AMN Healthcare Services (AMN) 10-Q 11 May 20 2020 Q1 Quarterly report Financial data

Cover Page

Cover Page - shares	3 Months Ended
	Mar. 31, 2020	May 07, 2020
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Mar. 31, 2020
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	8840 Cypress Waters Boulevard
Entity Address, Address Line Two	Suite 300
Entity Address, City or Town	Dallas
Entity Address, State or Province	TX
Entity Address, Postal Zip Code	75019
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)		46,976,251
Entity Central Index Key	0001142750
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2020
Document Fiscal Period Focus	Q1
Amendment Flag	false

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Current assets:
Cash and cash equivalents	$ 97,509	$ 82,985
Accounts receivable, net of allowances of $8,024 and $3,332 at March 31, 2020 and December 31, 2019, respectively	376,528	352,685
Accounts receivable, subcontractor	75,938	72,714
Prepaid expenses	19,950	11,669
Other current assets	30,669	40,446
Total current assets	600,594	560,499
Restricted cash, cash equivalents and investments	60,873	62,170
Fixed assets, net of accumulated depreciation of $138,589 and $132,900 at March 31, 2020 and December 31, 2019, respectively	116,718	104,832
Operating lease right-of-use assets	87,217	89,866
Other assets	104,829	120,254
Goodwill	851,459	595,551
Intangible assets, net of accumulated amortization of $164,848 and $151,417 at March 31, 2020 and December 31, 2019, respectively	638,443	398,474
Total assets	2,460,133	1,931,646
Current liabilities:
Accounts payable and accrued expenses	175,188	156,140
Accrued compensation and benefits	153,018	170,932
Current portion of notes payable	6,250	0
Current portion of operating lease liabilities	14,634	13,943
Deferred revenue	12,587	11,788
Other current liabilities	11,383	25,302
Total current liabilities	373,060	378,105
Revolving credit facility	225,000	0
Notes payable, less unamortized fees	858,906	617,159
Deferred income taxes, net	104,262	46,618
Operating lease liabilities	88,090	91,209
Other long-term liabilities	61,735	61,813
Total liabilities	1,711,053	1,194,904
Commitments and contingencies
Stockholders’ equity:
Preferred stock, $0.01 par value; 10,000 shares authorized; none issued and outstanding at March 31, 2020 and December 31, 2019	0	0
Common stock, $0.01 par value; 200,000 shares authorized; 49,423 issued and 46,862 outstanding at March 31, 2020 and 49,283 issued and 46,722 outstanding at December 31, 2019	494	493
Additional paid-in capital	455,766	455,193
Treasury stock, at cost (2,561 shares at March 31, 2020 and December 31, 2019)	(119,143)	(119,143)
Retained earnings	411,858	400,047
Accumulated other comprehensive income	105	152
Total stockholders’ equity	749,080	736,742
Total liabilities and stockholders’ equity	$ 2,460,133	$ 1,931,646

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Statement of Financial Position [Abstract]
Accounts receivable, allowance	$ 8,024	$ 3,332
Accumulated depreciation - fixed assets	138,589	132,900
Accumulated amortization	$ 164,848	$ 151,417
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)	49,423,000	49,283,000
Common stock, shares outstanding (in shares)	46,862,000	46,722,000
Treasury stock (in shares)	2,561,000	2,561,000

Condensed Consolidated Statemen

Condensed Consolidated Statements of Comprehensive Income - USD ($) shares in Thousands, $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Statement of Comprehensive Income [Abstract]
Revenue	$ 602,461	$ 532,441
Cost of revenue	400,395	355,682
Gross profit	202,066	176,759
Operating expenses:
Selling, general and administrative	146,234	119,997
Depreciation and amortization	20,089	11,710
Total operating expenses	166,323	131,707
Income from operations	35,743	45,052
Interest expense, net, and other	11,054	5,673
Income before income taxes	24,689	39,379
Income tax expense	11,724	5,257
Net income	12,965	34,122
Other comprehensive loss:
Foreign currency translation and other	(47)	(101)
Other comprehensive loss	(47)	(101)
Comprehensive income	$ 12,918	$ 34,021
Net income per common share:
Basic (in dollars per share)	$ 0.27	$ 0.73
Diluted (in dollars per share)	$ 0.27	$ 0.71
Weighted average common shares outstanding:
Basic (shares)	47,359	46,784
Diluted (shares)	47,641	47,772

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 Other Comprehensive Income
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, 2019		49,283		(2,561)
Beginning balance at Dec. 31, 2019	736,742	$ 493	455,193	$ (119,143)	400,047	152
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Equity awards vested and exercised, net of shares withheld for payroll taxes (in shares)		140
Equity awards vested and exercised, net of shares withheld for payroll taxes	(4,353)	$ 1	(4,354)
Share-based compensation	4,927		4,927
Comprehensive income (loss)	12,918				12,965	(47)
Ending balance (in shares) at Mar. 31, 2020		49,423		(2,561)
Ending balance at Mar. 31, 2020	$ 749,080	$ 494	$ 455,766	$ (119,143)	$ 411,858	$ 105

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Cash flows from operating activities:
Net income	$ 12,965	$ 34,122
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	20,234	11,710
Non-cash interest expense and other	1,911	543
Change in fair value of contingent consideration	200	(700)
Increase in allowance for credit losses and sales credits	4,735	2,608
Provision for deferred income taxes	733	(9,036)
Share-based compensation	4,927	5,186
Loss on disposal or sale of fixed assets	3,266	4
Amortization of discount on investments	(50)	(120)
Net gain on deferred compensation balances	(240)	0
Non-cash lease expense	(179)	(92)
Changes in assets and liabilities, net of effects from acquisitions:
Accounts receivable	(5,786)	(1,500)
Accounts receivable, subcontractor	(3,224)	(5,465)
Income taxes receivable	5,984	799
Prepaid expenses	(7,663)	(5,387)
Other current assets	3,463	(1,783)
Other assets	2,409	(6,202)
Accounts payable and accrued expenses	15,836	2,949
Accrued compensation and benefits	(2,031)	330
Other liabilities	(6,894)	9,630
Deferred revenue	748	(1,418)
Restricted investments balance	21	36
Net cash provided by operating activities	51,365	36,214
Cash flows from investing activities:
Purchase and development of fixed assets	(13,571)	(7,388)
Purchase of investments	(4,479)	(7,362)
Proceeds from maturity of investments	9,600	11,700
Payments to fund deferred compensation plan	(5,471)	(3,583)
Purchase of convertible promissory note	(490)	0
Cash paid for acquisitions, net of cash and restricted cash received	(476,392)	(29,525)
Cash paid for other intangibles	(1,400)	(90)
Cash received for working capital adjustments for prior year acquisitions	66	0
Net cash used in investing activities	(492,137)	(36,248)
Cash flows from financing activities:
Proceeds from term loans	250,000	0
Proceeds from revolving credit facility	225,000	30,000
Repurchase of common stock	0	(17,930)
Payment of financing costs	(3,899)	0
Earn-out payments for prior acquisitions	(10,622)	0
Cash paid for shares withheld for taxes	(4,353)	(10,280)
Net cash provided by financing activities	456,126	1,790
Effect of exchange rate changes on cash	(47)	(101)
Net increase in cash, cash equivalents and restricted cash	15,307	1,655
Cash, cash equivalents and restricted cash at the beginning of period	153,962	84,324
Cash, cash equivalents and restricted cash at the end of period	169,269	85,979
Supplemental disclosures of cash flow information:
Cash paid for amounts included in the measurement of operating lease liabilities	4,734	4,338
Cash paid for interest (net of $159 and $102 capitalized for the three months ended March 31, 2020 and 2019, respectively)	1,898	1,524
Cash paid for income taxes	45	4,192
Acquisitions:
Fair value of tangible assets acquired in acquisitions, net of cash and restricted cash received	37,240	1,041
Goodwill	255,974	26,494
Intangible assets	252,000	6,880
Liabilities assumed	(68,822)	(3,390)
Earn-out liabilities	0	(1,500)
Net cash paid for acquisitions	476,392	29,525
Supplemental disclosures of non-cash investing and financing activities:
Purchase of fixed assets recorded in accounts payable and accrued expenses	$ 1,786	$ 2,566

Condensed Consolidated Statem_4

Condensed Consolidated Statements of Cash Flows (Parenthetical) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Statement of Cash Flows [Abstract]
Interest capitalized	$ 159	$ 102

