AMN Healthcare Services (AMN) 10-Q 10 May 21 2021 Q1 Quarterly report Financial data

Cover Page

Cover Page - shares	3 Months Ended
	Mar. 31, 2021	May 06, 2021
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Mar. 31, 2021
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)		47,257,096
Entity Central Index Key	0001142750
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2021
Document Fiscal Period Focus	Q1
Amendment Flag	false

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Current assets:
Cash and cash equivalents	$ 78,325	$ 29,213
Accounts receivable, net of allowances of $7,050 and $7,043 at March 31, 2021 and December 31, 2020, respectively	562,163	376,099
Accounts receivable, subcontractor	138,367	73,985
Prepaid expenses	19,819	13,629
Other current assets	31,683	40,809
Total current assets	830,357	533,735
Restricted cash, cash equivalents and investments	62,319	61,347
Fixed assets, net of accumulated depreciation of $170,250 and $161,752 at March 31, 2021 and December 31, 2020, respectively	119,587	116,174
Operating lease right-of-use assets	74,746	77,735
Other assets	141,255	135,120
Goodwill	865,148	864,485
Intangible assets, net of accumulated amortization of $230,436 and $215,234 at March 31, 2021 and December 31, 2020, respectively	549,710	564,911
Total assets	2,643,122	2,353,507
Current liabilities:
Accounts payable and accrued expenses	271,903	167,881
Accrued compensation and benefits	282,981	213,414
Current portion of notes payable	0	4,688
Current portion of operating lease liabilities	15,200	15,032
Deferred revenue	14,999	11,004
Other current liabilities	13,911	10,938
Total current liabilities	598,994	422,957
Revolving credit facility	55,000	0
Notes payable, net of unamortized fees and premium	841,435	857,961
Deferred income taxes, net	68,920	67,205
Operating lease liabilities	74,214	77,800
Other long-term liabilities	110,499	107,907
Total liabilities	1,749,062	1,533,830
Commitments and contingencies
Stockholders’ equity:
Preferred stock, $0.01 par value; 10,000 shares authorized; none issued and outstanding at March 31, 2021 and December 31, 2020	0	0
Common stock, $0.01 par value; 200,000 shares authorized; 49,746 issued and 47,185 outstanding at March 31, 2021 and 49,614 issued and 47,053 outstanding at December 31, 2020	497	496
Additional paid-in capital	472,754	468,726
Treasury stock, at cost; 2,561 shares at March 31, 2021 and December 31, 2020	(119,143)	(119,143)
Retained earnings	539,936	469,558
Accumulated other comprehensive income	16	40
Total stockholders’ equity	894,060	819,677
Total liabilities and stockholders’ equity	$ 2,643,122	$ 2,353,507

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Statement of Financial Position [Abstract]
Accounts receivable, allowance	$ 7,050	$ 7,043
Accumulated depreciation - fixed assets	170,250	161,752
Accumulated amortization	$ 230,436	$ 215,234
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)	49,746,000	49,614,000
Common stock, shares outstanding (in shares)	47,185,000	47,053,000
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, 2021	Mar. 31, 2020
Statement of Comprehensive Income [Abstract]
Revenue	$ 885,945	$ 602,461
Cost of revenue	597,077	400,395
Gross profit	288,868	202,066
Operating expenses:
Selling, general and administrative	161,212	146,234
Depreciation and amortization	23,254	20,089
Total operating expenses	184,466	166,323
Income from operations	104,402	35,743
Interest expense, net, and other	8,944	11,054
Income before income taxes	95,458	24,689
Income tax expense	25,080	11,724
Net income	70,378	12,965
Other comprehensive loss:
Foreign currency translation and other	(24)	(47)
Other comprehensive loss	(24)	(47)
Comprehensive income	$ 70,354	$ 12,918
Net income per common share:
Basic (in dollars per share)	$ 1.48	$ 0.27
Diluted (in dollars per share)	$ 1.47	$ 0.27
Weighted average common shares outstanding:
Basic (in shares)	47,600	47,359
Diluted (in shares)	47,916	47,641

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Stockholders' Equity - USD ($) shares in Thousands, $ in Thousands	Total	Cumulative Effect, Period of Adoption, Adjustment	Common Stock	Additional Paid-in Capital	Treasury Stock	Retained Earnings	Retained EarningsCumulative Effect, Period of Adoption, Adjustment	Accumulated Other Comprehensive Income
Beginning balance (in shares) at Dec. 31, 2019			49,283		2,561
Beginning balance at Dec. 31, 2019	$ 736,742	$ (1,154)	$ 493	$ 455,193	$ (119,143)	$ 400,047	$ (1,154)	$ 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
Beginning balance (in shares) at Dec. 31, 2019			49,283		2,561
Beginning balance at Dec. 31, 2019	$ 736,742	$ (1,154)	$ 493	455,193	$ (119,143)	400,047	$ (1,154)	152
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Accounting Standards Update [Extensible List]	us-gaap:AccountingStandardsUpdate201613Member
Ending balance (in shares) at Dec. 31, 2020			49,614		2,561
Ending balance at Dec. 31, 2020	$ 819,677		$ 496	468,726	$ (119,143)	469,558		40
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Equity awards vested and exercised, net of shares withheld for payroll taxes (in shares)			132
Equity awards vested and exercised, net of shares withheld for payroll taxes	(5,258)		$ 1	(5,259)
Share-based compensation	9,287			9,287
Comprehensive income (loss)	70,354					70,378		(24)
Ending balance (in shares) at Mar. 31, 2021			49,746		2,561
Ending balance at Mar. 31, 2021	$ 894,060		$ 497	$ 472,754	$ (119,143)	$ 539,936		$ 16

