The Effects of Interstate Licensure Compacts on Care Delivery

Interstate licensure compacts reduce barriers to practicing across state lines, but whether expanded licensure changes how physicians deliver care remains unclear. Leveraging staggered adoption of the Interstate Medical Licensure Compact (IMLC), I examine effects on physician licensure and care delivery. I find that adoption increases multi-state licensure, primarily through physicians adding a second state license. IMLC adoption is also associated with declines in outpatient visit volume and measured telehealth use, but little change in new patient share or average visit length. However, pre-treatment trends complicate interpretation of some estimates, and differences among multi-state physicians are sensitive to excluding those already licensed in multiple states before adoption. Overall, expanded licensure does not consistently translate into broader changes in observed care delivery.