Telehealth Solved Distance. Licensure Re-Created It.
Telehealth was supposed to make geography irrelevant to care. For the patient, it largely has — a specialist three states away is now a video call. For the physician, geography came roaring back through a different door: licensure.
A physician can deliver care across the country technologically and still be barred from doing so legally, because most licensure is tied to the patient's state, not the physician's competence. The technology erased distance. The regulatory framework rebuilt it.
This is the central unfinished business of telehealth policy. Temporary cross-state flexibilities expanded access during the public health emergency, and much of that ground has since been ceded back. The compact helps, but compact membership and telehealth-specific licensure are not the same thing, and the patchwork that remains is genuinely confusing for physicians trying to do the right thing.
PLG's position: telehealth licensure should be resolved as a workforce-and-access question, not a turf question. We track the state-by-state rules, advise physicians on where they can lawfully practice, and push for frameworks that let the technology do what it was built to do.
The Holdout States Are Running Out of Reasons
When most states have adopted the Interstate Medical Licensure Compact and a handful have not, the holdouts owe their physicians and patients an explanation. The usual one — protecting the integrity of the state's medical board — no longer holds up. The compact does not weaken board authority. It streamlines verification for physicians who are already fully licensed and in good standing elsewhere.
So what is actually keeping the remaining states out? Usually some combination of legislative inertia, fee-structure concerns, and a general reluctance to cede any piece of a state-run process. None of those are reasons. They are obstacles, and obstacles can be moved.
The cost of staying out is real. Holdout states make themselves harder to staff, slower to fill shortage areas, and less attractive to the exact telehealth and locum physicians who could close gaps fastest.
PLG tracks compact adoption bill by bill and makes the case to the holdouts in terms their legislatures respond to: workforce, access, and competitiveness. If your state is on the outside of the map, there is a path in — and it runs through the statehouse.
Care Should Follow the Patient, Not the State Line
A physician licensed in one state is, in the eyes of the next state's medical board, often a stranger. That made sense when medicine was local. It makes far less sense in an era of telehealth, traveling specialists, and patients who cross state lines for care without thinking twice about it.
The result is friction that costs nobody's health and everybody's time. A qualified physician sits idle during a months-long licensure process while patients in a shortage county wait. Multiply that by every credentialing queue in the country.
The Interstate Medical Licensure Compact exists to ease exactly this. Adoption has spread to the large majority of states, which means the holdouts are increasingly conspicuous — and increasingly hard to defend.
PLG's view: licensure portability is not a convenience for physicians, it is access for patients. Care should follow the patient, not the state line. We work on the compact, on telehealth licensure, and on the credentialing reforms that let physicians practice where they're actually needed, rather than where a decades-old map says they may.