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Understanding the Medical Licensure Compact

Background Information

Compact Overview Webinar

Medical Boards Explore Licensure Compact


At the April 2013 Federation of State Medical Boards (FSMB) Annual Meeting, the House of Delegates unanimously passed Resolution 13-5: Development of an Interstate Compact to Expedite Medical Licensure and Facilitate Multi-State Practice, directing the FSMB to convene representatives from state medical boards and special experts to explore the formation of an Interstate Compact to enhance license portability.  Organized by the FSMB in 2013, a team of state medical board representatives and experts from the Council of State Governments (CSG) ) developed and drafted a framework for an Interstate Medical Licensure Compact — a new licensing option under which qualified physicians seeking to practice in multiple states would be eligible for expedited licensure in all states participating in the Compact.


State medical boards representatives from a diverse collection of states, in terms of population, size, and geographic region, worked in conjunction with compact experts from CSG and FSMB staff to define the component principles that guided the subcommittee tasked with creating a draft compact. 


The full list of eight consensus principles included:


•      Participation in an interstate compact for medical licensure will be strictly voluntary for both physicians and state boards of medicine.


•             Participation in an interstate compact creates another pathway for licensure, but does not otherwise change a state’s existing Medical Practice Act.


•             The practice of medicine occurs where the patient is located at the time of the physician-patient encounter, and therefore, requires the physician to be under the jurisdiction of the state medical board where the patient is located.


•             An interstate compact for medical licensure will establish a mechanism whereby any physician practicing in the state will be known by, and under the jurisdiction of, the state medical board where the practice occurs.


•             Regulatory authority will remain with the participating state medical boards, and will not be delegated to any entity that would administer a compact.


•             A physician practicing under an interstate compact is bound to comply with the statutes, rules and regulations of each compact state wherein he / she chooses to practice.


•             State boards participating in an interstate compact are required to share complaint / investigative information with each other.


•             The license to practice can be revoked by any or all of the compact states.


Development of the Compact


The drafting process for model legislation to create an Interstate Medical Licensure Compact has been completed. The model Compact can be found here. This document represents the culmination of the 18 month project undertaken by state medical boards, the FSMB, experts from the Council of State Governments, and interested stakeholder groups that explored the formation of an interstate compact to enhance medical license portability.

By 2015, state legislatures and medical boards will begin to consider the adoption of this model legislation to participate in the Interstate Medical Licensure Compact. Under the new proposed system, participating state medical boards would retain their licensing and disciplinary authority, but would agree to share information and processes essential to the licensing and regulation of physicians who practice across state borders. Participation in the Compact would be voluntary, for both states and physicians.

Support is growing among legislators and health policymakers for the Compact, which is expected to significantly reduce barriers to the process of gaining licensure in multiple states at a time when telemedicine is growing and millions of new patients are likely to enter into the U.S. health care system. Earlier this year, a bipartisan group of 16 U.S. Senators publicly commended the FSMB for its efforts. The Senate letter can be read here.

“The FSMB is pleased to have supported the state medical board community as it developed this compact to streamline licensure while maintaining patient protection as a top priority. We look forward to working with states that wish to implement this innovative new policy,” said Humayun J. Chaudhry, DO, MACP, president and CEO of FSMB.