State licensing for locum work.

How state licensing works

In the United States, clinical licenses are issued by the states. Each state's board (medical, nursing, or PA) decides who can practice there, what the scope of practice is, and how renewal works.

A license in one state doesn't carry over to another. Working in more than one state means holding a license in each, unless a compact applies.

The IMLC for physicians

The Interstate Medical Licensure Compact is an agreement among participating state medical boards. A physician who holds a full, unrestricted license in a member state applies once through that state, called the State of Principal License, and the other participating states the physician selects issue their licenses through an expedited process.

You still hold a separate license in each state. Eligibility turns on your State of Principal License, accredited medical school and residency training, passing each licensing exam component within three attempts, current board certification, and a record free of license discipline, criminal history, and controlled-substance actions.

The compact commission publishes the list of participating states.

The Nurse Licensure Compact for RNs

Registered nurses are licensed by each state's board of nursing. Under the Nurse Licensure Compact (NLC), an RN whose primary state of residence is a member state, and who meets the compact's licensure requirements, holds one multistate license and can practice in every other member state. The compact covers RN and LPN/VN licenses.

A state outside the compact requires its own license. The multistate license follows your primary state of residence, so a nurse who moves to a different compact state applies for a license there.

NPs and CRNAs

Nurse practitioners and CRNAs are advanced practice registered nurses (APRNs). Each holds an RN license, APRN licensure or authorization from the state board of nursing, and national certification, which for CRNAs is through the NBCRNA.

A multistate RN license under the NLC covers the RN license only. It doesn't cover APRN practice, so an NP or CRNA working in a second state needs that state's APRN license or authorization, and each state sets its own scope of practice.

The APRN Compact is a separate compact that some states have enacted. Whether it's operating, and whether your state takes part, is a question for your board of nursing.

PA licensing

PAs are licensed state by state, by a PA board or by a medical board, depending on the state. Working in a second state means applying to that state's board.

The PA Licensure Compact has been enacted by some states. Whether it's operating, and whether your state takes part, is a question for your state board.

Medical assistants

Most states don't license medical assistants. The usual credential is a national certification such as the CMA (AAMA), RMA (AMT), or CCMA (NHA). Some states set their own registration or training requirements, and what an MA may do is defined by state law and the supervising clinician.

Working in more than one state

Four things decide how a second state goes.

• Board processing timeEach board publishes its own processing times, and they vary widely. Check the board's current estimate before you count on a start date in a new state.
• Compact eligibilityIf a compact covers your license, its member states are open to you through the compact. Every other state is a separate application.
• DocumentsBoards ask for many of the same core documents credentialing does, so keeping them together means you aren't hunting for them twice.
• RenewalsMore licenses means more renewals, each on its own state's cycle.

What this guide is not

This guide explains how licensing generally works. It isn't legal advice. Rules, compact membership, and eligibility criteria change, and your state board is the authority on any specific license.