America has a shortage of healthcare workers, and patients are paying the price. Many communities, especially in rural areas, do not have enough doctors, registered nurses (RNs), and advanced practice registered nurses (APRNs) to meet basic healthcare needs. Providers cluster in urban markets while rural communities are left with too few options. Interstate licensure compacts can help fix that. By making it easier for qualified clinicians to practice across state lines, especially through telemedicine, compacts bring care to patients instead of pretending thousands of providers will suddenly pick up and move. Interstate medical licensure compacts are a cost-reducing, competition-enhancing reform that can expand supply and improve access without spending another taxpayer dollar.
Healthcare licensing is still structured as if patients never move, never travel, and never use remote care. A provider licensed and in good standing in one state can still face duplicative approval requirements just to treat a patient in another, even when the care could be delivered safely and efficiently. Those rules do not protect patients nearly as much as they protect incumbents. They restrict choice, suppress competition, and keep provider supply artificially low. Rural and underserved areas pay the highest price because they already have fewer physicians in general and fewer specialists in particular.
Interstate compacts lower the cost of practicing in multiple states, making it easier for providers to reach patients wherever they are. That means more remote care from clinicians based in urban areas and more options for patients in places that lack local providers. It also means more competition. Providers in crowded urban markets would have to compete harder on responsiveness, quality, and price, while patients in rural areas would no longer be stuck with whatever limited options happen to exist nearby.
Compacts also cut redundant applications, fees, and administrative hurdles. That matters most for independent providers and smaller practices, which are less able than large health systems to absorb pointless regulatory costs. By removing artificial limits on who can provide care, compacts allow the healthcare system to make better use of the workers it already has. That expands supply immediately by letting clinicians serve patients in the places they are needed most.
Healthcare should function like an open national market, not a collection of protected state fiefdoms. The principle should be simple: if a provider is licensed and in good standing in one state, that should usually be enough to serve patients in another. Interstate compacts preserve state authority over safety rules within each state’s borders. Providers still have to follow the rules of the state where the patient is located. Compacts simply reduce the duplicative barriers that block care for no good reason.
If state legislatures want a fast, low-cost way to expand access, increase choice, and put downward pressure on healthcare costs, interstate licensure compacts are an obvious place to start. Physician and RN compacts have already been adopted by most states, proving this reform is both practical and politically achievable. Yet there is still no active compact for APRNs, even though nurse practitioners and other advanced practice nurses play a vital role in routine and primary care. States that have not yet joined physician and RN compacts should do so. They should also work together to adopt an APRN compact with minimal burdens on licensed practitioners so patients can benefit from a broader pool of caregivers.
Consumers benefit when policy puts their needs ahead of provider geography. Patients need access to a broader pool of clinicians, especially in rural communities. People who move, travel, attend college out of state, or live near a border often want to keep seeing the same doctor or nurse practitioner. They should be able to. Interstate compacts are one of the simplest deregulatory reforms available. They expand access, strengthen competition, and make it easier for patients to get and keep the care they want.
Justin Leventhal is a senior policy analyst for the American Consumer Institute, a nonprofit education and research organization that advocates for consumers through evidence-based analysis and data. Visit www.TheAmericanConsumer.Org or follow us on X @ConsumerPal.
