AMN Healthcare Services (AMN) 10-Q 7 Aug 19 2019 Q2 Quarterly report Financial data

Cover Page

Cover Page - shares	6 Months Ended
	Jun. 30, 2019	Aug. 05, 2019
Cover page.
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Jun. 30, 2019
Document Transition Report	false
Entity File Number	001-16753
Entity Registrant Name	AMN HEALTHCARE SERVICES, INC.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	06-1500476
Entity Address, Address Line One	12400 High Bluff Drive
Entity Address, Address Line Two	Suite 100
Entity Address, City or Town	San Diego
Entity Address, State or Province	CA
Entity Address, Postal Zip Code	92130
City Area Code	866
Local Phone Number	871-8519
Title of 12(b) Security	Common Stock, $0.01 par value
Trading Symbol	AMN
Security Exchange Name	NYSE
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding (excluding treasury shares)		46,662,179
Entity Central Index Key	0001142750
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2019
Document Fiscal Period Focus	Q2
Amendment Flag	false

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Current assets:
Cash and cash equivalents	$ 20,937	$ 13,856
Accounts receivable, net of allowances of $12,273 and $10,560 at June 30, 2019 and December 31, 2018, respectively	369,372	365,871
Accounts receivable, subcontractor	50,058	50,143
Prepaid expenses	13,966	12,409
Other current assets	35,535	39,887
Total current assets	489,868	482,166
Restricted cash, cash equivalents and investments	65,919	59,331
Fixed assets, net of accumulated depreciation of $121,354 and $114,413 at June 30, 2019 and December 31, 2018, respectively	97,249	90,419
Operating lease right-of-use assets	95,247
Other assets	109,909	96,152
Goodwill	588,457	438,506
Intangible assets, net of accumulated amortization of $128,993 and $114,924 at June 30, 2019 and December 31, 2018, respectively	409,439	326,147
Total assets	1,856,088	1,492,721
Current liabilities:
Accounts payable and accrued expenses	124,672	149,603
Accrued compensation and benefits	149,937	135,059
Current portion of notes payable	3,750	0
Current portion of operating lease liabilities	13,068
Deferred revenue	11,053	12,365
Other current liabilities	14,344	10,243
Total current liabilities	316,824	307,270
Revolving credit facility	196,000	120,000
Notes payable, less unamortized fees	466,610	320,607
Deferred income taxes, net	39,273	27,326
Operating lease liabilities	97,355
Other long-term liabilities	59,586	78,528
Total liabilities	1,175,648	853,731
Commitments and contingencies
Stockholders’ equity:
Preferred stock, $0.01 par value; 10,000 shares authorized; none issued and outstanding at June 30, 2019 and December 31, 2018	0	0
Common stock, $0.01 par value; 200,000 shares authorized; 49,223 issued and 46,662 outstanding at June 30, 2019 and 48,809 issued and 46,643 outstanding at December 31, 2018	492	488
Additional paid-in capital	450,080	452,730
Treasury stock, at cost (2,561 and 2,166 shares at June 30, 2019 and December 31, 2018, respectively)	(119,143)	(100,438)
Retained earnings	349,050	286,059
Accumulated other comprehensive income (loss)	(39)	151
Total stockholders’ equity	680,440	638,990
Total liabilities and stockholders’ equity	$ 1,856,088	$ 1,492,721

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Statement of Financial Position [Abstract]
Accounts receivable, allowance	$ 12,273	$ 10,560
Accumulated depreciation - fixed assets	121,354	114,413
Accumulated amortization	$ 128,932	$ 114,924
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)	49,223,000	48,809,000
Common stock, shares outstanding (in shares)	46,662,000	46,643,000
Treasury stock (in shares)	2,561,000	2,166,000

Condensed Consolidated Statemen

Condensed Consolidated Statements of Comprehensive Income - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Statement of Comprehensive Income [Abstract]
Revenue	$ 535,177	$ 558,108	$ 1,067,618	$ 1,080,597
Cost of revenue	355,635	377,152	711,317	731,817
Gross profit	179,542	180,956	356,301	348,780
Operating expenses:
Selling, general and administrative	121,668	115,535	241,665	220,272
Depreciation and amortization	12,718	10,606	24,428	18,492
Total operating expenses	134,386	126,141	266,093	238,764
Income from operations	45,156	54,815	90,208	110,016
Interest expense, net, and other	6,065	6,376	11,738	11,711
Income before income taxes	39,091	48,439	78,470	98,305
Income tax expense	10,222	12,910	15,479	20,095
Net income	28,869	35,529	62,991	78,210
Other comprehensive income (loss):
Foreign currency translation and other	(89)	91	(190)	72
Other comprehensive income (loss)	(89)	91	(190)	72
Comprehensive income	$ 28,780	$ 35,620	$ 62,801	$ 78,282
Net income per common share:
Basic (in dollars per share)	$ 0.62	$ 0.75	$ 1.35	$ 1.64
Diluted (in dollars per share)	$ 0.61	$ 0.73	$ 1.32	$ 1.60
Weighted average common shares outstanding:
Basic (shares)	46,644	47,653	46,713	47,693
Diluted (shares)	47,424	48,936	47,597	49,026

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Stockholders' Equity - USD ($) shares in Thousands, $ in Thousands	Total	Common Stock	Additional Paid-in Capital	Treasury Stock	Retained Earnings (Accumulated Deficit)	Accumulated Other Comprehensive Income (Loss)
Beginning balance (in shares) at Dec. 31, 2017		48,411		930
Beginning balance at Dec. 31, 2017	$ 562,527	$ 484	$ 453,351	$ (33,425)	$ 142,229	$ (112)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Equity awards vested and exercised, net of shares withheld for payroll taxes (in shares)		349
Equity awards vested and exercised, net of shares withheld for payroll taxes	(10,926)	$ 4	(10,930)
Share-based compensation	2,864		2,864
Comprehensive income (loss)	42,662				42,681	(19)
Ending balance (in shares) at Mar. 31, 2018		48,760		930
Ending balance at Mar. 31, 2018	599,216	$ 488	445,285	$ (33,425)	186,999	(131)
Beginning balance (in shares) at Dec. 31, 2017		48,411		930
Beginning balance at Dec. 31, 2017	562,527	$ 484	453,351	$ (33,425)	142,229	(112)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Comprehensive income (loss)	78,282
Ending balance (in shares) at Jun. 30, 2018		48,807		1,315
Ending balance at Jun. 30, 2018	616,744	$ 488	448,084	$ (54,316)	222,528	(40)
Beginning balance (in shares) at Mar. 31, 2018		48,760		930
Beginning balance at Mar. 31, 2018	599,216	$ 488	445,285	$ (33,425)	186,999	(131)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Repurchase of common stock into treasury (in shares)				(385)
Repurchase of common stock into treasury	(20,891)			$ (20,891)
Equity awards vested and exercised, net of shares withheld for payroll taxes (in shares)		47
Equity awards vested and exercised, net of shares withheld for payroll taxes	(482)		(482)
Share-based compensation	3,281		3,281
Comprehensive income (loss)	35,620				35,529	91
Ending balance (in shares) at Jun. 30, 2018		48,807		1,315
Ending balance at Jun. 30, 2018	616,744	$ 488	448,084	$ (54,316)	222,528	(40)
Beginning balance (in shares) at Dec. 31, 2018		48,809		2,166
Beginning balance at Dec. 31, 2018	638,990	$ 488	452,730	$ (100,438)	286,059	151
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Repurchase of common stock into treasury (in shares)				(378)
Repurchase of common stock into treasury	(17,930)			$ (17,930)
Equity awards vested and exercised, net of shares withheld for payroll taxes (in shares)		313
Equity awards vested and exercised, net of shares withheld for payroll taxes	(10,281)	$ 3	(10,284)
Share-based compensation	5,186		5,186
Comprehensive income (loss)	34,021				34,122	(101)
Ending balance (in shares) at Mar. 31, 2019		49,122		2,544
Ending balance at Mar. 31, 2019	649,986	$ 491	447,632	$ (118,368)	320,181	50
Beginning balance (in shares) at Dec. 31, 2018		48,809		2,166
Beginning balance at Dec. 31, 2018	638,990	$ 488	452,730	$ (100,438)	286,059	151
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Comprehensive income (loss)	62,801
Ending balance (in shares) at Jun. 30, 2019		49,223		2,561
Ending balance at Jun. 30, 2019	680,440	$ 492	450,080	$ (119,143)	349,050	(39)
Beginning balance (in shares) at Mar. 31, 2019		49,122		2,544
Beginning balance at Mar. 31, 2019	649,986	$ 491	447,632	$ (118,368)	320,181	50
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Repurchase of common stock into treasury (in shares)				(17)
Repurchase of common stock into treasury	(775)			$ (775)
Equity awards vested and exercised, net of shares withheld for payroll taxes (in shares)		101
Equity awards vested and exercised, net of shares withheld for payroll taxes	(1,253)	$ 1	(1,254)
Share-based compensation	3,702		3,702
Comprehensive income (loss)	28,780				28,869	(89)
Ending balance (in shares) at Jun. 30, 2019		49,223		2,561
Ending balance at Jun. 30, 2019	$ 680,440	$ 492	$ 450,080	$ (119,143)	$ 349,050	$ (39)

