AMN Healthcare Services (AMN) 10-Q 2 May 14 2014 Q1 Quarterly report Financial data

Document_and_Entity_Informatio

Document and Entity Information	3 Months Ended
	Mar. 31, 2014	Apr. 30, 2014
Document and Entity Information [Abstract]	'	'
Entity Registrant Name	'AMN HEALTHCARE SERVICES INC	'
Entity Central Index Key	'0001142750	'
Document Type	'10-Q	'
Document Period End Date	31-Mar-14	'
Amendment Flag	'false	'
Document Fiscal Year Focus	'2014	'
Document Fiscal Period Focus	'Q1	'
Current Fiscal Year End Date	'--12-31	'
Entity Filer Category	'Accelerated Filer	'
Entity Common Stock, Shares Outstanding	'	46,499,332

Condensed_Consolidated_Balance

Condensed Consolidated Balance Sheets (USD $)	Mar. 31, 2014	Dec. 31, 2013
In Thousands, unless otherwise specified
Current assets:	'	'
Cash and cash equivalents	$9,269	$15,580
Accounts receivable, net of allowances of $4,575 and $5,118 at March 31, 2014 and December 31, 2013, respectively	150,840	147,477
Accounts receivable, subcontractor	18,680	18,271
Deferred income taxes, net	24,867	24,938
Prepaid and other current assets	24,818	23,833
Total current assets	228,474	230,099
Restricted cash, cash equivalents and investments	21,641	23,115
Fixed assets, net of accumulated depreciation of $64,849 and $63,031 at March 31, 2014 and December 31, 2013, respectively	24,400	21,158
Other assets	26,667	23,023
Goodwill	144,937	144,642
Intangible assets, net of accumulated amortization of $44,319 and $42,439 at March 31, 2014 and December 31, 2013, respectively	148,317	150,197
Total assets	594,436	592,234
Current liabilities:	'	'
Accounts payable and accrued expenses	62,685	69,407
Accrued compensation and benefits	55,833	54,825
Revolving credit facility	10,000	10,000
Current portion of notes payable	7,500	0
Other current liabilities	5,212	6,060
Total current liabilities	141,230	140,292
Notes payable, net of discount	141,227	148,672
Other long-term liabilities	87,098	85,528
Total liabilities	369,555	374,492
Commitments and contingencies and subsequent events (Notes 8 and 9)	'	'
Stockholders’ equity:	'	'
Preferred stock, $0.01 par value; 10,000 shares authorized; none issued and outstanding at March 31, 2014 and December 31, 2013	0	0
Common stock, $0.01 par value; 200,000 shares authorized; 46,409 and 46,011 shares issued and outstanding at March 31, 2014 and December 31, 2013, respectively	464	460
Additional paid-in capital	428,569	429,055
Accumulated deficit	-203,645	-211,275
Accumulated other comprehensive loss	-507	-498
Total stockholders’ equity	224,881	217,742
Total liabilities and stockholders’ equity	$594,436	$592,234

Condensed_Consolidated_Balance1

Condensed Consolidated Balance Sheets (Parenthetical) (USD $)	Mar. 31, 2014	Dec. 31, 2013
In Thousands, except Per Share data, unless otherwise specified
Accounts receivable, allowance	$4,575	$5,118
Accumulated depreciation	64,849	63,031
Accumulated amortization	$44,319	$42,439
Preferred stock, par value	$0.01	$0.01
Preferred stock, shares authorized	10,000	10,000
Preferred stock, shares issued	0	0
Preferred stock, shares outstanding	0	0
Common stock, par value	$0.01	$0.01
Common stock, shares authorized	200,000	200,000
Common stock, shares issued	46,409	46,011
Common stock, shares outstanding	46,409	46,011

Condensed_Consolidated_Stateme

Condensed Consolidated Statements of Comprehensive Income (USD $)	3 Months Ended
In Thousands, except Per Share data, unless otherwise specified	Mar. 31, 2014	Mar. 31, 2013
Revenue	$240,881	$252,120
Cost of revenue	166,925	179,113
Gross profit	73,956	73,007
Operating expenses:	'	'
Selling, general and administrative	54,667	53,607
Depreciation and amortization	3,820	3,290
Total operating expenses	58,487	56,897
Income from operations	15,469	16,110
Interest expense, net and other	1,846	2,859
Income before income taxes	13,623	13,251
Income tax expense	5,993	5,688
Net Income	7,630	7,563
Net income per common share:	'	'
Basic (in dollars per share)	$0.16	$0.17
Diluted (in dollars per share)	$0.16	$0.16
Weighted average common shares outstanding:	'	'
Basic (shares)	46,354	45,813
Diluted (shares)	47,917	47,679
Other comprehensive (loss) income - foreign currency translation	-9	93
Comprehensive income	$7,621	$7,656