Basis of Presentation

Basis of Presentation	3 Months Ended
	Mar. 31, 2020
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, 2019 , contained in the Company’s Annual Report on Form 10-K for the fiscal year ended December 31, 2019 , filed with the Securities and Exchange Commission on February 25, 2020 (“ 2019 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. Coronavirus Pandemic On March 11, 2020, the World Health Organization declared the outbreak of a novel strain of coronavirus, also known as COVID-19, a global pandemic. Due to the pandemic, there has been uncertainty and disruption in the global economy and significant volatility of financial markets. The Company is closely monitoring the impact of the pandemic, which is evolving, and its effects and risks on our operations, liquidity, financial condition and financial results for the full year 2020 and, possibly, beyond. The estimates used for, but not limited to, determining the collectability of accounts receivable, fair value of long-lived assets, and goodwill could be impacted by the pandemic. While the full impact of COVID-19 is unknown at this time, the Company has made appropriate estimates based on the facts and circumstances available as of the reporting date. Specifically, the Company continues to monitor the impacts of the pandemic on its customers’ liquidity and capital resources and, therefore, the Company’s ability to collect, or the timeliness of collection of accounts receivable. These estimates may change as new events occur and additional information is obtained. See additional information below regarding the allowance for credit losses for accounts receivable. Recently Adopted Accounting Pronouncements In June 2016, the Financial Accounting Standards Board (“FASB”) issued Accounting Standard Update (“ASU”) 2016-13, “Measurement of Credit Losses on Financial Instruments.” The FASB also issued a series of other ASUs, which update ASU 2016-13 (collectively, the “credit loss standard”). This new standard introduces new accounting models for determining and recognizing credit losses on certain financial instruments based on an estimate of current expected credit losses. The Company adopted this standard effective January 1, 2020 using the modified retrospective transition method. The Company recognized the cumulative effect of adopting this guidance as an adjustment to the opening balance of retained earnings of $1,154 , net of tax, primarily related to its allowance for credit losses for accounts receivable. Prior period amounts are not retrospectively adjusted. The impact of the adoption of the new standard was not material to the Company’s condensed consolidated financial statements for the quarter ended March 31, 2020. The Company expects the impact to be immaterial on an ongoing basis. See additional information below regarding the allowance for credit losses for accounts receivable. In January 2017, the FASB issued ASU 2017-04, “Simplifying the Test for Goodwill Impairment.” The standard simplifies the subsequent measurement of goodwill by removing the requirement to perform a hypothetical purchase price allocation to compute the implied fair value of goodwill to measure impairment. Instead, any goodwill impairment will equal the amount by which a reporting unit’s carrying value exceeds its fair value, not to exceed the carrying amount of goodwill. Further, the guidance eliminates the requirements for any reporting unit with a zero or negative carrying amount to perform a qualitative assessment and, if it fails that qualitative test, to perform Step 2 of the goodwill impairment test. The Company adopted this standard effective January 1, 2020 and the adoption did not have a material effect on the Company’s consolidated financial statements. In August 2018, the FASB issued ASU 2018-13, “Disclosure Framework—Changes to the Disclosure Requirements for Fair Value Measurement.” The standard modifies the current disclosure requirements on fair value measurements. The Company adopted this standard effective January 1, 2020. Refer to information regarding fair value measurements in Note (7), “Fair Value Measurement.” 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 (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. March 31, 2020 December 31, 2019 Cash and cash equivalents $ 97,509 $ 82,985 Restricted cash and cash equivalents (included in other current assets) 15,380 18,393 Restricted cash, cash equivalents and investments 60,873 62,170 Total cash, cash equivalents and restricted cash and investments 173,762 163,548 Less restricted investments (4,493 ) (9,586 ) Total cash, cash equivalents and restricted cash $ 169,269 $ 153,962 Accounts Receivable The Company records accounts receivable at the invoiced amount. Accounts receivable are non-interest bearing. The Company maintains an allowance for expected credit losses based on the Company’s historical write-off experience, an assessment of its customers’ financial conditions and available information that is relevant to assessing the collectability of cash flows, which includes current conditions and forecasts about future economic conditions. The following table provides a reconciliation of activity in the allowance for credit losses for accounts receivable: 2020 Balance as of January 1, $ 3,332 Adoption of the credit loss standard, cumulative-effect adjustment to retained earnings 1,334 Provision for expected credit losses 3,839 Amounts written off charged against the allowance (481 ) Balance as of March 31, $ 8,024 Reclassification The Company reclassified its allowance for accounts receivable in the prior year’s consolidated balance sheet to conform to the current year presentation. The prior year’s balance of accounts receivable (net of allowances) remains unchanged.

Acquisitions

Acquisitions	3 Months Ended
	Mar. 31, 2020
Business Combinations [Abstract]
ACQUISITIONS	ACQUISITIONS As set forth below, the Company completed four acquisitions from January 1, 2019 through March 31, 2020 . 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 March 31, 2020 . The allocations will continue to be updated through the measurement period, if necessary. The Company recognizes acquisition-related costs in selling, general and administrative expenses in the consolidated statements of comprehensive income. Stratus Video Acquisition On February 14, 2020, the Company completed its acquisition of Stratus Video, a remote video interpreting company that provides healthcare interpretation via remote video, over the phone, and onsite in-person, all supported by proprietary technology platforms. The initial purchase price of $485,568 consisted entirely of cash consideration paid upon acquisition. 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”), and (2) the Second Amendment (as defined in Note (6) below) to the New Credit Agreement, which provided $250,000 of additional available borrowings to the Company. The New Credit Agreement and the Second Amendment are more fully described in Note (6), “Notes Payable and Credit Agreement.” The results of Stratus Video have been included in the Company’s technology and workforce solutions segment since the date of acquisition. The Company incurred $7,812 of acquisition-related costs during the three months ended March 31, 2020 as a result of its acquisition of Stratus Video. The preliminary allocation of the $485,568 purchase price consisted of (1) $46,416 of fair value of tangible assets acquired, which included $9,176 cash received, (2) $68,822 of liabilities assumed, (3) $252,000 of identified intangible assets, and (4) $255,974 of goodwill, of which $10,186 is expected to be deductible for tax purposes. The provisional items pending finalization are the valuation of the acquired intangible assets, the final net working capital settlement, and income tax related matters. The intangible assets acquired have a weighted average useful life of approximately seventeen 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 $ 191,000 20 Tradenames and Trademarks 44,000 5 - 10 Developed Technology 16,000 5 Interpreter Database 1,000 4 $ 252,000 Approximately $14,433 of revenue and $1,606 of income before income taxes of Stratus Video were included in the unaudited condensed consolidated statement of comprehensive income for the three months ended March 31, 2020 . The following summary presents unaudited pro forma consolidated results of operations of the Company as if the Stratus Video and Advanced (as defined below) acquisitions had occurred on January 1, 2019, which gives effect to certain adjustments, including incremental acquisition-related costs of $11,681 , of which $7,812 was reclassified from the three months ended March 31, 2020 , amortization of intangible assets of $5,119 and interest expense of $2,727 during the three months ended March 31, 2019 . The pro forma financial information is not necessarily indicative of the operating results that would have occurred had the acquisitions been consummated as of the date indicated, nor is it necessarily indicative of our future operating results. Three Months Ended March 31, 2020 2019 Revenue $ 616,333 $ 583,311 Income from operations $ 44,853 $ 30,745 Net income $ 18,674 $ 18,681 b4health Acquisition On December 19, 2019, the Company completed its acquisition of B4Health, LLC (“b4health”), an innovative technology company and a leading provider of a web-based internal float pool management solution and vendor management system for healthcare facilities. The initial purchase price of $23,006 included (1) $19,906 cash consideration paid upon acquisition and (2) a contingent earn-out payment of up to $12,000 with an estimated fair value of $3,100 as of the acquisition date. The contingent earn-out payment is based on the operating results of b4health for the twelve months ending December 31, 2020. The results of b4health have been included in the Company’s technology and workforce solutions segment since the date of acquisition. During the first quarter of 2020, $66 was returned to the Company for the final working capital settlement. The allocation of the $22,940 purchase price, which was reduced by the final working capital settlement, consisted of (1) $1,169 of fair value of tangible assets acquired, which included $222 cash received, (2) $823 of liabilities assumed, (3) $9,000 of identified intangible assets, and (4) $13,594 of goodwill, all of which is deductible for tax purposes. The fair value of intangible assets includes $3,000 of developed technology, $4,000 of customer relationships, and $2,000 of trademarks with a weighted average useful life of approximately seven years . 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, which was settled in full during the first quarter of 2020. The acquisition was funded primarily through (1) borrowings under the Senior Credit Facility 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 results of Advanced have been included in the Company’s nurse and allied solutions segment since the date of acquisition. During the third quarter of 2019, an additional $73 of cash consideration was paid to the selling shareholders for the final working capital settlement. The allocation of the $211,816 purchase price, which included the additional cash consideration paid for the final working capital settlement, consisted of (1) $29,035 of fair value of tangible assets acquired, which included $2,497 cash and restricted cash received, (2) $28,758 of liabilities assumed, (3) $91,700 of identified intangible assets, and (4) $119,839 of goodwill, of which $57,121 is expected to be deductible for tax purposes. 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 $ 68,000 10 Tradenames and Trademarks 10,000 5 Staffing Database 10,300 10 Developed Technology 3,400 3 $ 91,700 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, which resulted in no earn-out payment, 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 technology and workforce solutions segment since the date of acquisition. The allocation of the $31,676 purchase price consisted of (1) $2,826 of fair value of tangible assets acquired, which included $651 cash received, (2) $1,567 of liabilities assumed, (3) $6,880 of identified intangible assets, and (4) $23,537 of goodwill, none of which is deductible for tax purposes. 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 .