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018
Cash flows from operating activities:
Net income	$ 62,991	$ 78,210
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	24,428	18,492
Non-cash interest expense and other	1,134	1,277
Write-off of fees on the prior credit facilities	0	574
Change in fair value of contingent consideration	(2,158)	19
Increase in allowances for doubtful accounts and sales credits	4,978	4,809
Provision for deferred income taxes	(10,328)	(7,173)
Share-based compensation	8,888	6,145
Loss on disposal or sale of fixed assets	39	39
Amortization of discount on investments	(229)	(62)
Non-cash lease expense	(106)
Changes in assets and liabilities, net of effects from acquisitions:
Accounts receivable	12,427	13,830
Accounts receivable, subcontractor	84	6,355
Income taxes receivable	(1,673)	13,986
Prepaid expenses	(1,523)	(2,012)
Other current assets	583	(613)
Other assets	(8,763)	556
Accounts payable and accrued expenses	(29,471)	(8,954)
Accrued compensation and benefits	11,774	5,468
Other liabilities	(5,852)	(6,588)
Deferred revenue	(2,025)	1,573
Restricted investments balance	93	7
Net cash provided by operating activities	65,291	125,938
Cash flows from investing activities:
Purchase and development of fixed assets	(15,532)	(16,457)
Purchase of investments	(13,281)	(6,742)
Proceeds from maturity of investments	22,670	8,200
Payments to fund deferred compensation plan	(5,279)	(4,724)
Cash paid for acquisitions, net of cash received	(228,149)	(218,047)
Cash paid for other intangibles	(1,120)	(1,180)
Net cash used in investing activities	(240,691)	(238,950)
Cash flows from financing activities:
Proceeds from term loans	150,000	0
Payments on revolving credit facility	(25,000)	(40,000)
Proceeds from revolving credit facility	101,000	195,000
Repurchase of common stock	(18,705)	(20,891)
Payment of financing costs	(777)	(2,331)
Earn-out payments for prior acquisitions	(5,700)	(1,713)
Cash paid for shares withheld for taxes	(11,533)	(11,408)
Net cash provided by financing activities	189,285	118,657
Effect of exchange rate changes on cash	(190)	72
Net increase in cash, cash equivalents and restricted cash	13,695	5,717
Cash, cash equivalents and restricted cash at the beginning of period	84,324	98,894
Cash, cash equivalents and restricted cash at the end of period	98,019	104,611
Supplemental disclosures of cash flow information:
Cash paid for amounts included in the measurement of operating lease liabilities	8,694
Cash paid for interest (net of $230 and $193 capitalized for the six months ended June 30, 2019 and 2018, respectively)	11,714	10,167
Cash paid for income taxes	27,369	14,405
Acquisitions:
Fair value of tangible assets acquired in acquisitions, net of cash and restricted cash received	27,674	23,577
Goodwill	149,941	98,538
Intangible assets	96,180	122,110
Liabilities assumed	(33,524)	(16,078)
Earn-out liabilities	(12,122)	(10,100)
Supplemental disclosures of non-cash investing and financing activities:
Purchase of fixed assets recorded in accounts payable and accrued expenses	$ 2,352	$ 1,800

Condensed Consolidated Statem_4

Condensed Consolidated Statements of Cash Flows (Parenthetical) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018
Statement of Cash Flows [Abstract]
Interest capitalized	$ 230	$ 193

Basis of Presentation

Basis of Presentation	6 Months Ended
	Jun. 30, 2019
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 (“U.S. GAAP”). Please refer to the Company’s audited consolidated financial statements and the related notes for the fiscal year ended December 31, 2018 , contained in the Company’s Annual Report on Form 10-K for the fiscal year ended December 31, 2018 , filed with the Securities and Exchange Commission on February 21, 2019 (“ 2018 Annual Report”). The preparation of financial statements in conformity with U.S. GAAP 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 intangible assets purchased in a business combination, 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 February 2016, the Financial Accounting Standards Board (“FASB”) issued Accounting Standard Update (“ASU”) 2016-02, “Leases.” This standard requires organizations that lease assets to recognize the assets and liabilities created by those leases. The standard also requires disclosures to help investors and other financial statement users better understand the amount, timing, and uncertainty of cash flows arising from leases. A modified retrospective transition approach is required, applying the standard to all leases existing at the date of initial application. In addition, the FASB has also issued several amendments to the standard, which clarify certain aspects of the guidance, including an optional transition method for adoption of this standard, which allows organizations to initially apply the new requirements at the effective date, recognize a cumulative effect adjustment to the opening balance of retained earnings, and continue to apply the legacy guidance in Accounting Standards Codification (“ASC”) 840, Leases, including its disclosure requirements, in the comparative periods presented. The new standard provides a number of optional practical expedients in transition. The Company elected the ‘package of practical expedients’, which permits organizations not to reassess under the new standard prior conclusions about lease identification, lease classification and initial direct costs. The Company did not elect to use the hindsight practical expedient to determine the lease term or evaluate impairment for existing leases. The Company adopted ASU 2016-02 effective January 1, 2019 , using the optional transition method described above. The Company recognized the cumulative effect of adopting this guidance as an adjustment as of the effective date, primarily related to the recognition of lease liabilities of $114,807 and corresponding right-of-use assets of $99,525 for existing operating leases. The Company also derecognized existing deferred rent liabilities of $15,302 . These adjustments had no effect on opening retained earnings and prior periods were not retrospectively adjusted and continue to be reported in accordance with ASC 840. The new standard also provides practical expedients for an organization’s ongoing accounting. The Company elected the short-term lease recognition exemption and the practical expedient to not separate lease and non-lease components for all leases that qualify. The Company does not expect the adoption of this standard to impact its results of operations. There was no other material impact to the Company’s condensed consolidated financial statements as a result of adopting this updated standard. Cash, cash equivalents and restricted cash The Company considers all highly liquid investments with an original maturity of three months or less to be cash equivalents. Cash and cash equivalents include currency on hand, deposits with financial institutions and highly liquid investments. Restricted cash and cash equivalents primarily represent cash and money market funds on deposit with financial institutions and investments represents commercial paper that serves as collateral for the Company’s outstanding letters of credit and captive insurance subsidiary claim payments. See Note (6), “Notes Payable and Credit Agreement” and Note (7), “Fair Value Measurement” for additional information. 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, 2019 December 31, 2018 Cash and cash equivalents $ 20,937 $ 13,856 Restricted cash and cash equivalents (included in other current assets) 17,102 26,329 Restricted cash, cash equivalents and investments 65,919 59,331 Total cash, cash equivalents and restricted cash and investments 103,958 99,516 Less restricted investments (5,939 ) (15,192 ) Total cash, cash equivalents and restricted cash $ 98,019 $ 84,324