Condensed_Consolidated_Stateme1

Condensed Consolidated Statements of Cash Flows (USD $)	3 Months Ended
In Thousands, unless otherwise specified	Mar. 31, 2014	Mar. 31, 2013
Cash flows from operating activities:	'	'
Net income	$7,630	$7,563
Adjustments to reconcile net income to net cash provided by operating activities:	'	'
Depreciation and amortization	3,820	3,290
Non-cash interest expense and other	295	295
Increase in allowances for doubtful accounts and sales credits	443	1,102
Provision for deferred income taxes	1,885	1,023
Share-based compensation	1,819	1,702
Excess tax benefits from share-based compensation	-1,546	-704
Loss on disposal or sale of fixed assets	1	8
Changes in assets and liabilities:	'	'
Accounts receivable, net	-3,806	-15,342
Accounts receivable, subcontractor	-409	-865
Prepaid expenses and other current assets	-954	-2,436
Other assets	-606	-1,127
Accounts payable and accrued expenses	-6,063	4,102
Accrued compensation and benefits	1,008	-50
Other liabilities	349	-779
Restricted cash, cash equivalents and investments balance	-2,875	0
Net cash provided by (used in) operating activities	991	-2,218
Cash flows from investing activities:	'	'
Purchase and development of fixed assets	-5,843	-2,215
Equity method investment	-2,000	0
Payments to fund deferred compensation plan	-1,215	-481
Change in restricted cash, cash equivalents and investments balance	4,349	60
Net cash used in investing activities	-4,709	-2,636
Cash flows from financing activities:	'	'
Capital lease repayments	-156	-158
Proceeds from revolving credit facility	1,000	1,000
Payments on revolving credit facility	-1,000	0
Proceeds from exercise of equity awards	58	711
Cash paid for shares withheld for taxes	-3,905	-1,403
Excess tax benefits from share-based compensation	1,546	704
Change in bank overdraft	-127	165
Net cash (used in) provided by financing activities	-2,584	1,019
Effect of exchange rate changes on cash	-9	93
Net decrease in cash and cash equivalents	-6,311	-3,742
Cash and cash equivalents at beginning of period	15,580	5,681
Cash and cash equivalents at end of period	9,269	1,939
Supplemental disclosures of cash flow information:	'	'
Cash paid for interest (net of $0 and $24 capitalized for the three months ended March 31, 2014 and 2013, respectively)	1,588	2,399
Cash paid for income taxes	$223	$4,876

Condensed_Consolidated_Stateme2

Condensed Consolidated Statements of Cash Flows (Parenthetical) (USD $)	3 Months Ended
In Thousands, unless otherwise specified	Mar. 31, 2014	Mar. 31, 2013
Interest capitalized	$0	$24

Basis_of_Presentation

Basis of Presentation	3 Months Ended
	Mar. 31, 2014
Organization, Consolidation and Presentation of Financial Statements [Abstract]	'
BASIS OF PRESENTATION	'
	BASIS OF PRESENTATION
	The condensed consolidated balance sheets and related condensed consolidated statements of comprehensive income and cash flows contained in this Quarterly Report on Form 10-Q (this “Quarterly Report”), which are unaudited, include the accounts of AMN Healthcare Services, Inc. and its wholly-owned subsidiaries (collectively, the “Company”). All significant intercompany balances and transactions have been eliminated in consolidation. In the opinion of management, all entries necessary for a fair presentation of such unaudited condensed consolidated financial statements have been included. These entries consisted of all normal recurring items. The results of operations for the interim period are not necessarily indicative of the results to be expected for any other interim period or for the entire fiscal year or for any future period.
	The unaudited condensed consolidated financial statements do not include all information and notes necessary for a complete presentation of financial position, results of operations and cash flows in conformity with accounting principles generally accepted in the United States. Please refer to the Company’s audited consolidated financial statements and the related notes for the fiscal year ended December 31, 2013, contained in the Company’s Annual Report on Form 10-K for the fiscal year ended December 31, 2013, filed with the Securities and Exchange Commission (“SEC”) on February 21, 2014.
	The preparation of financial statements in conformity with accounting principles generally accepted in the United States requires management to make a number of estimates and assumptions relating to the reporting of assets and liabilities and the disclosure of contingent assets and liabilities at the dates of the financial statements and the reported amounts of revenue and expenses during the reporting periods. On an ongoing basis, the Company evaluates its estimates, including those related to asset impairments, accruals for self-insurance, compensation and related benefits, accounts receivable, contingencies and litigation, valuation and recognition of share-based payments and income taxes. Actual results could differ from those estimates under different assumptions or conditions.
	Reclassification
	Certain reclassifications have been made to the prior year’s consolidated financial statement to conform to the current year presentation. Specifically, payments made into the Company’s life insurance policies to assist in funding the deferred compensation plan were reclassified from cash flows from operations to cash flows from investing activities in the unaudited condensed consolidated statement of cash flows for the three months ended March 31, 2013.

