Physicians licensed in one state cannot treat a patient who crosses a state line, even mid-treatment, and the Interstate Medical Licensure Compact covers only 40 states

A physician licensed in California who has been treating a patient for years via telemedicine cannot legally continue that care if the patient moves to -- or is even temporarily visiting -- a state where the physician is not licensed. The patient must find a new provider in their new state, re-establish care, repeat intake assessments, and hope their medical records transfer cleanly. For a cancer patient receiving ongoing chemotherapy management, a transplant patient in post-operative follow-up, or a psychiatric patient on a carefully titrated medication regimen, this disruption is not an inconvenience -- it is medically dangerous. The Interstate Medical Licensure Compact (IMLC) was created to address this, but as of 2025, only 40 states participate. Ten states and several territories remain outside the compact, and even within participating states, the IMLC merely expedites the licensing process -- physicians must still pay fees, submit applications, and wait for each additional state license. The practical burden on physicians is enormous. A telehealth-focused psychiatrist who wants to treat patients in all 50 states would need to obtain and maintain 50 separate medical licenses, each with its own renewal schedule, continuing education requirements, and fees. The average cost of a state medical license ranges from $200 to $1,000, and maintenance requires compliance with state-specific CME requirements that vary in hours, topic mandates, and reporting formats. For small practices and solo telehealth providers, the administrative burden of multi-state licensing is prohibitive, which means they limit their patient panel to one or two states and turn away patients from everywhere else. The patients turned away are often those who sought out telehealth specifically because they could not find a specialist locally. This problem persists because medical licensing is a state-level function rooted in the 10th Amendment police power, and state medical boards are reluctant to cede authority to interstate compacts. Each state board generates revenue from licensing fees and has a bureaucratic interest in maintaining its gatekeeping role. The IMLC represents a voluntary compact, not a federal mandate, so states that object on sovereignty grounds or that have strong physician lobbies opposed to out-of-state competition can simply decline to join. Federal legislation to mandate interstate telemedicine licensing has been proposed repeatedly (most recently the CONNECT for Health Act) but has never passed, because it triggers opposition from both state-rights advocates and medical board associations who frame it as a patient safety issue.