Acquisitions

Acquisitions	6 Months Ended
	Jun. 30, 2019
Business Combinations [Abstract]
ACQUISITIONS	ACQUISITIONS As set forth below, the Company completed four acquisitions from January 1, 2018 through June 30, 2019 . 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. Since the applicable date of acquisition, the Company has revised the allocation of the purchase price to the tangible and intangible assets acquired and liabilities assumed based on analysis of information that has been made available through June 30, 2019 . The allocations noted as preliminary will continue to be updated through the measurement period, if necessary. For each acquisition, the Company did not incur any material acquisition-related costs. Advanced Acquisition On June 14, 2019, the Company completed its acquisition of Advanced Medical Personnel Services, Inc. (“Advanced”), a national healthcare staffing company that specializes in placing therapists and nurses across multiple settings. The initial purchase price of $211,743 included (1) $201,121 cash consideration paid upon acquisition and (2) a contingent earn-out payment of up to $20,000 with an estimated fair value of $10,622 as of the acquisition date. The contingent earn-out payment is based on the operating results of Advanced for the twelve months ending December 31, 2019. The acquisition was funded primarily through (1) 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, and (2) the First Amendment (as defined in Note (6) below) to the New Credit Agreement, which provided $150,000 of additional available borrowings to the Company. The New Credit Agreement and the First Amendment are more fully described in Note (6), “Notes Payable and Credit Agreement.” The results of Advanced have been included in the Company’s nurse and allied solutions segment since the date of acquisition. The preliminary allocation of the $211,743 purchase price consisted of (1) $29,064 of fair value of tangible assets acquired, which included $2,497 cash and restricted cash received, (2) $30,134 of liabilities assumed, (3) $89,300 of identified intangible assets, and (4) $123,513 of goodwill, of which $75,493 is expected to be deductible for tax purposes. The provisional items pending finalization are the valuation of the acquired intangible assets, goodwill, and income tax related matters. The intangible assets acquired have a weighted average useful life of approximately nine years . The following table summarizes the fair value and useful life of each intangible asset acquired: Fair Value Useful Life (in years) Identifiable intangible assets Customer Relationships $ 71,000 10 Tradenames and Trademarks 10,000 5 Staffing Database 5,700 10 Developed Technology 2,600 3 $ 89,300 Silversheet Acquisition On January 30, 2019, the Company completed its acquisition of Silversheet, Inc. (“Silversheet”), which provides innovative software and services to reduce the complexities and challenges of the credentialing process for clinicians and healthcare organizations. The initial purchase price of $31,676 included (1) $30,176 cash consideration paid upon acquisition, funded primarily through borrowings under the Senior Credit Facility, and (2) a contingent earn-out payment of up to $25,000 with an estimated fair value of $1,500 as of the acquisition date. The contingent earn-out payment is based on (A) up to $6,000 based on the operating results of Silversheet for the twelve months ending December 31, 2019, and (B) up to $19,000 based on the operating results of Silversheet for the twelve months ending December 31, 2020. The results of Silversheet have been included in the Company’s other workforce solutions segment since the date of acquisition. The preliminary allocation of the $31,676 purchase price consisted of (1) $1,758 of fair value of tangible assets acquired, which included $651 cash received, (2) $3,390 of liabilities assumed, (3) $6,880 of identified intangible assets, and (4) $26,428 of goodwill, none of which is deductible for tax purposes. The provisional items pending finalization are the valuation of the acquired intangible assets, goodwill, and income tax related matters. The fair value of intangible assets primarily includes $5,300 of developed technology and $1,500 of trademarks with a weighted average useful life of approximately eight years . 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 $200,711 included (1) $196,533 cash consideration paid upon acquisition, funded primarily through borrowings under the Senior Credit Facility, 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, which resulted in no earn-out payment, and (B) up to $10,000 based on the operating results of MedPartners for the six months ending June 30, 2019. The results of MedPartners have been included in the Company’s other workforce solutions segment since the date of acquisition. During the third quarter of 2018, $222 was returned to the Company for the final working capital settlement. The allocation of the $200,711 purchase price, which was finalized during the second quarter of 2019, consisted of (1) $28,508 of fair value of tangible assets acquired, which included $8,403 cash received, (2) $11,933 of liabilities assumed, (3) $103,000 of identified intangible assets, and (4) $81,136 of goodwill, all of which is deductible for tax purposes. The intangible assets acquired have a weighted average useful life of approximately sixteen years . The following table summarizes the fair value and useful life of each intangible asset acquired: Fair Value Useful Life (in years) Identifiable intangible assets Tradenames and Trademarks $ 46,000 20 Customer Relationships 57,000 12 $ 103,000 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 $35,503 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, which was settled in full during the second quarter of 2019. The results of PDA and LFT have been included in the Company’s other workforce solutions segment since the date of acquisition. During the third quarter of 2018, $465 was returned to the Company for the final working capital settlement. The allocation of the $35,503 purchase price, which was finalized during the second quarter of 2019, consisted of (1) $4,389 of fair value of tangible assets acquired, which included $351 cash received, (2) $4,779 of liabilities assumed, (3) $19,110 of identified intangible assets, and (4) $16,783 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

Revenue Recognition	6 Months Ended
	Jun. 30, 2019
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, 2019 , previously deferred revenue recognized as revenue was $8,641 . The Company has elected to apply the following practical expedients and optional exemptions related to contract costs and revenue recognition: • 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 Note (5), “Segment Information” for additional information.

Net Income Per Common Share

Net Income Per Common Share	6 Months Ended
	Jun. 30, 2019
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, 2019 and 2018 , respectively: Three Months Ended June 30, Six Months Ended June 30, 2019 2018 2019 2018 Net income $ 28,869 $ 35,529 $ 62,991 $ 78,210 Net income per common share - basic $ 0.62 $ 0.75 $ 1.35 $ 1.64 Net income per common share - diluted $ 0.61 $ 0.73 $ 1.32 $ 1.60 Weighted average common shares outstanding - basic 46,644 47,653 46,713 47,693 Plus dilutive effect of potential common shares 780 1,283 884 1,333 Weighted average common shares outstanding - diluted 47,424 48,936 47,597 49,026 Share-based awards to purchase 66 and 66 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, 2019 , respectively, because the effect of these instruments was anti-dilutive. 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.

Segment Information

Segment Information	6 Months Ended
	Jun. 30, 2019
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, 2019 2018 2019 2018 Revenue Nurse and allied solutions $ 331,627 $ 332,728 $ 668,656 $ 670,907 Locum tenens solutions 82,074 107,297 162,564 210,414 Other workforce solutions 121,476 118,083 236,398 199,276 $ 535,177 $ 558,108 $ 1,067,618 $ 1,080,597 Segment operating income Nurse and allied solutions $ 48,694 $ 43,936 $ 96,616 $ 95,741 Locum tenens solutions 7,128 13,371 12,829 23,329 Other workforce solutions 27,127 28,576 53,315 48,427 82,949 85,883 162,760 167,497 Unallocated corporate overhead 21,373 17,181 39,236 32,844 Depreciation and amortization 12,718 10,606 24,428 18,492 Share-based compensation 3,702 3,281 8,888 6,145 Interest expense, net, and other 6,065 6,376 11,738 11,711 Income before income taxes $ 39,091 $ 48,439 $ 78,470 $ 98,305 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, 2019 and 2018 , revenue under the Company’s managed services program arrangements comprised approximately 65% and 56% for nurse and allied solutions revenue, 22% and 14% for locum tenens solutions revenue and 8% and 6% for other workforce solutions revenue, respectively. For the six months ended June 30, 2019 and 2018 , revenue under the Company’s managed services program arrangements comprised approximately 66% and 60% for nurse and allied solutions revenue, 23% and 14% 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, 2019 $ 103,107 $ 19,743 $ 315,656 $ 438,506 Goodwill adjustment for MedPartners acquisition — — 23 23 Goodwill adjustment for PDA and LFT acquisition — — (13 ) (13 ) Goodwill from Silversheet acquisition — — 26,428 26,428 Goodwill from Advanced acquisition 123,513 — — 123,513 Balance, June 30, 2019 $ 226,620 $ 19,743 $ 342,094 $ 588,457 Accumulated impairment loss as of December 31, 2018 and June 30, 2019 $ 154,444 $ 53,940 $ 6,555 $ 214,939

Notes Payable and Credit Agreem

Notes Payable and Credit Agreement	6 Months Ended
	Jun. 30, 2019
Debt Disclosure [Abstract]
Notes Payable and Credit Agreement	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. On June 14, 2019, the Company entered into the first amendment to the New Credit Agreement (the “First Amendment”) to provide for, among other things, a $150,000 secured term loan credit facility (the “Term Loan”). The First Amendment (together with the New Credit Agreement, the “Amended Credit Agreement”) also extended the maturity date of the Senior Credit Facility to be coterminous with the Term Loan. The obligations of the Company under the Amended Credit Agreement are secured by substantially all of the assets of the Company. The Company used the proceeds from the Term Loan, together with a drawdown of a portion of the Senior Credit Facility, to complete its acquisition of Advanced, as more fully described in Note (2), “Acquisitions.” Borrowings under the Senior Credit Facility and the Term Loan (together, the “Credit Facilities”) 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 Term Loan is subject to amortization of principal of 2.50% per year for the first year of the term and 5.00% per year thereafter, payable in equal quarterly installments. The Senior Credit Facility is available for working capital, capital expenditures, permitted acquisitions and general corporate purposes. The maturity date of the Credit Facilities is June 14, 2024. In connection with the First Amendment, the Company incurred $875 in fees paid to lenders and other third parties, which were capitalized during the three months ended June 30, 2019 and are amortized to interest expense over the term of the Credit Facilities. In addition, $1,702 of unamortized financing fees relating to obtaining the New Credit Agreement will continue to be amortized to interest expense over the term of the Credit Facilities.

