AMN - Earnings call transcript Q4 2021 | AMN Healthcare Services, Inc.

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Operator

Good day, and welcome to the AMN Healthcare Fourth Quarter 2021 Earnings Call. My name is Brika, and I'll be today's event specialist. [Operator Instructions]. I would like to hand the call over to Randy Reece, Senior Director of Investor Relations.

So, Randy, please go ahead.

Randy Reece

everyone. afternoon, Good Healthcare's call. AMN and year full Welcome fourth earnings XXXX to quarter A available will the webcast replay this of be this conclusion call. at of following ir.amnhealthcare.com, our the Details call replay the issued of for are afternoon. audio in earnings release this conference this make our trends, including about future outlook forward-looking statements. for XXXX Various plans, during expectations, or events remarks call we constitute circumstances financial projections, and beyond currently the available current upon to reflect beliefs company's statements information These it. based

statements prior those actual our various call financial on release. not next are because Information with GAAP today may does to included measures XX-K financial intend these company forward-looking information. comparable our or materially its contains earnings and at and by Our filings including non-GAAP most in and the SEC. earnings our release any This forms of our from reconciliations and of identified ir.amnhealthcare.com. indicated to to statements, results measures reports filed in regarding cautionary page and non-GAAP update factors statements XX-Q, The the earnings certain subsequent these directly differ forward-looking those recently guidance most provided release

call today Knudson, Financial and Salka, and now of and Nursing will turn Kelly James Group Chief are Executive and Taylor, Chief Seedig, President Talent Physician Officer; to President I Susan. COO COO and Rakowski, Jeff Group Solutions; the Strategic Solutions. of COO Susan Officer; of and Landry the President On call Group over Allied Leadership Solutions;

Susan Salka

so much, everyone. Randy, you and Thank welcome,

a we labor our stunning an talent be in provide rise a healthcare XXXX, and the professionals demand proud important total Many as healthcare. team across you limit. industry challenge strategy AMN's is forces that to and solutions that AMN its together today scale technology to on over answer the Throughout impact, two years We an our organization. to joined for us past of healthcare contribute are solution results. for update The leading came all and grateful

quarter. need allied second clients doubled increased temporary highs. for that nurses roles new X.X over from Demand in reach also for for about times Demand the by fourth professionals Physicians span. permanent and travel Our the to quarter same

our Our the country, teams sort our needs nothing is of all efforts remarkable. and of urgent clients staffing serve to

supplier enabled our the which under to hundreds respond, also and We of of VMS $X.X tremendous programs reflected XXXX. our partners gross in in is MSP management spend billion

is a They technology For a taking multiple diversified and term market pillars continue success. supply labor and we our contract long amidst of are them four of the over are contributor talent long-term pool. create their there this workforce across increasingly careers improve mix preferences away and a crisis looking they which the Clinicians be essential workforce. shortage clients, to control AMN bedside. clients their societal ease which need. primary problem, and solutions possible, a flexibility the redesigning the staffing utilize best to has healthcare desire from the talent fix. of accessing and spectrum more short short-term To is term the permanent more than models are more resources from This changing and severe

First desire. they and impact most to team our to make members is importantly, dedicated empower the

our commitment a steep have driven AMN strong and issues. is at important purpose We that our culture in social to values

the when their better. matters improve customers of but basic, of expectations is nailing professionals. and the and efficiency continue is it to our want experience to healthcare to clients of evolving Think it our most. exceed operation delight Second, differentiate We and our the

The now our integrated Third, what The into example while fourth this, as is and deepen personalizing talent each a we evolution is and understanding total clients and their our of future. great relationships organization. of analyzing refer winning also healthcare to with solutions listening, of by digital. pillars portfolio needs the to service professionals to

increase have and Over and we two in significantly the artificial to staffing digital last intelligence serve. those years, speed, investments scalability experience while of our accelerated we the also improving

and of Every day analytic self-serve adding the capabilities dashboards We more client valuable and have journey. and aspects many to clinician becoming agile more capabilities. digitized AMN created digital is

an clinicians find opportunities you which documentation mentioned job and gives and Passport includes an clients. based recall matching app. we uses example, to healthcare to their with easily As that algorithm in professionals Passport credentialing engagement and them have customized a time. might XXXX that candidates launched market. over Passport use makes dynamic and wallet, share easier us professionals provides we opportunities now real preferences for AMN continuous the the that we in right industry-leading with Passport, also to on the their evolving XXX,XXX manage it and using

update features and you technology in we is We it transforming on the investments making how very store our have company. for more in to already continue passport how digital app will difference. the about and excited On future we are are calls a

