The Nurse Licensure Compact began operating in 2000 and needed about twenty-five years, including a wholesale relaunch in 2018, to reach its current membership. That arc is the realistic benchmark for how long any newly proposed compact would take.
When someone argues that marriage and family therapists should have pushed for a compact instead of a model law, the nursing example is usually the evidence offered. It does prove that compacts work. It also shows exactly what they cost in time, and the second lesson is the one that tends to get skipped.
The actual arc
The Nurse Licensure Compact went live in 2000. It grew, then stalled. By the middle of the 2010s it had reached a point where its uniform requirements were considered too weak for several large states to join, which left the agreement covering a substantial part of the country but missing some of the biggest nursing workforces in it.
The answer was to rewrite the agreement. An enhanced version took effect in 2018 with tighter standards, including uniform background-check requirements. States already party to the original compact had to pass the new text to stay in. Some did so promptly. Others took years.
It is now the largest healthcare licensure compact in the country and it works well. Getting there took a quarter of a century and one full restart.
Why nursing had advantages this profession does not
Three things worked in nursing's favor, and it is worth being honest that marriage and family therapy has none of them at the same strength.
Scale came first. Nursing is one of the largest licensed professions in the country, which means legislative attention, staff capacity at the boards, and a lobbying presence in every state capital. Second, nursing regulation is comparatively uniform: most states license registered nurses through a dedicated board with recognizably similar standards, so the negotiation started from a narrower gap. Third, and probably decisive, hospital systems and staffing agencies wanted it badly, because they move nurses across state lines constantly and were paying for the friction.
Marriage and family therapists are a much smaller profession, regulated in many states by composite boards shared with counselors and social workers, and employed largely in small practices with no institutional lobby pressing legislators on portability.
What that implies for a profession starting now
A compact that began drafting in 2025 would plausibly issue its first privileges somewhere in the 2030s and reach a useful footprint later than that. Every therapist needing to practice across a state line between now and then would be doing what they do today, which is applying for a license in each state.
Seventeen states changed their endorsement statutes in roughly the time a new compact would have spent on drafting alone. Whatever else can be said for or against the model-law route, it has produced usable change inside two years, and that comparison is the strongest argument in its favor.
The lesson worth taking
Do not treat any announced portability initiative as something to wait for. Nursing's own members spent the early 2000s being told the compact would soon make their second license unnecessary, and for many of them in many states, it did not for another fifteen years.
Plan against the rules in force in the states you actually want, and treat any future improvement as a bonus rather than a schedule.
Common questions
- Why compare marriage and family therapy to nursing?
- Because nursing has the longest-running healthcare compact in the country, so its history is the only genuinely long-run evidence about how these agreements spread and what slows them down.
- Did the nursing compact really need a relaunch?
- Yes. An enhanced version took effect in 2018 with stricter uniform requirements, and states already in the original agreement had to enact the new text to remain members.
- What made it work in the end?
- A very large profession, a single dominant regulator model, and sustained pressure from employers who staff across state lines. Marriage and family therapy has none of those three advantages at the same scale.
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