New process will make it easier for physicians to practice in multiple states
from the AAP Division of State Government Affairs
A streamlined process soon will be available for pediatricians, pediatric medical
subspecialists and pediatric surgical specialists who want to practice medicine across
The Interstate Medical Licensure Compact is in the process of establishing an expedited
pathway to license qualified physicians to practice in multiple states in a safe and
accountable manner. Physicians now face the burdensome process of applying individually
to each state in which they want to practice.
The Federation of State Medical Boards (FSMB), which represents U.S. medical and osteopathic
licensing boards, released model language in July 2014 to help states create the compact.
In addition to improving efficiency for applicants, the compact will increase patients’
access to care.
The Academy, the American Academy of Family Physicians, the American College of Physicians,
the American Medical Association and other medical societies have endorsed the compact.
As of January, 18 states (Alabama, Arizona, Colorado, Iowa, Idaho, Illinois, Kansas,
Minnesota, Missouri, Montana, New Hampshire, Nevada, Pennsylvania, South Dakota, Utah,
Wisconsin, West Virginia and Wyoming) have enacted laws and five states (Arkansas,
Michigan, Nebraska, North Dakota and Washington) have introduced legislation that
would allow them to participate in the compact.
A commission that consists of two voting representatives from each member state governs
the compact. Commission members promulgate rules, enforce compliance with compact
provisions and issue advisory opinions on the meaning or interpretation of the compact.
The commission reports annually to the legislatures and governors of member states
as to its activities, financial audits and any adopted recommendations.
To obtain licensure through the compact, physicians will designate a member state
as a “state of principal licensure” and then select other states where they wish to
be licensed. A physician must have a full and unrestricted license in the state of
principal licensure, which is the physician’s primary residence, the state where at
least 25% of the practice of medicine occurs or the location of the physician’s employer.
If no state qualifies, the state of principal licensure would be the state designated
as the physician’s residence for federal income tax purposes.
The state of principal licensure will use the physician’s existing license and records
to verify eligibility and then provide the credentialing information to the commission.
Once eligibility is verified and state licensure fees are paid, each state would issue
a full license. Physicians will need to be licensed in the state where the patient
The compact ensures that state medical boards retain authority over the practice of
medicine and disciplinary authority over physicians. There is no impact on Medical
“It is important that states preserve their current authority over physicians who
are licensed in their state. Local oversight is vital to the safety and well-being
of patients,” said J. Gary Wheeler, M.D., FAAP, chair of the AAP Committee on State
The compact has the potential to have a positive impact on the practice of pediatrics
as well as children and families. The most direct application would be to expand access
to pediatricians and pediatric subspecialists through telehealth care. For example,
many children lack access to pediatric mental health services, and telehealth care
could help primary care practices expand access to child and adolescent psychiatrists.
William B. Moskowitz, M.D., FAAP, chair of the AAP Committee on Pediatric Workforce,
said easing the administrative burden of obtaining a medical license in multiple states
will increase the reach of pediatricians.
“The AAP wants to reduce barriers to the practice of telehealth care in order to achieve
the goal of pediatric physicians offering care to all children. The compact can help
to alleviate one of those barriers,” Dr. Moskowitz said.
Being licensed in multiple states also can help pediatricians collaborate with subspecialists
or surgical specialists in other states to care for children with special health care
needs; assist with emergency or disaster responses; and extend the reach of pediatric
subspecialists to underserved or rural areas.
The Academy continues to monitor the compact’s progress and commission’s work and
will keep pediatricians informed as to when expedited licenses will be available.