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Cash flows from operating activities:
Net income	$ 70,378	$ 12,965
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	23,725	20,234
Non-cash interest expense and other	(761)	1,911
Write-off of fees on credit facilities and senior notes	158	0
Change in fair value of contingent consideration	0	200
Increase in allowance for credit losses and sales credits	4,391	4,735
Provision for deferred income taxes	1,928	733
Share-based compensation	9,287	4,927
Loss on disposal or sale of fixed assets	353	3,266
Amortization of discount on investments	(30)	(50)
Net loss (gain) on deferred compensation balances	370	(240)
Non-cash lease expense	(429)	(179)
Changes in assets and liabilities, net of effects from acquisitions:
Accounts receivable	(191,271)	(5,786)
Accounts receivable, subcontractor	(64,382)	(3,224)
Income taxes receivable	6,591	5,984
Prepaid expenses	(6,190)	(7,663)
Other current assets	4,226	3,463
Other assets	(331)	2,409
Accounts payable and accrued expenses	103,278	15,836
Accrued compensation and benefits	64,985	(2,031)
Other liabilities	9,039	(6,894)
Deferred revenue	3,794	748
Restricted investments balance	22	21
Net cash provided by operating activities	39,131	51,365
Cash flows from investing activities:
Purchase and development of fixed assets	(11,607)	(13,571)
Purchase of investments	(10,299)	(4,479)
Proceeds from maturity of investments	25,200	9,600
Purchase of equity investment	(500)	0
Payments to fund deferred compensation plan	0	(5,471)
Purchase of convertible promissory notes	0	(490)
Cash paid for acquisitions, net of cash and restricted cash received	0	(476,392)
Cash paid for acquisitions, net of cash and restricted cash received	0	(476,392)
Cash paid for other intangibles	0	(1,400)
Cash received for working capital adjustments for prior year acquisitions	0	66
Net cash provided by (used in) investing activities	2,794	(492,137)
Cash flows from financing activities:
Payments on term loans	(21,875)	0
Proceeds from term loans	0	250,000
Payments on revolving credit facility	(15,000)	0
Proceeds from revolving credit facility	70,000	225,000
Payment of financing costs	0	(3,899)
Earn-out payments for prior acquisitions	(3,100)	(10,622)
Cash paid for shares withheld for taxes	(5,258)	(4,353)
Net cash provided by financing activities	24,767	456,126
Effect of exchange rate changes on cash	(24)	(47)
Net increase in cash, cash equivalents and restricted cash	66,668	15,307
Cash, cash equivalents and restricted cash at beginning of period	83,990	153,962
Cash, cash equivalents and restricted cash at end of period	150,658	169,269
Supplemental disclosures of cash flow information:
Cash paid for amounts included in the measurement of operating lease liabilities	4,894	4,734
Cash paid for interest (net of $102 and $159 capitalized for the three months ended March 31, 2021 and 2020, respectively)	320	1,898
Cash paid for income taxes	5,566	45
Acquisitions:
Fair value of tangible assets acquired in acquisitions, net of cash and restricted cash received	0	37,240
Goodwill	0	255,974
Intangible assets	0	252,000
Liabilities assumed	0	(68,822)
Net cash paid for acquisitions	0	476,392
Supplemental disclosures of non-cash investing and financing activities:
Purchase of fixed assets recorded in accounts payable and accrued expenses	$ 3,788	$ 1,786

Condensed Consolidated Statem_4

Condensed Consolidated Statements of Cash Flows (Parenthetical) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Statement of Cash Flows [Abstract]
Interest capitalized	$ 102	$ 159

Basis of Presentation

Basis of Presentation	3 Months Ended
	Mar. 31, 2021
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, 2020, contained in the Company’s Annual Report on Form 10-K for the fiscal year ended December 31, 2020, filed with the Securities and Exchange Commission on February 26, 2021 (“2020 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 The Company is closely monitoring the impact of the novel coronavirus (COVID-19) pandemic, which continues to evolve, and its effects and risks on our operations, liquidity, financial condition and financial results. 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, including the duration and severity of the pandemic, remains unknown, 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. The impact of COVID-19 did not have a material effect on the Company’s estimates as of March 31, 2021. 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 December 2019, the Financial Accounting Standards Board (“FASB”) issued Accounting Standard Update (“ASU”) 2019-12, “Simplifying the Accounting for Income Taxes.” The standard is expected to reduce cost and complexity related to accounting for income taxes. The new guidance eliminates certain exceptions and clarifies and amends existing guidance to promote consistent application among reporting entities. Depending on the amendment, adoption is to be applied on a retrospective, modified retrospective or prospective basis. The Company adopted this standard effective January 1, 2021 and the adoption did not have a material effect on the Company’s consolidated financial statements. In January 2020, the FASB issued ASU 2020-01, “Clarifying the Interactions between Topic 321, Topic 323, and Topic 815.” The new guidance clarifies the interactions between accounting standards that apply to equity investments without readily determinable fair values. Specifically, it addresses the accounting for the transition into and out of the equity method. The Company adopted this standard effective January 1, 2021 on a prospective basis and the adoption did not have a material effect on the Company’s consolidated financial statements. 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, 2021 December 31, 2020 Cash and cash equivalents $ 78,325 $ 29,213 Restricted cash and cash equivalents (included in other current assets) 20,317 18,626 Restricted cash, cash equivalents and investments 62,319 61,347 Total cash, cash equivalents and restricted cash and investments 160,961 109,186 Less restricted investments (10,303) (25,196) Total cash, cash equivalents and restricted cash $ 150,658 $ 83,990 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: 2021 2020 Balance as of January 1, $ 7,043 $ 3,332 Adoption of the credit loss standard, cumulative-effect adjustment to retained earnings — 1,334 Provision for expected credit losses 244 3,839 Amounts written off charged against the allowance (237) (481) Balance as of March 31, $ 7,050 $ 8,024

Acquisitions

Acquisitions	3 Months Ended
	Mar. 31, 2021
Business Combinations [Abstract]
Acquisitions	ACQUISITIONS As set forth below, the Company completed one acquisition from January 1, 2020 through March 31, 2021, which was accounted for using the acquisition method of accounting. Accordingly, the Company recorded the tangible and intangible assets acquired and liabilities assumed at their estimated fair values as of the date of acquisition. Since the 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, 2021. 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 Senior Credit Facility, New Credit Agreement and 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. During the second quarter of 2020, an additional $99 of cash consideration was paid to the selling shareholders for the final working capital settlement. 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 allocation of the $485,667 purchase price, which included the additional cash consideration paid for the final working capital settlement and was finalized during the first quarter of 2021, consisted of (1) $44,092 of fair value of tangible assets acquired, which included $9,176 cash received, (2) $56,059 of liabilities assumed, (3) $228,000 of identified intangible assets, and (4) $269,634 of goodwill, of which $10,182 is deductible for tax purposes. 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 as of the acquisition date: Fair Value Useful Life (in years) Identifiable intangible assets Customer Relationships $ 171,000 20 Tradenames and Trademarks 40,000 5 - 10 Developed Technology 16,000 5 Interpreter Database 1,000 4 $ 228,000 During the third quarter of 2020, the Company revised the estimated useful lives for the tradenames and trademarks intangible assets as a result of its plan to rebrand the language services business. Based on this change in circumstances since the date of acquisition, the Company determined that the remaining useful lives of the assets are 5 years and will amortize the remaining value on a straight-line basis over the remaining useful life. The Company will continue to evaluate the remaining useful lives of other intangible assets impacted by its brand consolidation efforts. 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. Pro Forma Financial Information (Unaudited) The following summary presents unaudited pro forma consolidated results of operations of the Company as if the acquisition of Stratus Video had occurred on January 1, 2019, which gives effect to certain adjustments, including acquisition-related costs of $7,812 that were reclassified from the three months ended March 31, 2020 to the three months ended March 31, 2019. The unaudited 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 the Company’s future operating results. Three Months Ended March 31, 2020 Revenue $ 616,333 Income from operations $ 44,853 Net income $ 18,674

Revenue Recognition

Revenue Recognition	3 Months Ended
	Mar. 31, 2021
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 language interpretation and recruitment process outsourcing. The Company recognizes revenue when control of its services is transferred to its 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, 2021 and 2020, previously deferred revenue recognized as revenue was $6,857 and $7,628, respectively. 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 regarding the Company’s revenue disaggregated by service type.