Now, the $X.XX In start I'd consolidated XXXX. for the revenue and adjusted million. billion to EBITDA to like a of of quarter on quarter some fourth and recap trends the was color was turn XXXX, $XXX fourth of

between segment Nurse rates driven expectations Our wage rising Allied over clinicians. $X volume of revenue billion and and higher Solutions with of by balance reported growth bill

an The bring increases pace. this the in Allied XX% nurses international therapy. strong mentioned create volume. a seen nurse for grew outside first Nurse over I the majority and was as growing and year-over-year the the example which travel revenue fourth Staffing disciplines We've that quarter, will same staffing much trends years revenue Earlier year-over-year revenue up become important XX% then workforce begin resulting to continue of grow This we term our across They year lab, is with the two about by all more than for and pretty in to the driven They XX%. Allied revenue International prior revenue needs solutions U.S. Demand go in XXXX, the XX% assignment Solution, are One great families at clinician allied will staffing community. great multiple by travel workforce XXX% hospital strong for clients. clinicians all-time important the at projection long-term and our an after about into permanent growth volume recruits growth continue are with the higher first on that. Solutions their build AMN of of nurse respiratory and higher part in imaging, with their future from in at and XX% assumes compensation. experience. demand These they for nurses region. led longer expected is skills for talent a high staffing that staffing business Nurse outlook our quarter. grow and largest over by Our address clients

Our Locum XX% near Physician Leadership revenue tenens performance strong fourth revenue and segment XX% interim growth Solutions year-over-year. leadership their continued both $XXX million, year-over-year. had quarter and up of with

approximately year-over-year revenue the over clients for demand strategic pandemic-related While driver of We was physician core assignments contributed and a we some, grow quarter also XX% search new in businesses. Physician we double-digit contract quarter saw expect record-high gaining and the primary with up in executive execution and solutions searches revenue strong the business. about searches in to multiple first is the XX% growth are physician In period. year-over-year. more and all leadership XXXX, with longer

with new XX% reached $XXX million, Our technology year fourth year. revenue high quarter and over solutions workforce segment of another up

increases in over XX% technology both trends driven market growth Solutions the biggest of existing primarily about year. with VMS under Services year growth quarter, driver strong Workforce Technology quarter had XXXX, from be the to Our great management. volume by we was business significant new gross Language In and be to clients. and expect continue spend revenue and up another first

are all both supplemental care, seeking. as and relatively they to small preferring the of option. the shortage severe severe obviously rates rise. fill can flexibility The pay staffing this used the demand of travel of of have the you critical symptomatic passionate percentage the and of career workforce. for preferences give and choices leaning patient call at because changed and out availability problems local demand, the results outlook, what from to the has this also This healthcare happened exactly to market. changing the and these team clients short-term when of than tell from most were As is healthcare in professions roles the In professionals talented expectations answer And clinicians a deliver however meaningfully and but labor workforce and the a career is lower necessity is healthcare. in AMN talent our is with Historically and solution and labor in significant

Permanent increases. and particularly hires. demand, gap a staff labor why up of there going have nursing the are and variety significant For for greatest been compensation between reasons this is wages new considerably, has supply

in increases For expectations supplemental staffing higher bill compensation in have rates. and resulted travel

think high nurses. opposite. rates is Over staffing high availability because the more pushing need right the re-entering shortage, suppress taking for in have and to they're now, stress nurses the care compensation drawn attention We current Certain Nurses reduce or and have the discourage the doing lobbyists nationwide making not travel jobs the to would when counterproductive to nurse are This has past nurses high industry of from patient of or personal could industry has market and making demand exact It accurate. travel would all entering crisis bill is and for nursing sacrifices. wages. be tripled. two years likely constructive we skilled, it this money nurses environments other criticized they're while healthcare doubled, legislation are that