Revenue Recognition

Revenue Recognition	3 Months Ended
	Mar. 31, 2020
Revenue from Contract with Customer [Abstract]
REVENUE RECOGNITION	REVENUE RECOGNITION Revenue primarily consists of fees earned from the temporary staffing and permanent placement of healthcare professionals, executives, and leaders (clinical and operational). The Company also generates revenue from its software as a service (“SaaS”)-based technologies, including vendor management systems and scheduling software, and outsourced workforce services, including revenue cycle solutions, language interpretation and recruitment process outsourcing. 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 (“MSP”) 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 permanent placement and outsourced workforce services is recognized as the services are rendered. Depending on the arrangement, the Company’s SaaS-based revenue is recognized either as the services are rendered or 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. While payment terms vary by the type of customer and the services rendered, the term between invoicing and when payment is due is not significant. During the three months ended March 31, 2020 , previously deferred revenue recognized as revenue was $7,628 . 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	3 Months Ended
	Mar. 31, 2020
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: Three Months Ended March 31, 2020 2019 Net income $ 12,965 $ 34,122 Net income per common share - basic $ 0.27 $ 0.73 Net income per common share - diluted $ 0.27 $ 0.71 Weighted average common shares outstanding - basic 47,359 46,784 Plus dilutive effect of potential common shares 282 988 Weighted average common shares outstanding - diluted 47,641 47,772 Share-based awards to purchase 27 and 66 shares of common stock were not included in the above calculation of diluted net income per common share for the three months ended March 31, 2020 and 2019 , respectively, because the effect of these instruments was anti-dilutive.

Segment Information

Segment Information	3 Months Ended
	Mar. 31, 2020
Segment Reporting [Abstract]
SEGMENT INFORMATION	SEGMENT INFORMATION The Company’s operating segments are identified in the same manner as they are reported internally and used by the Company’s chief operating decision maker for the purpose of evaluating performance and allocating resources. Effective March 8, 2020, the Company modified its reportable segments. The Company previously utilized three reportable segments, which it identified as follows: (1) nurse and allied solutions, (2) locum tenens solutions, and (3) other workforce solutions. In light of the Company’s recent acquisitions and organizational changes to better align its organizational structure with its strategy and operations, the Company’s management reorganized its reportable segments to better reflect how the business is evaluated by the chief operating decision maker. Beginning in the first quarter of 2020, the Company will disclose the following three reportable segments: (1) nurse and allied solutions, (2) physician and leadership solutions, and (3) technology and workforce solutions. The nurse and allied solutions segment includes the Company’s travel nurse staffing, rapid response nurse staffing and labor disruption, allied staffing, local staffing, and revenue cycle solutions businesses. The physician and leadership solutions segment includes the Company’s locum tenens staffing, healthcare interim leadership staffing, executive search, and physician permanent placement businesses. The technology and workforce solutions segment includes the Company’s remote video interpreting, vendor management systems, workforce optimization, recruitment process outsourcing, education, credentialing, and flex pool management businesses. 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, which includes reclassified prior period data to conform to the new segment reporting structure, provides a reconciliation of revenue and operating income by reportable segment to consolidated results and was derived from each segment’s internal financial information as used for corporate management purposes: Three Months Ended March 31, 2020 2019 Revenue Nurse and allied solutions $ 424,346 $ 373,472 Physician and leadership solutions 137,842 137,077 Technology and workforce solutions 40,273 21,892 $ 602,461 $ 532,441 Segment operating income Nurse and allied solutions $ 59,608 $ 53,556 Physician and leadership solutions 14,569 15,872 Technology and workforce solutions 15,295 10,383 89,472 79,811 Unallocated corporate overhead 28,568 17,863 Depreciation and amortization 20,089 11,710 Depreciation (included in cost of revenue) 145 — Share-based compensation 4,927 5,186 Interest expense, net, and other 11,054 5,673 Income before income taxes $ 24,689 $ 39,379 The following tables present the Company’s revenue disaggregated by service type: Three Months Ended March 31, 2020 Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Temporary staffing $ 392,671 $ 119,596 $ — $ 512,267 Permanent placement — 18,246 — 18,246 Outsourced workforce 31,675 — 17,680 49,355 SaaS-based technologies — — 22,593 22,593 Total revenue $ 424,346 $ 137,842 $ 40,273 $ 602,461 Three Months Ended March 31, 2019 Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Temporary staffing $ 337,029 $ 118,840 $ — $ 455,869 Permanent placement — 18,237 — 18,237 Outsourced workforce 36,443 — 3,695 40,138 SaaS-based technologies — — 18,197 18,197 Total revenue $ 373,472 $ 137,077 $ 21,892 $ 532,441 In connection with the reorganization of its reportable segments effective March 8, 2020, the Company reassigned the goodwill balances to the reporting units, the composition of which changed under the reorganized reportable segments, using the relative fair value reallocation approach. The Company performed a goodwill impairment test at the reporting unit level both immediately before and after the reorganization. The Company determined the fair values of its reporting units using a combination of the income approach (using discounted future cash flows) and the market valuation approach. Based on the results of this testing, the Company determined that the fair values of its reporting units were each greater than their respective carrying values both before and after the reorganization. Therefore, there was no impairment loss recognized during the three months ended March 31, 2020 . The following table summarizes the activity related to the carrying value of goodwill by reportable segment: Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Balance, January 1, 2020 $ 344,316 $ 163,348 $ 87,887 $ 595,551 Goodwill adjustment for b4health acquisition — — (66 ) (66 ) Goodwill from Stratus Video acquisition — — 255,974 255,974 Reallocation due to change in segments (14,600 ) 297 14,303 — Balance, March 31, 2020 $ 329,716 $ 163,645 $ 358,098 $ 851,459 Accumulated impairment loss as of December 31, 2019 and March 31, 2020 $ 154,444 $ 60,495 $ — $ 214,939

Notes Payable and Credit Agreem

Notes Payable and Credit Agreement	3 Months Ended
	Mar. 31, 2020
Debt Disclosure [Abstract]
NOTES PAYABLE AND CREDIT AGREEMENT	NOTES PAYABLE AND 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 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.” The Company fully repaid all amounts under the Term Loan in 2019. On February 14, 2020, the Company entered into the second amendment to the New Credit Agreement (the “Second Amendment”) to provide for, among other things, a $250,000 secured term loan credit facility (the “Additional Term Loan”). The Second Amendment (together with the New Credit Agreement and the First Amendment, collectively, the “Amended Credit Agreement”) extended the maturity date of the Senior Credit Facility to be coterminous with the Additional 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 Additional Term Loan, together with a drawdown of a portion of the Senior Credit Facility, to complete its acquisition of Stratus Video as more fully described in Note (2), “Acquisitions.” Borrowings under the Senior Credit Facility and the Additional 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 1.75% or a base rate plus a spread of 0.00% to 0.75% . The applicable spread is determined quarterly based upon the Company’s consolidated net leverage ratio. The Additional 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 February 14, 2025. In connection with the Second Amendment, the Company incurred $3,899 in fees paid to lenders and other third parties, which were capitalized during the three months ended March 31, 2020 and are amortized to interest expense over the term of the Credit Facilities. In addition, $1,681 of unamortized financing fees incurred in connection with obtaining the New Credit Agreement and First Amendment will continue to be amortized to interest expense over the term of the Credit Facilities.

