AMN Healthcare Services (AMN) 10-Q 3 Aug 18 2018 Q2 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	6 Months Ended
	Jun. 30, 2018	Aug. 01, 2018
Document and Entity Information [Abstract]
Entity Registrant Name	AMN HEALTHCARE SERVICES INC
Entity Central Index Key	1,142,750
Current Fiscal Year End Date	--12-31
Entity Filer Category	Large Accelerated Filer
Document Type	10-Q
Document Period End Date	Jun. 30, 2018
Document Fiscal Year Focus	2,018
Document Fiscal Period Focus	Q2
Amendment Flag	false
Entity Common Stock, Shares Outstanding (excluding treasury shares)		47,492,913

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Jun. 30, 2018	Dec. 31, 2017
Current assets:
Cash and cash equivalents	$ 22,894	$ 15,147
Accounts receivable, net of allowances of $9,710 and $9,801 at June 30, 2018 and December 31, 2017, respectively	354,781	350,496
Accounts receivable, subcontractor	34,657	41,012
Prepaid expenses	18,888	16,505
Other current assets	37,301	50,993
Total current assets	468,521	474,153
Restricted cash, cash equivalents and investments	61,839	64,315
Fixed assets, net of accumulated depreciation of $105,275 and $97,889 at June 30, 2018 and December 31, 2017, respectively	81,221	73,431
Other assets	83,034	74,366
Goodwill	439,134	340,596
Intangible assets, net of accumulated amortization of $101,557 and $90,685 at June 30, 2018 and December 31, 2017, respectively	339,514	227,096
Total assets	1,473,263	1,253,957
Current liabilities:
Accounts payable and accrued expenses	123,105	130,319
Accrued compensation and benefits	130,258	121,423
Deferred revenue	13,615	8,384
Other current liabilities	16,261	5,146
Total current liabilities	283,239	265,272
Revolving credit facility	155,000	0
Notes payable, less unamortized fees	320,225	319,843
Deferred income taxes, net	19,863	27,036
Other long-term liabilities	78,192	79,279
Total liabilities	856,519	691,430
Commitments and contingencies
Stockholders’ equity:
Preferred stock, $0.01 par value; 10,000 shares authorized; none issued and outstanding at June 30, 2018 and December 31, 2017	0	0
Common stock, $0.01 par value; 200,000 shares authorized; 48,807 issued and 47,492 outstanding, respectively, at June 30, 2018 and 48,411 issued and 47,481 outstanding, respectively, at December 31, 2017	488	484
Additional paid-in capital	448,084	453,351
Treasury stock, at cost (1,315 and 930 shares at June 30, 2018 and December 31, 2017, respectively)	(54,316)	(33,425)
Retained earnings	222,528	142,229
Accumulated other comprehensive loss	(40)	(112)
Total stockholders’ equity	616,744	562,527
Total liabilities and stockholders’ equity	$ 1,473,263	$ 1,253,957

Condensed Consolidated Balance3

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Jun. 30, 2018	Dec. 31, 2017
Statement of Financial Position [Abstract]
Accounts receivable, allowance	$ 9,710	$ 9,801
Accumulated depreciation	105,275	97,889
Accumulated amortization	$ 101,557	$ 90,685
Preferred stock, par value (in dollars per share)	$ 0.01	$ 0.01
Preferred stock, shares authorized (in shares)	10,000,000	10,000,000
Preferred stock, shares issued (in shares)	0	0
Preferred stock, shares outstanding (in shares)	0	0
Common stock, par value (in dollars per share)	$ 0.01	$ 0.01
Common stock, shares authorized (in shares)	200,000,000	200,000,000
Common stock, shares issued (in shares)	48,807,000	48,411,000
Common stock, shares outstanding (in shares)	47,492,000	47,481,000
Treasury stock (in shares)	1,315,000	930,000

Condensed Consolidated Statemen

Condensed Consolidated Statements of Comprehensive Income - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2018	Jun. 30, 2017	Jun. 30, 2018	Jun. 30, 2017
Statement of Comprehensive Income [Abstract]
Revenue	$ 558,108	$ 489,803	$ 1,080,597	$ 984,972
Cost of revenue	377,152	328,791	731,817	662,184
Gross profit	180,956	161,012	348,780	322,788
Operating expenses:
Selling, general and administrative	115,535	96,673	220,272	198,746
Depreciation and amortization	10,606	7,959	18,492	15,627	[1]
Total operating expenses	126,141	104,632	238,764	214,373
Income from operations	54,815	56,380	110,016	108,415
Interest expense, net, and other	6,376	4,928	11,711	10,058
Income before income taxes	48,439	51,452	98,305	98,357
Income tax expense	12,910	20,197	20,095	35,094
Net income	35,529	31,255	78,210	63,263	[1]
Other comprehensive income (loss):
Foreign currency translation and other	91	(41)	72	(38)
Cash flow hedge, net of income taxes	0	(58)	0	(15)
Other comprehensive income (loss)	91	(99)	72	(53)
Comprehensive income	$ 35,620	$ 31,156	$ 78,282	$ 63,210
Net income per common share:
Basic (in dollars per share)	$ 0.75	$ 0.65	$ 1.64	$ 1.32
Diluted (in dollars per share)	$ 0.73	$ 0.63	$ 1.60	$ 1.28
Weighted average common shares outstanding:
Basic (shares)	47,653	47,916	47,693	47,849
Diluted (shares)	48,936	49,475	49,026	49,498
[1]	See Note (1) for a summary of adjustments.

Condensed Consolidated Stateme5

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2018	Jun. 30, 2017	[1]
Cash flows from operating activities:
Net income	$ 78,210	$ 63,263
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	18,492	15,627
Non-cash interest expense and other	1,277	1,121
Write-off of fees on the prior credit facilities	574	0
Change in fair value of contingent consideration	19	46
Increase in allowances for doubtful accounts and sales credits	4,809	7,740
Provision for deferred income taxes	(7,173)	(9,024)
Share-based compensation	6,145	5,243
Loss on disposal or sale of fixed assets	39	43
Amortization of discount on investments	(62)	(42)
Changes in assets and liabilities, net of effects from acquisitions:
Accounts receivable	13,830	(360)
Accounts receivable, subcontractor	6,355	12,602
Income taxes receivable	13,986	(825)
Prepaid expenses	(2,012)	(2,964)
Other current assets	(613)	1,356
Other assets	556	(5,763)
Accounts payable and accrued expenses	(8,954)	(18,515)
Accrued compensation and benefits	5,468	(710)
Other liabilities	(6,588)	525
Deferred revenue	1,573	716
Restricted investments balance	7	(36)
Net cash provided by operating activities	125,938	70,043
Cash flows from investing activities:
Purchase and development of fixed assets	(16,457)	(11,741)
Purchase of investments	(6,742)	(7,251)
Proceeds from maturity of investments	8,200	8,200
Payments to fund deferred compensation plan	(4,724)	(6,824)
Equity investment	0	(2,000)
Cash paid for acquisitions, net of cash received	218,047	0
Cash paid for other intangibles	(1,180)	0
Net cash used in investing activities	(238,950)	(19,616)
Cash flows from financing activities:
Payments on term loans	0	(25,938)
Payments on revolving credit facility	(40,000)	0
Proceeds from revolving credit facility	195,000	0
Repurchase of common stock	(20,891)	(329)
Payment of financing costs	(2,331)	0
Earn-out payments for prior acquisitions	(1,713)	(3,677)
Proceeds from termination of derivative contract	0	85
Cash paid for shares withheld for taxes	(11,408)	(9,014)
Net cash provided by (used in) financing activities	118,657	(38,873)
Effect of exchange rate changes on cash	72	(38)
Net increase in cash, cash equivalents and restricted cash	5,717	11,516
Cash, cash equivalents and restricted cash at the beginning of period	98,894	51,028
Cash, cash equivalents and restricted cash at the end of period	104,611	62,544
Supplemental disclosures of cash flow information:
Cash paid for interest (net of $193 and $58 capitalized for the six months ended June 30, 2018 and 2017, respectively)	10,167	9,129
Cash paid for income taxes	14,405	45,164
Acquisitions:
Fair value of tangible assets acquired in acquisitions, net of cash received	23,577	0
Goodwill	98,538	0
Intangible assets	122,110	0
Liabilities assumed	(16,078)	0
Earn-out liabilities	(10,100)	0
Supplemental disclosures of non-cash investing and financing activities:
Purchase of fixed assets recorded in accounts payable and accrued expenses	$ 1,800	$ 2,239
[1]	See Note (1) for a summary of adjustments.