Fair Value Measurement

Fair Value Measurement	6 Months Ended
	Jun. 30, 2019
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 3—Fair Value Measurement” of the 2018 Annual Report. The Company has not changed the valuation techniques or inputs it uses for its fair value measurement during the three and six months ended June 30, 2019 . 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 $65,311 commercial paper issued and outstanding as of June 30, 2019 , $5,939 had original maturities greater than three months, which were considered available-for-sale securities. As of December 31, 2018 , the Company had $63,243 commercial paper issued and outstanding, of which $15,192 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 Company recognizes changes to the fair value of its contingent consideration liabilities in selling, general and administrative expenses in the condensed consolidated statements of comprehensive income. 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, 2019 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 $ 2,486 $ 2,486 $ — $ — Commercial paper 65,311 — 65,311 — Acquisition contingent consideration liabilities (10,664 ) — — (10,664 ) Fair Value Measurements as of December 31, 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 $ 2,461 $ 2,461 $ — $ — Commercial paper 63,243 — 63,243 — Acquisition contingent consideration liabilities (7,700 ) — — (7,700 ) 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, 2019 2018 Balance as of April 1, $ (8,500 ) $ — Settlement of PDA and LFT contingent consideration liability for year ended December 31, 2018 7,000 — 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 ) Contingent consideration liability from Advanced acquisition on June 14, 2019 (10,622 ) — Change in fair value of contingent consideration liability from PDA and LFT acquisition — (19 ) Change in fair value of contingent consideration liability from Silversheet acquisition 1,458 — Balance as of June 30, $ (10,664 ) $ (10,119 ) Six Months Ended June 30, 2019 2018 Balance as of January 1, $ (7,700 ) $ (2,070 ) Settlement of HSG contingent consideration liability for year ended December 31, 2016 — 70 Settlement of HSG contingent consideration liability for year ended December 31, 2017 — 2,000 Settlement of PDA and LFT contingent consideration liability for year ended December 31, 2018 7,000 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 ) Contingent consideration liability from Silversheet acquisition on January 30, 2019 (1,500 ) — Contingent consideration liability from Advanced acquisition on June 14, 2019 (10,622 ) — Change in fair value of contingent consideration liability from PDA and LFT acquisition — (19 ) Change in fair value of contingent consideration liability from Medpartners acquisition 700 — Change in fair value of contingent consideration liability from Silversheet acquisition 1,458 — Balance as of June 30, $ (10,664 ) $ (10,119 ) 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. The Company’s equity investment represents an investment in a non-controlled corporation without a readily determinable market value. The Company has elected to measure the investment at cost minus impairment, if any, plus or minus changes resulting from observable price changes. The fair value is determined by using quoted prices for identical or similar investments of the same issuer, which are Level 2 inputs. The Company recognizes changes to the fair value of its equity investment in interest expense, net, and other in the condensed consolidated statements of comprehensive income. The balance of the equity investment classified as Level 2 in the fair value hierarchy was $15,449 as of both June 30, 2019 and December 31, 2018 . There were no changes to the fair value of the equity investment recognized during the three and six months ended June 30, 2019 . There were no triggering events identified, no indication of impairment of the Company’s goodwill, indefinite-lived intangible assets, long-lived assets, or equity investments, and no impairment charges recorded during the six months ended June 30, 2019 and 2018 . 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, 2019 , the Company’s senior notes have a carrying amount of $325,000 and an estimated fair value of $331,500 . As of December 31, 2018 , the senior notes had a carrying amount of $325,000 and an estimated fair value of $310,375 . 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 (7), Notes Payable and Credit Agreement” of our 2018 Annual Report.

Leases

Leases	6 Months Ended
	Jun. 30, 2019
Leases [Abstract]
LEASES	LEASES The Company leases certain office facilities, data centers, and equipment under various operating leases. Leases with an initial term of 12 months or less (primarily related to housing arrangements for healthcare professionals on assignment) are not recorded on the balance sheet; the Company recognizes lease expense for these leases on a straight-line basis over the lease term. Most leases include one or more options to renew, with renewal terms that can extend the lease term up to 10 years. Certain leases also include options to terminate the leases within 3 years. The components of lease expense were as follows: Three Months Ended June 30, Six Months Ended June 30, 2019 2019 Lease Cost Operating lease cost $ 4,569 $ 9,105 Short-term lease cost 5,076 10,998 Variable and other lease cost 599 1,316 Net lease cost $ 10,244 $ 21,419 The maturity of lease liabilities as of June 30, 2019 were as follows: Operating Leases Years ending December 31, 2019 (excluding the six months ended June 30, 2019) $ 9,011 2020 18,220 2021 18,374 2022 18,181 2023 17,887 Thereafter 50,319 Total lease payments $ 131,992 Less imputed interest (21,569 ) Present value of lease liabilities $ 110,423 Supplemental cash flow information related to leases was as follows: Six Months Ended June 30, 2019 Cash paid for amounts included in the measurement of operating lease liabilities (operating cash flows) $ 8,694 Operating lease right-of-use assets obtained in exchange for lease obligations $ — Weighted average remaining lease term 7 years Weighted average discount rate 4.8 % Future minimum lease payments under noncancelable operating leases (with initial or remaining lease terms in excess of one year) as of December 31, 2018 were as follows: Operating Leases Years ending December 31, 2019 $ 18,218 2020 18,149 2021 18,349 2022 18,144 2023 17,990 Thereafter 50,436 Total minimum lease payments $ 141,286 Rent expense under operating leases (with initial lease terms in excess of one year ) was $21,402 for the year ended December 31, 2018 .

Income Taxes

Income Taxes	6 Months Ended
	Jun. 30, 2019
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, 2019 , the Company is no longer subject to state, local or foreign examinations by tax authorities for tax years before 2009 and the Company is no longer subject to U.S. federal income or payroll tax examinations for tax years before 2015. 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. Prior to the Company's acquisition of Advanced, on June 14, 2019, Advanced was under an IRS audit for the years 2011-2013 for various payroll tax matters related to the treatment of certain non-taxable per diem allowances and travel benefits. This audit was completed and an assessment was issued for $8,300 in July 2018. Advanced filed a protest in August 2018 and had their first IRS Appeals meeting in May 2019. Advanced is no longer subject to state or local examinations by tax authorities for tax years before 2011. Advanced is no longer subject to U.S. federal income or payroll tax examinations for tax years before 2011, payroll tax examination for the years 2014 and 2015 and income tax examination for the year 2014. The Company is indemnified for the potential contingent liability by Advanced. The Advanced acquisition is more fully described in Note (2), “Acquisitions.” 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.