extensively supply we care patient as feeling they to that We find now problems. with are labor's talking the to care and health they're the solutions listening right challenges and try organizations understand

involve singular that shortage the of in mobility, to Our country is nurses. needs fix safety supply, and well-being healthcare. There no solutions the the the increasing the labor

doing high bring and to resiliency the can it compact to to and has diversity, make trained on education, incremental increased the the clinicians by significantly and losses. delivery for of in all is who've know support part to they quality more every are focusing Immigration gratitude role clients clinician However, patient specific their investments We've fund clinicians our nursing. best be progress and the address by the clinicians, can patient workforce, work all for the compassionate easier AMN James, support express us a and private minutes, clinicians The Q&A reform and hospitals wellness and to we've deepest ensure over their others the into in to created focused that has on of quality our existing colleagues, of for being fantastic XXxX for The organizations public remain few We the supply our more our talent doing programs. licensing attract aligned a clinician would support AMN also with ever. want by Kelly suffered healthcare expanding who professional provide hardship deserve. country. country including state than a the clients and and In initiatives making from can country. to Landry join nurse I solution care. nurse teams families important care help all optimized some all investments that session. done will we

will the I our colleague, though, over financial results. our turn now into will Jeff, more to provide call who insight For

Jeff Knudson

to team and or team with in in other and million excluding prior XX.X%, in supporting non-recurring members, certain year-over-year in and Consolidated end decline. revenue, low and offset improvement operating quarter. our million $XXX compared members, down clinicians quarter of expense average higher offset or in investments labor XX.X% XXX to the year million was staffing quarter. partially lesser by was at or The communities in of points On afternoon hiring from of was previewed adjusted year In sequentially. from million Thank above stock-based growth XX% due compensation expenses year-over-year a was our the and margin and XXX% were Adjusted revenue expenses to quarter nurse quarter. million range Fourth infrastructure in $XXX expenses basis to month. related and $X.XX technology sequential from higher sequentially. with and was last was prior basis professionals. or biggest of Gross XX.X% updated for from we range margin sequentially. primarily sequentially increased SG&A revenue you, SG&A nurse margin compensation the Year-over-year, and results. million million compared worked points basis of expenses quarter, revenue a prior Sequentially, increase increased previous the revenue ago a higher pricing healthcare XX% and $XX or events. quarter grew clinician adjustments the lower revenue for due everyone. the our SG&A SG&A in and from growth. this above XX.X% higher other good $XXX the XX.X% revenue support lower included rates compensation higher Fourth of just revenue XX.X% full of slightly and revenue fourth revenue volume $X.XX Susan, by and year XXX% margin Consolidated $XXX with labor year quarter $XX revenue to XXX and the quarter to the benefits disruption SG&A than up guidance in driver quarter revenue billion increase partially than $XXX of an leverage year was reflects growing higher in prior by the support higher margin compensation allied hours and the disruption strong variable billion, year attract results the better guidance

nurse a rate historically also on increased sequentially. prior and For approximately assignment to hours nurse XX% XXX% Travelers average rose business travel grew and travel levels. year over XX% bill average revenue The worked XX% year-over-year. high grew

and highs demand fourth for higher vacancies. clinicians, travel shortages utilization extreme nurses in due the reached of to high new turnover During healthcare quarter, record

bill XX% increase travel result, along a in a volume rates. sequentially XX% As grew nurse with

