illustration of file of state medical licenses

Embarking on a locum tenens career offers exciting opportunities for physicians, physician assistants, and nurse practitioners to gain diverse experiences and flexibility in their work. However, one of the initial hurdles many face is navigating the complex process of obtaining licenses in multiple states. This can feel overwhelming, especially for those just starting.

In this article, we’ll provide practical tips and strategies to streamline the licensing process for locum tenens, helping you focus on what truly matters — delivering quality care to patients nationwide.

The licensing process: An overview

infographic explaining what documents doctors need to obtain a state license

The medical licensing process begins with completing the state application and submitting any required documents, such as copies of your diploma, postgraduate training certificates, notarized forms, and background checks. The application will outline precisely what is needed. Be sure to complete the application as thoroughly and accurately as possible to avoid delays.

Once the application is completed and submitted to the state medical board, the next step is to obtain all necessary direct source verifications. These typically include exam scores, verification of all state licenses, medical school and postgraduate training verifications, and possibly employment verifications, references, or board certifications, depending on the state. The applicant must contact these sources and ensure that the verifications are sent to the medical board.

Once the board has received the completed application and all verifications, it enters a review process, after which the license is issued.

Read licensing tips from the pros? Tips from locum tenens doctors

When should you start the licensing process?

infographic saying rule of thumb allow 90 days for licensing

A general rule of thumb is to allow 90 days for licensing before starting an assignment. However, the time required to obtain a license can vary widely from state to state, depending on the speed of the licensing board and the complexity of the application — ranging anywhere from one week to six months.

While most licensing boards provide estimated time frames on their websites, experienced locums recommend calling the board directly for a more accurate estimate.

What costs are involved?

graphic explaining that the cost of obtaining state licensing is relatively expensive

The cost of obtaining and maintaining multiple state medical licenses can be significant, with fees varying widely by state. For instance, while a license in Wisconsin may cost around $140, an initial license in California can be upwards of $1,300.

Additional expenses may include the Federation Credentials Verification Service (FCVS) application, DEA registration, and each state’s Controlled Substance Registration, which requires renewal fees every few years. Licensing verification services and miscellaneous costs, such as fingerprinting and postage, add to the expense.

Typically, the provider is responsible for these costs, but locum tenens working with a reputable agency may have some of these expenses covered.

infographic with best practices for locum tenens licensing success

Avoiding common licensing pitfalls

Even small mistakes in the licensing process can significantly slow down the approval timeline.

infographic explaining one common error doctors make in licensing

One common error is incomplete or inaccurate information on the application, particularly with dates and time gaps in employment history. To avoid this, it's crucial to understand the licensing board's specific requirements, ensure all forms are fully completed, and avoid guessing any details.

Another frequent issue is failing to disclose past disciplinary actions, which can cause complications if discovered later.

For physicians who have been in practice for many years — especially surgeons — frequent handwashing can sometimes lead to worn fingerprints and difficulty completing the fingerprinting requirement for background checks. Plan for repeat attempts, if necessary, to avoid delays.

Above all, being thorough and proactive in gathering necessary information beforehand can prevent these setbacks.

Federation Credentials Verification Service

The Federation Credentials Verification Service (FCVS), provided by the Federation of State Medical Boards (FSMB), offers a fast and convenient solution for managing medical credentials.

The FCVS maintains a centralized repository of verified educational and training information, which can be efficiently shared with multiple state medical boards. This service is particularly valuable for locum tenens providers, as it simplifies the credentialing process by avoiding the need to repeatedly submit verification documents to each state board individually.

While 14 state licensing boards require FCVS, all medical boards recognize it for primary source verification. Utilizing FCVS can significantly expedite the licensing process and reduce administrative burdens for providers working across state lines.

Interstate Medical Licensure Compact (IMLC)

infographic explaining physicians must be licensed in each state they practice in

Physicians must be licensed in each state where they plan to practice, and typically, there is no automatic reciprocity between states. An exception to this is with states that participate in the Interstate Medical Licensure Compact, or IMLC.