Commitments and Contingencies_

Commitments and Contingencies: Legal Proceedings	6 Months Ended
	Jun. 30, 2019
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 employees were not afforded required breaks or compensated for all time worked, employees’ wage statements are not sufficiently clear, and certain expense reimbursements should be included in the regular rate of pay for purposes of calculating overtime rates. The Company believes that its wage and hour practices conform with law in all material respects, but litigation is always subject to inherent uncertainty. With regard to outstanding loss contingencies as of June 30, 2019 , 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, 2019
Balance Sheet Related Disclosures [Abstract]
BALANCE SHEET DETAILS	BALANCE SHEET DETAILS The consolidated balance sheets detail is as follows as of June 30, 2019 and December 31, 2018 : June 30, 2019 December 31, 2018 Other current assets: Restricted cash and cash equivalents $ 17,102 $ 26,329 Income tax receivable 2,472 799 Other 15,961 12,759 Other current assets $ 35,535 $ 39,887 Fixed assets: Furniture and equipment $ 35,578 $ 34,211 Software 173,753 162,006 Leasehold improvements 9,272 8,615 218,603 204,832 Accumulated depreciation (121,354 ) (114,413 ) Fixed assets, net $ 97,249 $ 90,419 Other assets: Life insurance cash surrender value $ 68,122 $ 55,028 Other 41,787 41,124 Other assets $ 109,909 $ 96,152 Accounts payable and accrued expenses: Trade accounts payable $ 20,691 $ 31,537 Subcontractor payable 49,227 50,892 Accrued expenses 35,142 30,236 Loss contingencies 8,096 24,549 Professional liability reserve 8,073 8,633 Other 3,443 3,756 Accounts payable and accrued expenses $ 124,672 $ 149,603 Accrued compensation and benefits: Accrued payroll $ 41,660 $ 42,571 Accrued bonuses 18,367 18,021 Accrued travel expense 2,483 3,417 Health insurance reserve 3,985 3,559 Workers compensation reserve 8,566 7,817 Deferred compensation 71,292 55,720 Other 3,584 3,954 Accrued compensation and benefits $ 149,937 $ 135,059 Other current liabilities: Acquisition related liabilities $ 10,780 $ 7,918 Other 3,564 2,325 Other current liabilities $ 14,344 $ 10,243 Other long-term liabilities: Workers compensation reserve $ 19,078 $ 19,454 Professional liability reserve 33,439 38,324 Deferred rent — 15,012 Unrecognized tax benefits 5,540 4,862 Deferred revenue 571 865 Other 958 11 Other long-term liabilities $ 59,586 $ 78,528

Basis of Presentation (Policies

Basis of Presentation (Policies)	6 Months Ended
	Jun. 30, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Use of Estimates	The preparation of financial statements in conformity with U.S. GAAP 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 intangible assets purchased in a business combination, 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 February 2016, the Financial Accounting Standards Board (“FASB”) issued Accounting Standard Update (“ASU”) 2016-02, “Leases.” This standard requires organizations that lease assets to recognize the assets and liabilities created by those leases. The standard also requires disclosures to help investors and other financial statement users better understand the amount, timing, and uncertainty of cash flows arising from leases. A modified retrospective transition approach is required, applying the standard to all leases existing at the date of initial application. In addition, the FASB has also issued several amendments to the standard, which clarify certain aspects of the guidance, including an optional transition method for adoption of this standard, which allows organizations to initially apply the new requirements at the effective date, recognize a cumulative effect adjustment to the opening balance of retained earnings, and continue to apply the legacy guidance in Accounting Standards Codification (“ASC”) 840, Leases, including its disclosure requirements, in the comparative periods presented. The new standard provides a number of optional practical expedients in transition. The Company elected the ‘package of practical expedients’, which permits organizations not to reassess under the new standard prior conclusions about lease identification, lease classification and initial direct costs. The Company did not elect to use the hindsight practical expedient to determine the lease term or evaluate impairment for existing leases. The Company adopted ASU 2016-02 effective January 1, 2019 , using the optional transition method described above. The Company recognized the cumulative effect of adopting this guidance as an adjustment as of the effective date, primarily related to the recognition of lease liabilities of $114,807 and corresponding right-of-use assets of $99,525 for existing operating leases. The Company also derecognized existing deferred rent liabilities of $15,302 . These adjustments had no effect on opening retained earnings and prior periods were not retrospectively adjusted and continue to be reported in accordance with ASC 840. The new standard also provides practical expedients for an organization’s ongoing accounting. The Company elected the short-term lease recognition exemption and the practical expedient to not separate lease and non-lease components for all leases that qualify. The Company does not expect the adoption of this standard to impact its results of operations. There was no other material impact to the Company’s condensed consolidated financial statements as a result of adopting this updated standard. Cash, cash equivalents and restricted cash The Company considers all highly liquid investments with an original maturity of three months or less to be cash equivalents. Cash and cash equivalents include currency on hand, deposits with financial institutions and highly liquid investments. Restricted cash and cash equivalents primarily represent cash and money market funds on deposit with financial institutions and investments represents commercial paper that serves as collateral for the Company’s outstanding letters of credit and captive insurance subsidiary claim payments. See Note (6), “Notes Payable and Credit Agreement” and Note (7), “Fair Value Measurement” for additional information. 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, 2019 December 31, 2018 Cash and cash equivalents $ 20,937 $ 13,856 Restricted cash and cash equivalents (included in other current assets) 17,102 26,329 Restricted cash, cash equivalents and investments 65,919 59,331 Total cash, cash equivalents and restricted cash and investments 103,958 99,516 Less restricted investments (5,939 ) (15,192 ) Total cash, cash equivalents and restricted cash $ 98,019 $ 84,324
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, 2019 , previously deferred revenue recognized as revenue was $8,641 . The Company has elected to apply the following practical expedients and optional exemptions related to contract costs and revenue recognition: • 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, 2019 , the Company’s senior notes have a carrying amount of $325,000 and an estimated fair value of $331,500 . As of December 31, 2018 , the senior notes had a carrying amount of $325,000 and an estimated fair value of $310,375 . 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 (7), Notes Payable and Credit Agreement” of our 2018 Annual Report. 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. 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 $65,311 commercial paper issued and outstanding as of June 30, 2019 , $5,939 had original maturities greater than three months, which were considered available-for-sale securities. As of December 31, 2018 , the Company had $63,243 commercial paper issued and outstanding, of which $15,192 had original maturities greater than three months and were considered available-for-sale securities.

Basis of Presentation (Tables)

Basis of Presentation (Tables)	6 Months Ended
	Jun. 30, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Schedule of Restricted Cash	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, 2019 December 31, 2018 Cash and cash equivalents $ 20,937 $ 13,856 Restricted cash and cash equivalents (included in other current assets) 17,102 26,329 Restricted cash, cash equivalents and investments 65,919 59,331 Total cash, cash equivalents and restricted cash and investments 103,958 99,516 Less restricted investments (5,939 ) (15,192 ) Total cash, cash equivalents and restricted cash $ 98,019 $ 84,324
Schedule of Cash and Cash Equivalents	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, 2019 December 31, 2018 Cash and cash equivalents $ 20,937 $ 13,856 Restricted cash and cash equivalents (included in other current assets) 17,102 26,329 Restricted cash, cash equivalents and investments 65,919 59,331 Total cash, cash equivalents and restricted cash and investments 103,958 99,516 Less restricted investments (5,939 ) (15,192 ) Total cash, cash equivalents and restricted cash $ 98,019 $ 84,324

Acquisition (Tables)

Acquisition (Tables)	6 Months Ended
	Jun. 30, 2019
Business Combinations [Abstract]
Schedule of Intangible Assets Acquired	he following table summarizes the fair value and useful life of each intangible asset acquired: Fair Value Useful Life (in years) Identifiable intangible assets Customer Relationships $ 71,000 10 Tradenames and Trademarks 10,000 5 Staffing Database 5,700 10 Developed Technology 2,600 3 $ 89,300 Fair Value Useful Life (in years) Identifiable intangible assets Tradenames and Trademarks $ 46,000 20 Customer Relationships 57,000 12 $ 103,000

Net Income Per Common Share (Ta

Net Income Per Common Share (Tables)	6 Months Ended
	Jun. 30, 2019
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, 2019 and 2018 , respectively: Three Months Ended June 30, Six Months Ended June 30, 2019 2018 2019 2018 Net income $ 28,869 $ 35,529 $ 62,991 $ 78,210 Net income per common share - basic $ 0.62 $ 0.75 $ 1.35 $ 1.64 Net income per common share - diluted $ 0.61 $ 0.73 $ 1.32 $ 1.60 Weighted average common shares outstanding - basic 46,644 47,653 46,713 47,693 Plus dilutive effect of potential common shares 780 1,283 884 1,333 Weighted average common shares outstanding - diluted 47,424 48,936 47,597 49,026

Segment Information (Tables)

