The Interstate Medical Licensure Compact is faster than a single-state filing in most cases, but it is not always cheaper, and the math flips depending on which states you need. The IMLC charges a flat $700 application fee paid to the Compact Commission on top of each individual state's licensing fee — so a one-state IMLC license can cost more than the same state-only application. Where the compact pays off is when you are adding a second, third, or fourth state, or when the underlying state's processing time is long enough that a four-to-six-week IMLC turnaround changes a hiring timeline. Here is what the numbers actually look like in 2026 across four representative compact states.
The Two Pathways, In Plain Numbers
A single-state license is what it sounds like — you file directly with the state medical board, pay that state's fee, and wait. The IMLC pathway routes through your State of Principal Licensure (SPL), which issues a Letter of Qualification (LOQ) valid for 365 days. Once you have an LOQ, requesting any additional compact state takes days rather than months — the IMLC publishes a target of about ten business days for the issuing state to verify and release the license once your selection is submitted.
- Single state: One application, one state fee, primary-source verification (FCVS or direct), state-specific addenda. Typical timeline 60-120 days depending on the state.
- IMLC: One LOQ from your SPL ($700 to IMLCC + SPL background check), then $0-$1,000+ per additional state at issuance. Typical timeline 4-6 weeks for the LOQ, then 1-3 weeks per state once the LOQ is in hand.
Texas: The Compact Is Faster, Not Cheaper for One State
Texas joined the IMLC on March 1, 2022 (HB 1616) and is now a fully participating SPL-eligible compact state. The single-state Texas Medical Board application fee is $867 effective September 1, 2025, plus $21 NPDB and $7 Texas Physician Health Program surcharges — a $895 Texas-side total that includes the Jurisprudence Examination. The TMB is legislatively mandated to process applications in an average of 51 days from the Licensing Stage, but that clock only starts after every initial document is received, so total elapsed time is typically 8-12 weeks.
Through the compact, the same Texas license usually issues in about 30 days end-to-end, but you still pay the Texas registration fee plus $700 to the IMLCC and you still have to take the Jurisprudence Exam and submit proof of citizenship/lawful presence within 90 days of issuance to avoid penalty fees. If Texas is your only target, the single-state path is cheaper. If Texas is your second, third, or fourth state, the compact wins on every metric. Read our full Texas breakdown.
Arizona: A Tie on Cost, A Win for the Compact on Time
Arizona's MD application fee is $675 at the Arizona Medical Board (and the same at the Arizona Osteopathic Board for DOs), with a typical 60-90 day timeline. The IMLC pathway through Arizona is roughly $700 to the IMLCC plus the state-specific portion — close to the same total cost — but typically 4-6 weeks instead of 60-90 days. The deciding factor in Arizona is rarely fee parity; it is the notarized birth-certificate-or-passport requirement (A.A.C. R4-16-201(C)(1)) that catches many single-state filers off guard. See the Arizona detail page for the full requirement set.
Alabama: Single State Is Cheaper If It Is Your Only Target
Alabama's single-state out-of-pocket minimum is $375: $60 FSMB Uniform Application + $175 ALBME application + $65 background check + $75 issuance. That is meaningfully cheaper than the $700 IMLC application fee plus state fees if Alabama is your only state. But Alabama's process runs 8-12 weeks because Certificates of Qualification are approved at scheduled Board meetings on a fixed cadence, and a single missing document can push your file to the next meeting cycle. The IMLC pathway compresses that to 4-6 weeks. Read our full Alabama guide.
Colorado: One of the Fastest IMLC States
Colorado's single-state Medical Board application fee is $412, with a typical 60-90 day timeline driven mostly by primary-source verification. The IMLC pathway is meaningfully faster — Colorado is one of the quicker compact states, typically issuing the underlying license within about 30 days of receiving an LOQ. If you already have an LOQ from your SPL and are adding Colorado as a second or third state, you are likely a month from license in hand. More on Colorado.
Side-by-Side: When the Compact Wins
| Scenario | Single-State Path | IMLC Path | Better Choice |
|---|---|---|---|
| Adding only Alabama, no other states planned | $375, 8-12 weeks | $700+ to IMLCC + state, 4-6 weeks | Single state (cost) |
| Adding only Texas, no other states planned | $895, 8-12 weeks | $700+ + Texas registration, ~30 days | Single state on cost; IMLC on time |
| Adding Arizona + Colorado + Texas (3 states) | $1,954+, 60-120 days each in parallel | $700 LOQ + state fees, 4-6 weeks total | IMLC by a wide margin |
| Locum across 5+ compact states | Each state filed independently | One LOQ used to add states for 365 days | IMLC |
The Hidden Costs Most Comparisons Miss
Cost on paper is rarely the full cost. A few things to factor in:
- FCVS profile fees (~$375 base + $35 per destination) are usually required either way, but if you have not built a profile yet, the IMLC path tends to spread that cost across more states.
- State-specific surcharges at issuance — Texas TPHP, Florida NICA, Alabama ACSC — apply on either path and are often missing from headline fee lists.
- Locum revenue lost during processing is the real cost of slow timelines. A six-week head start on a $300/hr locum assignment is worth more than the entire IMLC fee.
- LOQ shelf life. Once you have an LOQ, it is good for 365 days. If you know you will add states over the next year, paying for an LOQ once is much cheaper than three independent state filings.
When Single-State Is Still The Right Call
The compact only works for compact states. If your portfolio includes California, Florida, New York, Massachusetts, Oregon, Connecticut, Rhode Island, or Alaska, those are still single-state filings — there is no compact pathway, regardless of how many SPL-eligible states you already hold. Florida specifically requires LiveScan with the correct ORI number, NICA election, and AIDS/HIV plus Florida Laws & Rules courses; no compact shortcut applies. New York's Form 1 process averages 3-4 months. California averages 100+ days from clean submission. For these states, the only question is how cleanly you can run the single-state filing.
Our Take
For one compact state and no near-term plans to add more, the single-state path is almost always cheaper and the time difference rarely matters. For two or more compact states, the IMLC pays for itself on the second license and saves weeks on every state after that. For high-volume locum or telehealth practices, the LOQ becomes the single most valuable document in your file — every additional state is a few clicks and a state fee away. See our concierge pricing for both pathways, since the right answer depends on which states you actually need and on what timeline.
Sources: IMLC Commission — Apply page; Texas Medical Board — IMLC Application; Arizona Medical Board — Licensure; Alabama Board of Medical Examiners — Full License; IMLCC FY2025 Annual Report.
Choosing between a single-state filing and the IMLC is rarely just about cost — it is about which combination of states you need, on what timeline, and how much friction you can absorb. We run that math for every client before any fee is paid, then handle the application end-to-end on whichever pathway wins.
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