How to Get Your IMLC Letter of Qualification: A Physician's Step-by-Step Guide

An IMLC Letter of Qualification (LOQ) is the document your State of Principal License issues to confirm you qualify to use the Interstate Medical Licensure Compact. It is not a medical license itself. It is the credential that unlocks an expedited path to licensure in dozens of participating states, so you can apply once and obtain licenses in multiple states without starting a separate application with each medical board.

If you are a physician exploring locum tenens, telemedicine, or a move to a new state, this guide explains what the LOQ is, whether you qualify, how to obtain one step by step, what it costs, how long it takes, and what to do once it is in hand. In physician licensing, “Letter of Qualification” refers specifically to this IMLC document, and it differs from documents of the same name used in estate administration or employment.

Quick Facts: The IMLC Letter of Qualification

• The LOQ is issued by your State of Principal License (SPL) and confirms you are eligible to use the Compact. It is not a license on its own.
• One qualified physician, one expedited process: the LOQ lets you obtain licenses in participating states without applying to each board separately.
• The IMLC includes more than 40 states plus the District of Columbia and Guam, and the list continues to grow. Confirm current members on the official IMLC map before you plan.
• The IMLC application fee is $700 and is non-refundable.
• An LOQ is valid for 365 days, and you can add states at any point during that window.
• Most physicians who hold a full, unrestricted license in a member state qualify.
• The IMLC is a pathway for physicians (MD and DO). Advanced practitioners use separate licensure pathways.

What Is an IMLC Letter of Qualification (LOQ)?

A Letter of Qualification is the document the Interstate Medical Licensure Compact uses to certify that a physician meets the Compact’s eligibility standards. Your State of Principal License reviews your credentials, and if you qualify, it issues the LOQ to the Compact on your behalf. From there, you can request full licenses in any participating state you choose.

The LOQ Is Not a Medical License

The LOQ does not let you practice anywhere by itself. It is a verification step, not a license. Once your LOQ is issued, each state you select still grants its own full, individual medical license, the Compact simply makes obtaining those licenses faster. Physicians who expect the LOQ to function as a single national license are the most common source of confusion, so it is worth stating plainly: the IMLC produces separate state licenses, issued quickly, not one license that covers every state.

How the LOQ Fits Into the Compact

The Interstate Medical Licensure Compact is an agreement among participating states to streamline licensure for qualified physicians. The LOQ is the gateway document within that system. You designate one member state as your State of Principal License, that state verifies your eligibility once, and the resulting LOQ travels with you as you request licenses elsewhere. For the full legislative background and the current member map, see the official Interstate Medical Licensure Compact site at imlcc.com.

Do You Qualify? IMLC Eligibility for Physicians

Most physicians who hold a full, unrestricted license in a Compact member state meet the IMLC’s eligibility standards. The Compact applies a single, high bar, and qualification comes down to two things: a State of Principal License that meets the criteria, and a clean professional record that satisfies the general requirements below.

Designating a State of Principal License (SPL)

Your State of Principal License is your entry point into the Compact. To use a state as your SPL, you must hold a full, unrestricted medical license there, and the state must meet at least one of these four criteria:

• It is your primary state of residence.
• At least 25% of your medical practice occurs there.
• Your employer is located there.
• It is the state you use for federal income tax purposes.

You must maintain a qualifying SPL while you hold your LOQ, though you can redesignate your SPL later if your circumstances change.

General Eligibility Requirements

Beyond the SPL, the Compact requires that you:

• Graduated from an accredited medical school, or one listed in the International Medical Education Directory.
• Completed graduate medical education accredited by the ACGME or AOA.
• Passed the USMLE, COMLEX-USA, or an accepted predecessor exam within three attempts per component. The Canadian LMCC is not accepted.
• Hold a current, or time-unlimited, specialty certification from an ABMS or AOA member board.
• Have no history of disciplinary action, criminal history, or controlled-substance actions against your license, and are not currently under investigation.

SPL Exceptions to Know

Some member states issue licenses through the Compact but cannot serve as a State of Principal License. Hawaii and Vermont fall into this category, which means you can obtain a license in those states through the Compact but cannot use them as your entry point. Because participation details change, confirm the current SPL-eligible list on imlcc.com before you designate yours.

How to Get Your Letter of Qualification, Step by Step

Obtaining your LOQ is a defined, six-step process managed through the Compact and your State of Principal License.

