Fueling telehealth’s rise, more doctors are licensed in all 50 states than ever before

STAT News – Tuesday, October 7, 2025
By Katie Palmer

Jonah Mink started racking up medical licenses during the Covid-19 pandemic. The family medicine doctor, who finished his residency at the University of Pennsylvania in 2016, was already working for a digital health company as the virus took root in the United States. But when doctors’ offices started shutting down, physicians like him saw the writing on the wall: Telehealth was the future.

At the end of 2019, Mink had licenses in just four states. Over the next three years, he accumulated 47 more — one for every state, plus the District of Columbia.

Just a decade ago, a doctor with multiple medical licenses was an anomaly. Sometimes physicians would apply for credentials from a few states if they lived near a border and wanted the flexibility to practice on either side, since a doctor needs to be licensed where their patient is physically located. In-demand specialists might get a few more if they wanted to see patients virtually. But in the years since Covid began driving patients online, the number of physicians seeking multi-state licensure has ballooned to support the growing field of telehealth.

Within that group, a STAT analysis of physician licenses shows that a small but powerful cohort of physicians is accumulating licenses in all 50 states, plus the nation’s capital and its territories. These physicians don’t max out on licenses just to practice across state lines. Often, they own the medical groups that are affiliated with nationwide telehealth companies. A doctor’s full roster of medical licenses can be leveraged for online businesses that provide specialty care, build patient funnels for pharma companies seeking to sell drugs directly to consumers, prescribe compounded meds — or sometimes, all of the above.

In 2016, just nine physicians in the U.S. held active licenses in all 50 states, according to data from the Federation of State Medical Boards. By 2024, 172 doctors had filled out their bingo card, and another 356 doctors had acquired at least 45 licenses — significantly outpacing the profession’s overall growth.

Mink’s licenses, for example, are deployed behind the scenes of multiple virtual care companies. He owns medical groups for his own company Beluga Health, which sells a plug-and-play, “white label” service to a variety of telehealth companies trying to get off the ground quickly. Its providers have been used by dozens of fledgling telehealth brands to prescribe controversial compounded versions of GLP-1 weight loss drugs.

At the same time, Mink’s licenses support platforms for patients to get competing FDA-approved drugs online. Up until this year, he owned the practice for virtual diabetes and weight loss clinic 9amHealth, one of just three telehealth companies that Zepbound-maker Eli Lilly links patients to through its direct-to-consumer site. As the drugmaker battles with telehealth companies prescribing compounded versions of its drugs, Mink’s medical groups have kept both prescription channels running.

9amHealth Chief Medical Officer Avantika Waring said the company was aware of Mink’s role at Beluga when it choose him as medical group owner in 2023, before GLP-1 compounding had exploded. “What people do in their other practices is pretty separate from what they do when they’re working in the 9amHealth medical group,” said Waring. Mink did not respond to requests for comment.

Multi-practice telehealth ownership isn’t an outlier. Physicians with all 51 licenses, sometimes called “51ers,” are still a relatively scarce resource, especially those who are willing to sign on to the liability of owning practices across the country. Without these partnerships between doctor-owned medical practices and telehealth companies, “multi-state telehealth would be impossible,” said attorney Ross Friedberg, founding partner at Goldsand Friedberg.

As a result, physicians may come to own a medical practice not because of their medical specialty, but because they’ve gone to the trouble of getting all 51 licenses. “It seems like it’s not always a matching of skills as much as it is just kind of the need to plug someone into that position,” said physician Lisa Czanko, who has owned medical groups and consulted for telehealth companies.

Practice ownership can be a lucrative gig. One recent job listing for a telehealth medical group owner cited a monthly salary of $2,000 to $3,000 for less than five hours of work a month. But accumulating the necessary licenses is a job in itself. Each one can cost several hundred dollars, and they need to be periodically renewed, typically every one to three years. New companies have emerged to act as licensing liaisons, managing all the paperwork required for applications and renewals for their own hefty fees.

Dermatologist Anna Chacon, who owns medical groups for Cortina Health, a teledermatology company linked to by Eli Lilly, said she spent about $180,000 to accumulate her 54 licenses — 50 states, D.C, and the territories of Puerto Rico, Guam, and the U.S. Virgin Islands, too.