Segment Information (Tables)	6 Months Ended
	Jun. 30, 2019
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, 2019 2018 2019 2018 Revenue Nurse and allied solutions $ 331,627 $ 332,728 $ 668,656 $ 670,907 Locum tenens solutions 82,074 107,297 162,564 210,414 Other workforce solutions 121,476 118,083 236,398 199,276 $ 535,177 $ 558,108 $ 1,067,618 $ 1,080,597 Segment operating income Nurse and allied solutions $ 48,694 $ 43,936 $ 96,616 $ 95,741 Locum tenens solutions 7,128 13,371 12,829 23,329 Other workforce solutions 27,127 28,576 53,315 48,427 82,949 85,883 162,760 167,497 Unallocated corporate overhead 21,373 17,181 39,236 32,844 Depreciation and amortization 12,718 10,606 24,428 18,492 Share-based compensation 3,702 3,281 8,888 6,145 Interest expense, net, and other 6,065 6,376 11,738 11,711 Income before income taxes $ 39,091 $ 48,439 $ 78,470 $ 98,305
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, 2019 $ 103,107 $ 19,743 $ 315,656 $ 438,506 Goodwill adjustment for MedPartners acquisition — — 23 23 Goodwill adjustment for PDA and LFT acquisition — — (13 ) (13 ) Goodwill from Silversheet acquisition — — 26,428 26,428 Goodwill from Advanced acquisition 123,513 — — 123,513 Balance, June 30, 2019 $ 226,620 $ 19,743 $ 342,094 $ 588,457 Accumulated impairment loss as of December 31, 2018 and June 30, 2019 $ 154,444 $ 53,940 $ 6,555 $ 214,939

Fair Value Measurement (Tables)

Fair Value Measurement (Tables)	6 Months Ended
	Jun. 30, 2019
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, 2019 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 $ 2,486 $ 2,486 $ — $ — Commercial paper 65,311 — 65,311 — Acquisition contingent consideration liabilities (10,664 ) — — (10,664 ) Fair Value Measurements as of December 31, 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 $ 2,461 $ 2,461 $ — $ — Commercial paper 63,243 — 63,243 — Acquisition contingent consideration liabilities (7,700 ) — — (7,700 )
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, 2019 2018 Balance as of April 1, $ (8,500 ) $ — Settlement of PDA and LFT contingent consideration liability for year ended December 31, 2018 7,000 — 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 ) Contingent consideration liability from Advanced acquisition on June 14, 2019 (10,622 ) — Change in fair value of contingent consideration liability from PDA and LFT acquisition — (19 ) Change in fair value of contingent consideration liability from Silversheet acquisition 1,458 — Balance as of June 30, $ (10,664 ) $ (10,119 ) Six Months Ended June 30, 2019 2018 Balance as of January 1, $ (7,700 ) $ (2,070 ) Settlement of HSG contingent consideration liability for year ended December 31, 2016 — 70 Settlement of HSG contingent consideration liability for year ended December 31, 2017 — 2,000 Settlement of PDA and LFT contingent consideration liability for year ended December 31, 2018 7,000 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 ) Contingent consideration liability from Silversheet acquisition on January 30, 2019 (1,500 ) — Contingent consideration liability from Advanced acquisition on June 14, 2019 (10,622 ) — Change in fair value of contingent consideration liability from PDA and LFT acquisition — (19 ) Change in fair value of contingent consideration liability from Medpartners acquisition 700 — Change in fair value of contingent consideration liability from Silversheet acquisition 1,458 — Balance as of June 30, $ (10,664 ) $ (10,119 )
Reconciliations of equity investments included in net income	The balance of the equity investment classified as Level 2 in the fair value hierarchy was $15,449 as of both June 30, 2019 and December 31, 2018 . There were no changes to the fair value of the equity investment recognized during the three and six months ended June 30, 2019 .

Leases (Tables)

Leases (Tables)	6 Months Ended
	Jun. 30, 2019
Leases [Abstract]
Maturity of Lease Liabilities	The maturity of lease liabilities as of June 30, 2019 were as follows: Operating Leases Years ending December 31, 2019 (excluding the six months ended June 30, 2019) $ 9,011 2020 18,220 2021 18,374 2022 18,181 2023 17,887 Thereafter 50,319 Total lease payments $ 131,992 Less imputed interest (21,569 ) Present value of lease liabilities $ 110,423
Supplemental Cash Flow Disclosures Related to Leases	Supplemental cash flow information related to leases was as follows: Six Months Ended June 30, 2019 Cash paid for amounts included in the measurement of operating lease liabilities (operating cash flows) $ 8,694 Operating lease right-of-use assets obtained in exchange for lease obligations $ — The components of lease expense were as follows: Three Months Ended June 30, Six Months Ended June 30, 2019 2019 Lease Cost Operating lease cost $ 4,569 $ 9,105 Short-term lease cost 5,076 10,998 Variable and other lease cost 599 1,316 Net lease cost $ 10,244 $ 21,419
Assumptions Used for Operating Leases	Weighted average remaining lease term 7 years Weighted average discount rate 4.8 %
Schedule of Future Minimum Payments for Operating Leases Under ASC 840	Future minimum lease payments under noncancelable operating leases (with initial or remaining lease terms in excess of one year) as of December 31, 2018 were as follows: Operating Leases Years ending December 31, 2019 $ 18,218 2020 18,149 2021 18,349 2022 18,144 2023 17,990 Thereafter 50,436 Total minimum lease payments $ 141,286

Balance Sheet Details (Tables)

Balance Sheet Details (Tables)	6 Months Ended
	Jun. 30, 2019
Balance Sheet Related Disclosures [Abstract]
Schedule of Supplemental Balance Sheet Disclosures	The consolidated balance sheets detail is as follows as of June 30, 2019 and December 31, 2018 : June 30, 2019 December 31, 2018 Other current assets: Restricted cash and cash equivalents $ 17,102 $ 26,329 Income tax receivable 2,472 799 Other 15,961 12,759 Other current assets $ 35,535 $ 39,887 Fixed assets: Furniture and equipment $ 35,578 $ 34,211 Software 173,753 162,006 Leasehold improvements 9,272 8,615 218,603 204,832 Accumulated depreciation (121,354 ) (114,413 ) Fixed assets, net $ 97,249 $ 90,419 Other assets: Life insurance cash surrender value $ 68,122 $ 55,028 Other 41,787 41,124 Other assets $ 109,909 $ 96,152 Accounts payable and accrued expenses: Trade accounts payable $ 20,691 $ 31,537 Subcontractor payable 49,227 50,892 Accrued expenses 35,142 30,236 Loss contingencies 8,096 24,549 Professional liability reserve 8,073 8,633 Other 3,443 3,756 Accounts payable and accrued expenses $ 124,672 $ 149,603 Accrued compensation and benefits: Accrued payroll $ 41,660 $ 42,571 Accrued bonuses 18,367 18,021 Accrued travel expense 2,483 3,417 Health insurance reserve 3,985 3,559 Workers compensation reserve 8,566 7,817 Deferred compensation 71,292 55,720 Other 3,584 3,954 Accrued compensation and benefits $ 149,937 $ 135,059 Other current liabilities: Acquisition related liabilities $ 10,780 $ 7,918 Other 3,564 2,325 Other current liabilities $ 14,344 $ 10,243 Other long-term liabilities: Workers compensation reserve $ 19,078 $ 19,454 Professional liability reserve 33,439 38,324 Deferred rent — 15,012 Unrecognized tax benefits 5,540 4,862 Deferred revenue 571 865 Other 958 11 Other long-term liabilities $ 59,586 $ 78,528

Basis of Presentation Basis of

Basis of Presentation Basis of Presentation - Recently Adopted Accounting Pronouncements (Details) - USD ($) $ in Thousands	Jan. 01, 2019	Jun. 30, 2019	Dec. 31, 2018	Jun. 30, 2018	Dec. 31, 2017
Lessee, Lease, Description [Line Items]
Operating lease right-of-use assets		$ 95,247
Present value of lease liabilities		110,423
Cash and cash equivalents		20,937	$ 13,856
Restricted cash and cash equivalents (included in other current assets)		17,102	26,329
Restricted cash, cash equivalents and investments		65,919	59,331
Total cash, cash equivalents and restricted cash and investments		103,958	99,516
Less restricted investments		(5,939)	(15,192)
Cash, cash equivalents and restricted cash at the end of period		$ 98,019	$ 84,324	$ 104,611	$ 98,894
Accounting Standards Update 2016-02
Lessee, Lease, Description [Line Items]
Operating lease right-of-use assets	$ 99,525
Present value of lease liabilities	(114,807)
Derecognition of existing deferred rent liabilities	$ 15,302