Condensed Consolidated Stateme6

Condensed Consolidated Statements of Cash Flows (Parenthetical) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2018	Jun. 30, 2017
Statement of Cash Flows [Abstract]
Interest capitalized	$ 193	$ 58

Basis of Presentation

Basis of Presentation	6 Months Ended
	Jun. 30, 2018
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, 2017 , contained in the Company’s Annual Report on Form 10-K for the fiscal year ended December 31, 2017 , filed with the Securities and Exchange Commission on February 16, 2018 (“ 2017 Annual Report”). 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, earn-out liabilities, and income taxes. Actual results could differ from those estimates under different assumptions or conditions. Recently Adopted Accounting Pronouncements In May 2014, the Financial Accounting Standards Board (“FASB”) issued Accounting Standard Update ("ASU") 2014-09, Revenue from Contracts with Customers (Topic 606).” The FASB also issued a series of other ASUs, which update ASU 2014-09 (collectively, the “new revenue recognition standard”). This new standard replaces all previous U.S. GAAP guidance on this topic and eliminates all industry-specific guidance. The new revenue recognition standard provides a unified model to determine when and how revenue is recognized. The core principle is that a company should recognize revenue to depict the transfer of promised goods or services to customers in an amount that reflects the consideration for which the entity expects to be entitled in exchange for those goods or services. The Company adopted this standard effective January 1, 2018, using the modified retrospective transition method applied to those contracts which were not completed as of that date. Revenue from substantially all of our contracts with customers continues to be recognized over time as services are rendered. The Company recognized the cumulative effect of adopting this guidance as an adjustment to its opening balance of retained earnings of $2,089 , net of tax, primarily related to capitalization of contract costs. Prior period amounts are not retrospectively adjusted and continue to be reported in accordance with the accounting standards in effect for those periods. The impact of the adoption of the new standard was not material to the Company’s condensed consolidated financial statements for the three and six months ended June 30, 2018 . The Company expects the impact to be immaterial on an ongoing basis. See additional information regarding revenue recognition and disaggregated revenue in Note (3), “Revenue Recognition” and Note (5), “Segment Information,” respectively. In August 2016, the FASB issued ASU 2016-15, “Statement of Cash Flows (Topic 230): Classification of Certain Cash Receipts and Cash Payments.” The standard provides guidance on how certain cash receipts and payments are presented and classified in the statement of cash flows. For public entities, ASU 2016-15 is effective for fiscal years beginning after December 15, 2017, and interim periods within those annual periods, and requires a retrospective approach. The Company adopted this standard effective January 1, 2018 and the adoption did not have a material effect on the Company’s consolidated financial statements. In November 2016, the FASB issued ASU 2016-18, “Statement of Cash Flows (Topic 230): Restricted Cash.” The standard requires that a statement of cash flows explains the change during the period in the total of cash, cash equivalents, and amounts generally described as restricted cash or restricted cash equivalents (collectively, "restricted cash"). Therefore, restricted cash should be included with cash and cash equivalents when reconciling the beginning-of-period and end-of-period total amounts shown on the statement of cash flows. The new guidance is effective for interim and annual periods beginning after December 15, 2017. The Company adopted this standard retrospectively effective January 1, 2018 and included certain restricted cash amounts for the period ended June 30, 2017 within the accompanying condensed consolidated statements of cash flows. These adjustments had no effect on previously reported results of operations or retained earnings. The following table provides a summary of the adjustments from amounts previously reported. Six Months Ended June 30, 2017 As Previously Reported Adjustments As Adjusted Cash flows from operating activities: Changes in assets and liabilities: Other Current Assets 5,562 (4,206 ) 1,356 Restricted cash, cash equivalents and investments balance (3,497 ) 3,461 (36 ) Net cash provided by operating activities 70,788 (745 ) 70,043 Cash flows from investing activities Change in restricted cash, cash equivalents and investments balance (5 ) 5 — Net cash used in investing activities (19,621 ) 5 (19,616 ) Net increase in cash, cash equivalents and restricted cash $ 12,256 $ (740 ) $ 11,516 Cash, cash equivalents and restricted cash at the beginning of period 10,622 40,406 51,028 Cash, cash equivalents and restricted cash at the end of period $ 22,878 $ 39,666 $ 62,544 The following table provides a reconciliation of cash, cash equivalents and restricted cash reported within the accompanying condensed consolidated balance sheets and related notes to the amounts presented in the accompanying condensed consolidated statements of cash flows. June 30, 2018 December 31, 2017 Cash and cash equivalents $ 22,894 $ 15,147 Restricted cash and cash equivalents (included in other current assets) 24,550 25,506 Restricted cash, cash equivalents and investments 61,839 64,315 Total cash, cash equivalents and restricted cash and investments 109,283 104,968 Less restricted investments (4,672 ) (6,074 ) Total cash, cash equivalents and restricted cash $ 104,611 $ 98,894 There were no other material impacts to the Company's consolidated financial statements as a result of adopting these updated standards.

Acquisitions

Acquisitions	6 Months Ended
	Jun. 30, 2018
Business Combinations [Abstract]
ACQUISITIONS	As set forth below, the Company completed two acquisitions during the six months ended June 30, 2018 . The Company accounted for each acquisition using the acquisition method of accounting. Accordingly, it recorded the tangible and intangible assets acquired and liabilities assumed at their estimated fair values as of the applicable date of acquisition. For each acquisition, the Company did not incur any material acquisition-related costs. MedPartners Acquisition On April 9, 2018, the Company completed its acquisition of MedPartners HIM (“MedPartners”), which provides case management, clinical documentation improvement, medical coding and registry services to hospitals and physician medical groups nationwide. The initial purchase price of $200,933 included (1) $196,533 cash consideration paid upon acquisition, funded through borrowings under the Company’s $400,000 secured revolving credit facility (the “Senior Credit Facility”), provided for under a credit agreement (the “New Credit Agreement”), dated as of February 9, 2018, by and among the Company and several lenders, and (2) a contingent earn-out payment of up to $20,000 with an estimated fair value of $4,400 as of the acquisition date. The contingent earn-out payment is based on (A) up to $10,000 based on the operating results of MedPartners for the twelve months ending December 31, 2018, and (B) up to $10,000 based on the operating results of MedPartners for the six months ending June 30, 2019. As the acquisition’s operations are not considered material, pro forma information is not provided. The results of MedPartners have been included in the Company’s other workforce solutions segment since the date of acquisition. The preliminary allocation of the $200,933 purchase price consisted of (1) $27,975 of fair value of tangible assets acquired, which included $8,403 cash received, (2) $11,339 of liabilities assumed, (3) $103,000 of identified intangible assets, and (4) $81,297 of goodwill, all of which is deductible for tax purposes. The fair value of intangible assets includes $46,000 of trademarks and $57,000 of customer relationships with a weighted average useful life of approximately sixteen years. Phillips DiPisa and Leaders For Today Acquisition On April 6, 2018, the Company completed its acquisition of two related entities, Phillips DiPisa and Leaders For Today (“PDA and LFT”), which offer a range of leadership staffing and permanent placement solutions for the healthcare industry. The initial purchase price of $35,968 included (1) $30,268 cash consideration paid upon acquisition, funded through cash on hand, and (2) a contingent earn-out payment of up to $7,000 with an estimated fair value of $5,700 as of the acquisition date. The contingent earn-out payment is based on the operating results of PDA and LFT for the twelve months ending December 31, 2018. As the acquisition’s operations are not considered material, pro forma information is not provided. The results of PDA and LFT have been included in the Company’s other workforce solutions segment since the date of acquisition. The preliminary allocation of the $35,968 purchase price consisted of (1) $4,356 of fair value of tangible assets acquired, which included $351 cash received, (2) $4,739 of liabilities assumed, (3) $19,110 of identified intangible assets, and (4) $17,241 of goodwill, all of which is deductible for tax purposes. The fair value of intangible assets includes $5,400 of trademarks, $8,000 of customer relationships and $5,710 of staffing databases with a weighted average useful life of approximately twelve years.