Fair Value Measurement

Fair Value Measurement	3 Months Ended
	Mar. 31, 2020
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 2019 Annual Report. The Company has not changed the valuation techniques or inputs it uses for its fair value measurement during the three months ended March 31, 2020 . 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 has a deferred compensation plan for certain executives and key employees, which is composed of deferred compensation and all related income and losses attributable thereto. The Company’s obligation under its deferred compensation plan is measured at fair value based on quoted market prices of the participants’ elected investments, 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 $56,553 commercial paper issued and outstanding as of March 31, 2020 , $4,493 had original maturities greater than three months, which were considered available-for-sale securities. As of December 31, 2019 , the Company had $59,243 commercial paper issued and outstanding, of which $9,586 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 March 31, 2020 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 $ 2,517 $ 2,517 $ — $ — Deferred compensation (64,966 ) (64,966 ) — — Commercial paper 56,553 — 56,553 — Acquisition contingent consideration liabilities (3,300 ) — — (3,300 ) Fair Value Measurements as of December 31, 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 $ 2,508 $ 2,508 $ — $ — Deferred compensation (81,064 ) (81,064 ) — — Commercial paper 59,243 — 59,243 — Acquisition contingent consideration liabilities (23,100 ) — — (23,100 ) Level 3 Information The following table sets forth a reconciliation of changes in the fair value of contingent consideration liabilities classified as Level 3 in the fair value hierarchy: 2020 2019 Balance as of January 1, $ (23,100 ) $ (7,700 ) Settlement of Advanced contingent consideration liability for year ended December 31, 2019 20,000 — Contingent consideration liability from Silversheet acquisition on January 30, 2019 — (1,500 ) Change in fair value of contingent consideration liability from MedPartners acquisition — 700 Change in fair value of contingent consideration liability from b4health acquisition (200 ) — Balance as of March 31, $ (3,300 ) $ (8,500 ) 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 March 31, 2020 and December 31, 2019 . There were no changes to the fair value of the equity investment recognized during the three months ended March 31, 2020 . 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 three months ended March 31, 2020 and 2019 . 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. The fair value of the Company’s 5.125% senior notes due 2024 (the “2024 Notes”) and 4.625% senior notes due 2027 (the “2027 Notes”) was estimated using quoted market prices in active markets for identical liabilities, which are Level 1 inputs. The carrying amounts and estimated fair value of the 2024 Notes and the 2027 Notes are presented in the following table. See additional information in “Item 8. Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note (8), Notes Payable and Credit Agreement” of our 2019 Annual Report. As of March 31, 2020 As of December 31, 2019 Carrying Estimated Carrying Estimated 2024 Notes $ 325,000 $ 312,000 $ 325,000 $ 337,188 2027 Notes 300,000 283,500 300,000 301,500

Income Taxes

Income Taxes	3 Months Ended
	Mar. 31, 2020
Income Tax Disclosure [Abstract]
INCOME TAXES	INCOME TAXES The Company is subject to taxation in the U.S. and various states and foreign jurisdictions. With few exceptions, as of March 31, 2020 , the Company is no longer subject to state, local or foreign examinations by tax authorities for tax years before 2010, and the Company is no longer subject to U.S. federal income or payroll tax examinations for tax years before 2016. 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. The Company received a final determination from the IRS in November 2019 for $1,300 . The Company is indemnified by Advanced for the potential contingent liability for all pre-acquisition open years. The Company acquired Stratus Video on February 14, 2020. The Company is indemnified by Stratus Video for any potential international income tax and contingent tax liability items for pre-acquisition open years up to $2,500 . The Advanced and Stratus Video acquisitions are more fully described in Note (2), “Acquisitions.” The Company believes its indemnifications by Advanced and Stratus Video for all pre-acquisition years and its reserve for unrecognized tax benefits and contingent tax issues are 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	3 Months Ended
	Mar. 31, 2020
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 loss contingencies accrued as of March 31, 2020 , which are included in accounts payable and accrued expenses in the condensed consolidated balance sheets, 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	3 Months Ended
	Mar. 31, 2020
Balance Sheet Related Disclosures [Abstract]
BALANCE SHEET DETAILS	BALANCE SHEET DETAILS The consolidated balance sheets detail is as follows: March 31, 2020 December 31, 2019 Other current assets: Restricted cash and cash equivalents $ 15,380 $ 18,393 Income tax receivable — 5,984 Other 15,289 16,069 Other current assets $ 30,669 $ 40,446 Fixed assets: Furniture and equipment $ 45,895 $ 37,315 Software 199,587 191,050 Leasehold improvements 9,825 9,367 255,307 237,732 Accumulated depreciation (138,589 ) (132,900 ) Fixed assets, net $ 116,718 $ 104,832 Other assets: Life insurance cash surrender value $ 65,008 $ 79,515 Other 39,821 40,739 Other assets $ 104,829 $ 120,254 Accounts payable and accrued expenses: Trade accounts payable $ 26,001 $ 26,985 Subcontractor payable 81,385 75,562 Accrued expenses 50,151 36,344 Loss contingencies 6,521 6,146 Professional liability reserve 7,941 7,925 Other 3,189 3,178 Accounts payable and accrued expenses $ 175,188 $ 156,140 Accrued compensation and benefits: Accrued payroll $ 55,312 $ 47,381 Accrued bonuses 15,511 22,613 Accrued travel expense 2,446 2,459 Health insurance reserve 4,484 4,019 Workers compensation reserve 7,788 8,782 Deferred compensation 64,966 81,064 Other 2,511 4,614 Accrued compensation and benefits $ 153,018 $ 170,932 Other current liabilities: Acquisition related liabilities $ 3,300 $ 20,000 Other 8,083 5,302 Other current liabilities $ 11,383 $ 25,302 Other long-term liabilities: Workers compensation reserve $ 16,668 $ 18,291 Professional liability reserve 35,146 34,606 Unrecognized tax benefits 5,641 5,431 Other 4,280 3,485 Other long-term liabilities $ 61,735 $ 61,813