Acquisitions (Details)

Acquisitions (Details)	Jun. 14, 2019USD ($)	Jan. 30, 2019USD ($)	Apr. 09, 2018USD ($)	Apr. 06, 2018USD ($)	Sep. 30, 2018USD ($)	Jun. 30, 2019USD ($)aquisition	Dec. 31, 2018USD ($)	Feb. 09, 2018USD ($)
Business Acquisition [Line Items]
Number of acquisitions | aquisition						4
Goodwill						$ 588,457,000	$ 438,506,000
Advanced
Business Acquisition [Line Items]
Initial purchase price	$ 211,743,000
Cash consideration	201,121,000
Tiered contingent earn-out payment	20,000,000
Estimated fair value of contingent earn-out payment	10,622,000
Tangible assets acquired, including cash received	29,064,000
Cash received	2,497,000
Liabilities assumed	30,134,000
Intangible assets acquired	89,300,000
Goodwill	123,513,000
Goodwill expected to be deductible for tax purposes	$ 75,493,000
Intangible assets, weighted-average useful life (in years)	9 years
Advanced | Developed Technology
Business Acquisition [Line Items]
Intangible assets acquired	$ 2,600,000
Advanced | Customer Relationships
Business Acquisition [Line Items]
Intangible assets acquired	71,000,000
Advanced | Staffing Database
Business Acquisition [Line Items]
Intangible assets acquired	5,700,000
Silversheet
Business Acquisition [Line Items]
Initial purchase price		$ 31,676,000
Cash consideration		30,176,000
Tiered contingent earn-out payment		25,000,000
Estimated fair value of contingent earn-out payment		1,500,000
Tangible assets acquired, including cash received		1,758,000
Cash received		651,000
Liabilities assumed		3,390,000
Intangible assets acquired		6,880,000
Goodwill		$ 26,428,000
Intangible assets, weighted-average useful life (in years)		8 years
Silversheet | Based on operating results for the twelve months ending December 31, 2019
Business Acquisition [Line Items]
Tiered contingent earn-out payment		$ 6,000,000
Silversheet | Based on operating results for the twelve months ending December 31, 2020
Business Acquisition [Line Items]
Tiered contingent earn-out payment		19,000,000
Silversheet | Developed Technology
Business Acquisition [Line Items]
Intangible assets acquired		5,300,000
Silversheet | Trademarks
Business Acquisition [Line Items]
Intangible assets acquired		$ 1,500,000
MedPartners
Business Acquisition [Line Items]
Initial purchase price			$ 200,711,000
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			28,508,000
Cash received			8,403,000
Liabilities assumed			11,933,000
Intangible assets acquired			103,000,000
Goodwill			$ 81,136,000
Intangible assets, weighted-average useful life (in years)			16 years
Working capital settlement received					$ 222,000
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 ended June 30, 2019
Business Acquisition [Line Items]
Tiered contingent earn-out payment			10,000,000
MedPartners | Customer Relationships
Business Acquisition [Line Items]
Intangible assets acquired			$ 57,000,000
PDA and LFT
Business Acquisition [Line Items]
Initial purchase price				$ 35,503,000
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				4,389,000
Cash received				351,000
Liabilities assumed				4,779,000
Intangible assets acquired				19,110,000
Goodwill				$ 16,783,000
Intangible assets, weighted-average useful life (in years)				12 years
Working capital settlement received					$ 465,000
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 Database
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
Secured Debt | Line of Credit
Business Acquisition [Line Items]
Maximum borrowing capacity	$ 150,000,000

Acquisitions - Schedule of Inta

Acquisitions - Schedule of Intangible Assets Acquired (Details) - USD ($) $ in Thousands	Jun. 14, 2019	Apr. 09, 2018
Advanced
Acquired Finite-Lived Intangible Assets [Line Items]
Intangible assets acquired	$ 89,300
Advanced | Customer Relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Intangible assets acquired	$ 71,000
Useful Life	10 years
Advanced | Tradenames and Trademarks
Acquired Finite-Lived Intangible Assets [Line Items]
Intangible assets acquired	$ 10,000
Useful Life	5 years
Advanced | Staffing Database
Acquired Finite-Lived Intangible Assets [Line Items]
Intangible assets acquired	$ 5,700
Useful Life	10 years
Advanced | Developed Technology
Acquired Finite-Lived Intangible Assets [Line Items]
Intangible assets acquired	$ 2,600
Useful Life	3 years
MedPartners
Acquired Finite-Lived Intangible Assets [Line Items]
Intangible assets acquired		$ 103,000
MedPartners | Customer Relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Intangible assets acquired		$ 57,000
Useful Life		12 years
MedPartners | Tradenames and Trademarks
Acquired Finite-Lived Intangible Assets [Line Items]
Intangible assets acquired		$ 46,000
Useful Life		20 years

Revenue Recognition Revenue Rec

Revenue Recognition Revenue Recognition - Narrative (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2019USD ($)
Revenue from Contract with Customer [Abstract]
Previously deferred revenue recognized during period	$ 8,641

Net Income Per Common Share - N

Net Income Per Common Share - Narrative (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Computation of basic and diluted net income per common share
Net income	$ 28,869	$ 35,529	$ 62,991	$ 78,210
Net income per common share - basic (in dollars per share)	$ 0.62	$ 0.75	$ 1.35	$ 1.64
Net income per common share - diluted (in dollars per share)	$ 0.61	$ 0.73	$ 1.32	$ 1.60
Weighted average common shares outstanding - basic (in shares)	46,644	47,653	46,713	47,693
Plus dilutive effect of potential common shares (in shares)	780	1,283	884	1,333
Weighted average common shares outstanding - diluted (in shares)	47,424	48,936	47,597	49,026
Common stock excluded from calculation of EPS (in shares)	66	36	66	23

Segment Information - Narrative

Segment Information - Narrative (Details) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019USD ($)	Jun. 30, 2018USD ($)	Jun. 30, 2019USD ($)segment	Jun. 30, 2018USD ($)
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	$ 535,177	$ 558,108	$ 1,067,618	$ 1,080,597
Segment operating income	45,156	54,815	90,208	110,016
Depreciation and amortization	12,718	10,606	24,428	18,492
Share-based compensation	3,702	3,281	8,888	6,145
Interest expense, net, and other	6,065	6,376	11,738	11,711
Income before income taxes	39,091	48,439	78,470	98,305
Operating segments
Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results
Revenue	535,177	558,108	1,067,618	1,080,597
Segment operating income	82,949	85,883	162,760	167,497
Operating segments | Nurse and Allied Solutions
Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results
Revenue	331,627	332,728	668,656	670,907
Segment operating income	48,694	43,936	96,616	95,741
Operating segments | Locum Tenens Solutions
Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results
Revenue	82,074	107,297	162,564	210,414
Segment operating income	7,128	13,371	12,829	23,329
Operating segments | Other Workforce Solutions
Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results
Revenue	121,476	118,083	236,398	199,276
Segment operating income	27,127	28,576	53,315	48,427
Unallocated corporate overhead
Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results
Unallocated corporate overhead	$ 21,373	$ 17,181	$ 39,236	$ 32,844
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	65.00%	56.00%	66.00%	60.00%
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	22.00%	14.00%	23.00%	14.00%
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	8.00%	6.00%	8.00%	8.00%