Net Income Per Common Share

Net Income Per Common Share	3 Months Ended
	Mar. 31, 2021
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, 2021 2020 Net income $ 70,378 $ 12,965 Net income per common share - basic $ 1.48 $ 0.27 Net income per common share - diluted $ 1.47 $ 0.27 Weighted average common shares outstanding - basic 47,600 47,359 Plus dilutive effect of potential common shares 316 282 Weighted average common shares outstanding - diluted 47,916 47,641

Segment Information

Segment Information	3 Months Ended
	Mar. 31, 2021
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. The Company has 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 language services, vendor management systems, workforce optimization, recruitment process outsourcing, 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 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, 2021 2020 Revenue Nurse and allied solutions $ 656,661 $ 424,346 Physician and leadership solutions 140,756 137,842 Technology and workforce solutions 88,528 40,273 $ 885,945 $ 602,461 Segment operating income Nurse and allied solutions $ 101,530 $ 59,608 Physician and leadership solutions 21,216 14,569 Technology and workforce solutions 42,089 15,295 164,835 89,472 Unallocated corporate overhead 27,421 28,568 Depreciation and amortization 23,254 20,089 Depreciation (included in cost of revenue) 471 145 Share-based compensation 9,287 4,927 Interest expense, net, and other 8,944 11,054 Income before income taxes $ 95,458 $ 24,689 The following tables present the Company’s revenue disaggregated by service type. Certain prior period amounts have been reclassified to conform with current period presentation. These reclassifications have no impact on total revenue by reportable segment. Three Months Ended March 31, 2021 Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Temporary staffing $ 656,661 $ 125,214 $ — $ 781,875 Permanent placement — 15,542 — 15,542 Outsourced workforce — — 50,607 50,607 SaaS-based technologies — — 37,921 37,921 Total revenue $ 656,661 $ 140,756 $ 88,528 $ 885,945 Three Months Ended March 31, 2020 Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Temporary staffing $ 424,346 $ 119,596 $ — $ 543,942 Permanent placement — 18,246 — 18,246 Outsourced workforce — — 17,680 17,680 SaaS-based technologies — — 22,593 22,593 Total revenue $ 424,346 $ 137,842 $ 40,273 $ 602,461 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, 2021 $ 339,015 $ 152,800 $ 372,670 $ 864,485 Goodwill adjustment for Stratus Video acquisition — — 663 663 Balance, March 31, 2021 $ 339,015 $ 152,800 $ 373,333 $ 865,148 Accumulated impairment loss as of December 31, 2020 and March 31, 2021 $ 154,444 $ 60,495 $ — $ 214,939

Notes Payable and Credit Agreem

Notes Payable and Credit Agreement	3 Months Ended
	Mar. 31, 2021
Debt Disclosure [Abstract]
Notes Payable and Credit Agreement	NOTES PAYABLE AND CREDIT AGREEMENTOn 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. 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 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 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.” The Company repaid its outstanding indebtedness under the Additional Term Loan in the first quarter of 2021. The maturity date of the Senior Credit Facility is February 14, 2025. See Note (11), “Subsequent Events” for additional information.

Fair Value Measurement

Fair Value Measurement	3 Months Ended
	Mar. 31, 2021
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 2020 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, 2021. 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 $52,433 commercial paper issued and outstanding as of March 31, 2021, $10,303 had original maturities greater than three months, which were considered available-for-sale securities. As of December 31, 2020, the Company had $58,345 commercial paper issued and outstanding, of which $25,196 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, 2021 Total Quoted Prices in Significant Other Observable Inputs Significant Unobservable Inputs Money market funds $ 2,198 $ 2,198 $ — $ — Deferred compensation (105,498) (105,498) — — Commercial paper 52,433 — 52,433 — Fair Value Measurements as of December 31, 2020 Total Quoted Prices in Significant Other Observable Inputs Significant Unobservable Inputs Money market funds $ 2,198 $ 2,198 $ — $ — Deferred compensation (97,184) (97,184) — — Commercial paper 58,345 — 58,345 — Acquisition contingent consideration liabilities (8,000) — — (8,000) 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: 2021 2020 Balance as of January 1, $ (8,000) $ (23,100) Settlement of Advanced contingent consideration liability for year ended December 31, 2019 — 20,000 Settlement of b4health contingent consideration liability for year ended December 31, 2020 8,000 — Change in fair value of contingent consideration liability from b4health acquisition — (200) Balance as of March 31, $ — $ (3,300) 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 events or changes in circumstances indicate that it is more likely than not that an impairment exists. 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 following table sets forth a reconciliation of changes in the balance of the equity investment classified as Level 2 in the fair value hierarchy: 2021 2020 Balance as of January 1, $ 15,449 $ 15,449 Additional investments 500 — Change in fair value 1,271 — Balance as of March 31, $ 17,220 $ 15,449 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, 2021 and 2020. 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 4.625% senior notes due 2027 (the “2027 Notes”) and 4.000% senior notes due 2029 (the “2029 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 2027 Notes and the 2029 Notes are presented in the following table. See additional information regarding the 2027 Notes and the 2029 Notes in Part II, Item 8, “Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note (8), Notes Payable and Credit Agreement” of the 2020 Annual Report. As of March 31, 2021 As of December 31, 2020 Carrying Estimated Carrying Estimated 2027 Notes $ 500,000 $ 513,750 $ 500,000 $ 521,250 2029 Notes 350,000 350,000 350,000 357,000

Income Taxes

Income Taxes	3 Months Ended
	Mar. 31, 2021
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, 2021, the Company is no longer subject to state, local or foreign examinations by tax authorities for tax years before 2011, and the Company is no longer subject to U.S. federal income or payroll tax examinations for tax years before 2017. Notwithstanding the foregoing, the Company could adjust its provision for income taxes and contingent tax liability based on future developments. CARES Act On March 27, 2020, the Coronavirus Aid, Relief, and Economic Security Act (the “CARES Act”) was enacted and signed into law in response to the COVID-19 pandemic. Among other things, the CARES Act contains significant business tax provisions, including a deferral of payment of employer payroll taxes and an employer retention credit for employer payroll taxes. The Company deferred payment of the employer’s share of payroll taxes of $48,249, which is included in accrued compensation and benefits and other long-term liabilities in the consolidated balance sheet as of March 31, 2021, with half of such taxes to be paid by the end of 2021 and the other half to be paid by the end of 2022. The Company has claimed an employee retention employment tax credit of $1,201.