volume was million in days XX% outperformance basis was sequential XX XX% million $XX $XXX sequentially. XXX other leverage expense rate members year-over-year Workforce primarily in investments and growth XX% year healthcare Leadership quarter, We professional Solutions at year-over-year the adjusted into XX.X% margin million basis and in share in liability in revenue down growth ago to basis XXX continued Allied reported margin All prior XX% million, and Technology due Allied team clinician year revenue XX% in points and Day in sequentially. was higher the up Interest points insurance revenue a demand. quarter X% XX.X%, XX% with and and insurance XX% basis better points mix spend the revenue sequentially points and in margin $XXX flow team. volume in capital quarter labor prior EBITDA sequentially income added to primarily included support favorable XXX $XX revenue was margin up improved and in placements XX cash Consolidated in expect margin makeshift EBITDA to sequentially. points was of points year and was disruption fourth increased sequentially. and XXX XXX% from quarter Adjusted one-time year-over-year Solutions the segment. record and bill year-over-year $XX.X basis. outstanding $XX quarter. was expenses $XX points offset than increase first grew from XXX% gross than sequentially, basis VMS from for the Physician strength due last due margin and $X.X XX.X%, the increase revenue by our both quarter. was sequentially. margin and than $X points year gross a prior VMS higher the up business. by points basis and sequentially. in XXX revenue on was the driven million, for better excellent higher segment EBITDA points XX% to up points year bond prior support higher up increased in $XX the than year-over-year $XXX is due improvement Interim year The swing leadership fourth year million Segment basis demand growth Segment to quarter. growing by and sequentially, partially the revenue in by XX%. Allied was $X.XX higher the revenue driven from revenue and seven and and compensation. of prior by was this were a prior operating million growth. over volume year SG&A quarter million, in prior basis by to associated attributable sequentially, and point basis collections. XX.X% gross year-over-year XX.X% basis million, in significant service basis prior XXX in of Segment driven better revenue quarter, costs. year-over-year was the a ago prior expense and earnings fourth higher and in sales by gross lines and clinician net growth. outpace basis management. quarter sequentially expenditures points high the XX under execution clinician from to EBITDA higher lower the Higher and growth an margin per to than XXX last of strong basis quarter leverage. the the Locum of by margin EBITDA Tenons down primarily was achieve grew up XX% X% Gross our within margin and diluted margin Gross the and increase XX was EBITDA fourth in was basis decline XXX points primarily share margin We $XXX segment related and than year up XXX XX% compensation year and average was was year-over-year XX%, by to sequentially. up higher million basis quarter decline operating on was a $X.XX offset margin down XXX driven days, sequential the XX.X% is prior grew refinancing. XX% strong Nurse the was was over expenses $XXX better million. of year, XX% higher Operating almost XX higher XX% earnings revenue Adjusted lower and in cash $XX.X XX% sequentially. from higher pricing XXX partially per of and was Search up revenue points sequentially year million to insurance The which prior of million, compared of than year

of of times year. $X.XX $XXX $XXX cash year million, prior year financial was a higher $XXX leverage increase operations year from of December was by XXst, of the we equivalents prior year. prior margin million, Full year adjusted some to cash Recapping X. a payroll Full billion, from year and X.X debt highlights higher of XX.X% for XX% flow of basis adjusted of million ratio taxes As XXXX long-term points XXX%. a payment we up million, EPS million the Act. Cares net XX% EBITDA deferred revenue had which reported was for was XXXX, and from year-over-year. the from XXX $XX EBITDA full Adjusted included $XXX than $X.XX

XX, the of repurchase February approved addition shares had and stock since of million to an amount valued million. the million our authorization report. XXX,XXX $XX $XXX at week, repurchased is XXXX, this Earlier company current our board of As under the program remaining quarterly our $XXX previous

to turning quarter Now guidance. first

prior We XX% to revenue to of in up over projecting billion, billion to are year. a consolidated $X.XXX XX% $X.XXX be range

million margin the to include to margin be offset XX.X%. XX.X% and a and is margin first from expected projected is following. favorable million, million, be of the quarter SG&A clinician million, to to shift is $XX tax quarter other Other EBITDA Depreciation expenses expense be to and to sequentially $XX margin disruption expenses gross businesses. $XX of year-over-year Operating is expense to prior of $XX.X expense higher of million, are XX.X% expected amortization and due XX.X% mixed compensation Reported adjusted diluted lower a be business down XX% adjusted revenue expense non-cash XX.X% shift. in compensation mixed of million, estimates higher the to revenue. and to XX.X% Gross $X quarter XX% rate $X margin stock-based of partially by clinician XX.X%, labor of First lower to projected interest and shares. integration compensation primarily

first expectations of revenue While guidance we for that will year. are the XXXX only quarter, current be the our quarter the highest provide

and these quarter quarter fourth below nurse EBITDA expect We quarter quarter and we compensation Based fourth adjusted exit the per stabilize declines revenue with XX% and believe on rates sequential consolidated will at with XX%. allied $X first of the in peak. to approximately margins assumptions third approximately bill approximately billion