Revenue Recognition (Notes)

Revenue Recognition (Notes)	6 Months Ended
	Jun. 30, 2018
Revenue Recognition and Deferred Revenue [Abstract]
Revenue Recognition	REVENUE RECOGNITION Revenue primarily consists of fees earned from the temporary and permanent placement of healthcare professionals and executives as well as from the Company’s SaaS-based technology, including its vendor management systems and its scheduling software. Revenue is recognized when control of these services is transferred to the customers, in an amount that reflects the consideration the Company expects to be entitled to in exchange for those services. Revenue from temporary staffing services is recognized as the services are rendered by clinical and non-clinical healthcare professionals. Under the Company’s managed services program arrangements, the Company manages all or a part of a customer’s supplemental workforce needs utilizing its own network of healthcare professionals along with those of third-party subcontractors. Revenue and the related direct costs under MSP arrangements are recorded in accordance with the accounting guidance on reporting revenue gross as a principal versus net as an agent. When the Company uses subcontractors and acts as an agent, revenue is recorded net of the related subcontractor’s expense. Revenue from executive search, physician permanent placement, and recruitment process outsourcing services is recognized as the services are rendered. The Company’s SaaS-based revenue is recognized ratably over the applicable arrangement’s service period. The Company’s customers are primarily billed as services are rendered. Any fees billed in advance of being earned are recorded as deferred revenue. During the six months ended June 30, 2018 , the amount recognized as revenue that was previously deferred was not material. Under the new revenue standard, the Company has elected to apply the following practical expedients and optional exemptions: • Recognize incremental costs of obtaining a contract with amortization periods of one year or less as expense when incurred. These costs are recorded within selling, general and administrative expenses. • Recognize revenue in the amount of consideration to which the Company has a right to invoice the customer if that amount corresponds directly with the value to the customer of the Company’s services completed to date. • Exemptions from disclosing the value of unsatisfied performance obligations for (i) contracts with an original expected length of one year or less, (ii) contracts for which revenue is recognized in the amount of consideration to which the Company has a right to invoice for services performed and (iii) contracts for which variable consideration is allocated entirely to a wholly unsatisfied performance obligation or to a wholly unsatisfied promise to transfer a distinct service that forms part of a single performance obligation. See additional information regarding adoption of the new revenue standard in Note (1), “Basis of Presentation” and additional disclosures required by the new revenue standard in Note (5), “Segment Information.”

Net Income Per Common Share

Net Income Per Common Share	6 Months Ended
	Jun. 30, 2018
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. The following table sets forth the computation of basic and diluted net income per common share for the three and six months ended June 30, 2018 and 2017 , respectively: Three Months Ended June 30, Six Months Ended June 30, 2018 2017 2018 2017 Net income $ 35,529 $ 31,255 $ 78,210 $ 63,263 Net income per common share - basic $ 0.75 $ 0.65 $ 1.64 $ 1.32 Net income per common share - diluted $ 0.73 $ 0.63 $ 1.60 $ 1.28 Weighted average common shares outstanding - basic 47,653 47,916 47,693 47,849 Plus dilutive effect of potential common shares 1,283 1,559 1,333 1,649 Weighted average common shares outstanding - diluted 48,936 49,475 49,026 49,498 Share-based awards to purchase 36 and 23 shares of common stock were not included in the above calculation of diluted net income per common share for the three and six months ended June 30, 2018 , respectively, because the effect of these instruments was anti-dilutive. Share-based awards to purchase 33 and 16 shares of common stock were not included in the above calculation of diluted net income per common share for the three and six months ended June 30, 2017 , respectively, because the effect of these instruments was anti-dilutive.

Segment Information

Segment Information	6 Months Ended
	Jun. 30, 2018
Segment Reporting [Abstract]
SEGMENT INFORMATION	SEGMENT INFORMATION The Company has three reportable segments: nurse and allied solutions, locum tenens solutions, and other workforce solutions. The Company’s chief operating decision maker 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, 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 June 30, Six Months Ended June 30, 2018 2017 2018 2017 Revenue Nurse and allied solutions $ 332,728 $ 300,727 $ 670,907 $ 614,250 Locum tenens solutions 107,297 108,215 210,414 211,058 Other workforce solutions 118,083 80,861 199,276 159,664 $ 558,108 $ 489,803 $ 1,080,597 $ 984,972 Segment operating income Nurse and allied solutions $ 43,936 $ 47,851 $ 95,741 $ 93,831 Locum tenens solutions 13,371 12,371 23,329 24,590 Other workforce solutions 28,576 22,041 48,427 41,898 85,883 82,263 167,497 160,319 Unallocated corporate overhead 17,181 15,362 32,844 31,034 Depreciation and amortization 10,606 7,959 18,492 15,627 Share-based compensation 3,281 2,562 6,145 5,243 Interest expense, net, and other 6,376 4,928 11,711 10,058 Income before income taxes $ 48,439 $ 51,452 $ 98,305 $ 98,357 The Company offers a comprehensive managed services program, in which the Company manages all or a portion of a client's contingent staffing needs. This service includes both the placement of the Company's own healthcare professionals and the utilization of other staffing agencies to fulfill the client's staffing needs. See additional information in Note (3), “Revenue Recognition.” For the three months ended June 30, 2018 and 2017 , revenue under the Company’s managed services program arrangements comprised approximately 56% and 55% for nurse and allied solutions revenue, 14% and 11% for locum tenens solutions revenue and 6% and 8% for other workforce solutions revenue, respectively. For the six months ended June 30, 2018 and 2017 , revenue under the Company’s managed services program arrangements comprised approximately 60% and 56% for nurse and allied solutions revenue, 14% and 12% for locum tenens solutions revenue and 8% and 8% for other workforce solutions revenue, respectively. The following table summarizes the activity related to the carrying value of goodwill by reportable segment: Nurse and Allied Solutions Locum Tenens Solutions Other Workforce Solutions Total Balance, January 1, 2018 $ 103,107 $ 19,743 $ 217,746 $ 340,596 Goodwill from MedPartners acquisition — — 81,297 81,297 Goodwill from PDA and LFT acquisition — — 17,241 17,241 Balance, June 30, 2018 $ 103,107 $ 19,743 $ 316,284 $ 439,134 Accumulated impairment loss as of December 31, 2017 and June 30, 2018 $ 154,444 $ 53,940 $ 6,555 $ 214,939

New Credit Agreement

New Credit Agreement	6 Months Ended
	Jun. 30, 2018
Debt Disclosure [Abstract]
New Credit Agreement	NEW CREDIT AGREEMENT On February 9, 2018, the Company entered into the New Credit Agreement with several lenders to provide for the $400,000 Senior Credit Facility to replace its then-existing credit facilities. The Senior Credit Facility includes a $50,000 sublimit for the issuance of letters of credit and a $50,000 sublimit for swingline loans. The obligations of the Company under the New Credit Agreement and the Senior Credit Facility are secured by substantially all of the assets of the Company. Borrowings under the Senior Credit Facility bear interest at floating rates, at the Company’s option, based upon either LIBOR plus a spread of 1.00% to 2.00% or a base rate plus a spread of 0.00% to 1.00% . The applicable spread is determined quarterly based upon the Company’s consolidated net leverage ratio. The Senior Credit Facility is available for working capital, capital expenditures, permitted acquisitions and general corporate purposes. The maturity date of the Senior Credit Facility is February 9, 2023. In connection with obtaining the New Credit Agreement, the Company incurred $2,331 in fees paid to lenders and other third parties, which were capitalized and are amortized to interest expense over the term of the New Credit Facility. In addition, the Company wrote off $574 of unamortized financing fees during the six months ended June 30, 2018 relating to the prior credit facilities.