The IMLC is an agreement among participating U.S. states and territories to streamline the licensing process for physicians who want to practice in multiple states. It offers an expedited pathway to licensure for physicians who qualify.

The first requirement for physicians to participate in the IMLC is to hold a full, unrestricted medical license in an IMLC member state that can serve as a declared State of Principal License (SPL). After verifying a physician’s eligibility for the Compact, the SPL shares this information with additional states where the physician wants to practice medicine. By expedited information-sharing, participating states can significantly speed up the licensure process.

The IMLC currently includes 40 states, the District of Columbia, and the Territory of Guam. Other states are also introducing legislation to adopt the Compact.

Locum tenens vs. permanent licensing: What sets them apart?

graphic saying licensing for locums is the same as licensing for perm positions

The licensing process for locum tenens positions is generally the same as for permanent positions, with states requiring the same application steps and verifications.

However, one key difference is the level of support you may receive if you work with a reputable locum tenens agency. These agencies often handle much of the licensing process for you, from managing paperwork to coordinating with licensing boards and primary sources for verifications. This support can make the process smoother and less time-consuming, allowing you to focus more on preparing for your assignment rather than navigating the licensing complexities on your own.

Want to learn more about telehealth? Here are your telehealth licensing answers (CHG Healthcare)

Telehealth licensing: What you need to know

Telehealth has become a highly cost-effective and popular complement to in-person care, addressing a wide range of patient needs. A recent survey found that 90% of Americans had a positive telehealth experience and favored it over in-person visits because of its convenience.

graphic about licensing if working telehealth as a locum tenens

Federal and state laws generally require healthcare providers to be licensed in both the state where they are located and the state where the patient is during a telehealth visit. For example, a provider in Washington treating a patient in Florida must be licensed in both states. However, many states offer cross-state licensing or telehealth-specific exceptions allowing out-of-state providers to deliver services if conditions are met. Understanding the telehealth licensing requirements for each state where you plan to practice is essential.

As with in-person locum tenens, the IMLC can streamline and simplify the licensing process for physicians providing telehealth services to hold licenses in multiple states.

Strategic license management: How and when to keep licenses active

infographic explaining that renewing licenses in multiple states is more streamlined

Renewing medical licenses in multiple states offers a quicker and more streamlined process than reapplying after a lapse. While you still need to cover renewal fees, the application process is generally shorter and less complex.

However, when managing multiple medical licenses, it’s essential to be strategic about which ones to keep active due to the renewal costs and continuing medical education (CME) requirements. If you are sure you won’t be practicing in a particular state, it may be reasonable to let that license lapse.

For states where renewal fees are high but the license is easy to reacquire, consider allowing those licenses to expire only if you're unlikely to need them in the near future.

Some states also offer the option to switch your license status from “active” to “inactive,” which exempts you from CME requirements, though you’ll still need to pay renewal fees.

Additionally, state-controlled substance registrations can be allowed to lapse without affecting your medical license and can typically be renewed quickly if needed.

Locum tenens licensing: Key tips and takeaways

Get organized

Keep electronic copies of all transcripts, certificates, and records and store them in one easy-to-access place.

Confirm the chronology

Ensure accurate dates for employment, graduation, training, and exam attempts to facilitate a smoother application process.

Streamline and consolidate

Apply for the FCVS and consider participating in the IMLC (depending on your state of primary licensure and intended states in which to practice) to streamline the licensing process.

Plan ahead

Allow adequate time for processing, including unexpected issues that may arise.

Keep current

Keep your licenses active and plan ahead for renewals.

Ask questions

Look to seasoned locums or a locum tenens agency for support, and don’t hesitate to reach out to the medical board directly with questions.

If you’re working with a locum tenens agency, most agencies have dedicated licensing and credentialing personnel to help manage the process. Agencies also typically have well-established relationships with medical boards, which can help facilitate the process and address questions as they arise.

While there is a lot to consider when managing medical licenses, good planning and supporting a reputable locum tenens agency can help the locum tenens licensing process go more smoothly.