Basis of Presentation (Policies

Basis of Presentation (Policies)	3 Months Ended
	Mar. 31, 2020
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 June 2016, the Financial Accounting Standards Board (“FASB”) issued Accounting Standard Update (“ASU”) 2016-13, “Measurement of Credit Losses on Financial Instruments.” The FASB also issued a series of other ASUs, which update ASU 2016-13 (collectively, the “credit loss standard”). This new standard introduces new accounting models for determining and recognizing credit losses on certain financial instruments based on an estimate of current expected credit losses. The Company adopted this standard effective January 1, 2020 using the modified retrospective transition method. The Company recognized the cumulative effect of adopting this guidance as an adjustment to the opening balance of retained earnings of $1,154 , net of tax, primarily related to its allowance for credit losses for accounts receivable. Prior period amounts are not retrospectively adjusted. The impact of the adoption of the new standard was not material to the Company’s condensed consolidated financial statements for the quarter ended March 31, 2020. The Company expects the impact to be immaterial on an ongoing basis. See additional information below regarding the allowance for credit losses for accounts receivable. In January 2017, the FASB issued ASU 2017-04, “Simplifying the Test for Goodwill Impairment.” The standard simplifies the subsequent measurement of goodwill by removing the requirement to perform a hypothetical purchase price allocation to compute the implied fair value of goodwill to measure impairment. Instead, any goodwill impairment will equal the amount by which a reporting unit’s carrying value exceeds its fair value, not to exceed the carrying amount of goodwill. Further, the guidance eliminates the requirements for any reporting unit with a zero or negative carrying amount to perform a qualitative assessment and, if it fails that qualitative test, to perform Step 2 of the goodwill impairment test. The Company adopted this standard effective January 1, 2020 and the adoption did not have a material effect on the Company’s consolidated financial statements. In August 2018, the FASB issued ASU 2018-13, “Disclosure Framework—Changes to the Disclosure Requirements for Fair Value Measurement.” The standard modifies the current disclosure requirements on fair value measurements. The Company adopted this standard effective January 1, 2020. Refer to information regarding fair value measurements in Note (7), “Fair Value Measurement.”
Cash, cash equivalents and restricted cash	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 (7), “Fair Value Measurement” for additional information.
Accounts Receivable	Accounts Receivable The Company records accounts receivable at the invoiced amount. Accounts receivable are non-interest bearing. The Company maintains an allowance for expected credit losses based on the Company’s historical write-off experience, an assessment of its customers’ financial conditions and available information that is relevant to assessing the collectability of cash flows, which includes current conditions and forecasts about future economic conditions.
Reclassification	Reclassification The Company reclassified its allowance for accounts receivable in the prior year’s consolidated balance sheet to conform to the current year presentation. The prior year’s balance of accounts receivable (net of allowances) remains unchanged.
Revenue Recognition	Revenue primarily consists of fees earned from the temporary staffing and permanent placement of healthcare professionals, executives, and leaders (clinical and operational). The Company also generates revenue from its software as a service (“SaaS”)-based technologies, including vendor management systems and scheduling software, and outsourced workforce services, including revenue cycle solutions, language interpretation and recruitment process outsourcing. 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 (“MSP”) 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 permanent placement and outsourced workforce services is recognized as the services are rendered. Depending on the arrangement, the Company’s SaaS-based revenue is recognized either as the services are rendered or 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. While payment terms vary by the type of customer and the services rendered, the term between invoicing and when payment is due is not significant. During the three months ended March 31, 2020 , previously deferred revenue recognized as revenue was $7,628 . 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	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 has a deferred compensation plan for certain executives and key employees, which is composed of deferred compensation and all related income and losses attributable thereto. The Company’s obligation under its deferred compensation plan is measured at fair value based on quoted market prices of the participants’ elected investments, 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 $56,553 commercial paper issued and outstanding as of March 31, 2020 , $4,493 had original maturities greater than three months, which were considered available-for-sale securities. As of December 31, 2019 , the Company had $59,243 commercial paper issued and outstanding, of which $9,586 had original maturities greater than three months and were considered available-for-sale securities. 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. The fair value of the Company’s 5.125% senior notes due 2024 (the “2024 Notes”) and 4.625% senior notes due 2027 (the “2027 Notes”) was estimated using quoted market prices in active markets for identical liabilities, which are Level 1 inputs. The carrying amounts and estimated fair value of the 2024 Notes and the 2027 Notes are presented in the following table. See additional information in “Item 8. Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note (8), Notes Payable and Credit Agreement” of our 2019 Annual Report. As of March 31, 2020 As of December 31, 2019 Carrying Estimated Carrying Estimated 2024 Notes $ 325,000 $ 312,000 $ 325,000 $ 337,188 2027 Notes 300,000 283,500 300,000 301,500 Assets Measured on a Non-Recurring Basis The Company applies fair value techniques on a non-recurring basis associated with valuing potential impairment losses related to its goodwill, indefinite-lived intangible assets, long-lived assets, and equity investments. The Company evaluates goodwill and indefinite-lived intangible assets annually for impairment and whenever circumstances occur indicating that goodwill might be impaired. The Company determines the fair value of its reporting units based on a combination of inputs, including the market capitalization of the Company, as well as Level 3 inputs such as discounted cash flows, which are not observable from the market, directly or indirectly. The Company determines the fair value of its indefinite-lived intangible assets using the income approach (relief-from-royalty method) based on Level 3 inputs.

Basis of Presentation (Tables)

Basis of Presentation (Tables)	3 Months Ended
	Mar. 31, 2020
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Reconciliation of Cash, Cash Equivalents and 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. March 31, 2020 December 31, 2019 Cash and cash equivalents $ 97,509 $ 82,985 Restricted cash and cash equivalents (included in other current assets) 15,380 18,393 Restricted cash, cash equivalents and investments 60,873 62,170 Total cash, cash equivalents and restricted cash and investments 173,762 163,548 Less restricted investments (4,493 ) (9,586 ) Total cash, cash equivalents and restricted cash $ 169,269 $ 153,962
Accounts Receivable, Allowance for Credit Loss Roll-Forward	The following table provides a reconciliation of activity in the allowance for credit losses for accounts receivable: 2020 Balance as of January 1, $ 3,332 Adoption of the credit loss standard, cumulative-effect adjustment to retained earnings 1,334 Provision for expected credit losses 3,839 Amounts written off charged against the allowance (481 ) Balance as of March 31, $ 8,024

Acquisitions (Tables)

Acquisitions (Tables)	3 Months Ended
	Mar. 31, 2020
Business Combinations [Abstract]
Schedule of Intangible Assets Acquired	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 $ 191,000 20 Tradenames and Trademarks 44,000 5 - 10 Developed Technology 16,000 5 Interpreter Database 1,000 4 $ 252,000 Fair Value Useful Life (in years) Identifiable intangible assets Customer Relationships $ 68,000 10 Tradenames and Trademarks 10,000 5 Staffing Database 10,300 10 Developed Technology 3,400 3 $ 91,700
Business Acquisition, Pro Forma Financial Information	The pro forma financial information is not necessarily indicative of the operating results that would have occurred had the acquisitions been consummated as of the date indicated, nor is it necessarily indicative of our future operating results. Three Months Ended March 31, 2020 2019 Revenue $ 616,333 $ 583,311 Income from operations $ 44,853 $ 30,745 Net income $ 18,674 $ 18,681

Net Income Per Common Share (Ta

Net Income Per Common Share (Tables)	3 Months Ended
	Mar. 31, 2020
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: Three Months Ended March 31, 2020 2019 Net income $ 12,965 $ 34,122 Net income per common share - basic $ 0.27 $ 0.73 Net income per common share - diluted $ 0.27 $ 0.71 Weighted average common shares outstanding - basic 47,359 46,784 Plus dilutive effect of potential common shares 282 988 Weighted average common shares outstanding - diluted 47,641 47,772

Segment Information (Tables)

Segment Information (Tables)	3 Months Ended
	Mar. 31, 2020
Segment Reporting [Abstract]
Reconciliation of Revenue and Segment Operating Income by Reportable Segment	The following table, which includes reclassified prior period data to conform to the new segment reporting structure, provides a reconciliation of revenue and operating income by reportable segment to consolidated results and was derived from each segment’s internal financial information as used for corporate management purposes: Three Months Ended March 31, 2020 2019 Revenue Nurse and allied solutions $ 424,346 $ 373,472 Physician and leadership solutions 137,842 137,077 Technology and workforce solutions 40,273 21,892 $ 602,461 $ 532,441 Segment operating income Nurse and allied solutions $ 59,608 $ 53,556 Physician and leadership solutions 14,569 15,872 Technology and workforce solutions 15,295 10,383 89,472 79,811 Unallocated corporate overhead 28,568 17,863 Depreciation and amortization 20,089 11,710 Depreciation (included in cost of revenue) 145 — Share-based compensation 4,927 5,186 Interest expense, net, and other 11,054 5,673 Income before income taxes $ 24,689 $ 39,379
Disaggregation of Revenue	The following tables present the Company’s revenue disaggregated by service type: Three Months Ended March 31, 2020 Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Temporary staffing $ 392,671 $ 119,596 $ — $ 512,267 Permanent placement — 18,246 — 18,246 Outsourced workforce 31,675 — 17,680 49,355 SaaS-based technologies — — 22,593 22,593 Total revenue $ 424,346 $ 137,842 $ 40,273 $ 602,461 Three Months Ended March 31, 2019 Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Temporary staffing $ 337,029 $ 118,840 $ — $ 455,869 Permanent placement — 18,237 — 18,237 Outsourced workforce 36,443 — 3,695 40,138 SaaS-based technologies — — 18,197 18,197 Total revenue $ 373,472 $ 137,077 $ 21,892 $ 532,441
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 Physician and Leadership Solutions Technology and Workforce Solutions Total Balance, January 1, 2020 $ 344,316 $ 163,348 $ 87,887 $ 595,551 Goodwill adjustment for b4health acquisition — — (66 ) (66 ) Goodwill from Stratus Video acquisition — — 255,974 255,974 Reallocation due to change in segments (14,600 ) 297 14,303 — Balance, March 31, 2020 $ 329,716 $ 163,645 $ 358,098 $ 851,459 Accumulated impairment loss as of December 31, 2019 and March 31, 2020 $ 154,444 $ 60,495 $ — $ 214,939