Fair Value Measurement

Fair Value Measurement	6 Months Ended
	Jun. 30, 2018
Fair Value Disclosures [Abstract]
FAIR VALUE MEASUREMENT	FAIR VALUE MEASUREMENT The Company’s valuation techniques and inputs used to measure fair value and the definition of the three levels (Level 1, Level 2, and Level 3) of the fair value hierarchy are disclosed in Part II, Item 8, “Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note 4—Fair Value Measurement” of the 2017 Annual Report. The Company has not changed the valuation techniques or inputs it uses for its fair value measurement during the six months ended June 30, 2018 . Assets and Liabilities Measured on a Recurring Basis The Company’s restricted cash equivalents that serve as collateral for the Company’s outstanding letters of credit typically consist of money market funds that are measured at fair value based on quoted prices, which are Level 1 inputs. The Company’s restricted cash equivalents and investments that serve as collateral for the Company’s captive insurance company primarily consist of commercial paper that is measured at observable market prices for identical securities that are traded in less active markets, which are Level 2 inputs. Of the $32,228 commercial paper issued and outstanding as of June 30, 2018 , $4,672 had original maturities greater than three months, which were considered available-for-sale securities. As of December 31, 2017 , the Company had $28,708 commercial paper issued and outstanding, of which $6,074 had original maturities greater than three months and were considered available-for-sale securities. The Company’s contingent consideration liabilities are measured at fair value using a probability-weighted discounted cash flow analysis or a simulation-based methodology for the acquired companies, which are Level 3 inputs. The following tables present information about the above-referenced assets and liabilities and indicate the fair value hierarchy of the valuation techniques utilized to determine such fair value: Fair Value Measurements as of June 30, 2018 Total Quoted Prices in Active Markets for Identical Assets (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Money market funds $ 2,728 $ 2,728 $ — $ — Commercial paper 32,228 — 32,228 — Acquisition contingent consideration liabilities (10,119 ) — — (10,119 ) Fair Value Measurements as of December 31, 2017 Total Quoted Prices in Active Markets for Identical Assets (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Money market funds $ 2,713 $ 2,713 $ — $ — Commercial paper 28,708 — 28,708 — Acquisition contingent consideration liabilities (2,070 ) — — (2,070 ) Level 3 Information The following tables set forth a reconciliation of changes in the fair value of contingent consideration liabilities classified as Level 3 in the fair value hierarchy: Three Months Ended June 30, 2018 2017 Balance as of April 1, $ — $ (1,909 ) Contingent consideration liability from PDA and LFT acquisition on April 6, 2018 (5,700 ) — Contingent consideration liability from MedPartners acquisition on April 9, 2018 (4,400 ) — Change in fair value of contingent consideration liability from HealthSource Global Stafffing (“HSG”) acquisition — (23 ) Change in fair value of contingent consideration liability from PDA and LFT acquisition (19 ) — Balance as of June 30, $ (10,119 ) $ (1,932 ) Six Months Ended June 30, 2018 2017 Balance as of January 1, $ (2,070 ) $ (6,816 ) Settlement of The First String Healthcare contingent consideration liability for year ended December 31, 2016 — 3,000 Settlement of HSG contingent consideration liability for year ended December 31, 2016 70 1,930 Settlement of HSG contingent consideration liability for year ended December 31, 2017 2,000 — Contingent consideration liability from PDA and LFT acquisition on April 6, 2018 (5,700 ) — Contingent consideration liability from MedPartners acquisition on April 9, 2018 (4,400 ) — Change in fair value of contingent consideration liability from HSG acquisition — (46 ) Change in fair value of contingent consideration liability from PDA and LFT acquisition (19 ) — Balance as of June 30, $ (10,119 ) $ (1,932 ) 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 investments. The Company evaluates goodwill and indefinite-lived intangible assets annually for impairment and whenever circumstances occur indicating that goodwill might be impaired. The Company determines the fair value of its reporting units based on a combination of inputs, including the market capitalization of the Company, as well as Level 3 inputs such as discounted cash flows, which are not observable from the market, directly or indirectly. The Company determines the fair value of its indefinite-lived intangible assets using the income approach (relief-from-royalty method) based on 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 investments during the six months ended June 30, 2018 and 2017 . Fair Value of Financial Instruments The Company is required to disclose the fair value of financial instruments for which it is practicable to estimate the value, even though these instruments are not recognized at fair value in the consolidated balance sheets. As of June 30, 2018 , the Company's senior notes have a carrying amount of $325,000 and an estimated fair value of $315,250 . As of December 31, 2017 , the senior notes had a carrying amount of $325,000 and an estimated fair value of $335,156 . Quoted market prices in active markets for identical liabilities based inputs (level 1) were used to estimate fair value. The senior notes were issued in October 2016 and have a fixed rate of 5.125% . See additional information in “Item 8. Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note (8), Notes Payable and Credit Agreement” of our 2017 Annual Report. 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	6 Months Ended
	Jun. 30, 2018
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 June 30, 2018 , the Company is no longer subject to state, local or foreign examinations by tax authorities for tax years before 2006, and the Company is no longer subject to U.S. federal income or payroll tax examinations for tax years before 2014. The IRS conducted, completed, and settled audits of the Company’s 2011-2012 and 2013 tax years related to income and employment tax issues for the Company’s treatment of certain non-taxable per diem allowances and travel benefits in November 2017 and May 2018, respectively. The Company believes its reserve for unrecognized tax benefits and contingent tax issues is adequate with respect to all open years. Notwithstanding the foregoing, the Company could adjust its provision for income taxes and contingent tax liability based on future developments. Immaterial Tax Correction Related to Prior Periods During the first quarter of 2018, the Company identified an error related to the income tax treatment of fair value changes in the cash surrender value of its Company Owned Life Insurance (COLI) for prior years. These fair value changes had not previously been included as a net tax benefit in the provision for prior periods. In accordance with ASC 250, Accounting Changes and Error Corrections , management evaluated the materiality of the error from qualitative and quantitative perspectives, and concluded that the error was not material to the consolidated financial statements of prior years, nor is it believed to be material to 2018’s full year consolidated financial statements. As result, the Company recorded a net tax benefit of $2,501 in the six months ended June 30, 2018 to adjust for this immaterial error correction. Tax Cuts and Jobs Act On December 22, 2017, the U.S. government enacted comprehensive tax legislation commonly referred to as the Tax Cuts and Jobs Act (the “Tax Act”). The Tax Act makes broad and complex changes to the U.S. tax code, including, but not limited to, reducing the U.S. federal corporate tax rate from 35 percent to 21 percent. The Tax Act changes that affected the Company in 2017 are primarily tax rate changes on certain deferred tax assets (“DTAs”) and deferred tax liabilities (“DTLs”). The staff of the Securities and Exchange Commission issued Staff Accounting Bulletin No. 118 (“SAB 118”), which provides guidance on accounting for the tax effects of the Tax Act. SAB 118 provides a measurement period that should not extend beyond one year from the Tax Act enactment date for companies to complete the accounting under ASC 740. To the extent that a company’s accounting for certain income tax effects of the Tax Act is incomplete but it is able to determine a reasonable estimate, it must record a provisional estimate in the financial statements. The Tax Act also establishes new tax laws that will affect 2018 and beyond, including, but not limited to, (1) reduction of the U.S. federal corporate tax rate; (2) the repeal of the domestic production activity deduction; (3) limitations on the deductibility of certain executive compensation; and (4) limitations on various entertainment and meals deductions. The Company's accounting for certain elements of the Tax Act is incomplete, primarily relating to executive compensation and accounting methods. However, the Company was able to make reasonable estimates of these elements and, therefore, recorded provisional adjustments for these items.

Commitments and Contingencies_

Commitments and Contingencies: Legal Proceedings	6 Months Ended
	Jun. 30, 2018
Commitments and Contingencies Disclosure [Abstract]
COMMITMENTS AND CONTINGENCIES: LEGAL PROCEEDINGS	COMMITMENTS AND CONTINGENCIES: LEGAL PROCEEDINGS From time to time, the Company is involved in various lawsuits, claims, investigations, and proceedings that arise in the ordinary course of business. These matters typically relate to professional liability, tax, compensation, contract, competitor disputes and employee-related matters and include individual and class action lawsuits, as well as inquiries and investigations by governmental agencies regarding the Company’s employment and compensation practices. 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 healthcare professionals. Depending upon the particular facts and circumstances, the Company may also be subject to indemnification obligations under its contracts with such clients relating to these matters. The Company records a liability when management believes an adverse outcome from a loss contingency is both probable and the amount, or a range, can be reasonably estimated. Significant judgment is required to determine both probability of loss and the estimated amount. The Company reviews its loss contingencies at least quarterly and adjusts its accruals and/or disclosures to reflect the impact of negotiations, settlements, rulings, advice of legal counsel, or other new information, as deemed necessary. The most significant matters for which the Company has established loss contingencies are class actions related to wage and hour claims under California and Federal law. Specifically, among other claims in these lawsuits, it is alleged that certain expense reimbursements should be included in the regular rate of pay for purposes of calculating overtime rates, employees were not afforded required breaks or compensated for all time worked and the employees' wage statements are not sufficiently clear. While the Company believes that its wage and hour practices conform with law in all material respects, litigation is always subject to inherent uncertainty, and the Company is not able to reasonably predict if any matter will be resolved in a manner that is materially adverse to the Company beyond the amounts accrued. With regards to outstanding loss contingencies as of June 30, 2018 , which are included in accounts payable and accrued expenses in the condensed consolidated balance sheet, the Company believes that such matters will not, either individually or in the aggregate, have a material adverse effect on its business, consolidated financial position, results of operations, or cash flows.

