Compact vs. Non-Compact: What If Only Some States Accept My Credentials?

Can I Use the IMLC and Still Apply Directly to Other States?

Yes. Many physicians build a hybrid licensing model using both the Interstate Medical Licensure Compact (IMLC) and direct state-by-state applications. This approach is especially helpful when some of your target states are IMLC members and others are not.

Why Would You Need a Hybrid Strategy?

Because not all U.S. States participate in the IMLC. If you plan to practice in a mix of compact and non-compact states — for example, telemedicine across the U.S. Or a multi-state locum assignment — you’ll need to navigate both pathways.

Which States Are NOT in the IMLC?

As of now, large states like California, New York, and Massachusetts are not part of the compact. That means any physician wanting to practice there must go through the state’s traditional licensing process — see, for example, our walkthrough of getting a New York medical license without IMLC. These applications often require more paperwork, longer wait times, and more redundancy.

How to Structure a Hybrid Licensing Plan

1. Start with your IMLC application: Get your Letter of Qualification (LOQ) and license in as many compact states as needed.
2. Identify your non-compact targets: List the remaining states you need and check their board requirements.
3. Apply directly to those states: Begin early — especially if the state is known for long processing times.
4. Track everything: Use a spreadsheet or credentialing software to monitor application, renewal, and CME deadlines for each license.

What About Credentialing and Malpractice?

Credentialing teams often require proof of licensure before onboarding you at a hospital, health system, or telemedicine platform. A hybrid approach makes this smoother by letting you submit compact credentials quickly while awaiting longer approvals from non-compact states.

Malpractice insurance is not affected by how you obtained your license, but the insurer must list each active state on your policy.

Tips for Managing a Hybrid Strategy

• Stagger applications to reduce workload and financial strain
• Use licensing services if applying to 5+ states
• Renew proactively — every state has different cycles
• Keep CME documentation well organized across jurisdictions

Are There Any Risks?

Only if you let things slip. Missed renewals, inconsistent application info, or delays in fingerprinting can cause headaches. Hybrid models demand discipline and a good system for tracking statuses and deadlines.

Which Mix Makes Sense for You?

Not every state will meet you halfway — but with the right plan, you can still meet them all. A hybrid licensing strategy using the IMLC where possible and traditional applications elsewhere gives you the widest reach and the flexibility to grow your career across the country. See our concierge pricing for help running both pathways at once.