Business_Combination_and_Equit

Business Combination and Equity Investment	3 Months Ended
	Mar. 31, 2014
Business Combinations [Abstract]	'
BUSINESS COMBINATION AND EQUITY INVESTMENT	'
	ShiftWise Acquisition
	On November 20, 2013, the Company completed its acquisition of ShiftWise, a leading national provider of web-based healthcare workforce solutions, including its vendor management systems, or “VMS,” utilized by hospitals and other healthcare systems. The strategic combination has added a new and more robust technology platform to the Company’s current workforce solutions offerings and will allow the Company to enhance its managed services business and provide a vendor neutral VMS option for interested clients. The acquisition is not considered a material business combination and, accordingly, pro forma information is not provided. The Company accounted for the acquisition using the acquisition method of accounting and, accordingly, it recorded the tangible and intangible assets acquired and liabilities assumed at their estimated fair values as of the date of the acquisition. The purchase price of the acquisition totaled $39,500, of which $6,000 was deposited in escrow to satisfy any indemnification claims by the Company with respect to, among other customary items, breaches of representations, warranties and covenants by ShiftWise and post-closing purchase price adjustments. As of the date of this Form 10-Q, the Company is still finalizing the allocation of the purchase price. The provisional items pending finalization are primarily related to tax related matters upon the completion of ShiftWise’s tax return, which the Company expects to complete during 2014.
	The preliminary allocation of the purchase price consisted of $9,899 of fair value of assets acquired, $11,801 of liabilities assumed (including $2,933 of deferred tax liabilities), $21,612 of goodwill and $19,790 of identified intangible assets. The intangible assets include the fair value of trade names and trademarks, customer relationships, non-compete agreements and acquired technologies. The weighted average useful life of the acquired intangible assets subject to amortization is approximately 8 years. There is no goodwill recognized as part of this acquisition that is deductible for tax purposes.
	The results of operations of ShiftWise have been included in the nurse and allied healthcare staffing segment in the Company’s consolidated financial statements since the date of acquisition.
	Pipeline Equity Investment
	In March 2014, the Company entered into an agreement (the “Pipeline Agreement”) under which it made an initial $2,000 investment in Pipeline Health Holdings LLC (“Pipeline”), a telepharmacy provider. The Company’s ownership percentage in Pipeline at March 31, 2014 was approximately 9%. Under the Pipeline Agreement, the Company committed to invest up to an additional $3,000 contingent upon Pipeline reaching two milestone commitments within a year. In April 2014, the Company made the first milestone investment of $1,000, which increased its ownership percentage in Pipeline to approximately 13%. The investment is accounted for under the equity method of accounting. The Company’s share of the investee’s results is included within “Interest expense, net and other” in the accompanying unaudited condensed consolidated statement of comprehensive income for the three months ended March 31, 2014, as the results are not material to the Company’s unaudited condensed consolidated financial statements.

Revenue_Recognition

Revenue Recognition	3 Months Ended
	Mar. 31, 2014
Revenue Recognition [Abstract]	'
REVENUE RECOGNITION	'
	REVENUE RECOGNITION
	Revenue consists of fees earned from the permanent and temporary placement of clinicians and physicians. Revenue is recognized when earned and realizable. The Company has entered into certain contracts with healthcare organizations to provide managed services programs. Under these contract arrangements, the Company uses its clinicians and physicians along with those of third party subcontractors to fulfill client orders. If the Company uses subcontractors, it records revenue net of related subcontractors expense. The resulting net revenue represents the administrative fee the Company charges for its vendor management services. The Company records subcontractor accounts receivable from the client in the consolidated balance sheets. The Company generally pays the subcontractor after it has received payment from the client. Payables to subcontractors of $22,349 and $22,051, respectively, were included in accounts payable and accrued expenses in the unaudited condensed consolidated balance sheet as of March 31, 2014 and the audited consolidated balance sheet as of December 31, 2013.

Net_Income_Per_Common_Share

Net Income Per Common Share	3 Months Ended
	Mar. 31, 2014
Earnings Per Share [Abstract]	'
NET INCOME PER COMMON SHARE	'
	NET INCOME PER COMMON SHARE
	Basic net income per common share is calculated by dividing net income by the weighted average number of common shares outstanding during the reporting period. Diluted net income per common share reflects the effects of potentially dilutive share-based equity instruments.
	Share-based awards to purchase 361 and 308 shares of common stock for the three months ended March 31, 2014 and 2013 respectively, were not included in the calculation of diluted net income per common share because the effect of these instruments was anti-dilutive.
	The following table sets forth the computation of basic and diluted net income per common share for the three months ended March 31, 2014 and 2013, respectively:
		Three Months Ended March 31,
		2014		2013
	Net income	$	7,630	$	7,563
	Net income per common share - basic	$	0.16	$	0.17
	Net income per common share - diluted	$	0.16	$	0.16
	Weighted average common shares outstanding - basic	46,354		45,813
	Plus dilutive effect of potential common shares	1,563		1,866
	Weighted average common shares outstanding - diluted	47,917		47,679

