Individual state legislatures and the District of Columbia have traditionally determined the licensure requirements for professionals to practice in their jurisdiction. As a result, there is an inherent lack of uniformity of requirements across the country.

The requirements, while arguably necessary to ensure the public's health and safety, can nonetheless be quite burdensome. For a North Carolina military spouse who needs to relocate swiftly and apply for a new license, or a telehealth practitioner who must amass multiple licenses to practice in each desired state, including North Carolina, the cost, required documents, and application to licensure administrative time of this process can be difficult to navigate.

Recent healthcare workforce shortages and the global pandemic made clear the need to lessen the burden of licensing practitioners to ensure access to quality healthcare. As a result, initiatives for lessening the burden of license mobility and portability for healthcare workers took off in the months since the beginning of the COVID-19 pandemic when the country's need for a mobile workforce became dire.

While there is not a one-size-fits-all approach, a few key avenues have proven effective in easing the burden on North Carolina licensed professionals. The most popular of these initiatives are interstate compacts and universal licensure recognition laws.

Interstate Compacts

Interstate Compacts are a creation of the Compacts Clause of the Constitution, whereby states are granted the authority to enter into interstate agreements to achieve a common purpose.

If you have a driver's license and have driven over your state line, you have benefited from a compact, The Driver License Compact. These agreements ensure that qualifications accepted in one state are recognized in other participating states and the practitioner only needs one license.

They also offer state regulators the ability to access a centralized licensure database of discipline records of licensees to assist their mission in public protection.

Licensure compacts offer several benefits, particularly for North Carolina healthcare professionals who need to practice across state lines or relocate quickly.

Here are three key advantages of Interstate Compacts:

Increased Mobility: Licensure compacts allow professionals to practice in multiple states without needing to obtain separate licenses for each state. This is especially beneficial for highly mobile populations, such as military spouses and telehealth providers.

Reduced Costs and Streamlined Processes: By holding a multistate license, professionals can save on the costs and administrative burdens associated with obtaining and maintaining multiple single-state licenses.

Enhanced Access to Care: For healthcare professionals, licensure compacts can improve access to care by allowing them to provide services in more locations. This is particularly important in addressing healthcare shortages and ensuring patients receive timely care.

In the healthcare arena, compacts that are making a significant dent in access to care include:

• The Nurse Licensure Compact (NLC)
• The Interstate Medical Licensure Compact (IMLC)
• The Physical Therapy Compact (PTC)
• Emergency Medical Technicians Compact (REPLICA)
• Psychologist Interstate Compact (PsyPact)
• PA Licensure Compact (PA Compact)
• Interstate Counseling Compact (Counseling Compact)
• Audiology & Speech Language Pathology Interstate Compact (ASLP-IC)
• Social Work Licensure Compact

North Carolina currently participates in the NLC, PTC, PsyPact, Counseling Compact, and ASLP-IC.

Universal License Recognition

Another avenue receiving praise for improving licensure mobility is the adoption of universal license recognition (ULR) laws.

These laws provide states the ability to retain authority over the determination of licensure in their state and the benefit of continued revenue from initial application and renewal while also enabling them to license practitioners from other states more quickly.

Generally, the ULR allows the state to license a practitioner who already holds a license in good standing in another state.

The downside to ULR, however, is they do not offer mutual recognition as found in interstate compacts or instantaneous recognition as found with reciprocity. Regardless, they do lead to faster processing time from application to licensure.

In 2017, the North Carolina General Assembly passed legislation to assist military-trained individuals and military spouses with licensure mobility. However, excepted from this legislation, were the practices of law and medicine.

Navigating Relocation and Telehealth

Practitioners who are military spouses, practice in telehealth, or just need to relocate should pay close attention to the requirements of licensure in the state in which they intend to practice.

Strict adherence to the requirements of state licensing boards for the ability to practice in a state is of utmost importance. Failure to do so could result in disciplinary action, lead to payment problems, and result in civil or even criminal liability.