Balance Sheet Details

Balance Sheet Details	6 Months Ended
	Jun. 30, 2018
Balance Sheet Related Disclosures [Abstract]
BALANCE SHEET DETAILS	BALANCE SHEET DETAILS The consolidated balance sheets detail is as follows as of June 30, 2018 and December 31, 2017 : June 30, 2018 December 31, 2017 Other current assets: Restricted cash and cash equivalents $ 24,550 $ 25,506 Income tax receivable 1,912 15,898 Other 10,839 9,589 Other current assets $ 37,301 $ 50,993 Fixed assets: Furniture and equipment $ 31,123 $ 29,494 Software 147,094 132,770 Leasehold improvements 8,279 9,056 186,496 171,320 Accumulated depreciation (105,275 ) (97,889 ) Fixed assets, net $ 81,221 $ 73,431 Other assets: Life insurance cash surrender value $ 54,158 $ 48,145 Other 28,876 26,221 Other assets $ 83,034 $ 74,366 Accounts payable and accrued expenses: Trade accounts payable $ 26,369 $ 31,420 Subcontractor payable 34,354 41,786 Accrued expenses 47,545 40,403 Professional liability reserve 8,575 7,672 Other 6,262 9,038 Accounts payable and accrued expenses $ 123,105 $ 130,319 Accrued compensation and benefits: Accrued payroll $ 39,428 $ 33,923 Accrued bonuses 15,431 19,489 Accrued travel expense 4,727 3,256 Health insurance reserve 4,078 3,658 Workers compensation reserve 7,970 8,553 Deferred compensation 55,320 49,330 Other 3,304 3,214 Accrued compensation and benefits $ 130,258 $ 121,423 Other long-term liabilities: Workers compensation reserve $ 19,225 $ 19,074 Professional liability reserve 36,076 38,964 Deferred rent 14,890 14,744 Unrecognized tax benefits 4,890 5,270 Deferred revenue 1,279 960 Other 1,832 267 Other long-term liabilities $ 78,192 $ 79,279

Basis of Presentation (Policies

Basis of Presentation (Policies)	6 Months Ended
	Jun. 30, 2018
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, earn-out liabilities, and income taxes. Actual results could differ from those estimates under different assumptions or conditions.
Recently Adopted Accounting Pronouncements	Recently Adopted Accounting Pronouncements In May 2014, the Financial Accounting Standards Board (“FASB”) issued Accounting Standard Update ("ASU") 2014-09, Revenue from Contracts with Customers (Topic 606).” The FASB also issued a series of other ASUs, which update ASU 2014-09 (collectively, the “new revenue recognition standard”). This new standard replaces all previous U.S. GAAP guidance on this topic and eliminates all industry-specific guidance. The new revenue recognition standard provides a unified model to determine when and how revenue is recognized. The core principle is that a company should recognize revenue to depict the transfer of promised goods or services to customers in an amount that reflects the consideration for which the entity expects to be entitled in exchange for those goods or services. The Company adopted this standard effective January 1, 2018, using the modified retrospective transition method applied to those contracts which were not completed as of that date. Revenue from substantially all of our contracts with customers continues to be recognized over time as services are rendered. The Company recognized the cumulative effect of adopting this guidance as an adjustment to its opening balance of retained earnings of $2,089 , net of tax, primarily related to capitalization of contract costs. Prior period amounts are not retrospectively adjusted and continue to be reported in accordance with the accounting standards in effect for those periods. The impact of the adoption of the new standard was not material to the Company’s condensed consolidated financial statements for the three and six months ended June 30, 2018 . The Company expects the impact to be immaterial on an ongoing basis. See additional information regarding revenue recognition and disaggregated revenue in Note (3), “Revenue Recognition” and Note (5), “Segment Information,” respectively. In August 2016, the FASB issued ASU 2016-15, “Statement of Cash Flows (Topic 230): Classification of Certain Cash Receipts and Cash Payments.” The standard provides guidance on how certain cash receipts and payments are presented and classified in the statement of cash flows. For public entities, ASU 2016-15 is effective for fiscal years beginning after December 15, 2017, and interim periods within those annual periods, and requires a retrospective approach. The Company adopted this standard effective January 1, 2018 and the adoption did not have a material effect on the Company’s consolidated financial statements. In November 2016, the FASB issued ASU 2016-18, “Statement of Cash Flows (Topic 230): Restricted Cash.” The standard requires that a statement of cash flows explains the change during the period in the total of cash, cash equivalents, and amounts generally described as restricted cash or restricted cash equivalents (collectively, "restricted cash"). Therefore, restricted cash should be included with cash and cash equivalents when reconciling the beginning-of-period and end-of-period total amounts shown on the statement of cash flows. The new guidance is effective for interim and annual periods beginning after December 15, 2017. The Company adopted this standard retrospectively effective January 1, 2018 and included certain restricted cash amounts for the period ended June 30, 2017 within the accompanying condensed consolidated statements of cash flows. These adjustments had no effect on previously reported results of operations or retained earnings. The following table provides a summary of the adjustments from amounts previously reported. Six Months Ended June 30, 2017 As Previously Reported Adjustments As Adjusted Cash flows from operating activities: Changes in assets and liabilities: Other Current Assets 5,562 (4,206 ) 1,356 Restricted cash, cash equivalents and investments balance (3,497 ) 3,461 (36 ) Net cash provided by operating activities 70,788 (745 ) 70,043 Cash flows from investing activities Change in restricted cash, cash equivalents and investments balance (5 ) 5 — Net cash used in investing activities (19,621 ) 5 (19,616 ) Net increase in cash, cash equivalents and restricted cash $ 12,256 $ (740 ) $ 11,516 Cash, cash equivalents and restricted cash at the beginning of period 10,622 40,406 51,028 Cash, cash equivalents and restricted cash at the end of period $ 22,878 $ 39,666 $ 62,544 The following table provides a reconciliation of cash, cash equivalents and restricted cash reported within the accompanying condensed consolidated balance sheets and related notes to the amounts presented in the accompanying condensed consolidated statements of cash flows. June 30, 2018 December 31, 2017 Cash and cash equivalents $ 22,894 $ 15,147 Restricted cash and cash equivalents (included in other current assets) 24,550 25,506 Restricted cash, cash equivalents and investments 61,839 64,315 Total cash, cash equivalents and restricted cash and investments 109,283 104,968 Less restricted investments (4,672 ) (6,074 ) Total cash, cash equivalents and restricted cash $ 104,611 $ 98,894 There were no other material impacts to the Company's consolidated financial statements as a result of adopting these updated standards.
Revenue Recognition	Revenue primarily consists of fees earned from the temporary and permanent placement of healthcare professionals and executives as well as from the Company’s SaaS-based technology, including its vendor management systems and its scheduling software. Revenue is recognized when control of these services is transferred to the customers, in an amount that reflects the consideration the Company expects to be entitled to in exchange for those services. Revenue from temporary staffing services is recognized as the services are rendered by clinical and non-clinical healthcare professionals. Under the Company’s managed services program arrangements, the Company manages all or a part of a customer’s supplemental workforce needs utilizing its own network of healthcare professionals along with those of third-party subcontractors. Revenue and the related direct costs under MSP arrangements are recorded in accordance with the accounting guidance on reporting revenue gross as a principal versus net as an agent. When the Company uses subcontractors and acts as an agent, revenue is recorded net of the related subcontractor’s expense. Revenue from executive search, physician permanent placement, and recruitment process outsourcing services is recognized as the services are rendered. The Company’s SaaS-based revenue is recognized ratably over the applicable arrangement’s service period. The Company’s customers are primarily billed as services are rendered. Any fees billed in advance of being earned are recorded as deferred revenue. During the six months ended June 30, 2018 , the amount recognized as revenue that was previously deferred was not material. Under the new revenue standard, the Company has elected to apply the following practical expedients and optional exemptions: • Recognize incremental costs of obtaining a contract with amortization periods of one year or less as expense when incurred. These costs are recorded within selling, general and administrative expenses. • Recognize revenue in the amount of consideration to which the Company has a right to invoice the customer if that amount corresponds directly with the value to the customer of the Company’s services completed to date. • Exemptions from disclosing the value of unsatisfied performance obligations for (i) contracts with an original expected length of one year or less, (ii) contracts for which revenue is recognized in the amount of consideration to which the Company has a right to invoice for services performed and (iii) contracts for which variable consideration is allocated entirely to a wholly unsatisfied performance obligation or to a wholly unsatisfied promise to transfer a distinct service that forms part of a single performance obligation.
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.
Segment Information	The Company’s chief operating decision maker 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, 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 of Financial Instruments	Fair Value of Financial Instruments The Company is required to disclose the fair value of financial instruments for which it is practicable to estimate the value, even though these instruments are not recognized at fair value in the consolidated balance sheets. As of June 30, 2018 , the Company's senior notes have a carrying amount of $325,000 and an estimated fair value of $315,250 . As of December 31, 2017 , the senior notes had a carrying amount of $325,000 and an estimated fair value of $335,156 . Quoted market prices in active markets for identical liabilities based inputs (level 1) were used to estimate fair value. The senior notes were issued in October 2016 and have a fixed rate of 5.125% . See additional information in “Item 8. Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note (8), Notes Payable and Credit Agreement” of our 2017 Annual Report. 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 and Liabilities Measured on a Recurring Basis The Company’s restricted cash equivalents that serve as collateral for the Company’s outstanding letters of credit typically consist of money market funds that are measured at fair value based on quoted prices, which are Level 1 inputs. The Company’s restricted cash equivalents and investments that serve as collateral for the Company’s captive insurance company primarily consist of commercial paper that is measured at observable market prices for identical securities that are traded in less active markets, which are Level 2 inputs. Of the $32,228 commercial paper issued and outstanding as of June 30, 2018 , $4,672 had original maturities greater than three months, which were considered available-for-sale securities. As of December 31, 2017 , the Company had $28,708 commercial paper issued and outstanding, of which $6,074 had original maturities greater than three months and were considered available-for-sale securities. 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 investments. The Company evaluates goodwill and indefinite-lived intangible assets annually for impairment and whenever circumstances occur indicating that goodwill might be impaired. The Company determines the fair value of its reporting units based on a combination of inputs, including the market capitalization of the Company, as well as Level 3 inputs such as discounted cash flows, which are not observable from the market, directly or indirectly. The Company determines the fair value of its indefinite-lived intangible assets using the income approach (relief-from-royalty method) based on Level 3 inputs.