Segment_Information

Segment Information	3 Months Ended
	Mar. 31, 2014
Segment Reporting [Abstract]	'
SEGMENT INFORMATION	'
	SEGMENT INFORMATION
	The Company has three reportable segments: nurse and allied healthcare staffing, locum tenens staffing and physician permanent placement services.
	The Company’s management relies on internal management reporting processes that provide revenue and operating income by reportable segment for making financial decisions and allocating resources. Segment operating income represents income before income taxes plus depreciation, amortization of intangible assets, share-based compensation expense, interest expense (net) and other, and unallocated corporate overhead. The Company’s management does not evaluate, manage or measure performance of segments using asset information; accordingly, asset information by segment is not prepared or disclosed.
	The following table provides a reconciliation of revenue and operating income by reportable segment to consolidated results and was derived from each segment’s internal financial information as used for corporate management purposes:
		Three Months Ended March 31,
		2014		2013
	Revenue
	Nurse and allied healthcare staffing	$	163,450	$	176,765
	Locum tenens staffing	66,871		65,456
	Physician permanent placement services	10,560		9,899
		$	240,881	$	252,120
	Segment Operating Income
	Nurse and allied healthcare staffing	$	19,972	$	22,474
	Locum tenens staffing	6,873		4,892
	Physician permanent placement services	2,131		2,241
		28,976		29,607
	Unallocated corporate overhead	7,868		8,505
	Depreciation and amortization	3,820		3,290
	Share-based compensation	1,819		1,702
	Interest expense, net and other	1,846		2,859
	Income before income taxes	$	13,623	$	13,251

Fair_Value_Measurement

Fair Value Measurement	3 Months Ended
	Mar. 31, 2014
Fair Value Disclosures [Abstract]	'
FAIR VALUE MEASUREMENT	'
	FAIR VALUE MEASUREMENTS
	Fair value represents price that would be received for an asset or paid to transfer a liability (an exit price) in the principal or most advantageous market for the asset or liability in an orderly transaction between market participants on the measurement date. When determining fair value, the Company considers the principal or most advantageous market in which the Company would conduct a transaction, in addition to the assumptions that market participants would use when pricing the related assets or liabilities, including non-performance risk.
	A three-level hierarchy prioritizes the inputs to valuation techniques used to measure fair value and requires an entity to maximize the use of observable inputs and minimize the use of unobservable inputs when measuring fair value. The three levels of the fair value hierarchy are as follows:
	Level 1—Quoted prices in active markets for identical assets or liabilities.
	Level 2—Observable inputs other than Level 1 prices such as quoted prices for similar assets or liabilities; quoted prices in markets that are not active; or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the assets or liabilities.
	Level 3—Unobservable inputs that are supported by little or no market activity and that are significant to the fair value of the assets or liabilities.
	Assets Measured on a Recurring Basis
	The Company’s assets that are measured at fair value on a recurring basis include restricted cash equivalents and investments and the Company’s investments associated with its deferred compensation plan. The following tables present information about these assets and indicate the fair value hierarchy of the valuation techniques utilized to determine such fair value:
		Fair Value Measurements as of March 31, 2014
		Total		Quoted Prices in		Significant		Significant
				Active Markets		Other		Unobservable
				for Identical		Observable		Inputs
				Assets		Inputs		(Level 3)
				(Level 1)		(Level 2)
	U.S. Treasury securities	$	13,467	$	13,467	$	—	$	—
	Money market funds	360		360		—		—
	Total financial assets measured at fair value	$	13,827	$	13,827	$	—	$	—
		Fair Value Measurements as of December 31, 2013
		Total		Quoted Prices in		Significant		Significant
				Active Markets		Other		Unobservable
				for Identical		Observable		Inputs
				Assets		Inputs		(Level 3)
				(Level 1)		(Level 2)
	U.S. Treasury securities	$	17,817	$	17,817	$	—	$	—
	Money market funds	359		359		—		—
	Total financial assets measured at fair value	$	18,176	$	18,176	$	—	$	—
	The Company’s restricted cash equivalents and investments typically consist of U.S. Treasury securities and money market funds, and the Company’s investments associated with its deferred compensation plan typically consist of money market funds, which fair values are based on quoted prices in active markets for identical assets.
	Assets Measured on a Non-Recurring Basis
	The Company applies fair value techniques on a non-recurring basis associated with valuing potential impairment losses related to its goodwill, indefinite-lived intangible assets, long-lived assets and equity method investment. If impaired, the carrying values of such assets would be written down to fair value using Level 3 inputs. There were no triggering events identified and no indication of impairment of the Company’s goodwill, indefinite-lived intangible assets, long-lived assets or equity method investment during the three months ended March 31, 2014 and 2013.
	Fair Value of Financial Instruments
	The carrying amount of notes payable approximates its fair value as the instrument’s interest rates are variable and comparable to rates currently offered for similar debt instruments of comparable maturity (significant other observable inputs - level 2). The fair value of the Company’s long-term self-insurance accruals cannot be estimated as the Company cannot reasonably determine the timing of future payments.

