The provider shortage and preceptor bottleneck are at crisis levels. Physician enrollment has grown dramatically, overall medical school enrollment is 52 % higher than in 2002 yet programs still struggle to find enough rotation sites and mentors, and nearly 87 % of deans worry about shortages of primary‑care preceptors.
At the same time, telehealth demand has exploded, breaking down geographic barriers to care. Unfortunately, licensing rules often lag behind technology, making it illegal to treat a patient located in another state without proper authorization. This hurdle also affects preceptors who want to supervise students virtually or across state lines.
For providers who want to expand their reach, both to deliver care and to precept more students, obtaining additional state licenses is a powerful strategy. Below is a guide to the multistate compacts that make licensure easier for physicians, physician assistants (PAs) and nurse practitioners (NPs), along with tips on identifying the most telehealth friendly states.
Why more licenses matter
- Increase patient access: With multiple state authorizations, you can treat patients where the need is greatest without relocating. Telehealth appointments occur in the state where the patient sits, so holding a license or compact privilege there is crucial.
- Precept across state lines: Schools struggle to place students in clinical rotations; expanded licensure means you can mentor students from programs outside your home state, often remotely via telehealth.
- Protect income and flexibility: Having licenses in backup states can keep your practice running if local policies change (e.g., a state enacts telehealth restrictions).
- Boost your résumé: Multi‑state practice demonstrates versatility and may qualify you for leadership roles in digital health.
For Physicians: Interstate Medical Licensure Compact (IMLC)
The Interstate Medical Licensure Compact (IMLC) provides an expedited pathway for physicians to obtain licenses in other member states. Participating states agree on core standards; physicians who meet the criteria can apply once through the compact to secure licenses in multiple states rather than starting from scratch in each state.
How it works
- Participating states: More than 35 states, the District of Columbia and Guam are members of the IMLC. The compact’s official map (see IMLC website) identifies each state. A physician’s principal state of licensure must be a member for them to use the process.
- Single application, multiple licenses: The IMLC issues a “Letter of Qualification” verifying you meet baseline requirements (education, training, board certification, clean disciplinary record). Once granted, you can select additional member states and pay individual fees to receive licenses.
- Telehealth friendly: The compact is recognized by Medicare and makes it easier to practice telehealth across state lines. Telehealth.HHS.gov notes that compacts such as the IMLC provide a faster pathway to interstate practice and reduce administrative hurdles.
- Costs and timeline: You still pay license fees for each state, but the paperwork is significantly streamlined. Some states issue licenses within a few days.
Tips for physicians
- Check your eligibility: Generally, you must hold an unrestricted license in a compact member state, be board certified, and have no criminal or disciplinary actions.
- Decide where to expand first: Target states with a large patient base or where you intend to precept students. Consider states with telehealth friendly laws (see list below).
- Maintain compliance: Even with IMLC licenses, you must adhere to each state’s scope‑of‑practice laws and controlled‑substance regulations.
For Physician Assistants: PA Licensure Compact
The PA Licensure Compact, enacted in 2023, is a newer agreement that streamlines multi‑state practice for physician assistants.
Key facts
- Member states: As of mid‑2025, the compact has been enacted by 20 jurisdictions including: Delaware, Utah, Washington, Wisconsin, West Virginia, Nebraska, Virginia, Ohio, Oklahoma, Maine, Colorado, Minnesota, Tennessee, Arkansas, Montana, Kansas, Iowa, Connecticut and North Carolina
- Compact privileges: Once operational, eligible PAs will hold a home state license and may obtain compact privileges to practice in other member states without obtaining separate licenses. A PA could apply once and then select multiple states; the example provided by the American Academy of PAs notes that a PA in Virginia could apply for privileges in West Virginia, Tennessee and Washington via the compactaapa.org.
- Eligibility requirements: To qualify, PAs must graduate from an ARC‑PA–accredited program, hold current NCCPA certification, have no felony convictions or significant disciplinary actions, and meet individual states’ jurisprudence requirementsaapa.org. Adverse actions must be reported to the commission within 30 daysaapa.org.
- Operational timeline: Although 20 states have enacted the compact, the commission is still being formed. The AAPA notes that PAs cannot yet apply for the compact privilege; operationalization may take 18–24 months after the seventh state.
Tips for PAs
- Stay informed: Follow the PA Compact Commission’s updates. Operational rules will define fees, renewal requirements and telehealth policies.
- Prepare your documentation: Ensure your license and NCCPA certification are current and that any disciplinary issues are resolved.