Fair Value Measurement (Tables)

Fair Value Measurement (Tables)	3 Months Ended
	Mar. 31, 2020
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 March 31, 2020 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 $ 2,517 $ 2,517 $ — $ — Deferred compensation (64,966 ) (64,966 ) — — Commercial paper 56,553 — 56,553 — Acquisition contingent consideration liabilities (3,300 ) — — (3,300 ) Fair Value Measurements as of December 31, 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 $ 2,508 $ 2,508 $ — $ — Deferred compensation (81,064 ) (81,064 ) — — Commercial paper 59,243 — 59,243 — Acquisition contingent consideration liabilities (23,100 ) — — (23,100 )
Reconciliations of Changes in the Fair Value of Contingent Consideration Liabilities	The following table sets forth a reconciliation of changes in the fair value of contingent consideration liabilities classified as Level 3 in the fair value hierarchy: 2020 2019 Balance as of January 1, $ (23,100 ) $ (7,700 ) Settlement of Advanced contingent consideration liability for year ended December 31, 2019 20,000 — Contingent consideration liability from Silversheet acquisition on January 30, 2019 — (1,500 ) Change in fair value of contingent consideration liability from MedPartners acquisition — 700 Change in fair value of contingent consideration liability from b4health acquisition (200 ) — Balance as of March 31, $ (3,300 ) $ (8,500 )
Schedule of Fair Value of Financial Instruments	See additional information in “Item 8. Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note (8), Notes Payable and Credit Agreement” of our 2019 Annual Report. As of March 31, 2020 As of December 31, 2019 Carrying Estimated Carrying Estimated 2024 Notes $ 325,000 $ 312,000 $ 325,000 $ 337,188 2027 Notes 300,000 283,500 300,000 301,500

Balance Sheet Details (Tables)

Balance Sheet Details (Tables)	3 Months Ended
	Mar. 31, 2020
Balance Sheet Related Disclosures [Abstract]
Schedule of Supplemental Balance Sheet Disclosures	The consolidated balance sheets detail is as follows: March 31, 2020 December 31, 2019 Other current assets: Restricted cash and cash equivalents $ 15,380 $ 18,393 Income tax receivable — 5,984 Other 15,289 16,069 Other current assets $ 30,669 $ 40,446 Fixed assets: Furniture and equipment $ 45,895 $ 37,315 Software 199,587 191,050 Leasehold improvements 9,825 9,367 255,307 237,732 Accumulated depreciation (138,589 ) (132,900 ) Fixed assets, net $ 116,718 $ 104,832 Other assets: Life insurance cash surrender value $ 65,008 $ 79,515 Other 39,821 40,739 Other assets $ 104,829 $ 120,254 Accounts payable and accrued expenses: Trade accounts payable $ 26,001 $ 26,985 Subcontractor payable 81,385 75,562 Accrued expenses 50,151 36,344 Loss contingencies 6,521 6,146 Professional liability reserve 7,941 7,925 Other 3,189 3,178 Accounts payable and accrued expenses $ 175,188 $ 156,140 Accrued compensation and benefits: Accrued payroll $ 55,312 $ 47,381 Accrued bonuses 15,511 22,613 Accrued travel expense 2,446 2,459 Health insurance reserve 4,484 4,019 Workers compensation reserve 7,788 8,782 Deferred compensation 64,966 81,064 Other 2,511 4,614 Accrued compensation and benefits $ 153,018 $ 170,932 Other current liabilities: Acquisition related liabilities $ 3,300 $ 20,000 Other 8,083 5,302 Other current liabilities $ 11,383 $ 25,302 Other long-term liabilities: Workers compensation reserve $ 16,668 $ 18,291 Professional liability reserve 35,146 34,606 Unrecognized tax benefits 5,641 5,431 Other 4,280 3,485 Other long-term liabilities $ 61,735 $ 61,813

Basis of Presentation (Details)

Basis of Presentation (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Jan. 01, 2020	Dec. 31, 2019	Mar. 31, 2019	Dec. 31, 2018
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Reduction to retained earnings		$ 1,154
Cash and cash equivalents	$ 97,509		$ 82,985
Restricted cash and cash equivalents (included in other current assets)	15,380		18,393
Restricted cash, cash equivalents and investments	60,873		62,170
Total cash, cash equivalents and restricted cash and investments	173,762		163,548
Less restricted investments	(4,493)		(9,586)
Cash, cash equivalents and restricted cash at the end of period	$ 169,269		$ 153,962	$ 85,979	$ 84,324
Retained Earnings
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Reduction to retained earnings		1,154
Retained Earnings | Accounting Standards Update 2016-13
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Reduction to retained earnings		$ 1,154

Basis of Presentation - Allowan

Basis of Presentation - Allowance for Credit Losses (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Jan. 01, 2020
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Beginning Balance, January 1	$ 3,332
Adoption of the credit loss standard, cumulative-effect adjustment to retained earnings	8,024
Increase in allowances for doubtful accounts and sales credits	3,839
Amounts written off charged against the allowance	(481)
Ending Balance, March 31	$ 8,024
Adjustment
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Adoption of the credit loss standard, cumulative-effect adjustment to retained earnings		$ 1,334

Acquisitions - Narrative (Detai

Acquisitions - Narrative (Details)	Feb. 14, 2020USD ($)	Dec. 19, 2019USD ($)	Jun. 14, 2019USD ($)	Jan. 30, 2019USD ($)	Mar. 31, 2020USD ($)acquisition	Dec. 31, 2019USD ($)	Sep. 30, 2019USD ($)	Jun. 30, 2019USD ($)	Mar. 31, 2019USD ($)	Feb. 09, 2018USD ($)
Business Acquisition [Line Items]
Number of acquisitions | acquisition					4
Cash consideration					$ 476,392,000				$ 29,525,000
Goodwill					851,459,000	$ 595,551,000
Revenue					602,461,000				532,441,000
Income before income taxes					24,689,000				39,379,000
Interest expense					11,054,000				5,673,000
Stratus Video
Business Acquisition [Line Items]
Initial purchase price					485,568,000
Cash consideration	$ 485,568,000
Acquisition-related costs					7,812,000
Fair value of tangible assets acquired	46,416,000
Cash and restricted cash received	9,176,000
Liabilities assumed	68,822,000
Identifiable intangible assets	252,000,000
Goodwill	255,974,000
Goodwill expected to be deductible for tax purposes	$ 10,186,000
Intangible assets acquired, weighted average useful life	17 years
Revenue					14,433,000
Income before income taxes					1,606,000
Incremental acquisition-related costs									11,681,000
Amortization of intangible assets									5,119,000
Interest expense									2,727,000
Stratus Video | Developed Technology
Business Acquisition [Line Items]
Identifiable intangible assets	$ 16,000,000
Stratus Video | Customer Relationships
Business Acquisition [Line Items]
Identifiable intangible assets	191,000,000
b4health
Business Acquisition [Line Items]
Initial purchase price		$ 23,006,000				$ 22,940,000
Cash consideration		19,906,000
Contingent earn-out payment (up to)		12,000,000
Estimated fair value of contingent earn-out payment		3,100,000
Fair value of tangible assets acquired		1,169,000
Cash and restricted cash received		222,000
Liabilities assumed		823,000
Identifiable intangible assets		9,000,000
Goodwill		$ 13,594,000
Intangible assets acquired, weighted average useful life		7 years
Final working capital settlement					$ 66,000
b4health | Developed Technology
Business Acquisition [Line Items]
Identifiable intangible assets		$ 3,000,000
b4health | Trademarks
Business Acquisition [Line Items]
Identifiable intangible assets		2,000,000
b4health | Customer Relationships
Business Acquisition [Line Items]
Identifiable intangible assets		$ 4,000,000
Advanced
Business Acquisition [Line Items]
Initial purchase price			$ 211,743,000					$ 211,816,000
Cash consideration			201,121,000				$ 73,000
Contingent earn-out payment (up to)			20,000,000
Estimated fair value of contingent earn-out payment			10,622,000
Fair value of tangible assets acquired			29,035,000
Cash and restricted cash received			2,497,000
Liabilities assumed			28,758,000
Identifiable intangible assets			91,700,000
Goodwill			119,839,000
Goodwill expected to be deductible for tax purposes			$ 57,121,000
Intangible assets acquired, weighted average useful life			9 years
Advanced | Developed Technology
Business Acquisition [Line Items]
Identifiable intangible assets			$ 3,400,000
Advanced | Customer Relationships
Business Acquisition [Line Items]
Identifiable intangible assets			68,000,000
Silversheet
Business Acquisition [Line Items]
Initial purchase price				$ 31,676,000					$ 31,676,000
Cash consideration				30,176,000
Contingent earn-out payment (up to)				25,000,000
Estimated fair value of contingent earn-out payment				1,500,000
Fair value of tangible assets acquired				2,826,000
Cash and restricted cash received				651,000
Liabilities assumed				1,567,000
Identifiable intangible assets				6,880,000
Goodwill				$ 23,537,000
Intangible assets acquired, weighted average useful life				8 years
Silversheet | Based on operating results for the twelve months ending December 31, 2019
Business Acquisition [Line Items]
Contingent earn-out payment (up to)				$ 6,000,000
Silversheet | Based on operating results for the twelve months ending December 31, 2020
Business Acquisition [Line Items]
Contingent earn-out payment (up to)				19,000,000
Silversheet | Developed Technology
Business Acquisition [Line Items]
Identifiable intangible assets				5,300,000
Silversheet | Trademarks
Business Acquisition [Line Items]
Identifiable intangible assets				$ 1,500,000
Revolving Credit Facility | Line of Credit
Business Acquisition [Line Items]
Maximum borrowing capacity										$ 400,000,000
Term Loan | Term Debt
Business Acquisition [Line Items]
Term loan credit facility	$ 250,000,000		$ 150,000,000