Income_Taxes

Income Taxes	3 Months Ended
	Mar. 31, 2014
Income Tax Disclosure [Abstract]	'
INCOME TAXES	'
	INCOME TAXES
	The Company is subject to taxation in the U.S. and various states and foreign jurisdictions. With few exceptions, as of March 31, 2014, the Company is no longer subject to U.S. federal, state, local or foreign examinations by tax authorities for years before 2005. During 2013, the Internal Revenue Service (“IRS”) completed its tax audit of the Company for the years 2007, 2008, 2009 and 2010. The IRS issued a Revenue Agent Report (“RAR”) to the Company related to its completed tax examination. The RAR seeks adjustments to the Company’s taxable income for 2007-2010 and net operating loss carryforwards for 2005-2006. The adjustments to the Company’s taxable income relate to the proposed disallowance of certain per diems paid to our clinicians and locum tenens providers on the Company’s income tax return. Concurrent with the RAR, the Company received an Employment Tax Examination Report (“ETER”) for 2009 and 2010. The ETER adjustments propose additional Company payroll tax liabilities and penalties related to the treatment of certain non-taxable per diem allowances and travel benefits. The positions in the RAR and ETER are mutually exclusive. The RAR and ETER contain multiple tax positions, some of which are contrary to each other. Thus, the Company is unable to determine any reasonable range of potential claim at this time.
	The Company has filed a Protest Letter for both the RAR and ETER and intends to defend its position. The Company recently held its first meeting with the IRS Appeals office and will continue to meet with the IRS Appeals office throughout the course of the year. The Company cannot predict with certainty the timing of such resolution. The Company believes its reserve for unrecognized tax benefits and contingent tax issues is adequate. Notwithstanding, the Company could adjust its provision for income taxes and contingent tax liability based on future developments.
	The IRS commenced income and payroll tax audits for the years 2011 and 2012 during November 2013.

Commitments_and_Contingencies_

Commitments and Contingencies: Legal	3 Months Ended
	Mar. 31, 2014
Commitments and Contingencies Disclosure [Abstract]	'
COMMITMENTS AND CONTINGENCIES: LEGAL	'
	COMMITMENTS AND CONTINGENCIES: LEGAL
	The Company is subject to various claims and legal actions in the ordinary course of its business. Some of these matters relate to professional liability, tax, payroll, contract and employee-related matters and include individual and collective lawsuits, as well as inquiries and investigations by governmental agencies regarding the Company’s employment practices. The Company recently completed the settlement of a wage and hour class action (and a related action) for an immaterial amount.
	Additionally, some of the Company’s clients may also become subject to claims, governmental inquiries and investigations and legal actions relating to services provided by the Company’s clinicians and physicians. Depending upon the particular facts and circumstances, the Company may be subject to indemnification obligations under its contracts with certain clients relating to these matters.

Subsequent_Events

Subsequent Events	3 Months Ended
	Mar. 31, 2014
Subsequent Events [Abstract]	'
Subsequent Events	'
	On April 18, 2014, the Company entered into a Credit Agreement (the “Credit Agreement”) with several lenders to provide for two credit facilities (the “New Credit Facilities”) to replace its prior credit facilities, including (A) a $225,000 secured revolving credit facility (the “Revolver”) that includes a $40,000 sublimit for the issuance of letters of credit and a $20,000 sublimit for swingline loans and (B) a $150,000 secured term loan credit facility (the “Term Loan”). In addition, the Credit Agreement provides that the Company may from time to time obtain an increase in the Revolver or the Term Loan or both in an aggregate principal amount not to exceed $125,000 subject to, among other conditions, the arrangement of additional commitments with financial institutions reasonably acceptable to the Company and the administrative agent. The obligations of the Company under the Credit Agreement and the New Credit Facilities are secured by substantially all of the assets of the Company.
	The Revolver carries an unused fee of 0.25% to 0.35% per annum and each standby letter of credit issued under the Revolver is subject to a letter of credit fee ranging from 1.50% to 2.25% per annum of the average daily maximum amount available to be drawn under the standby letter of credit, in each case, depending on the Company’s consolidated leverage ratio, as calculated quarterly in accordance with the Credit Agreement. The Term Loan is subject to amortization of principal of 5.00% per year of the original Term Loan amount, payable in equal quarterly installments; however, there are no mandatory reductions in the Revolver. Borrowings under the Term Loan and Revolver bear interest at floating rates based upon either LIBOR plus a spread of 1.50% to 2.25% or a base rate plus a spread of 0.50% to 1.25%. The applicable spread is determined quarterly based upon the Company’s consolidated leverage ratio, as calculated quarterly in accordance with the Credit Agreement.
	The Company used the proceeds from the initial drawdown under the New Credit Facilities to repay in full all outstanding indebtedness under its prior credit facilities and to pay related transaction costs. In addition, approximately $9,500 of standby letters of credit issued under the prior credit facilities have been rolled into and been deemed issued under the Revolver.
	The New Credit Facilities are available for working capital, capital expenditures, permitted acquisitions and general corporate purposes of the Company. The maturity date of the New Credit Facilities is April 18, 2019.
	In connection with obtaining the New Credit Facilities, the Company incurred approximately $3,500 in fees paid to lenders and other third parties.

