While a virtual doctor visit might feel borderless, medical board authority stops right at the state line. According to an analysis released by Scottsdale-based telehealth platform Promise, physician licensing rules still depend entirely on where the patient is physically sitting during a consultation, rather than where the doctor or the company is based.
Drawing on data from the Federation of State Medical Boards, the American Medical Association, and the Center for Connected Health Policy, the report breaks down the regulatory frameworks governing cross-state digital care and highlights key steps patients should take before receiving treatment.
Under the longstanding FSMB model policy, a doctor must hold a license or official authorization from the medical board in the state where the patient is located at the exact time of the appointment.
To keep up with soaring demand for virtual appointments, states created the Interstate Medical Licensure Compact to streamline multi-state licensing.
Data from the Interstate Medical Licensure Compact Commission shows rapid adoption of the system. In March 2026 alone, the compact issued 3,633 physician licenses, compared to just three during its first month of operation in April 2017. More than 200,000 total licenses have been processed through the pathway to date.
The footprint continues to expand. On June 26, 2026, Alaska officially became the 44th member state, bringing the compact’s total jurisdiction count to 46 when including Washington, D.C., and Guam. According to the AMA, physicians completed nearly 11,000 applications for the compact’s qualifying credentials between April 2025 and March 2026.
The IMLC is one of several systems facilitating cross-border care. According to the Center for Connected Health Policy’s Fall 2025 report, 13 distinct interstate compacts now cover various healthcare professions, while 18 states, along with Puerto Rico and the U.S. Virgin Islands, offer specialized telehealth registrations as alternatives to standard in-state medical licenses.
Because six states remain outside the primary medical compact, authorization rules still vary by location. The report notes that patients should verify three details before starting virtual care: ensuring a licensed physician reviews the case prior to any prescription decisions, confirming that the clinician holds active authorization in the patient’s state, and checking that the platform clearly outlines how it meets local medical board regulations.
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