Interstate Medical Licensure Compact — CME and renewal in each state

The Interstate Medical Licensure Compact (IMLC) is the fastest route for many physicians to add licenses in other states. The Compact Commission calls it "a voluntary, expedited pathway to state licensure for physicians who want to practice medicine in multiple states." What it does not do is give you one license or one set of rules. Each state still issues its own license, and each license comes with that state's renewal date, fee and CME. This guide explains the parts that matter once you hold several.

What you get, and what you do not

Through the Compact you apply once, are qualified once, and then choose the member states you want licenses from. Each state issues its own license. The Commission's FAQ is explicit that physicians do not receive a "Compact license" or a nationally recognized license.

More than half of U.S. states, the District of Columbia and Guam take part. Some issue licenses but cannot serve as your principal state, and some have passed the Compact but are still implementing it. The Commission's participating-states map shows the current status.

Who qualifies

From the Commission's FAQ, you need:

• a full, unrestricted license in a member state that serves as your State of Principal License (SPL). The SPL must be a state where you live, do at least 25% of your practice, are employed by an entity located there, or file federal income taxes as a resident. You must keep SPL status at all times;
• graduation from an accredited medical school (or one listed in the International Medical Education Directory) and ACGME- or AOA-accredited graduate medical education;
• each component of the USMLE or COMLEX-USA (or an accepted equivalent) passed within three attempts;
• current specialty certification, or time-unlimited certification, from an ABMS or AOA board. Maintenance of Certification is not required to apply;
• no history of discipline or controlled substance actions against a medical license, no criminal history, and no current investigation.

What it costs

All fees are non-refundable. The Letter of Qualification is valid for 365 days with no waivers; after that, adding a state means a new application and a new fee.

CME: every state's rules still apply

This is the point most physicians miss. Section 7 of the Compact, as each member state enacts it (for example West Virginia Code §30-1C-7 and Delaware Code title 24 §1707A), says physicians "shall comply with all continuing professional development or continuing medical education requirements for renewal of a license issued by a member state."

In practice that means, for each license:

• its own hours and cycle. One state may want 25 hours every year, another 40 every two years, another 150 every three;
• its own required topics. A course on one state's opioid or medical-errors requirement may not meet another state's version;
• its own accepted credit types, especially for DO licenses;
• its own deadline. Your licenses will not expire on the same day.

National CME often counts in several states at once, so the hours overlap more than the topics do. The work is keeping each state's list straight.

Renewing a Compact license

Licenses you obtained through the Compact renew through the Compact's website, with the state's renewal fee, the $25 Compact fee and an attestation for each license you renew. You do not need a current Letter of Qualification to renew.

Some states add a step of their own, and the windows change. The Compact's renewal page lists them; as of October 2026, for example:

• Florida: a two-step process: wait for renewal instructions emailed by the Florida Department of Health, then return to the Compact renewal page. Florida's windows open and close by cycle, so check the Compact page for the current one.
• Ohio: submit through the Compact, then finish in Ohio's eLicense Center when the Board sends instructions.
• Maryland: submit through the Compact, then complete the Board of Physicians renewal; a Maryland license expires if both steps are not done. A lapsed Maryland license is reinstated through Maryland, not the Compact.
• Vermont: also renew with the Office of Professional Regulation and upload the Compact renewal document.
• Washington: return the physician demographic census to the Washington Medical Commission.
• Alabama (from the Alabama Board's renewal page): renew a Compact-issued license on the Compact's site, not in the Board's Licensee Gateway; if you also hold an Alabama Controlled Substances Certificate, renew the license first, then the certificate with the Board.

To renew through the Compact, section 7 also requires that you still hold a full, unrestricted license in a state of principal license, have no convictions or similar dispositions, have no license under discipline (other than for nonpayment of fees), and have not had a state or DEA controlled substance license or permit suspended or revoked.

Things the Compact does not cover

• DEA registration: DEA requires a separate registration for each principal place of practice, and its exception for prescribing-only offices covers only offices in the same state as your registration (21 CFR 1301.12). Plan on a DEA registration in each state where you prescribe controlled substances, and confirm with DEA for your setup.
• State controlled substance registrations, where a state requires one.
• Hospital privileges and payer enrollment in each new state.

Keeping several licenses straight

Each state guide lists that state's hours, topics and deadline with its sources, for example Florida MD, Texas and Pennsylvania. The renewal planner puts every license, its own deadline and its open topics in one list, so a course you take once is counted everywhere it applies.

This guide was checked against the Compact Commission's pages and the Compact's statutory text in October 2026. Each member state's board makes the final call on its own license; confirm with the Board of every state you hold a license in.