Commitments and Contingencies_

Commitments and Contingencies: Legal Proceedings	3 Months Ended
	Mar. 31, 2021
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies: Legal Proceedings	COMMITMENTS AND CONTINGENCIES: LEGAL PROCEEDINGSFrom 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 accrues for contingencies and records a liability when management believes an adverse outcome from a loss contingency is both probable and the amount, or a range, can be reasonably estimated. Significant judgment is required to determine both probability of loss and the estimated amount. The Company reviews its loss contingencies at least quarterly and adjusts its accruals and/or disclosures to reflect the impact of negotiations, settlements, rulings, advice of legal counsel, or other new information, as deemed necessary. The most significant matters for which the Company has established loss contingencies are class actions related to wage and hour claims under California and Federal law. Specifically, among other claims in these lawsuits, it is alleged that certain expense reimbursements should be considered wages and included in the regular rate of pay for purposes of calculating overtime rates. On May 26, 2016, former travel nurse Verna Maxwell Clarke filed a complaint against AMN Services, LLC, in California Superior Court in Los Angeles County. The Company removed the case to the United States District Court for the Central District of California (Case No. 2:16-cv-04132-DSF-KS) (the “Clarke Matter”). The complaint asserts that, due to the Company’s per diem adjustment practices, traveling nurses’ per diem benefits should be included in their regular rate of pay for the purposes of calculating their overtime compensation. On June 26, 2018, the district court denied the plaintiffs’ Motion for Summary Judgment in its entirety, and granted the Company’s Motion for Summary Judgment with respect to the Plaintiffs’ per diem and overtime claims. The plaintiffs filed an appeal of the judgment relating to the per diem claims with the Ninth Circuit Court of Appeals (the “Ninth Circuit”). On February 8, 2021, a three-judge panel of the Ninth Circuit issued an opinion that reversed the district court’s granting of the Company’s Motion for Summary Judgment and remanded the matter to the district court instructing the district to enter partial summary judgment in favor of the Plaintiffs. On May 7, 2021, the Ninth Circuit issued an order denying the Company’s petition for rehearing. The Company will continue to defend the lawsuit vigorously and intends to appeal the Ninth Circuit’s decision to the United States Supreme Court. On May 2, 2019, former travel nurse Sara Woehrle filed a complaint against AMN Services, LLC, and Providence Health System – Southern California in California Superior Court in Los Angeles County. The Company removed the case to the United States District Court for the Central District of California (Case No. 2:19-cv-05282 DSF-KS). The complaint asserts that, due to the Company’s per diem adjustment practices, traveling nurses’ per diem benefits should be included in their regular rate of pay for the purposes of calculating their overtime compensation. The Complaint also alleges that the putative class members were denied required meal periods, denied proper overtime compensation, were not compensated for all time worked, including reporting time and training time, and received non-compliant wage statements. The case was stayed pending a decision by the Ninth Circuit in the Clarke Matter. The Company believes that its wage and hour practices, including those associated with the cases described above, conform with the applicable law in all material respects. However, because of the recent ruling by the Ninth Circuit in the Clarke Matter and the inherent uncertainty of litigation, the Company is not able to reasonably predict if any matter will be resolved in a manner that is materially adverse to the Company it recorded an increase to its accruals established in connection with the matters described above amounting to $20,000 during the fourth quarter of 2020. While the Company continues to believe that it has meritorious defenses against the suits described above, the ultimate resolution of these matters could result in a loss of up to $15,000, excluding interest and penalties, in excess of the amounts currently accrued. For all other matters, the Company is unable to currently estimate the possible loss or range of loss beyond the amounts already accrued. Loss contingencies accrued as of March 31, 2021 are included in accounts payable and accrued expenses and other long-term liabilities in the consolidated balance sheets.

Balance Sheet Details

Balance Sheet Details	3 Months Ended
	Mar. 31, 2021
Balance Sheet Related Disclosures [Abstract]
Balance Sheet Details	BALANCE SHEET DETAILS The consolidated balance sheets detail is as follows: March 31, 2021 December 31, 2020 Other current assets: Restricted cash and cash equivalents $ 20,317 $ 18,626 Income taxes receivable — 6,591 Other 11,366 15,592 Other current assets $ 31,683 $ 40,809 Fixed assets: Furniture and equipment $ 50,206 $ 47,355 Software 230,029 220,971 Leasehold improvements 9,602 9,600 289,837 277,926 Accumulated depreciation (170,250) (161,752) Fixed assets, net $ 119,587 $ 116,174 Other assets: Life insurance cash surrender value $ 102,068 $ 98,161 Other 39,187 36,959 Other assets $ 141,255 $ 135,120 Accounts payable and accrued expenses: Trade accounts payable $ 49,578 $ 28,089 Subcontractor payable 146,116 79,364 Accrued expenses 52,525 37,849 Loss contingencies 9,675 7,613 Professional liability reserve 8,143 8,897 Other 5,866 6,069 Accounts payable and accrued expenses $ 271,903 $ 167,881 Accrued compensation and benefits: Accrued payroll $ 112,977 $ 59,721 Accrued bonuses and commissions 41,577 34,514 Accrued travel expense 2,305 1,998 Health insurance reserve 5,807 5,590 Workers compensation reserve 10,855 10,244 Deferred compensation 105,498 97,184 Other 3,962 4,163 Accrued compensation and benefits $ 282,981 $ 213,414 Other long-term liabilities: Workers compensation reserve $ 21,789 $ 20,930 Professional liability reserve 33,833 31,997 Unrecognized tax benefits 5,479 5,447 Other 49,398 49,533 Other long-term liabilities $ 110,499 $ 107,907

Subsequent Events

Subsequent Events	3 Months Ended
	Mar. 31, 2021
Subsequent Events [Abstract]
Subsequent Events	SUBSEQUENT EVENTSOn April 7, 2021, the Company completed its acquisition of Synzi Holdings, Inc. (“Synzi”) and its wholly-owned subsidiary, SnapMD, LLC (“SnapMD”), for $42,500 in cash. Synzi is a virtual care communication platform that enables organizations to conduct virtual visits and use secure messaging, text, and email for clinician-to-patient and clinician-to-clinician communications. SnapMD is a full-service virtual care management company, specializing in providing software to enable healthcare providers to better engage with their patients. On March 30, 2021, the Company borrowed $45,000 under the Senior Credit Facility to fund the acquisition. The Senior Credit Facility is defined in Note (2), “Acquisitions” and more fully described in Note (6), “Notes Payable and Credit Agreement.”