Basis of Presentation (Tables)

Basis of Presentation (Tables)	6 Months Ended
	Jun. 30, 2018
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Schedule of Error Corrections and Prior Period Adjustments [Table Text Block]	These adjustments had no effect on previously reported results of operations or retained earnings. The following table provides a summary of the adjustments from amounts previously reported. Six Months Ended June 30, 2017 As Previously Reported Adjustments As Adjusted Cash flows from operating activities: Changes in assets and liabilities: Other Current Assets 5,562 (4,206 ) 1,356 Restricted cash, cash equivalents and investments balance (3,497 ) 3,461 (36 ) Net cash provided by operating activities 70,788 (745 ) 70,043 Cash flows from investing activities Change in restricted cash, cash equivalents and investments balance (5 ) 5 — Net cash used in investing activities (19,621 ) 5 (19,616 ) Net increase in cash, cash equivalents and restricted cash $ 12,256 $ (740 ) $ 11,516 Cash, cash equivalents and restricted cash at the beginning of period 10,622 40,406 51,028 Cash, cash equivalents and restricted cash at the end of period $ 22,878 $ 39,666 $ 62,544 The following table provides a reconciliation of cash, cash equivalents and restricted cash reported within the accompanying condensed consolidated balance sheets and related notes to the amounts presented in the accompanying condensed consolidated statements of cash flows. June 30, 2018 December 31, 2017 Cash and cash equivalents $ 22,894 $ 15,147 Restricted cash and cash equivalents (included in other current assets) 24,550 25,506 Restricted cash, cash equivalents and investments 61,839 64,315 Total cash, cash equivalents and restricted cash and investments 109,283 104,968 Less restricted investments (4,672 ) (6,074 ) Total cash, cash equivalents and restricted cash $ 104,611 $ 98,894

Net Income Per Common Share (Ta

Net Income Per Common Share (Tables)	6 Months Ended
	Jun. 30, 2018
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 and six months ended June 30, 2018 and 2017 , respectively: Three Months Ended June 30, Six Months Ended June 30, 2018 2017 2018 2017 Net income $ 35,529 $ 31,255 $ 78,210 $ 63,263 Net income per common share - basic $ 0.75 $ 0.65 $ 1.64 $ 1.32 Net income per common share - diluted $ 0.73 $ 0.63 $ 1.60 $ 1.28 Weighted average common shares outstanding - basic 47,653 47,916 47,693 47,849 Plus dilutive effect of potential common shares 1,283 1,559 1,333 1,649 Weighted average common shares outstanding - diluted 48,936 49,475 49,026 49,498

Segment Information (Tables)

Segment Information (Tables)	6 Months Ended
	Jun. 30, 2018
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 June 30, Six Months Ended June 30, 2018 2017 2018 2017 Revenue Nurse and allied solutions $ 332,728 $ 300,727 $ 670,907 $ 614,250 Locum tenens solutions 107,297 108,215 210,414 211,058 Other workforce solutions 118,083 80,861 199,276 159,664 $ 558,108 $ 489,803 $ 1,080,597 $ 984,972 Segment operating income Nurse and allied solutions $ 43,936 $ 47,851 $ 95,741 $ 93,831 Locum tenens solutions 13,371 12,371 23,329 24,590 Other workforce solutions 28,576 22,041 48,427 41,898 85,883 82,263 167,497 160,319 Unallocated corporate overhead 17,181 15,362 32,844 31,034 Depreciation and amortization 10,606 7,959 18,492 15,627 Share-based compensation 3,281 2,562 6,145 5,243 Interest expense, net, and other 6,376 4,928 11,711 10,058 Income before income taxes $ 48,439 $ 51,452 $ 98,305 $ 98,357
Summary of goodwill by reportable segment	The following table summarizes the activity related to the carrying value of goodwill by reportable segment: Nurse and Allied Solutions Locum Tenens Solutions Other Workforce Solutions Total Balance, January 1, 2018 $ 103,107 $ 19,743 $ 217,746 $ 340,596 Goodwill from MedPartners acquisition — — 81,297 81,297 Goodwill from PDA and LFT acquisition — — 17,241 17,241 Balance, June 30, 2018 $ 103,107 $ 19,743 $ 316,284 $ 439,134 Accumulated impairment loss as of December 31, 2017 and June 30, 2018 $ 154,444 $ 53,940 $ 6,555 $ 214,939

Fair Value Measurement (Tables)

Fair Value Measurement (Tables)	6 Months Ended
	Jun. 30, 2018
Fair Value Disclosures [Abstract]
Schedule of financial assets and liabilities measured at fair value on recurring basis	The following tables present information about the above-referenced assets and liabilities and indicate the fair value hierarchy of the valuation techniques utilized to determine such fair value: Fair Value Measurements as of June 30, 2018 Total Quoted Prices in Active Markets for Identical Assets (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Money market funds $ 2,728 $ 2,728 $ — $ — Commercial paper 32,228 — 32,228 — Acquisition contingent consideration liabilities (10,119 ) — — (10,119 ) Fair Value Measurements as of December 31, 2017 Total Quoted Prices in Active Markets for Identical Assets (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Money market funds $ 2,713 $ 2,713 $ — $ — Commercial paper 28,708 — 28,708 — Acquisition contingent consideration liabilities (2,070 ) — — (2,070 )
Reconciliations of changes in the fair value of contingent consideration liabilities	The following tables set forth a reconciliation of changes in the fair value of contingent consideration liabilities classified as Level 3 in the fair value hierarchy: Three Months Ended June 30, 2018 2017 Balance as of April 1, $ — $ (1,909 ) Contingent consideration liability from PDA and LFT acquisition on April 6, 2018 (5,700 ) — Contingent consideration liability from MedPartners acquisition on April 9, 2018 (4,400 ) — Change in fair value of contingent consideration liability from HealthSource Global Stafffing (“HSG”) acquisition — (23 ) Change in fair value of contingent consideration liability from PDA and LFT acquisition (19 ) — Balance as of June 30, $ (10,119 ) $ (1,932 )

Balance Sheet Details (Tables)

Balance Sheet Details (Tables)	6 Months Ended
	Jun. 30, 2018
Balance Sheet Related Disclosures [Abstract]
Schedule of Supplemental Balance Sheet Disclosures	The consolidated balance sheets detail is as follows as of June 30, 2018 and December 31, 2017 : June 30, 2018 December 31, 2017 Other current assets: Restricted cash and cash equivalents $ 24,550 $ 25,506 Income tax receivable 1,912 15,898 Other 10,839 9,589 Other current assets $ 37,301 $ 50,993 Fixed assets: Furniture and equipment $ 31,123 $ 29,494 Software 147,094 132,770 Leasehold improvements 8,279 9,056 186,496 171,320 Accumulated depreciation (105,275 ) (97,889 ) Fixed assets, net $ 81,221 $ 73,431 Other assets: Life insurance cash surrender value $ 54,158 $ 48,145 Other 28,876 26,221 Other assets $ 83,034 $ 74,366 Accounts payable and accrued expenses: Trade accounts payable $ 26,369 $ 31,420 Subcontractor payable 34,354 41,786 Accrued expenses 47,545 40,403 Professional liability reserve 8,575 7,672 Other 6,262 9,038 Accounts payable and accrued expenses $ 123,105 $ 130,319 Accrued compensation and benefits: Accrued payroll $ 39,428 $ 33,923 Accrued bonuses 15,431 19,489 Accrued travel expense 4,727 3,256 Health insurance reserve 4,078 3,658 Workers compensation reserve 7,970 8,553 Deferred compensation 55,320 49,330 Other 3,304 3,214 Accrued compensation and benefits $ 130,258 $ 121,423 Other long-term liabilities: Workers compensation reserve $ 19,225 $ 19,074 Professional liability reserve 36,076 38,964 Deferred rent 14,890 14,744 Unrecognized tax benefits 4,890 5,270 Deferred revenue 1,279 960 Other 1,832 267 Other long-term liabilities $ 78,192 $ 79,279