Basis_of_Presentation_Policies

Basis of Presentation (Policies)	3 Months Ended
	Mar. 31, 2014
Organization, Consolidation and Presentation of Financial Statements [Abstract]	'
Use of Estimates	'
	The preparation of financial statements in conformity with accounting principles generally accepted in the United States requires management to make a number of estimates and assumptions relating to the reporting of assets and liabilities and the disclosure of contingent assets and liabilities at the dates of the financial statements and the reported amounts of revenue and expenses during the reporting periods. On an ongoing basis, the Company evaluates its estimates, including those related to asset impairments, accruals for self-insurance, compensation and related benefits, accounts receivable, contingencies and litigation, valuation and recognition of share-based payments and income taxes. Actual results could differ from those estimates under different assumptions or conditions.
Revenue Recognition	'
	Revenue consists of fees earned from the permanent and temporary placement of clinicians and physicians. Revenue is recognized when earned and realizable. The Company has entered into certain contracts with healthcare organizations to provide managed services programs. Under these contract arrangements, the Company uses its clinicians and physicians along with those of third party subcontractors to fulfill client orders. If the Company uses subcontractors, it records revenue net of related subcontractors expense. The resulting net revenue represents the administrative fee the Company charges for its vendor management services. The Company records subcontractor accounts receivable from the client in the consolidated balance sheets. The Company generally pays the subcontractor after it has received payment from the client.
Net Income per Common Share	'
	Basic net income per common share is calculated by dividing net income by the weighted average number of common shares outstanding during the reporting period. Diluted net income per common share reflects the effects of potentially dilutive share-based equity instruments.
Segment Information	'
	The Company’s management relies on internal management reporting processes that provide revenue and operating income by reportable segment for making financial decisions and allocating resources. Segment operating income represents income before income taxes plus depreciation, amortization of intangible assets, share-based compensation expense, interest expense (net) and other, and unallocated corporate overhead. The Company’s management does not evaluate, manage or measure performance of segments using asset information; accordingly, asset information by segment is not prepared or disclosed.
Fair Value Measurement	'
	Fair Value of Financial Instruments
	The carrying amount of notes payable approximates its fair value as the instrument’s interest rates are variable and comparable to rates currently offered for similar debt instruments of comparable maturity (significant other observable inputs - level 2). The fair value of the Company’s long-term self-insurance accruals cannot be estimated as the Company cannot reasonably determine the timing of future payments.
	Assets Measured on a Non-Recurring Basis
	The Company applies fair value techniques on a non-recurring basis associated with valuing potential impairment losses related to its goodwill, indefinite-lived intangible assets, long-lived assets and equity method investment. If impaired, the carrying values of such assets would be written down to fair value using Level 3 inputs.
	Fair value represents price that would be received for an asset or paid to transfer a liability (an exit price) in the principal or most advantageous market for the asset or liability in an orderly transaction between market participants on the measurement date. When determining fair value, the Company considers the principal or most advantageous market in which the Company would conduct a transaction, in addition to the assumptions that market participants would use when pricing the related assets or liabilities, including non-performance risk.
	A three-level hierarchy prioritizes the inputs to valuation techniques used to measure fair value and requires an entity to maximize the use of observable inputs and minimize the use of unobservable inputs when measuring fair value. The three levels of the fair value hierarchy are as follows:
	Level 1—Quoted prices in active markets for identical assets or liabilities.
	Level 2—Observable inputs other than Level 1 prices such as quoted prices for similar assets or liabilities; quoted prices in markets that are not active; or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the assets or liabilities.
	Level 3—Unobservable inputs that are supported by little or no market activity and that are significant to the fair value of the assets or liabilities.
	Assets Measured on a Recurring Basis
	The Company’s assets that are measured at fair value on a recurring basis include restricted cash equivalents and investments and the Company’s investments associated with its deferred compensation plan.

Net_Income_Per_Common_Share_Ta

Net Income Per Common Share (Tables)	3 Months Ended
	Mar. 31, 2014
Earnings Per Share [Abstract]	'
Computation of basic and diluted net income per common share	'
	The following table sets forth the computation of basic and diluted net income per common share for the three months ended March 31, 2014 and 2013, respectively:
		Three Months Ended March 31,
		2014		2013
	Net income	$	7,630	$	7,563
	Net income per common share - basic	$	0.16	$	0.17
	Net income per common share - diluted	$	0.16	$	0.16
	Weighted average common shares outstanding - basic	46,354		45,813
	Plus dilutive effect of potential common shares	1,563		1,866
	Weighted average common shares outstanding - diluted	47,917		47,679

Segment_Information_Tables

Segment Information (Tables)	3 Months Ended
	Mar. 31, 2014
Segment Reporting [Abstract]	'
Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results	'
	The following table provides a reconciliation of revenue and operating income by reportable segment to consolidated results and was derived from each segment’s internal financial information as used for corporate management purposes:
		Three Months Ended March 31,
		2014		2013
	Revenue
	Nurse and allied healthcare staffing	$	163,450	$	176,765
	Locum tenens staffing	66,871		65,456
	Physician permanent placement services	10,560		9,899
		$	240,881	$	252,120
	Segment Operating Income
	Nurse and allied healthcare staffing	$	19,972	$	22,474
	Locum tenens staffing	6,873		4,892
	Physician permanent placement services	2,131		2,241
		28,976		29,607
	Unallocated corporate overhead	7,868		8,505
	Depreciation and amortization	3,820		3,290
	Share-based compensation	1,819		1,702
	Interest expense, net and other	1,846		2,859
	Income before income taxes	$	13,623	$	13,251