Basis of Presentation (Policies

Basis of Presentation (Policies)	3 Months Ended
	Mar. 31, 2021
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.
Coronavirus Pandemic	Coronavirus Pandemic The Company is closely monitoring the impact of the novel coronavirus (COVID-19) pandemic, which continues to evolve, and its effects and risks on our operations, liquidity, financial condition and financial results. 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, including the duration and severity of the pandemic, remains unknown, 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. The impact of COVID-19 did not have a material effect on the Company’s estimates as of March 31, 2021. 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	Recently Adopted Accounting Pronouncements In December 2019, the Financial Accounting Standards Board (“FASB”) issued Accounting Standard Update (“ASU”) 2019-12, “Simplifying the Accounting for Income Taxes.” The standard is expected to reduce cost and complexity related to accounting for income taxes. The new guidance eliminates certain exceptions and clarifies and amends existing guidance to promote consistent application among reporting entities. Depending on the amendment, adoption is to be applied on a retrospective, modified retrospective or prospective basis. The Company adopted this standard effective January 1, 2021 and the adoption did not have a material effect on the Company’s consolidated financial statements. In January 2020, the FASB issued ASU 2020-01, “Clarifying the Interactions between Topic 321, Topic 323, and Topic 815.” The new guidance clarifies the interactions between accounting standards that apply to equity investments without readily determinable fair values. Specifically, it addresses the accounting for the transition into and out of the equity method. The Company adopted this standard effective January 1, 2021 on a prospective basis and the adoption did not have a material effect on the Company’s consolidated financial statements.
Cash, Cash Equivalents and Restricted Cash	Cash, Cash Equivalents and Restricted CashThe 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.
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 language interpretation and recruitment process outsourcing. The Company recognizes revenue when control of its services is transferred to its 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, 2021 and 2020, previously deferred revenue recognized as revenue was $6,857 and $7,628, respectively. 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 Assets and Liabilities	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 $52,433 commercial paper issued and outstanding as of March 31, 2021, $10,303 had original maturities greater than three months, which were considered available-for-sale securities. As of December 31, 2020, the Company had $58,345 commercial paper issued and outstanding, of which $25,196 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. 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 events or changes in circumstances indicate that it is more likely than not that an impairment exists. 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. 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 4.625% senior notes due 2027 (the “2027 Notes”) and 4.000% senior notes due 2029 (the “2029 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 2027 Notes and the 2029 Notes are presented in the following table. See additional information regarding the 2027 Notes and the 2029 Notes in Part II, Item 8, “Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note (8), Notes Payable and Credit Agreement” of the 2020 Annual Report. As of March 31, 2021 As of December 31, 2020 Carrying Estimated Carrying Estimated 2027 Notes $ 500,000 $ 513,750 $ 500,000 $ 521,250 2029 Notes 350,000 350,000 350,000 357,000

Basis of Presentation (Tables)

Basis of Presentation (Tables)	3 Months Ended
	Mar. 31, 2021
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, 2021 December 31, 2020 Cash and cash equivalents $ 78,325 $ 29,213 Restricted cash and cash equivalents (included in other current assets) 20,317 18,626 Restricted cash, cash equivalents and investments 62,319 61,347 Total cash, cash equivalents and restricted cash and investments 160,961 109,186 Less restricted investments (10,303) (25,196) Total cash, cash equivalents and restricted cash $ 150,658 $ 83,990
Reconciliation of Activity in Allowance for Credit Losses for Accounts Receivable	The following table provides a reconciliation of activity in the allowance for credit losses for accounts receivable: 2021 2020 Balance as of January 1, $ 7,043 $ 3,332 Adoption of the credit loss standard, cumulative-effect adjustment to retained earnings — 1,334 Provision for expected credit losses 244 3,839 Amounts written off charged against the allowance (237) (481) Balance as of March 31, $ 7,050 $ 8,024

Acquisitions (Tables)

Acquisitions (Tables)	3 Months Ended
	Mar. 31, 2021
Business Combinations [Abstract]
Schedule of Intangible Assets Acquired	The following table summarizes the fair value and useful life of each intangible asset acquired as of the acquisition date: Fair Value Useful Life (in years) Identifiable intangible assets Customer Relationships $ 171,000 20 Tradenames and Trademarks 40,000 5 - 10 Developed Technology 16,000 5 Interpreter Database 1,000 4 $ 228,000
Schedule of Pro Forma Financial Information	The unaudited 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 the Company’s future operating results. Three Months Ended March 31, 2020 Revenue $ 616,333 Income from operations $ 44,853 Net income $ 18,674

Net Income Per Common Share (Ta

Net Income Per Common Share (Tables)	3 Months Ended
	Mar. 31, 2021
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, 2021 2020 Net income $ 70,378 $ 12,965 Net income per common share - basic $ 1.48 $ 0.27 Net income per common share - diluted $ 1.47 $ 0.27 Weighted average common shares outstanding - basic 47,600 47,359 Plus dilutive effect of potential common shares 316 282 Weighted average common shares outstanding - diluted 47,916 47,641

Segment Information (Tables)

Segment Information (Tables)	3 Months Ended
	Mar. 31, 2021
Segment Reporting [Abstract]
Reconciliation of Revenue and Segment Operating Income by Reportable Segment	The following table provides a reconciliation of revenue and operating income by reportable segment to consolidated results and was derived from each segment’s internal financial information as used for corporate management purposes: Three Months Ended March 31, 2021 2020 Revenue Nurse and allied solutions $ 656,661 $ 424,346 Physician and leadership solutions 140,756 137,842 Technology and workforce solutions 88,528 40,273 $ 885,945 $ 602,461 Segment operating income Nurse and allied solutions $ 101,530 $ 59,608 Physician and leadership solutions 21,216 14,569 Technology and workforce solutions 42,089 15,295 164,835 89,472 Unallocated corporate overhead 27,421 28,568 Depreciation and amortization 23,254 20,089 Depreciation (included in cost of revenue) 471 145 Share-based compensation 9,287 4,927 Interest expense, net, and other 8,944 11,054 Income before income taxes $ 95,458 $ 24,689
Disaggregation of Revenue	The following tables present the Company’s revenue disaggregated by service type. Certain prior period amounts have been reclassified to conform with current period presentation. These reclassifications have no impact on total revenue by reportable segment. Three Months Ended March 31, 2021 Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Temporary staffing $ 656,661 $ 125,214 $ — $ 781,875 Permanent placement — 15,542 — 15,542 Outsourced workforce — — 50,607 50,607 SaaS-based technologies — — 37,921 37,921 Total revenue $ 656,661 $ 140,756 $ 88,528 $ 885,945 Three Months Ended March 31, 2020 Nurse and Allied Solutions Physician and Leadership Solutions Technology and Workforce Solutions Total Temporary staffing $ 424,346 $ 119,596 $ — $ 543,942 Permanent placement — 18,246 — 18,246 Outsourced workforce — — 17,680 17,680 SaaS-based technologies — — 22,593 22,593 Total revenue $ 424,346 $ 137,842 $ 40,273 $ 602,461
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, 2021 $ 339,015 $ 152,800 $ 372,670 $ 864,485 Goodwill adjustment for Stratus Video acquisition — — 663 663 Balance, March 31, 2021 $ 339,015 $ 152,800 $ 373,333 $ 865,148 Accumulated impairment loss as of December 31, 2020 and March 31, 2021 $ 154,444 $ 60,495 $ — $ 214,939