Basis of Presentation Basis of

Basis of Presentation Basis of Presentation - Recently Adopted Accounting Pronouncements (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2018	Jun. 30, 2017		Jan. 01, 2018	Dec. 31, 2017
Revenue, Initial Application Period Cumulative Effect Transition [Line Items]
Retained earnings	$ 222,528				$ 142,229
Cash flows from operating activities:
Other Current Assets	(613)	$ 1,356	[1]
Restricted cash, cash equivalents and investments balance	7	(36)	[1]
Net cash provided by operating activities	125,938	70,043	[1]
Cash flows from investing activities
Change in restricted cash, cash equivalents and investments balance		0
Net cash used in investing activities	(238,950)	(19,616)	[1]
Net increase in cash, cash equivalents and restricted cash	5,717	11,516	[1]
Cash, cash equivalents and restricted cash at the beginning of period	98,894	51,028	[1]
Cash, cash equivalents and restricted cash at the end of period	104,611	62,544	[1]
Cash and cash equivalents	22,894				15,147
Restricted cash and cash equivalents (included in other current assets)	24,550				25,506
Restricted cash, cash equivalents and investments	61,839				64,315
Total cash, cash equivalents and restricted cash and investments	109,283				104,968
Less restricted investments	$ (4,672)				$ (6,074)
Accounting Standards Update 2014-09 | Difference between Revenue Guidance in Effect before and after Topic 606
Revenue, Initial Application Period Cumulative Effect Transition [Line Items]
Retained earnings				$ 2,089
As Previously Reported
Cash flows from operating activities:
Other Current Assets		5,562
Restricted cash, cash equivalents and investments balance		(3,497)
Net cash provided by operating activities		70,788
Cash flows from investing activities
Change in restricted cash, cash equivalents and investments balance		(5)
Net cash used in investing activities		(19,621)
Net increase in cash, cash equivalents and restricted cash		12,256
Cash, cash equivalents and restricted cash at the beginning of period		10,622
Cash, cash equivalents and restricted cash at the end of period		22,878
Adjustments | Accounting Standards Update 2016-18 [Member]
Cash flows from operating activities:
Other Current Assets		(4,206)
Restricted cash, cash equivalents and investments balance		3,461
Net cash provided by operating activities		(745)
Cash flows from investing activities
Change in restricted cash, cash equivalents and investments balance		5
Net cash used in investing activities		5
Net increase in cash, cash equivalents and restricted cash		(740)
Cash, cash equivalents and restricted cash at the beginning of period		40,406
Cash, cash equivalents and restricted cash at the end of period		$ 39,666
[1]	See Note (1) for a summary of adjustments.

Acquisitions (Details)

Acquisitions (Details)	Apr. 09, 2018USD ($)	Apr. 06, 2018USD ($)	Jun. 30, 2018USD ($)aquisition	Jun. 30, 2017USD ($)	[1]	Feb. 09, 2018USD ($)	Dec. 31, 2017USD ($)
Business Acquisition [Line Items]
Number of acquisitions | aquisition			2
Proceeds from line of credit			$ 195,000,000	$ 0
Goodwill			$ 439,134,000				$ 340,596,000
MedPartners
Business Acquisition [Line Items]
Initial purchase price	$ 200,933,000
Cash consideration	196,533,000
Tiered contingent earn-out payment	20,000,000
Estimated fair value of contingent earn-out payment	4,400,000
Tangible assets acquired, including cash received	27,975,000
Cash received	8,403,000
Liabilities assumed	11,339,000
Intangible assets acquired	103,000,000
Goodwill	$ 81,297,000
Intangible assets, weighted-average useful life (in years)	16 years
MedPartners | Based on operating results for the twelve months ending December 31, 2018
Business Acquisition [Line Items]
Tiered contingent earn-out payment	$ 10,000,000
MedPartners | Based on operating results for the six months ending June 30, 2019
Business Acquisition [Line Items]
Tiered contingent earn-out payment	10,000,000
MedPartners | Trademarks
Business Acquisition [Line Items]
Intangible assets acquired	46,000,000
MedPartners | Customer Relationships
Business Acquisition [Line Items]
Intangible assets acquired	$ 57,000,000
PDA and LFT
Business Acquisition [Line Items]
Initial purchase price		$ 35,968,000
Cash consideration		30,268,000
Tiered contingent earn-out payment		7,000,000
Estimated fair value of contingent earn-out payment		5,700,000
Tangible assets acquired, including cash received		4,356,000
Cash received		351,000
Liabilities assumed		4,739,000
Intangible assets acquired		19,110,000
Goodwill		$ 17,241,000
Intangible assets, weighted-average useful life (in years)		12 years
PDA and LFT | Trademarks
Business Acquisition [Line Items]
Intangible assets acquired		$ 5,400,000
PDA and LFT | Customer Relationships
Business Acquisition [Line Items]
Intangible assets acquired		8,000,000
PDA and LFT | Staffing Databases
Business Acquisition [Line Items]
Intangible assets acquired		$ 5,710,000
Revolving Credit Facility | Line of Credit
Business Acquisition [Line Items]
Maximum borrowing capacity						$ 400,000,000
[1]	See Note (1) for a summary of adjustments.

Net Income Per Common Share (De

Net Income Per Common Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2018	Jun. 30, 2017	Jun. 30, 2018	Jun. 30, 2017
Computation of basic and diluted net income per common share
Net income	$ 35,529	$ 31,255	$ 78,210	$ 63,263	[1]
Net income per common share - basic (in dollars per share)	$ 0.75	$ 0.65	$ 1.64	$ 1.32
Net income per common share - diluted (in dollars per share)	$ 0.73	$ 0.63	$ 1.60	$ 1.28
Weighted average common shares outstanding - basic (in shares)	47,653	47,916	47,693	47,849
Plus dilutive effect of potential common shares (in shares)	1,283	1,559	1,333	1,649
Weighted average common shares outstanding - diluted (in shares)	48,936	49,475	49,026	49,498
Common stock excluded from calculation of EPS (in shares)	36	33	23	16
[1]	See Note (1) for a summary of adjustments.

Segment Information (Details)

Segment Information (Details) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2018USD ($)	Jun. 30, 2017USD ($)	Jun. 30, 2018USD ($)segment	Jun. 30, 2017USD ($)
Segment Reporting, Revenue Reconciling Item [Line Items]
Number of reportable segments | segment			3
Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results
Revenue	$ 558,108	$ 489,803	$ 1,080,597	$ 984,972
Segment operating income	54,815	56,380	110,016	108,415
Depreciation and amortization	10,606	7,959	18,492	15,627	[1]
Share-based compensation	3,281	2,562	6,145	5,243	[1]
Interest expense, net, and other	6,376	4,928	11,711	10,058
Income before income taxes	48,439	51,452	98,305	98,357
Operating segments
Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results
Revenue	558,108	489,803	1,080,597	984,972
Segment operating income	85,883	82,263	167,497	160,319
Operating segments | Nurse and Allied Solutions
Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results
Revenue	332,728	300,727	670,907	614,250
Segment operating income	43,936	47,851	95,741	93,831
Operating segments | Locum Tenens Solutions
Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results
Revenue	107,297	108,215	210,414	211,058
Segment operating income	13,371	12,371	23,329	24,590
Operating segments | Other Workforce Solutions
Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results
Revenue	118,083	80,861	199,276	159,664
Segment operating income	28,576	22,041	48,427	41,898
Unallocated corporate overhead
Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results
Unallocated corporate overhead	$ 17,181	$ 15,362	$ 32,844	$ 31,034
Product concentration risk | Sales revenue, net | Managed Services Program Arrangements | Nurse and Allied Solutions
Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results
Revenue from contract with customer, percent	56.00%	55.00%	60.00%	56.00%
Product concentration risk | Sales revenue, net | Managed Services Program Arrangements | Locum Tenens Solutions
Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results
Revenue from contract with customer, percent	14.00%	11.00%	14.00%	12.00%
Product concentration risk | Sales revenue, net | Managed Services Program Arrangements | Other Workforce Solutions
Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results
Revenue from contract with customer, percent	6.00%	8.00%	8.00%	8.00%
[1]	See Note (1) for a summary of adjustments.