Fair_Value_Measurement_Tables

Fair Value Measurement (Tables)	3 Months Ended
	Mar. 31, 2014
Fair Value Disclosures [Abstract]	'
Schedule of financial assets and liabilities measured at fair value on recurring basis	'
		Fair Value Measurements as of March 31, 2014
		Total		Quoted Prices in		Significant		Significant
				Active Markets		Other		Unobservable
				for Identical		Observable		Inputs
				Assets		Inputs		(Level 3)
				(Level 1)		(Level 2)
	U.S. Treasury securities	$	13,467	$	13,467	$	—	$	—
	Money market funds	360		360		—		—
	Total financial assets measured at fair value	$	13,827	$	13,827	$	—	$	—
		Fair Value Measurements as of December 31, 2013
		Total		Quoted Prices in		Significant		Significant
				Active Markets		Other		Unobservable
				for Identical		Observable		Inputs
				Assets		Inputs		(Level 3)
				(Level 1)		(Level 2)
	U.S. Treasury securities	$	17,817	$	17,817	$	—	$	—
	Money market funds	359		359		—		—
	Total financial assets measured at fair value	$	18,176	$	18,176	$	—	$	—

Business_Combination_and_Equit1

Business Combination and Equity Investment (Details) (USD $)	3 Months Ended	0 Months Ended	3 Months Ended
	Mar. 31, 2014	Nov. 20, 2013	Mar. 31, 2014	Apr. 30, 2014
	Pipeline Equity Investment [Member]	Shiftwise Acquisition	Shiftwise Acquisition	Subsequent Event [Member]
				Pipeline Equity Investment [Member]
Business Combination, Description	'	'	'	'
Total purchase price of the acquisition	'	$39,500,000	'	'
Amount deposited into escrow	'	6,000,000	'	'
Allocation of Purchase Price	'	'	'	'
Fair Value of Assets Acquired	'	'	9,899,000	'
Liabilities Assumed	'	'	11,801,000	'
Deferred tax liability	'	'	2,933,000	'
Goodwill	'	'	21,612,000	'
Intangible assets	'	'	19,790,000	'
Intangible Assets, Net (Excluding Goodwill) [Abstract]	'	'	'	'
Weighted average useful life of intangible assets	'	'	'8 years	'
Equity Method Investments and Joint Ventures [Abstract]	'	'	'	'
Equity method investment	2,000	'	'	1,000
Ownership percentage	9.00%	'	'	13.00%
Investment commitment	$3,000	'	'	'
Number of milestone commitments	2	'	'	'

Revenue_Recognition_Details

Revenue Recognition (Details) (USD $)	Mar. 31, 2014	Dec. 31, 2013
In Thousands, unless otherwise specified
Revenue Recognition [Abstract]	'	'
Accounts Payable to Subcontractor	$22,349	$22,051

Net_Income_Per_Common_Share_De

Net Income Per Common Share (Details) (USD $)	3 Months Ended
In Thousands, except Per Share data, unless otherwise specified	Mar. 31, 2014	Mar. 31, 2013
Earnings Per Share [Abstract]	'	'
Common stock excluded from calculation of EPS	361	308
Computation of basic and diluted net income per common share	'	'
Net income	$7,630	$7,563
Basic (in dollars per share)	$0.16	$0.17
Diluted (in dollars per share)	$0.16	$0.16
Weighted average common shares outstanding - basic	46,354	45,813
Plus dilutive effect of potential common shares	1,563	1,866
Weighted average common shares outstanding - diluted	47,917	47,679

Segment_Information_Details

Segment Information (Details) (USD $)	3 Months Ended
In Thousands, unless otherwise specified	Mar. 31, 2014	Mar. 31, 2013
	segment
Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results	'	'
Revenue	$240,881	$252,120
Operating Income	15,469	16,110
Depreciation and amortization	3,820	3,290
Share-based compensation	1,819	1,702
Interest expense, net and other	1,846	2,859
Income before income taxes	13,623	13,251
Segment Information (Textual) [Abstract]	'	'
Reportable business segments	3	'
Operating segments [Member]	'	'
Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results	'	'
Revenue	240,881	252,120
Operating Income	28,976	29,607
Operating segments [Member] | Nurse and allied healthcare staffing [Member]	'	'
Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results	'	'
Revenue	163,450	176,765
Operating Income	19,972	22,474
Operating segments [Member] | Locum tenens staffing [Member]	'	'
Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results	'	'
Revenue	66,871	65,456
Operating Income	6,873	4,892
Operating segments [Member] | Physician permanent placement services [Member]	'	'
Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results	'	'
Revenue	10,560	9,899
Operating Income	2,131	2,241
Corporate, non-segment [Member]	'	'
Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results	'	'
Unallocated corporate overhead	$7,868	$8,505