- Consider interim licensing: While waiting for the compact to activate, you can still apply for additional state licenses via regular processes. Some states offer reduced requirements or telehealth‑only registrations.
For Nurse Practitioners and Nurses: APRN Compact and NLC
Advanced practice registered nurses (APRNs) have two key pathways to multi‑state licensure: the Nurse Licensure Compact (NLC) for registered nurses (RNs) and licensed practical/vocational nurses (LPNs/LVNs), and the emerging APRN Compact for nurse practitioners, clinical nurse specialists, nurse anesthetists and nurse midwives.
Nurse Licensure Compact (NLC)
- The NLC allows nurses to have one multistate license while practicing in any of the compact’s member states. Telehealth.HHS.gov explains that the NLC authorizes nurses to practice across member states while maintaining a single license.
- Scope: The NLC covers RNs and LPNs/LVNs, not APRNs. As of 2025, more than 40 states and territories participate.
- Benefits for precepting: With an NLC license, nurse preceptors can supervise students from any member state without obtaining additional licenses.
APRN Compact
- Multistate privileges for APRNs: The APRN Compact would grant APRNs one multistate license to practice, prescribe and provide telehealth across member states. It isn’t yet operational because seven states must enact the compact before it takes effect.
- States that have enacted legislation: According to the Council of State Governments’ compact database, Delaware (2021), North Dakota (2021), Utah (2022) and South Dakota (2024) have joined.
- Pending states: A recent summary by Medicus Healthcare Solutions notes that Montana, Arizona, Texas, Kentucky, New York and Maryland have pending legislation, but the compact won’t become active until at least seven states sign.
- Activation threshold: Once seven states enact the APRN Compact, APRNs in those states can practice under a single license; the remaining member states would need to pass similar legislation.
Tips for NPs
- Maintain dual pathways: Because the APRN Compact isn’t yet operational, many NPs maintain an RN license under the NLC and obtain individual APRN licenses where needed.
- Advocate for legislation: Work with your professional associations to promote compact bills in your state; the sooner seven states enact it, the sooner APRNs gain multistate privileges.
- Check supervision and prescribing rules: Each state may have differing scope‑of‑practice laws; multi‑state authorization doesn’t override local regulations.
Telehealth‑Friendly States and Special Licenses
Outside of the formal compacts, some states offer special telehealth or registration licenses that let out‑of‑state clinicians practice without meeting all the requirements of a full license. These rules change frequently, so you should always confirm with each state’s medical or nursing board. Examples include:
- Florida: Offers an out‑of‑state telehealth provider registration that allows licensed providers from other states to treat Florida patients virtually if they register with the Florida Department of Health.
- Arizona and Indiana: Have special telemedicine registrations that simplify practice for out‑of‑state physicians.
- Kansas, Minnesota and West Virginia: Provide special telehealth or telemedicine permits enabling physicians to see patients without relocating.
- Delaware and Idaho: Allow out‑of‑state providers to practice telehealth with a streamlined registration.
These states are often considered easier for telehealth licensure because they waive certain requirements (e.g., in‑state residency or in‑person exams) and charge modest fees. However, each program has limitations (such as restricting in‑person visits) and may not cover all specialties. Before pursuing these licenses, review state statutes carefully and consider working with a credentialing specialist.
Choosing which states to target
- Demand and patient need: Look at states with clinician shortages or high telehealth usage. Rural areas and states with aging populations often have significant unmet needs.
- Preceptor opportunities: If your goal is to mentor students, identify states where nursing or PA programs face rotation shortages (e.g., primary care or psychiatry).
- Regulatory flexibility: States that offer telehealth registrations or have enacted compacts reduce the administrative burden. Florida, Arizona, Kansas, Minnesota, Texas, Delaware and West Virginia are commonly cited as telehealth‑friendly.
- Cost and reciprocity: Compare licensing fees and renewal schedules. Some states have lower costs or reciprocity agreements that reduce paperwork.
Final Thoughts: Empowering Providers and Students
Expanding your licensure footprint isn’t just a bureaucratic exercise, it’s a way to amplify your impact. Multi‑state licensure lets you reach patients who need care, support schools struggling to find preceptors, and future‑proof your career against regulatory shifts.
At MomentMD, we help providers navigate these complexities. Our platform connects preceptors and students across specialties, manages compliance and documentation, and offers telehealth rotations that meet accreditation standards. By embracing multi‑state licensing and telehealth friendly policies, we can close the gap between where providers are and where patients and students need them most.