Segment Information - Goodwill

Segment Information - Goodwill (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2018	Dec. 31, 2017
Goodwill [Roll Forward]
Goodwill, beginning balance	$ 340,596
Goodwill, ending balance	439,134
Accumulated impairment loss	214,939	$ 214,939
Nurse and Allied Solutions
Goodwill [Roll Forward]
Goodwill, beginning balance	103,107
Goodwill, ending balance	103,107
Accumulated impairment loss	154,444	154,444
Locum Tenens Solutions
Goodwill [Roll Forward]
Goodwill, beginning balance	19,743
Goodwill, ending balance	19,743
Accumulated impairment loss	53,940	53,940
Other Workforce Solutions
Goodwill [Roll Forward]
Goodwill, beginning balance	217,746
Goodwill, ending balance	316,284
Accumulated impairment loss	6,555	$ 6,555
MedPartners
Goodwill [Roll Forward]
Goodwill acquired	81,297
MedPartners | Nurse and Allied Solutions
Goodwill [Roll Forward]
Goodwill acquired	0
MedPartners | Locum Tenens Solutions
Goodwill [Roll Forward]
Goodwill acquired	0
MedPartners | Other Workforce Solutions
Goodwill [Roll Forward]
Goodwill acquired	81,297
PDA and LFT
Goodwill [Roll Forward]
Goodwill acquired	17,241
PDA and LFT | Nurse and Allied Solutions
Goodwill [Roll Forward]
Goodwill acquired	0
PDA and LFT | Locum Tenens Solutions
Goodwill [Roll Forward]
Goodwill acquired	0
PDA and LFT | Other Workforce Solutions
Goodwill [Roll Forward]
Goodwill acquired	$ 17,241

New Credit Agreement (Details)

New Credit Agreement (Details) - Line of Credit - USD ($)	Feb. 09, 2018	Jun. 30, 2018
Debt Instrument [Line Items]
Fees paid to lenders and other third parties		$ 2,331,000
Unamortized financing fees written off		$ 574,000
Revolving Credit Facility
Debt Instrument [Line Items]
Maximum borrowing capacity	$ 400,000,000
Revolving Credit Facility | London Interbank Offered Rate (LIBOR) | Minimum
Debt Instrument [Line Items]
Basis spread on variable rate	1.00%
Revolving Credit Facility | London Interbank Offered Rate (LIBOR) | Maximum
Debt Instrument [Line Items]
Basis spread on variable rate	2.00%
Revolving Credit Facility | Base Rate | Minimum
Debt Instrument [Line Items]
Basis spread on variable rate	0.00%
Revolving Credit Facility | Base Rate | Maximum
Debt Instrument [Line Items]
Basis spread on variable rate	1.00%
Letter of Credit
Debt Instrument [Line Items]
Maximum borrowing capacity	$ 50,000,000
Revolving Credit Facility, Swing Line Loan
Debt Instrument [Line Items]
Maximum borrowing capacity	$ 50,000,000

Fair Value Measurement - Additi

Fair Value Measurement - Additional Information (Details) - USD ($) $ in Thousands	Jun. 30, 2018	Dec. 31, 2017	Oct. 31, 2016
Commercial paper | Fair Value, Measurements, Recurring
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Commercial paper	$ 32,228	$ 28,708
Commercial paper | Fair Value, Measurements, Recurring | Significant Other Observable Inputs (Level 2)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Commercial paper	32,228	28,708
Available for sale securities	4,672	6,074
5.125% Senior Notes due 2024 [Member] | Senior Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Carrying amount of senior notes	325,000	325,000
Estimated fair value of senior notes	$ 315,250	$ 335,156
5.125% Senior Notes Due 2024 | Senior Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate			5.125%

Fair Value Measurement - Financ

Fair Value Measurement - Financial Assets and Liabilities (Details) - Fair Value, Measurements, Recurring - USD ($) $ in Thousands	Jun. 30, 2018	Dec. 31, 2017
Money market funds
Schedule of financial assets and liabilities measured at fair value on recurring basis
Financial assets and liabilities measured at fair value	$ 2,728	$ 2,713
Money market funds | Quoted Prices in Active Markets for Identical Assets (Level 1)
Schedule of financial assets and liabilities measured at fair value on recurring basis
Financial assets and liabilities measured at fair value	2,728	2,713
Money market funds | Significant Other Observable Inputs (Level 2)
Schedule of financial assets and liabilities measured at fair value on recurring basis
Financial assets and liabilities measured at fair value	0	0
Money market funds | Significant Unobservable Inputs (Level 3)
Schedule of financial assets and liabilities measured at fair value on recurring basis
Financial assets and liabilities measured at fair value	0	0
Commercial paper
Schedule of financial assets and liabilities measured at fair value on recurring basis
Financial assets and liabilities measured at fair value	32,228	28,708
Commercial paper | Quoted Prices in Active Markets for Identical Assets (Level 1)
Schedule of financial assets and liabilities measured at fair value on recurring basis
Financial assets and liabilities measured at fair value	0	0
Commercial paper | Significant Other Observable Inputs (Level 2)
Schedule of financial assets and liabilities measured at fair value on recurring basis
Financial assets and liabilities measured at fair value	32,228	28,708
Commercial paper | Significant Unobservable Inputs (Level 3)
Schedule of financial assets and liabilities measured at fair value on recurring basis
Financial assets and liabilities measured at fair value	0	0
Acquisition contingent consideration liabilities
Schedule of financial assets and liabilities measured at fair value on recurring basis
Financial assets and liabilities measured at fair value	(10,119)	(2,070)
Acquisition contingent consideration liabilities | Quoted Prices in Active Markets for Identical Assets (Level 1)
Schedule of financial assets and liabilities measured at fair value on recurring basis
Financial assets and liabilities measured at fair value	0	0
Acquisition contingent consideration liabilities | Significant Other Observable Inputs (Level 2)
Schedule of financial assets and liabilities measured at fair value on recurring basis
Financial assets and liabilities measured at fair value	0	0
Acquisition contingent consideration liabilities | Significant Unobservable Inputs (Level 3)
Schedule of financial assets and liabilities measured at fair value on recurring basis
Financial assets and liabilities measured at fair value	$ (10,119)	$ (2,070)

Fair Value Measurement - Reconc

Fair Value Measurement - Reconciliation of Changes in Contingent Consideration Liabilities (Details) - Significant Unobservable Inputs (Level 3) - Acquisition contingent consideration liabilities - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2018	Jun. 30, 2017	Jun. 30, 2018	Jun. 30, 2017
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Beginning balance	$ 0	$ (1,909)	$ (2,070)	$ (6,816)
Ending balance	(10,119)	(1,932)	(10,119)	(1,932)
PDA and LFT
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Contingent consideration earn-out liability	(5,700)	0	(5,700)
Change in fair value of contingent consideration earn-out liability from acquisition	(19)	0	(19)	0
MedPartners
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Contingent consideration earn-out liability	(4,400)	0	(4,400)
HSG
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Change in fair value of contingent consideration earn-out liability from acquisition	$ 0	$ (23)	0	(46)
TFS
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Settlement of earn-out			0	3,000
2016 Earn-out | HSG
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Settlement of earn-out			70	1,930
2017 Earn-out | HSG
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Settlement of earn-out			$ 2,000	$ 0

Income Taxes (Details)

Income Taxes (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2018	Jun. 30, 2017	Jun. 30, 2018	Jun. 30, 2017
Error Corrections and Prior Period Adjustments Restatement [Line Items]
Income tax benefit	$ (12,910)	$ (20,197)	$ (20,095)	$ (35,094)
Adjustments
Error Corrections and Prior Period Adjustments Restatement [Line Items]
Income tax benefit			$ 2,501

Balance Sheet Details (Details)

Balance Sheet Details (Details) - USD ($) $ in Thousands	Jun. 30, 2018	Dec. 31, 2017
Other current assets:
Restricted cash and cash equivalents	$ 24,550	$ 25,506
Income tax receivable	1,912	15,898
Other	10,839	9,589
Other current assets	37,301	50,993
Fixed assets:
Furniture and equipment	31,123	29,494
Software	147,094	132,770
Leasehold improvements	8,279	9,056
Fixed assets, gross	186,496	171,320
Accumulated depreciation	(105,275)	(97,889)
Fixed assets, net	81,221	73,431
Other assets:
Life insurance cash surrender value	54,158	48,145
Other	28,876	26,221
Other assets	83,034	74,366
Accounts payable and accrued expenses:
Trade accounts payable	26,369	31,420
Subcontractor payable	34,354	41,786
Accrued expenses	47,545	40,403
Professional liability reserve	8,575	7,672
Other	6,262	9,038
Accounts payable and accrued expenses	123,105	130,319
Accrued compensation and benefits:
Accrued payroll	39,428	33,923
Accrued bonuses	15,431	19,489
Accrued travel expense	4,727	3,256
Health insurance reserve	4,078	3,658
Workers compensation reserve	7,970	8,553
Deferred compensation	55,320	49,330
Other	3,304	3,214
Accrued compensation and benefits	130,258	121,423
Other long-term liabilities:
Workers compensation reserve	19,225	19,074
Professional liability reserve	36,076	38,964
Deferred rent	14,890	14,744
Unrecognized tax benefits	4,890	5,270
Deferred revenue	1,279	960
Other	1,832	267
Other long-term liabilities	$ 78,192	$ 79,279