1. Confirm your eligibility. Review the SPL and general requirements above before you begin. Compact fees are non-refundable, so it is worth verifying you qualify first.
2. Start your application and designate your SPL. Create your account through the Compact and select the member state that will serve as your State of Principal License.
3. Complete the application and pay the $700 fee. Submit your application to your SPL’s medical board along with the non-refundable application fee.
4. Complete fingerprinting and a national background check. This is a required step in verifying your record.
5. Wait for SPL verification. Your SPL board verifies your credentials and eligibility. Allow several weeks for this stage.
6. Receive your LOQ. Once approved, your Letter of Qualification is issued and is valid for 365 days. You can now request licenses in the participating states you choose.

How Long Does It Take to Get an LOQ?

Most physicians receive their LOQ within several weeks of applying, and individual state licenses follow quickly after that. The timeline below shows the typical path. The single biggest variable is SPL verification, so if you have a target assignment start date, begin the process early and build in buffer time.

Stage	What Happens	Typical Time
Application and SPL designation	You apply and select your State of Principal License	1 to 2 days
Fingerprinting and background check	You complete the required national background check	1 to 2 weeks
SPL verification	Your SPL board verifies credentials and eligibility	Several weeks
LOQ issuance	Your Letter of Qualification is issued, valid 365 days	After verification
State license issuance	Each selected state issues a full license after payment	Often a few business days

Note: Timelines vary by state and by individual circumstances. Confirm current processing details with your SPL board.

What Does the IMLC Cost? Full Fee Breakdown

The IMLC application fee is $700, but the total cost depends on how many states you ultimately license in. The $700 covers the Compact application and the LOQ. Each state license carries its own separate fee, and a few additional costs apply.

Item	Amount	Notes
IMLC application fee	$700	Non-refundable; covers the LOQ
Fingerprinting and background check	Varies	Required step
Per-state license fee	Varies by state	Charged by each state you license in
Add-states handling fee	$100	To add states later, within your LOQ’s validity
Renewal fees	Varies	Ongoing, per state

As an example, a physician obtaining licenses in three states would pay the $700 application fee plus fingerprinting, plus each of the three states’ individual license fees. Because all Compact fees are non-refundable, confirm your eligibility before you pay.

Documents to Gather Before You Apply

Missing documents are the most common cause of delay. Having these ready before you start keeps your application moving:

• Your active, unrestricted license in your State of Principal License
• Medical school details and graduation information
• Graduate medical education and residency information
• Your USMLE or COMLEX-USA examination history
• Current board certification
• Government-issued identification
• Proof supporting your SPL (residence, practice percentage, employer, or tax residence)

Common Reasons Physicians Are Found Ineligible (and How to Avoid Them)

The IMLC sets a deliberately high bar, and most physicians clear it. A small number of issues account for most denials, and knowing them in advance helps you avoid a non-refundable application that will not be approved.

• More than three attempts on a USMLE or COMLEX-USA component. The Compact’s three-attempt limit is firm. If this applies to you, traditional state-by-state licensure may be the better route.
• Reliance on the Canadian LMCC. The LMCC is not an accepted examination for the Compact. You will need USMLE or COMLEX-USA.
• Graduate medical education that is not ACGME or AOA accredited. International or non-accredited GME does not satisfy the requirement.
• Prior discipline or an open investigation. Any disciplinary action, or an active investigation at the time you apply, makes you ineligible.
• A lapsed or restricted SPL license. Your State of Principal License must be full and unrestricted, and you must maintain it while you hold your LOQ.

After Your LOQ Is Issued: Selecting States and Managing Licenses

Once your LOQ is issued, the slow part is behind you. The Letter of Qualification is your standing credential within the Compact for the next 365 days, and the steps below are fast by comparison.

Selecting States and Paying Per-State Fees

You can request licenses in as many participating states as you need, and you can apply to multiple states at once. Each state issues its own full license after you pay its individual fee, often within a few business days.

Your LOQ Is Valid for 365 Days

Your Letter of Qualification stays active for one year. During that window you can add states as new opportunities come up, for a $100 handling fee each time, without restarting the process.

Re-Applying After Expiration

If your LOQ expires, adding states later requires a new application, including the $700 fee and fingerprinting again. If you anticipate ongoing multistate work, it is worth tracking your expiration date.