Fair Value Measurement (Tables)

Fair Value Measurement (Tables)	3 Months Ended
	Mar. 31, 2021
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, 2021 Total Quoted Prices in Significant Other Observable Inputs Significant Unobservable Inputs Money market funds $ 2,198 $ 2,198 $ — $ — Deferred compensation (105,498) (105,498) — — Commercial paper 52,433 — 52,433 — Fair Value Measurements as of December 31, 2020 Total Quoted Prices in Significant Other Observable Inputs Significant Unobservable Inputs Money market funds $ 2,198 $ 2,198 $ — $ — Deferred compensation (97,184) (97,184) — — Commercial paper 58,345 — 58,345 — Acquisition contingent consideration liabilities (8,000) — — (8,000)
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: 2021 2020 Balance as of January 1, $ (8,000) $ (23,100) Settlement of Advanced contingent consideration liability for year ended December 31, 2019 — 20,000 Settlement of b4health contingent consideration liability for year ended December 31, 2020 8,000 — Change in fair value of contingent consideration liability from b4health acquisition — (200) Balance as of March 31, $ — $ (3,300)
Schedule of Assets Measured on a Non-Recurring Basis	The following table sets forth a reconciliation of changes in the balance of the equity investment classified as Level 2 in the fair value hierarchy: 2021 2020 Balance as of January 1, $ 15,449 $ 15,449 Additional investments 500 — Change in fair value 1,271 — Balance as of March 31, $ 17,220 $ 15,449
Schedule of Fair Value of Financial Instruments	See additional information regarding the 2027 Notes and the 2029 Notes in Part II, Item 8, “Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note (8), Notes Payable and Credit Agreement” of the 2020 Annual Report. As of March 31, 2021 As of December 31, 2020 Carrying Estimated Carrying Estimated 2027 Notes $ 500,000 $ 513,750 $ 500,000 $ 521,250 2029 Notes 350,000 350,000 350,000 357,000

Balance Sheet Details (Tables)

Balance Sheet Details (Tables)	3 Months Ended
	Mar. 31, 2021
Balance Sheet Related Disclosures [Abstract]
Schedule of Supplemental Balance Sheet Disclosures	The consolidated balance sheets detail is as follows: March 31, 2021 December 31, 2020 Other current assets: Restricted cash and cash equivalents $ 20,317 $ 18,626 Income taxes receivable — 6,591 Other 11,366 15,592 Other current assets $ 31,683 $ 40,809 Fixed assets: Furniture and equipment $ 50,206 $ 47,355 Software 230,029 220,971 Leasehold improvements 9,602 9,600 289,837 277,926 Accumulated depreciation (170,250) (161,752) Fixed assets, net $ 119,587 $ 116,174 Other assets: Life insurance cash surrender value $ 102,068 $ 98,161 Other 39,187 36,959 Other assets $ 141,255 $ 135,120 Accounts payable and accrued expenses: Trade accounts payable $ 49,578 $ 28,089 Subcontractor payable 146,116 79,364 Accrued expenses 52,525 37,849 Loss contingencies 9,675 7,613 Professional liability reserve 8,143 8,897 Other 5,866 6,069 Accounts payable and accrued expenses $ 271,903 $ 167,881 Accrued compensation and benefits: Accrued payroll $ 112,977 $ 59,721 Accrued bonuses and commissions 41,577 34,514 Accrued travel expense 2,305 1,998 Health insurance reserve 5,807 5,590 Workers compensation reserve 10,855 10,244 Deferred compensation 105,498 97,184 Other 3,962 4,163 Accrued compensation and benefits $ 282,981 $ 213,414 Other long-term liabilities: Workers compensation reserve $ 21,789 $ 20,930 Professional liability reserve 33,833 31,997 Unrecognized tax benefits 5,479 5,447 Other 49,398 49,533 Other long-term liabilities $ 110,499 $ 107,907

Basis of Presentation - Recentl

Basis of Presentation - Recently Adopted Accounting Pronouncements (Details) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020	Mar. 31, 2020	Dec. 31, 2019
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Reduction to retained earnings	$ (894,060)	$ (819,677)	$ (749,080)	$ (736,742)
Cumulative Effect, Period of Adoption, Adjustment
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Reduction to retained earnings				1,154
Retained Earnings
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Reduction to retained earnings	$ (539,936)	$ (469,558)	$ (411,858)	(400,047)
Retained Earnings | Cumulative Effect, Period of Adoption, Adjustment
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Reduction to retained earnings				$ 1,154

Basis of Presentation - Reconci

Basis of Presentation - Reconciliation of Cash, Cash Equivalents and Restricted Cash (Details) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020	Mar. 31, 2020	Dec. 31, 2019
Accounting Policies [Abstract]
Cash and cash equivalents	$ 78,325	$ 29,213
Restricted cash and cash equivalents (included in other current assets)	20,317	18,626
Restricted cash, cash equivalents and investments	62,319	61,347
Total cash, cash equivalents and restricted cash and investments	160,961	109,186
Less restricted investments	(10,303)	(25,196)
Total cash, cash equivalents and restricted cash	$ 150,658	$ 83,990	$ 169,269	$ 153,962

Basis of Presentation - Recon_2

Basis of Presentation - Reconciliation of Activity in Allowance for Credit Losses for Accounts Receivable (Details) - USD ($) $ in Thousands	3 Months Ended		12 Months Ended
	Mar. 31, 2021	Mar. 31, 2020	Dec. 31, 2020	Dec. 31, 2019
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance	$ 7,043	$ 3,332	$ 3,332
Accounting Standards Update [Extensible List]			us-gaap:AccountingStandardsUpdate201613Member	us-gaap:AccountingStandardsUpdate201613Member
Provision for expected credit losses	244	3,839
Amounts written off charged against the allowance	(237)	(481)
Ending balance	7,050	8,024	$ 7,043	$ 3,332
Cumulative Effect, Period of Adoption, Adjustment
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance	$ 0	$ 1,334	1,334
Ending balance			$ 0	$ 1,334