Segment Information - Goodwill

Segment Information - Goodwill (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2019	Dec. 31, 2018
Goodwill [Roll Forward]
Goodwill, beginning balance	$ 438,506
Goodwill, ending balance	588,457
Accumulated impairment loss	214,939	$ 214,939
Nurse and Allied Solutions
Goodwill [Roll Forward]
Goodwill, beginning balance	103,107
Goodwill, ending balance	226,620
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	315,656
Goodwill, ending balance	342,094
Accumulated impairment loss	6,555	$ 6,555
MedPartners
Goodwill [Roll Forward]
Goodwill, adjustments	23
MedPartners | Nurse and Allied Solutions
Goodwill [Roll Forward]
Goodwill, adjustments	0
MedPartners | Locum Tenens Solutions
Goodwill [Roll Forward]
Goodwill, adjustments	0
MedPartners | Other Workforce Solutions
Goodwill [Roll Forward]
Goodwill, adjustments	23
PDA and LFT
Goodwill [Roll Forward]
Goodwill, adjustments	(13)
PDA and LFT | Nurse and Allied Solutions
Goodwill [Roll Forward]
Goodwill, adjustments	0
PDA and LFT | Locum Tenens Solutions
Goodwill [Roll Forward]
Goodwill, adjustments	0
PDA and LFT | Other Workforce Solutions
Goodwill [Roll Forward]
Goodwill, adjustments	(13)
Silversheet
Goodwill [Roll Forward]
Goodwill acquired	26,428
Silversheet | Nurse and Allied Solutions
Goodwill [Roll Forward]
Goodwill acquired	0
Silversheet | Locum Tenens Solutions
Goodwill [Roll Forward]
Goodwill acquired	0
Silversheet | Other Workforce Solutions
Goodwill [Roll Forward]
Goodwill acquired	26,428
Advanced
Goodwill [Roll Forward]
Goodwill acquired	123,513
Advanced | Nurse and Allied Solutions
Goodwill [Roll Forward]
Goodwill acquired	123,513
Advanced | Locum Tenens Solutions
Goodwill [Roll Forward]
Goodwill acquired	0
Advanced | Other Workforce Solutions
Goodwill [Roll Forward]
Goodwill acquired	$ 0

Notes Payable and Credit Agre_2

Notes Payable and Credit Agreement - Narrative (Details) - Line of Credit - USD ($)	Feb. 09, 2018	Jun. 30, 2019	Jun. 14, 2019
Debt Instrument [Line Items]
Fees paid to lenders and other third parties		$ 875,000
Unamortized financing fees		$ 1,702,000
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
Secured Debt
Debt Instrument [Line Items]
Maximum borrowing capacity			$ 150,000,000
Percent of term loan amortized in year one		2.50%
Percent of term loan amortized after year one		5.00%
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%

Fair Value Measurement - Narrat

Fair Value Measurement - Narrative (Details) - USD ($)	6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Dec. 31, 2018	Oct. 31, 2016
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Impairment charges	$ 0	$ 0
Fair Value, Measurements, Nonrecurring | Significant Other Observable Inputs (Level 2)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Equity investment balance	15,449,000		$ 15,449,000
Commercial paper | Fair Value, Measurements, Recurring
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Commercial paper	65,311,000		63,243,000
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	65,311,000		63,243,000
Available-for-sale securities	5,939,000		15,192,000
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	325,000,000		325,000,000
Estimated fair value of senior notes	$ 331,500,000		$ 310,375,000
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, 2019	Dec. 31, 2018
Money market funds
Schedule of financial assets and liabilities measured at fair value on recurring basis
Financial assets and liabilities measured at fair value	$ 2,486	$ 2,461
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	2,486	2,461
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	65,311	63,243
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	65,311	63,243
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	(10,664)	(7,700)
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	$ (10,664)	$ (7,700)

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, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Beginning balance	$ (8,500)	$ 0	$ (7,700)	$ (2,070)
Ending balance	(10,664)	(10,119)	(10,664)	(10,119)
PDA and LFT
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Settlement of earn-out	7,000	0	7,000
Contingent consideration earn-out liability	0	(5,700)	0	(5,700)
Change in fair value of contingent consideration earn-out liability from acquisition	0	(19)	0	(19)
MedPartners
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Contingent consideration earn-out liability	0	(4,400)	0	(4,400)
Change in fair value of contingent consideration earn-out liability from acquisition			700	0
Advanced
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Contingent consideration earn-out liability	(10,622)	0	(10,622)	0
Silversheet
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Contingent consideration earn-out liability			(1,500)	0
Change in fair value of contingent consideration earn-out liability from acquisition	$ 1,458	$ 0	1,458	0
Contingent consideration liability for year ended December 31, 2016 | HSG
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Settlement of earn-out			0	70
Contingent consideration liability for year ended December 31, 2017 | HSG
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Settlement of earn-out			$ 0	$ 2,000

Leases - Narrative (Details)

Leases - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Jun. 30, 2019	Dec. 31, 2018
Lessee, Lease, Description [Line Items]
Option to extend, term	10 years
Option to terminate, term	3 years
Rent expense		$ 21,402
Minimum
Lessee, Lease, Description [Line Items]
Lease term	1 year

Leases - Components of Lease Ex

Leases - Components of Lease Expense (Details) - USD ($) $ in Thousands	3 Months Ended	6 Months Ended
	Jun. 30, 2019	Jun. 30, 2019
Leases [Abstract]
Operating lease cost	$ 4,569	$ 9,105
Short-term lease cost	5,076	10,998
Variable and other lease cost	599	1,316
Net lease cost	$ 10,244	$ 21,419

Leases - Maturity of Lease Liab

Leases - Maturity of Lease Liabilities (Details) $ in Thousands	Jun. 30, 2019USD ($)
Leases [Abstract]
2019 (excluding the three months ended March 31, 2019)	$ 9,011
2020	18,220
2021	18,374
2022	18,181
2023	17,887
Thereafter	50,319
Total lease payments	131,992
Less imputed interest	(21,569)
Present value of lease liabilities	$ 110,423

Leases - Supplemental Cash Flow

Leases - Supplemental Cash Flow Information Regarding Leases (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2019USD ($)
Leases [Abstract]
Cash paid for amounts included in the measurement of operating lease liabilities (operating cash flows)	$ 8,694
Operating lease right-of-use assets obtained in exchange for lease obligations	$ 0

Leases - Assumptions Used for O

Leases - Assumptions Used for Operating Leases (Details)	Jun. 30, 2019
Leases [Abstract]
Weighted average remaining lease term	7 years
Weighted average discount rate	4.80%

Leases - Minimum Lease Payments

Leases - Minimum Lease Payments Under ASC 840 (Details) $ in Thousands	Dec. 31, 2018USD ($)
Leases [Abstract]
2019	$ 18,218
2020	18,149
2021	18,349
2022	18,144
2023	17,990
Thereafter	50,436
Total minimum lease payments	$ 141,286

Income Taxes - Additional Infor

Income Taxes - Additional Information (Details)	1 Months Ended
	Jul. 31, 2018USD ($)
Advanced
Error Corrections and Prior Period Adjustments Restatement [Line Items]
Income tax assessment	$ 8,300

Balance Sheet Details - Narrati

Balance Sheet Details - Narrative (Details) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Other current assets:
Restricted cash and cash equivalents	$ 17,102	$ 26,329
Income tax receivable	2,472	799
Other	15,961	12,759
Other current assets	35,535	39,887
Fixed assets:
Furniture and equipment	35,578	34,211
Software	173,753	162,006
Leasehold improvements	9,272	8,615
Fixed assets, gross	218,603	204,832
Accumulated depreciation	(121,354)	(114,413)
Fixed assets, net	97,249	90,419
Other assets:
Life insurance cash surrender value	68,122	55,028
Other	41,787	41,124
Other assets	109,909	96,152
Accounts payable and accrued expenses:
Trade accounts payable	20,691	31,537
Subcontractor payable	49,227	50,892
Accrued expenses	35,142	30,236
Loss contingencies	8,096	24,549
Professional liability reserve	8,073	8,633
Other	3,443	3,756
Accounts payable and accrued expenses	124,672	149,603
Accrued compensation and benefits:
Accrued payroll	41,660	42,571
Accrued bonuses	18,367	18,021
Accrued travel expense	2,483	3,417
Health insurance reserve	3,985	3,559
Workers compensation reserve	8,566	7,817
Deferred compensation	71,292	55,720
Other	3,584	3,954
Accrued compensation and benefits	149,937	135,059
Other current liabilities:
Acquisition related liabilities	10,780	7,918
Other	3,564	2,325
Other current liabilities	14,344	10,243
Other long-term liabilities:
Workers compensation reserve	19,078	19,454
Professional liability reserve	33,439	38,324
Deferred rent	0	15,012
Unrecognized tax benefits	5,540	4,862
Deferred revenue	571	865
Other	958	11
Other long-term liabilities	$ 59,586	$ 78,528

Uncategorized Items - amn-20190

Label	Element	Value
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	$ 2,089,000
Retained Earnings [Member]
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	$ 2,089,000