Renewals and Staying Compliant

Each state license you hold renews on its own schedule, and you remain responsible for keeping every license current. If your circumstances change, you can redesignate your State of Principal License through the Compact.

Is the IMLC Right for You?

The Compact is built for physicians who practice, or want to practice, across more than one state. It fits three situations especially well. Locum tenens physicians use it to take assignments in multiple states without a separate months-long licensing process for each. Telemedicine providers use it to treat patients across state lines, since care is regulated where the patient is located. And physicians relocating or expanding their practice use it to get licensed in a new state quickly. If you expect to practice in only one state for the foreseeable future, traditional licensure may be all you need.

How All Star Healthcare Solutions Supports Your Multistate Licensing

Getting licensed is one step. Putting that license to work, across the right assignments, at the right compensation, is where it pays off. For more than two decades, All Star Healthcare Solutions has placed physicians and advanced practitioners across 85 specialties in all 50 states, and licensing support is built into how we work.

Comprehensive Credentialing and Licensing Support

We manage the credentialing process from start to finish, handling document collection, primary source verification, and direct communication with facility credentialing offices. We coordinate Interstate Medical Licensure Compact filings for eligible physicians and manage state-by-state licensing for physicians outside IMLC scope, removing a substantial administrative burden from your side. All Star also covers licensing costs as part of the assignment.

A Dedicated, Specialty-Focused Consultant

You work with a consultant who knows your specialty, your market, and the licensing pathway that fits your situation, not a generalist managing a mixed caseload. Your consultant stays your advocate from the first conversation through the end of every assignment.

Access to Opportunities Once You’re Licensed

Our network spans more than 150 hospital systems and more than 1,600 healthcare facilities nationwide, from critical access hospitals to academic centers and telehealth roles, so the license you earn opens real, current opportunities.

All Star is a NALTO member and a ClearlyRated 2026 Best of Staffing award winner, with a 99.5% rematch rate that reflects how often providers choose to work with us again.

Ready to Put Your Multistate License to Work?

Whether you are starting the IMLC process, weighing whether it fits your goals, or already licensed and looking for your next assignment, All Star Healthcare Solutions can help. Our specialty-focused consultants understand the licensing pathways, the credentialing timelines, and the assignments available in your specialty and preferred states.

Frequently Asked Questions About the IMLC Letter of Qualification

What Does LOQ Mean in Medical Terms?

In medical licensing, LOQ stands for Letter of Qualification. It is the document issued by your State of Principal License confirming that you meet the Interstate Medical Licensure Compact’s eligibility standards. It is the first credential you obtain in the Compact process, and it lets you request expedited licenses in participating states.

Is the Letter of Qualification a Medical License?

No. The Letter of Qualification is a verification document, not a license to practice. It confirms you are eligible to use the Compact. Each participating state you select then issues its own full, individual medical license.

How Long Is an IMLC Letter of Qualification Valid?

An LOQ is valid for 365 days from issuance. During that year, you can add new states for a $100 handling fee each time without restarting the process (as of June 2026). After it expires, adding states requires a new application and the $700 fee again.

How Long Does It Take to Get an LOQ?

Most physicians receive their LOQ within several weeks of applying, with SPL verification being the longest stage. Once your LOQ is issued, individual states often grant their licenses within a few business days of payment. If you have a target start date, begin early and allow buffer time.

How Much Does the IMLC Cost?

The IMLC application fee is $700 and is non-refundable. Beyond that, you pay fingerprinting costs, a separate license fee for each state you license in, and a $100 handling fee to add states later. Confirm your eligibility before paying, since Compact fees are not refundable.

How Many States Participate in the IMLC?

The Compact includes more than 40 states plus the District of Columbia and Guam, and the list continues to grow as more states adopt the legislation. Because participation changes regularly, check the official IMLC map at imlcc.com for the current members.

Can I Apply for Licenses in Multiple States at Once?

Yes. Once your LOQ is issued, you can request licenses in as many participating states as you need, at the same time. Each state issues its own full license after you pay its individual fee.

What Happens When My LOQ Expires?

Your LOQ is valid for 365 days. The state licenses you already obtained remain valid on their own renewal schedules, but to add new states after your LOQ expires, you must submit a new application, including the $700 fee and fingerprinting.

Data Sources

• Interstate Medical Licensure Compact Commission (imlcc.com)
• Federation of State Medical Boards (FSMB)