Acquisitions - Narrative (Detai

Acquisitions - Narrative (Details)	Feb. 14, 2020USD ($)	Mar. 31, 2021USD ($)acquisition	Sep. 30, 2020	Jun. 30, 2020USD ($)	Mar. 31, 2020USD ($)	Dec. 31, 2020USD ($)	Jun. 14, 2019USD ($)	Feb. 09, 2018USD ($)
Business Acquisition [Line Items]
Number of acquisitions | acquisition		1
Cash consideration		$ 0			$ 476,392,000
Goodwill		865,148,000				$ 864,485,000
Net income		(70,378,000)			(12,965,000)
Stratus Video
Business Acquisition [Line Items]
Cash consideration	$ 485,568,000			$ 99,000
Acquisition-related costs					7,812,000
Purchase price, net of working capital adjustment		485,667,000
Fair value of tangible assets acquired		44,092,000
Cash and restricted cash received		9,176,000
Liabilities assumed		56,059,000
Identifiable intangible assets	$ 228,000,000	228,000,000
Goodwill		269,634,000
Goodwill expected to be deductible for tax purposes		$ 10,182,000
Intangible assets acquired, weighted average useful life	17 years
Pro forma information, revenue of acquiree since acquisition date					14,433,000
Pro forma information, income before income taxes of acquiree since acquisition date					1,606,000
Stratus Video | Acquisition-related Costs
Business Acquisition [Line Items]
Net income					$ 7,812,000
Stratus Video | Tradenames and Trademarks
Business Acquisition [Line Items]
Identifiable intangible assets	$ 40,000,000
Useful Life			5 years
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) - Stratus Video - USD ($) $ in Thousands	Feb. 14, 2020	Sep. 30, 2020	Mar. 31, 2021
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 228,000		$ 228,000
Customer Relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 171,000
Useful Life	20 years
Tradenames and Trademarks
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 40,000
Useful Life		5 years
Developed Technology
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 16,000
Useful Life	5 years
Interpreter Database
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 1,000
Useful Life	4 years
Minimum | Tradenames and Trademarks
Acquired Finite-Lived Intangible Assets [Line Items]
Useful Life	5 years
Maximum | Tradenames and Trademarks
Acquired Finite-Lived Intangible Assets [Line Items]
Useful Life	10 years

Acquisitions - Schedule of Pro

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

Revenue Recognition (Details)

Revenue Recognition (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Revenue from Contract with Customer [Abstract]
Previously deferred revenue recognized during period	$ 6,857	$ 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, 2021	Mar. 31, 2020
Earnings Per Share [Abstract]
Net income	$ 70,378	$ 12,965
Net income per common share - basic (in dollars per share)	$ 1.48	$ 0.27
Net income per common share - diluted (in dollars per share)	$ 1.47	$ 0.27
Weighted average common shares outstanding - basic (in shares)	47,600	47,359
Plus dilutive effect of potential common shares (in shares)	316	282
Weighted average common shares outstanding - diluted (in shares)	47,916	47,641
Common stock excluded from calculation of EPS (in shares)	22	27

Segment Information - Narrative

Segment Information - Narrative (Details)	3 Months Ended
	Mar. 31, 2021segment
Segment Reporting [Abstract]
Number of reportable segments	3

Segment Information - Reconcili

Segment Information - Reconciliation of Revenue and Segment Operating Income by Reportable Segment (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	$ 885,945	$ 602,461
Segment operating income	104,402	35,743
Depreciation and amortization	23,254	20,089
Depreciation (included in cost of revenue)	471	145
Share-based compensation	9,287	4,927
Interest expense, net, and other	8,944	11,054
Income before income taxes	95,458	24,689
Nurse and allied solutions
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	656,661	424,346
Physician and leadership solutions
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	140,756	137,842
Technology and workforce solutions
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	88,528	40,273
Operating segments
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	885,945	602,461
Segment operating income	164,835	89,472
Operating segments | Nurse and allied solutions
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	656,661	424,346
Segment operating income	101,530	59,608
Operating segments | Physician and leadership solutions
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	140,756	137,842
Segment operating income	21,216	14,569
Operating segments | Technology and workforce solutions
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	88,528	40,273
Segment operating income	42,089	15,295
Unallocated corporate overhead
Segment Reporting, Revenue Reconciling Item [Line Items]
Unallocated corporate overhead	$ 27,421	$ 28,568

Segment Information - Disaggreg

Segment Information - Disaggregation of Revenue (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Segment Reporting Information [Line Items]
Revenue	$ 885,945	$ 602,461
Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	656,661	424,346
Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	140,756	137,842
Technology and workforce solutions
Segment Reporting Information [Line Items]
Revenue	88,528	40,273
Temporary staffing
Segment Reporting Information [Line Items]
Revenue	781,875	543,942
Temporary staffing | Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	656,661	424,346
Temporary staffing | Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	125,214	119,596
Temporary staffing | Technology and workforce solutions
Segment Reporting Information [Line Items]
Revenue	0	0
Permanent placement
Segment Reporting Information [Line Items]
Revenue	15,542	18,246
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	15,542	18,246
Permanent placement | Technology and workforce solutions
Segment Reporting Information [Line Items]
Revenue	0	0
Outsourced workforce
Segment Reporting Information [Line Items]
Revenue	50,607	17,680
Outsourced workforce | Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	0	0
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	50,607	17,680
SaaS-based technologies
Segment Reporting Information [Line Items]
Revenue	37,921	22,593
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	$ 37,921	$ 22,593

Segment Information - Summary o

Segment Information - Summary of Goodwill by Reportable Segment (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Dec. 31, 2020
Goodwill [Roll Forward]
Goodwill, beginning balance	$ 864,485
Goodwill adjustment for Stratus Video acquisition	663
Goodwill, ending balance	865,148
Accumulated impairment loss	214,939	$ 214,939
Nurse and Allied Solutions
Goodwill [Roll Forward]
Goodwill, beginning balance	339,015
Goodwill adjustment for Stratus Video acquisition	0
Goodwill, ending balance	339,015
Accumulated impairment loss	154,444	154,444
Physician and Leadership Solutions
Goodwill [Roll Forward]
Goodwill, beginning balance	152,800
Goodwill adjustment for Stratus Video acquisition	0
Goodwill, ending balance	152,800
Accumulated impairment loss	60,495	60,495
Technology and workforce solutions
Goodwill [Roll Forward]
Goodwill, beginning balance	372,670
Goodwill adjustment for Stratus Video acquisition	663
Goodwill, ending balance	373,333
Accumulated impairment loss	$ 0	$ 0