Fair_Value_Measurement_Financi

Fair Value Measurement - Financial Assets and Liabilities (Details) (USD $)	Mar. 31, 2014	Dec. 31, 2013
In Thousands, unless otherwise specified
Schedule of financial assets and liabilities measured at fair value on recurring basis	'	'
Total financial assets measured at fair value	$13,827	$18,176
US Treasury securities [Member]	'	'
Schedule of financial assets and liabilities measured at fair value on recurring basis	'	'
Total financial assets measured at fair value	13,467	17,817
Money Market Funds [Member]	'	'
Schedule of financial assets and liabilities measured at fair value on recurring basis	'	'
Total financial assets measured at fair value	360	359
Quoted Prices in Active Markets for Identical Assets (Level 1) [Member]	'	'
Schedule of financial assets and liabilities measured at fair value on recurring basis	'	'
Total financial assets measured at fair value	13,827	18,176
Quoted Prices in Active Markets for Identical Assets (Level 1) [Member] | US Treasury securities [Member]	'	'
Schedule of financial assets and liabilities measured at fair value on recurring basis	'	'
Total financial assets measured at fair value	13,467	17,817
Quoted Prices in Active Markets for Identical Assets (Level 1) [Member] | Money Market Funds [Member]	'	'
Schedule of financial assets and liabilities measured at fair value on recurring basis	'	'
Total financial assets measured at fair value	360	359
Significant Other Observable Inputs (Level 2) [Member]	'	'
Schedule of financial assets and liabilities measured at fair value on recurring basis	'	'
Total financial assets measured at fair value	0	0
Significant Other Observable Inputs (Level 2) [Member] | US Treasury securities [Member]	'	'
Schedule of financial assets and liabilities measured at fair value on recurring basis	'	'
Total financial assets measured at fair value	0	0
Significant Other Observable Inputs (Level 2) [Member] | Money Market Funds [Member]	'	'
Schedule of financial assets and liabilities measured at fair value on recurring basis	'	'
Total financial assets measured at fair value	0	0
Significant Unobservable Inputs (Level 3) [Member]	'	'
Schedule of financial assets and liabilities measured at fair value on recurring basis	'	'
Total financial assets measured at fair value	0	0
Significant Unobservable Inputs (Level 3) [Member] | US Treasury securities [Member]	'	'
Schedule of financial assets and liabilities measured at fair value on recurring basis	'	'
Total financial assets measured at fair value	0	0
Significant Unobservable Inputs (Level 3) [Member] | Money Market Funds [Member]	'	'
Schedule of financial assets and liabilities measured at fair value on recurring basis	'	'
Total financial assets measured at fair value	$0	$0

Subsequent_Events_Details

Subsequent Events (Details) (Subsequent Event [Member], USD $)	0 Months Ended
	Apr. 18, 2014
Line of Credit Facility [Line Items]	'
Deferred financing fees	$3,500,000
Line of Credit [Member]	'
Line of Credit Facility [Line Items]	'
Number of credit facilities	2
Credit facility, available	125,000,000
Line of Credit [Member] | Letter of Credit [Member]	'
Line of Credit Facility [Line Items]	'
Credit facility, available	40,000,000
Line of Credit Facility, Amount Outstanding	9,500,000
Line of Credit [Member] | Revolving Credit Facility [Member]	'
Line of Credit Facility [Line Items]	'
Credit facility, available	225,000,000
Line of Credit [Member] | Term Loan [Member]	'
Line of Credit Facility [Line Items]	'
Credit facility, available	150,000,000
Amortization of principal, rate	5.00%
Line of Credit [Member] | Revolving Credit Facility, Swing Line Loan [Member]	'
Line of Credit Facility [Line Items]	'
Credit facility, available	$20,000,000
Minimum [Member] | Line of Credit [Member] | Revolving Credit Facility [Member]	'
Line of Credit Facility [Line Items]	'
Unused fee	0.25%
Maximum [Member] | Line of Credit [Member] | Revolving Credit Facility [Member]	'
Line of Credit Facility [Line Items]	'
Unused fee	0.35%
London Interbank Offered Rate (LIBOR) [Member] | Minimum [Member] | Line of Credit [Member] | Revolving Credit Facility [Member]	'
Line of Credit Facility [Line Items]	'
Basis spread	1.50%
London Interbank Offered Rate (LIBOR) [Member] | Minimum [Member] | Line of Credit [Member] | Term Loan [Member]	'
Line of Credit Facility [Line Items]	'
Basis spread	1.50%
London Interbank Offered Rate (LIBOR) [Member] | Maximum [Member] | Line of Credit [Member] | Revolving Credit Facility [Member]	'
Line of Credit Facility [Line Items]	'
Basis spread	2.25%
London Interbank Offered Rate (LIBOR) [Member] | Maximum [Member] | Line of Credit [Member] | Term Loan [Member]	'
Line of Credit Facility [Line Items]	'
Basis spread	2.25%
Base Rate [Member] | Minimum [Member] | Line of Credit [Member] | Revolving Credit Facility [Member]	'
Line of Credit Facility [Line Items]	'
Basis spread	0.50%
Base Rate [Member] | Minimum [Member] | Line of Credit [Member] | Term Loan [Member]	'
Line of Credit Facility [Line Items]	'
Basis spread	0.50%
Base Rate [Member] | Maximum [Member] | Line of Credit [Member] | Revolving Credit Facility [Member]	'
Line of Credit Facility [Line Items]	'
Basis spread	1.25%
Base Rate [Member] | Maximum [Member] | Line of Credit [Member] | Term Loan [Member]	'
Line of Credit Facility [Line Items]	'
Basis spread	1.25%