Acquisitions - Schedule of Inta

Acquisitions - Schedule of Intangible Assets Acquired (Details) - USD ($) $ in Thousands	Feb. 14, 2020	Jun. 14, 2019
Stratus Video
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 252,000
Stratus Video | Customer Relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 191,000
Useful Life	20 years
Stratus Video | Tradenames and Trademarks
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 44,000
Stratus Video | Developed Technology
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 16,000
Useful Life	5 years
Stratus Video | Interpreter Database
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 1,000
Useful Life	4 years
Advanced
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value		$ 91,700
Advanced | Customer Relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value		$ 68,000
Useful Life		10 years
Advanced | Tradenames and Trademarks
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value		$ 10,000
Useful Life		5 years
Advanced | Developed Technology
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value		$ 3,400
Useful Life		3 years
Advanced | Staffing Database
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value		$ 10,300
Useful Life		10 years
Minimum | Stratus Video | Tradenames and Trademarks
Acquired Finite-Lived Intangible Assets [Line Items]
Useful Life	5 years
Maximum | Stratus Video | Tradenames and Trademarks
Acquired Finite-Lived Intangible Assets [Line Items]
Useful Life	10 years

Acquisitions - Pro Forma Financ

Acquisitions - Pro Forma Financial Information (Details) - Stratus Video - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Business Acquisition [Line Items]
Revenue	$ 616,333	$ 583,311
Income from operations	44,853	30,745
Net income	$ 18,674	$ 18,681

Revenue Recognition (Details)

Revenue Recognition (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2020USD ($)
Revenue from Contract with Customer [Abstract]
Previously deferred revenue recognized during period	$ 7,628

Net Income Per Common Share (De

Net Income Per Common Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Computation of basic and diluted net income per common share
Net income	$ 12,965	$ 34,122
Net income per common share - basic (in dollars per share)	$ 0.27	$ 0.73
Net income per common share - diluted (in dollars per share)	$ 0.27	$ 0.71
Weighted average common shares outstanding - basic (in shares)	47,359	46,784
Plus dilutive effect of potential common shares (in shares)	282	988
Weighted average common shares outstanding - diluted (in shares)	47,641	47,772
Common stock excluded from calculation of EPS (in shares)	27	66

Segment Information - Narrative

Segment Information - Narrative (Details)	3 Months Ended	12 Months Ended
	Mar. 31, 2020USD ($)segment	Dec. 31, 2019segment
Segment Reporting [Abstract]
Number of reportable segments | segment	3	3
Goodwill impairment | $	$ 0

Segment Information - Reconcili

Segment Information - Reconciliation of Revenue and Segment Operating Income by Reportable Segment (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	$ 602,461	$ 532,441
Segment operating income	35,743	45,052
Depreciation and amortization	20,089	11,710
Depreciation (included in cost of revenue)	145	0
Share-based compensation	4,927	5,186
Interest expense, net, and other	11,054	5,673
Income before income taxes	24,689	39,379
Technology and Workforce Solutions
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	40,273	21,892
Nurse and allied solutions
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	424,346	373,472
Physician and leadership solutions
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	137,842	137,077
Operating segments
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	602,461	532,441
Segment operating income	89,472	79,811
Operating segments | Technology and Workforce Solutions
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	40,273	21,892
Segment operating income	15,295	10,383
Operating segments | Nurse and allied solutions
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	424,346	373,472
Segment operating income	59,608	53,556
Operating segments | Physician and leadership solutions
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	137,842	137,077
Segment operating income	14,569	15,872
Unallocated corporate overhead
Segment Reporting, Revenue Reconciling Item [Line Items]
Unallocated corporate overhead	$ 28,568	$ 17,863

Segment Information - Disaggreg

Segment Information - Disaggregation of Revenue (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Segment Reporting Information [Line Items]
Revenue	$ 602,461	$ 532,441
Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	424,346	373,472
Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	137,842	137,077
Technology and Workforce Solutions
Segment Reporting Information [Line Items]
Revenue	40,273	21,892
Temporary staffing
Segment Reporting Information [Line Items]
Revenue	512,267	455,869
Temporary staffing | Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	392,671	337,029
Temporary staffing | Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	119,596	118,840
Temporary staffing | Technology and Workforce Solutions
Segment Reporting Information [Line Items]
Revenue	0	0
Permanent placement
Segment Reporting Information [Line Items]
Revenue	18,246	18,237
Permanent placement | Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	0	0
Permanent placement | Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	18,246	18,237
Permanent placement | Technology and Workforce Solutions
Segment Reporting Information [Line Items]
Revenue	0	0
Outsourced workforce
Segment Reporting Information [Line Items]
Revenue	49,355	40,138
Outsourced workforce | Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	31,675	36,443
Outsourced workforce | Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	0	0
Outsourced workforce | Technology and Workforce Solutions
Segment Reporting Information [Line Items]
Revenue	17,680	3,695
SaaS-based technologies
Segment Reporting Information [Line Items]
Revenue	22,593	18,197
SaaS-based technologies | Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	0	0
SaaS-based technologies | Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	0	0
SaaS-based technologies | Technology and Workforce Solutions
Segment Reporting Information [Line Items]
Revenue	$ 22,593	$ 18,197

Segment Information - Summary o

Segment Information - Summary of Goodwill by Reportable Segment (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Dec. 31, 2019
Goodwill [Roll Forward]
Goodwill, beginning balance	$ 595,551
Reallocation due to change in segments	0
Goodwill, ending balance	851,459
Accumulated impairment loss	214,939	$ 214,939
Nurse and Allied Solutions
Goodwill [Roll Forward]
Goodwill, beginning balance	344,316
Reallocation due to change in segments	(14,600)
Goodwill, ending balance	329,716
Accumulated impairment loss	154,444	154,444
Physician and Leadership Solutions
Goodwill [Roll Forward]
Goodwill, beginning balance	163,348
Reallocation due to change in segments	297
Goodwill, ending balance	163,645
Accumulated impairment loss	60,495	60,495
Technology and Workforce Solutions
Goodwill [Roll Forward]
Goodwill, beginning balance	87,887
Reallocation due to change in segments	14,303
Goodwill, ending balance	358,098
Accumulated impairment loss	0	$ 0
b4health
Goodwill [Roll Forward]
Goodwill adjustment for b4health acquisition	(66)
b4health | Nurse and Allied Solutions
Goodwill [Roll Forward]
Goodwill adjustment for b4health acquisition	0
b4health | Physician and Leadership Solutions
Goodwill [Roll Forward]
Goodwill adjustment for b4health acquisition	0
b4health | Technology and Workforce Solutions
Goodwill [Roll Forward]
Goodwill adjustment for b4health acquisition	(66)
Stratus Video
Goodwill [Roll Forward]
Goodwill from Stratus Video acquisition	255,974
Stratus Video | Nurse and Allied Solutions
Goodwill [Roll Forward]
Goodwill from Stratus Video acquisition	0
Stratus Video | Physician and Leadership Solutions
Goodwill [Roll Forward]
Goodwill from Stratus Video acquisition	0
Stratus Video | Technology and Workforce Solutions
Goodwill [Roll Forward]
Goodwill from Stratus Video acquisition	$ 255,974