Notes Payable and Credit Agre_2

Notes Payable and Credit Agreement (Details) - USD ($)	Feb. 14, 2020	Jun. 14, 2019	Feb. 09, 2018
Senior Credit Facility | Line of Credit
Debt Instrument [Line Items]
Maximum borrowing capacity			$ 400,000,000
Term Loan | Term Debt
Debt Instrument [Line Items]
Term loan credit facility	$ 250,000,000	$ 150,000,000

Fair Value Measurement - Narrat

Fair Value Measurement - Narrative (Details) - USD ($)	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020	Dec. 31, 2020	Oct. 20, 2020	Aug. 13, 2020
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Impairment charges	$ 0	$ 0
2027 Notes | Senior Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate					4.625%
2029 Notes | Senior Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate				4.00%
Commercial paper | Fair Value, Measurements, Recurring
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Commercial paper	52,433,000		$ 58,345,000
Commercial paper | Fair Value, Measurements, Recurring | Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Commercial paper	52,433,000		58,345,000
Available-for-sale securities	$ 10,303,000		$ 25,196,000

Fair Value Measurement - Financ

Fair Value Measurement - Financial Assets and Liabilities (Details) - Fair Value, Measurements, Recurring - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Deferred compensation
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value	$ (105,498)	$ (97,184)
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]
Assets (liabilities) measured at fair value	(105,498)	(97,184)
Deferred compensation | Significant Other Observable Inputs (Level 2)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (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]
Assets (liabilities) measured at fair value	0	0
Acquisition contingent consideration liabilities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value		(8,000)
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]
Assets (liabilities) measured at fair value		0
Acquisition contingent consideration liabilities | Significant Other Observable Inputs (Level 2)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value		0
Acquisition contingent consideration liabilities | Significant Unobservable Inputs (Level 3)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value		(8,000)
Money market funds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value	2,198	2,198
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]
Assets (liabilities) measured at fair value	2,198	2,198
Money market funds | Significant Other Observable Inputs (Level 2)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (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]
Assets (liabilities) measured at fair value	0	0
Commercial paper
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value	52,433	58,345
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]
Assets (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]
Assets (liabilities) measured at fair value	52,433	58,345
Commercial paper | Significant Unobservable Inputs (Level 3)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value	$ 0	$ 0

Fair Value Measurement - Reconc

Fair Value Measurement - Reconciliation of Changes in Contingent Consideration Liabilities (Details) - Level 3 - Acquisition contingent consideration liabilities - Fair Value, Measurements, Recurring - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Beginning balance	$ (8,000)	$ (23,100)
Ending balance	0	(3,300)
Advanced
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Settlement of contingent consideration liability	0	20,000
b4health
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Settlement of contingent consideration liability	8,000	0
Change in fair value of contingent consideration liability from acquisition	$ 0	$ (200)

Fair Value Measurement - Schedu

Fair Value Measurement - Schedule of Assets Measured on a Non-Recurring Basis (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Equity Securities, FV-NI [Roll Forward]
Additional investments	$ 500	$ 0
Fair Value, Measurements, Nonrecurring | Significant Other Observable Inputs (Level 2)
Equity Securities, FV-NI [Roll Forward]
Beginning balance	15,449	15,449
Additional investments	500	0
Change in fair value	1,271	0
Ending balance	$ 17,220	$ 15,449

Fair Value Measurement - Fair V

Fair Value Measurement - Fair Value of Financial Instruments (Details) - Senior Notes - USD ($)	Mar. 31, 2021	Dec. 31, 2020
2027 Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Carrying Amount	$ 500,000,000	$ 500,000,000
Estimated Fair Value	513,750,000	521,250,000
2029 Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Carrying Amount	350,000,000	350,000,000
Estimated Fair Value	$ 350,000,000	$ 357,000,000

Income Taxes (Details)

Income Taxes (Details) $ in Thousands	Mar. 31, 2021USD ($)
Income Tax Disclosure [Abstract]
Deferred payroll taxes, CARES Act	$ 48,249
Employee retention employment tax credit, CARES Act	$ 1,201

Commitments and Contingencies_2

Commitments and Contingencies: Legal Proceedings (Details) - Wage and Hour claims - Pending Litigation - USD ($) $ in Thousands	3 Months Ended
	Dec. 31, 2020	Mar. 31, 2021
Loss Contingencies [Line Items]
Increase to loss contingency accruals	$ 20,000
Maximum
Loss Contingencies [Line Items]
Estimate of possible loss		$ 15,000

Balance Sheet Details (Details)

Balance Sheet Details (Details) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Other current assets:
Restricted cash and cash equivalents	$ 20,317	$ 18,626
Income taxes receivable	0	6,591
Other	11,366	15,592
Other current assets	31,683	40,809
Fixed assets:
Furniture and equipment	50,206	47,355
Software	230,029	220,971
Leasehold improvements	9,602	9,600
Fixed assets, gross	289,837	277,926
Accumulated depreciation	(170,250)	(161,752)
Fixed assets, net	119,587	116,174
Other assets:
Life insurance cash surrender value	102,068	98,161
Other	39,187	36,959
Other assets	141,255	135,120
Accounts payable and accrued expenses:
Trade accounts payable	49,578	28,089
Subcontractor payable	146,116	79,364
Accrued expenses	52,525	37,849
Loss contingencies	9,675	7,613
Professional liability reserve	8,143	8,897
Other	5,866	6,069
Accounts payable and accrued expenses	271,903	167,881
Accrued compensation and benefits:
Accrued payroll	112,977	59,721
Accrued bonuses and commissions	41,577	34,514
Accrued travel expense	2,305	1,998
Health insurance reserve	5,807	5,590
Workers compensation reserve	10,855	10,244
Deferred compensation	105,498	97,184
Other	3,962	4,163
Accrued compensation and benefits	282,981	213,414
Other long-term liabilities:
Workers compensation reserve	21,789	20,930
Professional liability reserve	33,833	31,997
Unrecognized tax benefits	5,479	5,447
Other	49,398	49,533
Other long-term liabilities	$ 110,499	$ 107,907

Subsequent Events - Narrative (

Subsequent Events - Narrative (Details) - USD ($) $ in Thousands	Apr. 07, 2021	Mar. 30, 2021	Mar. 31, 2021	Mar. 31, 2020
Subsequent Event [Line Items]
Cash consideration			$ 0	$ 476,392
Proceeds from lines of credit			$ 70,000	$ 225,000
Subsequent Event | Synzi
Subsequent Event [Line Items]
Cash consideration	$ 42,500
Line of Credit | Senior Credit Facility
Subsequent Event [Line Items]
Proceeds from lines of credit		$ 45,000