To get her last license in Puerto Rico, Chacon said, she had to travel in person to the island to navigate the bureaucracy and notarize documents. It took her thousands of dollars, two attorneys, and a local errand-runner to nail it down. “It’s really not worth it unless you really value working remotely,” said Chacon. “Unless you are doing this a lot, it’s not worth it for just a handful of patients.”

That process is out of reach for most doctors on their own. So it is sometimes managed and underwritten by telehealth companies themselves. For Czanko, the path to 50 licenses took two years, even when it was supported by her former company. “For some reason, you always have these stragglers,” she said. “There’s always that one left over that’s causing problems.”

In Massachusetts, for example, the medical board has required letters from every state confirming that a doctor is in good standing — but they all have to arrive within three months. For Tzvi Doron, who formerly owned medical groups for telehealth company Ro, that turned into a huge headache. Because he had so many licenses before he applied for Massachusetts, “I never could get them to send all the letters within a given time frame.”

In recent years, it’s become easier for physicians to rack up more licenses, thanks to growing participation in an interstate licensure compact system that allows physicians to more easily apply for multiple licenses simultaneously. “That’s been a true blessing in a lot of ways,” said Peter Ax, CEO of UpScript Health, a company that provides telehealth services to pharmaceutical companies. “But it’s not complete enough.”

To help with ongoing licensing challenges and telehealth career advice for wannabe 51ers, physicians Takashi Nakamura and Suneer Chander launched a coaching program called Air Physician Academy in 2023. So far, 150 physicians have gone through the six-month program.

They’ve gone on to become telehealth medical group owners, serve in part-time clinical leadership roles for digital health companies, and launch their own telemedicine practices.

“As you get to larger licensure, you’re in this pool of doctors that are super valuable for startup medical practices,” said Chander. “All of a sudden you’re tasked to not only take care of the patients, but you also have the opportunity to have leadership positions.”

Doctors with many licenses can also sell their services as a “collaborating physician” to a growing number of practices, including medical spas and IV clinics, that are run by midlevel providers like physician assistants and nurse practitioners. Many states require PAs and NPs to practice under the supervision of a physician — and increasingly, that supervision happens remotely.

“The telemedicine clients I work with, they can’t get into enough states fast enough or hire people fast enough because there’s such a big push right now,” said Bradford Adatto, an attorney who advises medspas. One company, Baton Health, recently launched a recruiting tool to help companies find providers with licenses in the right places and specialties.

Telehealth companies, along with some physicians and health policy researchers, have increasingly advocated against the state-based licensure system that has spawned the phenomenon of 51ers.

“It really highlights the perversities of our licensure system,” said Ateev Mehrotra, chair of health services, policy, and practice at the Brown University School of Public Health. “The reason that these docs that are licensed in 51 states are such a hot commodity is that we’ve created a system that’s just incompatible with telehealth and that has substantial costs.”

That system can also create risks for physicians who seek out so many licenses. States have different standards for best practices in telehealth, and it can be challenging to stay on top of them all. “When you have an investigation or a bad mark against your license, it’s something that cascades into other states,” said Czanko. “All of a sudden, what could be a relatively minor issue can affect your ability to work nationwide.”

Two doctors and their patients recently filed lawsuits against state medical boards arguing that keeping them from speaking with patients in other states violates their right to free speech. Both were dismissed and are being appealed.

“Anyone should be able to consult with a specialist in another state, especially if that specialist is the best at treating the illness they have,” said Friedberg. “However, state license and corporate practice laws continue to make it difficult for doctors to meet these demands.”

Unless those standards change, the number of 51ers will likely continue to grow. One recent entrant is endocrinologist Elizabeth Reilly, 9amHealth’s newest medical group owner.

“There’s two ways that you can build up a medical group,” said 9am’s Waring. “One is by finding doctors who have the 51 state licenses, and then the other is by finding a doctor that you want to be the owner of that practice and helping them pursue those licenses.” One by one, starting in 2024, 9am supported Reilly with the expenses and bureaucracy until she got every last license lined up. The company says she started in January.

STAT’s reporting on how telehealth is driving the consumerization of drugs is supported by a grant from the NIHCM Foundation. Our financial supporters are not involved in any decisions about our journalism.

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