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IMLC letter of qualification: steps, fees and timeline

How to get a medical license in another state through the Interstate Medical Licensure Compact. Every fact comes from imlcc.com or a state board’s site, with the source under each section.

What the Compact is

An agreement among member states that gives qualified physicians (MD and DO) a voluntary, expedited pathway to licensure. You apply once, your state of principal license confirms you qualify, and that is shared with the states you choose. Each state issues its own license. There is no “Compact license” and no national license.

Source: imlcc.com/a-faster-pathway-to-physician-licensure, checked October 17, 2026.

Who is eligible

You need a full, unrestricted medical license in a member state that can serve as your state of principal license (SPL), and at least one of these must be true of that state:

• it is your primary residence;
• at least 25% of your practice of medicine happens there;
• your employer is located there; or
• it is your state of residence for US federal income tax.

You must also:

• have graduated from an accredited medical school, or one listed in the International Medical Education Directory or its equivalent;
• have completed ACGME- or AOA-accredited graduate medical education;
• have passed each component of the USMLE, COMLEX-USA or an accepted equivalent in no more than three attempts per component (the Canadian LMCC does not count);
• hold a current or time-unlimited specialty certification from an ABMS or AOABOS board;
• have no history of discipline or controlled-substance action on your license, no criminal history, and no current investigation.

The Commission says about 80% of US physicians qualify. You judge your own eligibility before applying; the fee is not refunded.

Sources: imlcc.com/apply and imlcc.com/faqs, checked October 17, 2026.

The letter of qualification, step by step

1. Confirm you are eligible. Fees are non-refundable.
2. Start the application from the Apply tab at imlcc.com.
3. Choose your SPL. It processes your application.
4. Complete the short application.
5. Pay the $700 application fee.
6. Background check. If your SPL requires fingerprints, it sends instructions; you have 60 days. It also checks your training and queries data banks.
7. Receive your letter of qualification by email, or a notice that you do not qualify.
8. Select states and pay each state’s license fee.
9. Receive your licenses, then answer anything extra a board asks for, such as a jurisprudence exam, an online profile or proof you may work in the US.

Source: imlcc.com/information-for-physicians, checked October 17, 2026.

What it costs

• Application: $700, paid when you apply.
• License fee: each state you select charges its own fee (table below).
• Adding states later: a $100 handling fee plus each new state’s fee, while your letter is still valid.
• Card payments: since August 2026, 2.9% plus 30 cents per card transaction. Paying by ACH avoids it.
• Renewal: set by each state’s board, not the Compact.
• Changing your SPL (redesignation): no charge.

All fees are non-refundable. The Commission offers no military discounts; some boards do.

Sources: imlcc.com/what-does-it-cost, imlcc.com/add-states, imlcc.com/information-for-physicians and the Commission’s June 15, 2026 information release, checked October 17, 2026.

Initial license fee through the Compact, by board

Initial license fees as listed by the IMLCC, on top of the $700 application fee. Source: imlcc.com/what-does-it-cost, checked October 17, 2026.

Which states take part

Only some members can be your state of principal license. The others issue licenses but cannot issue your letter.

Statuses as shown on the IMLCC map. Arkansas: the IMLCC home page says physicians can choose it as their state of principal license from October 12, 2026, but the Arkansas State Medical Board still says the Compact is not yet operational there. Ask the board before you count on it. The Commission says to direct questions about a state’s participation to its board. Sources: imlcc.com/participating-states and imlcc.com, checked October 17, 2026.

How long it takes

The Commission’s information page says the SPL step “may take several weeks” and that issuing licenses “usually takes only a few days.” Its own data study for April 1, 2025 to March 31, 2026 gives the averages:

Sources: IMLCC Data Study Year 9 (completed applications, April 1, 2025 to March 31, 2026) and imlcc.com/information-for-physicians, checked October 17, 2026.

Common delays

• Fingerprints and background checks can take several weeks.
• A lapsed license in the state you want. Contact that board first; you may need its reinstatement process instead.
• Two-step states. Florida (MQA Online Services) and Ohio (eLicense Center) need a second application after the Compact one.
• Training outside the US. Graduate training must have been ACGME- or AOA-accredited when you attended; the Commission says this most often affects Canadian training.
• Missed emails. Every notice goes by email; check spam.
• An expired letter. After 365 days you reapply and pay $700 again. No waivers.
• Requests after issue. Ignoring a board’s follow-up can lead to action against the license.

Sources: imlcc.com/information-for-physicians, imlcc.com/apply, imlcc.com/add-states and imlcc.com/faqs, checked October 17, 2026.

The Compact or the board directly?

Through the Compact, one application serves every member state you choose, sparing you separate applications to each board. Applicants in the Year 9 data took four licenses on average.

Apply to the board directly if you are not eligible (for example, no current board certification or more than three exam attempts), if the state is not a member, or if you are not a physician. Direct timelines vary. The Texas Medical Board says it is required by law to process physician applications within an average of 51 days, counted once your initial documents are in.

Sources: imlcc.com/information-for-physicians, the IMLCC Data Study Year 9 and the Texas Medical Board’s full medical license page, checked October 17, 2026.

Once you hold the licenses

Each Compact license is an ordinary state license with its own expiration date, renewal fee and CME rules. You renew through the Compact website and each state sends a notice, but the Commission says you are responsible for knowing your renewal dates and fees. The Compact does not coordinate CME: see what each state requires.

The Interstate Medicine Ledger keeps every license, its renewal date and each state’s CME in one record, with alerts before each renewal.

Common questions

How long does an IMLC letter of qualification take?

38 days on average from application to letter, in the IMLCC’s Year 9 data (April 2025 to March 2026), with 55% issued within 30 days. Licenses then took 22 days on average.

How much does it cost to get licensed through the IMLC?

A $700 application fee plus each state’s initial license fee, which runs from $35 (Pennsylvania State Board of Medicine) to $895 (Texas Medical Board) on the IMLCC’s fee list. Adding states later costs $100 plus each state’s fee.

How long is a letter of qualification valid?

365 days from issue, with no waivers. You can add states while it is valid.

Is a letter of qualification a medical license?

No. It shows your state of principal license found you eligible for the Compact. Each state you select then issues its own separate license.

Related: Your first attending license · CME requirements for Compact physicians · CME requirements by state · Multi-state license management · The Ledger