Notes Payable and Credit Agre_2

Notes Payable and Credit Agreement (Details) - USD ($)	Feb. 09, 2018	Mar. 31, 2020	Feb. 14, 2020	Oct. 01, 2019	Jun. 14, 2019
Line of Credit
Debt Instrument [Line Items]
Fees paid to lenders and other third parties		$ 3,899,000
Unamortized financing fees		$ 1,681,000
The Credit Facilities | Line of Credit | London Interbank Offered Rate (LIBOR) | Minimum
Debt Instrument [Line Items]
Basis spread on variable rate	1.00%
The Credit Facilities | Line of Credit | London Interbank Offered Rate (LIBOR) | Maximum
Debt Instrument [Line Items]
Basis spread on variable rate	1.75%
The Credit Facilities | Line of Credit | Base Rate | Minimum
Debt Instrument [Line Items]
Basis spread on variable rate	0.00%
The Credit Facilities | Line of Credit | Base Rate | Maximum
Debt Instrument [Line Items]
Basis spread on variable rate	0.75%
Senior Credit Facility | Line of Credit
Debt Instrument [Line Items]
Maximum borrowing capacity	$ 400,000,000
Letters of credit | Line of Credit
Debt Instrument [Line Items]
Maximum borrowing capacity	50,000,000
Swingline loans | Line of Credit
Debt Instrument [Line Items]
Maximum borrowing capacity	$ 50,000,000
Term Loan | Line of Credit
Debt Instrument [Line Items]
Percent of term loan amortized in year one		2.50%
Percent of term loan amortized after year one		5.00%
Term Loan | Term Debt
Debt Instrument [Line Items]
Term loan credit facility			$ 250,000,000		$ 150,000,000
4.625% Senior Notes due 2027 | Senior Notes
Debt Instrument [Line Items]
Interest rate				4.625%

Fair Value Measurement - Narrat

Fair Value Measurement - Narrative (Details) - USD ($)	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019	Dec. 31, 2019	Oct. 01, 2019	Oct. 31, 2016
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Impairment charges	$ 0	$ 0
Fair Value, Measurements, Nonrecurring | 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	56,553,000		59,243,000
Commercial paper | Fair Value, Measurements, Recurring | Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Commercial paper	56,553,000		59,243,000
Available-for-sale securities	4,493,000		9,586,000
5.125% Senior Notes Due 2024 | 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	312,000,000		337,188,000
Interest rate					5.125%
4.625% Senior Notes due 2027 | Senior Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Carrying amount of senior notes	300,000,000		300,000,000
Estimated Fair Value	$ 283,500,000		$ 301,500,000
Interest rate				4.625%

Fair Value Measurement - Financ

Fair Value Measurement - Financial Assets and Liabilities (Details) - Fair Value, Measurements, Recurring - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Money market funds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Financial assets and liabilities measured at fair value	$ 2,517	$ 2,508
Money market funds | Quoted Prices in Active Markets for Identical Assets (Level 1)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Financial assets and liabilities measured at fair value	2,517	2,508
Money market funds | Significant Other Observable Inputs (Level 2)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Financial assets and liabilities measured at fair value	0	0
Money market funds | Significant Unobservable Inputs (Level 3)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Financial assets and liabilities measured at fair value	0	0
Commercial paper
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Financial assets and liabilities measured at fair value	56,553	59,243
Commercial paper | Quoted Prices in Active Markets for Identical Assets (Level 1)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Financial assets and liabilities measured at fair value	0	0
Commercial paper | Significant Other Observable Inputs (Level 2)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Financial assets and liabilities measured at fair value	56,553	59,243
Commercial paper | Significant Unobservable Inputs (Level 3)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Financial assets and liabilities measured at fair value	0	0
Deferred compensation
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Financial assets and liabilities measured at fair value	(64,966)	(81,064)
Deferred compensation | Quoted Prices in Active Markets for Identical Assets (Level 1)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Financial assets and liabilities measured at fair value	(64,966)	(81,064)
Deferred compensation | Significant Other Observable Inputs (Level 2)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Financial assets and liabilities measured at fair value	0	0
Deferred compensation | Significant Unobservable Inputs (Level 3)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Financial assets and liabilities measured at fair value	0	0
Acquisition contingent consideration liabilities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Financial assets and liabilities measured at fair value	(3,300)	(23,100)
Acquisition contingent consideration liabilities | Quoted Prices in Active Markets for Identical Assets (Level 1)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Financial assets and liabilities measured at fair value	0	0
Acquisition contingent consideration liabilities | Significant Other Observable Inputs (Level 2)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Financial assets and liabilities measured at fair value	0	0
Acquisition contingent consideration liabilities | Significant Unobservable Inputs (Level 3)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Financial assets and liabilities measured at fair value	$ (3,300)	$ (23,100)

Fair Value Measurement - Reconc

Fair Value Measurement - Reconciliation of Changes in Contingent Consideration Liabilities (Details) - Level 3 - Acquisition contingent consideration liabilities - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Beginning balance	$ (23,100)	$ (7,700)
Ending balance	(3,300)	(8,500)
Advanced
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Settlement of contingent consideration liability	20,000	0
Silversheet
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Contingent consideration liability	0	(1,500)
MedPartners
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Change in fair value of contingent consideration liability from acquisition	0	700
b4health
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Change in fair value of contingent consideration liability from acquisition	$ (200)	$ 0

Fair Value Measurement - Fair V

Fair Value Measurement - Fair Value of Financial Instruments (Details) - Senior Notes - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
2024 Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Carrying Amount	$ 325,000	$ 325,000
Estimated Fair Value	312,000	337,188
2027 Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Carrying Amount	300,000	300,000
Estimated Fair Value	$ 283,500	$ 301,500

Income Taxes (Details)

Income Taxes (Details) - USD ($) $ in Thousands	1 Months Ended
	Nov. 30, 2019	Jul. 31, 2018	Feb. 14, 2020
Advanced
Error Corrections and Prior Period Adjustments Restatement [Line Items]
Income tax assessment		$ 8,300
Internal Revenue Service (IRS) | Advanced
Error Corrections and Prior Period Adjustments Restatement [Line Items]
Income tax assessment	$ 1,300
Stratus Video
Error Corrections and Prior Period Adjustments Restatement [Line Items]
Indemnification for potential income tax and contingent tax liability for pre-acquisition open years			$ 2,500

Balance Sheet Details (Details)

Balance Sheet Details (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Other current assets:
Restricted cash and cash equivalents	$ 15,380	$ 18,393
Income tax receivable	0	5,984
Other	15,289	16,069
Other current assets	30,669	40,446
Fixed assets:
Furniture and equipment	45,895	37,315
Software	199,587	191,050
Leasehold improvements	9,825	9,367
Fixed assets, gross	255,307	237,732
Accumulated depreciation	(138,589)	(132,900)
Fixed assets, net	116,718	104,832
Other assets:
Life insurance cash surrender value	65,008	79,515
Other	39,821	40,739
Other assets	104,829	120,254
Accounts payable and accrued expenses:
Trade accounts payable	26,001	26,985
Subcontractor payable	81,385	75,562
Accrued expenses	50,151	36,344
Loss contingencies	6,521	6,146
Professional liability reserve	7,941	7,925
Other	3,189	3,178
Accounts payable and accrued expenses	175,188	156,140
Accrued compensation and benefits:
Accrued payroll	55,312	47,381
Accrued bonuses	15,511	22,613
Accrued travel expense	2,446	2,459
Health insurance reserve	4,484	4,019
Workers compensation reserve	7,788	8,782
Deferred compensation	64,966	81,064
Other	2,511	4,614
Accrued compensation and benefits	153,018	170,932
Other current liabilities:
Acquisition related liabilities	3,300	20,000
Other	8,083	5,302
Other current liabilities	11,383	25,302
Other long-term liabilities:
Workers compensation reserve	16,668	18,291
Professional liability reserve	35,146	34,606
Unrecognized tax benefits	5,641	5,431
Other	4,280	3,485
Other long-term liabilities	$ 61,735	$ 61,813