
PAs currently have no interstate compact in active operation — meaning every new state requires its own full application. There is no expedited multi-state pathway equivalent to the IMLC for physicians or the NLC for nurses. That is changing.
The PA Licensure Compact has been enacted in 19 states as of October 2025, with active legislation in New Jersey, Michigan, and Massachusetts. The data infrastructure needed to grant compact practice privileges is still being built — multi-state compact practice for PAs is projected to launch in early 2027.
Barton’s licensing team is monitoring developments closely and will help PA clinicians navigate this pathway as it becomes available. When it does, it will represent a significant shift in how PAs access multi-state opportunities.
Source: IMLCC FY2025 Annual Report
If you want to practice in a state that is not an NLC member — or if your home state is not a member — a separate state license is required through the standard application process. Barton will confirm your NLC status and determine the right path for each state.
Barton confirms your NLC status as part of every licensing plan. Where your multistate license covers the assignment state, Barton factors that in and focuses effort on what’s still needed — typically the APRN license for NP roles. Where a separate state license is required, Barton manages that application end to end.
Physicians who are already licensed move faster. Instead of waiting until an opportunity opens, get licensed in the states where you want to work now.
Barton helps you identify high-demand states for your specialty and manages the licensing process from application to approval, so you're ready to submit on day one.
The IMLC covers physicians and gives them an expedited pathway to individual state licenses in member states. The NLC covers RNs and LPN/VNs and allows them to hold one multistate license that covers all compact states. They are governed by different organizations, cover different clinician types, and work through different models — one expedites individual licenses, the other replaces the need for them.
No. The IMLC is for physicians (MD/DO) only. NPs and PAs have separate compact pathways — the NLC for NPs (RN layer), and the PA Compact currently in development for PAs.
No. The NLC covers RNs and LPN/VNs. For NPs, it covers the RN license layer only — a separate APRN license is still required in each state. Physicians use the IMLC; PAs have no operational compact at this time.
No. There is no separate IMLCC license. Physicians who use the compact receive full, unrestricted individual state licenses from each member state’s medical board. The IMLC is a technology and process pathway — not a credential.
One year. The LOQ is renewable — renewal requires repeating certain steps, including fingerprinting. Barton manages IMLC renewal as part of ongoing licensing support.
If your primary state of residence is not an NLC member state, you cannot hold a multistate license — and will need a separate state license in each state where you want to practice. Barton manages that process end to end.
Not yet in active operation. The PA Licensure Compact has been enacted in 19 states as of October 2025, with multi-state compact privileges projected to launch in early 2027. Barton’s licensing team is monitoring developments closely.
Yes. For the IMLC, Barton covers the LOQ fee and manages enrollment and renewal end to end. For the NLC, Barton confirms your multistate license status and factors it into every licensing plan. Talk to your licensing specialist about your specific situation.
One call with your dedicated licensor is all it takes to get started. Barton handles the rest.