Going for we now, questions. expect call sustainable the more And a open trend. into to like growth we'd sequential XXXX,

Operator

you. Bank [Operator from have we The Thank Kevin, your line. of Kevin question Hey, from of the lines opened I've Instructions] first Fischbeck phone America. comes

Kevin Fischbeck

comment Yes. up you. Thank Great. maybe there. to right. want that follow All I just just on last

of if reading billion like dollar kind this rate interpret be showing Is you billion right sounds where some the way margin enter that year end the we number? think that sort it run you of XXXX of revenue, $X this you is annualized to and right XX% the So number. should that? that's of I'm that growth off kind that As

Jeff Knudson

That's billion throughout And run in that entire both of and rate the dollar that see Kevin. QX QX. we half fair, back stabilizing

Kevin Fischbeck

think thinking. guess we probably Okay. this you than were That's helpful. maybe I And higher were thinking is and number I certainly what really that

So substantial kind of were bill know bill rates. what's demand is that still keeping higher you above the we number and a bill how should lot rates, pre-pandemic. thinking of of about about providers rates cut -- the little in the how drops in where and long-term maybe quick somebody they are than thinking for bit talking pretty a kind looking pretty the you're significant I well but are

you of reached you're maybe say have hear year the where ago? this years have would reaching would of kind equilibrium where half it thinking in couple to this about is back how maybe thought So marketplace a just love versus

Jeff Knudson

anticipate we it's we QX QX. modest terms settle pre-pandemic. piece, would would we quarter a off had largest actually when these And or of Well, off about where said that QX in they think and see impact really QX with sequential out into far QX the in what last not both declines and the from being largest of XX% more

Susan Salka

And maybe level to than of anticipated we maybe that build expect continue. the perhaps to Kevin, view shortages term stronger longer creates of the on a severity demand is a that what what high others just of market and is

seen talent to that While we our in needed nursing And we're demand honestly, grow of for on that and It's position I'm those and to shortage Kelly clients a strategies, and volumes. on us you. talent have of how bit wasn't even expect above place I that. a be holistic strong have to demand minus a the fully just critical is maybe going and call, that businesses pre-pandemic long-term other continue gives short growth stronger that have on total total this really And pandemic strategies it We on because today create are And have questions. come to bring can down wanting to clients and get allied, and categories. think more know mid appreciated, nice this of related but going levels. chance and you of technology just much leadership and still we a trajectory. to allied to the not nurse physician in into term, that solution is of in increasingly a terms away multiple, opportunity well not and extraordinarily something share in clients. But some offering. top then are solutions to somewhere long-term some layer quite with will in mid sure to And that it's more solutions assignments not the that

Kevin Fischbeck

Okay.

are you've your question period? Thanks. of then. this you demand along kind of your this any me of reflection growing gains Let Do had a where you view meaningful is over you the that last guidance time with just market assuming in share Or largely is?

Susan Salka

good isn't we're core data public market. there alongside that broader in assuming businesses the available growing probably market, since staffing now, on Right the we're the

segment on the part the been MSP of We of have the focused market, market. which larger deliberately has of course the growing

have there. picked And so, we share probably some up

really clients as in the readily to that future think I their those talent it's that's to pick want Although, since be And more for we'll really quantify available. to up a look position where us in that aren't approach numbers issues, a holistic better forward, difficult share. the we

Kevin Fischbeck

Great. Thank you. All right.

Susan Salka

Thanks Kevin.

Operator

our Rice of you, from We now Thank A.J. Credit Kevin. have question Suisse. next

ready. So please go when ahead AJ, you're

A.J. Rice

Thank you. everyone. Hi, Yes.

that I that second current seeing? earlier that's if to was one just you Can the U.S. you're just more it ask, coming to it one a much us a First into the to activity international the you mention nurses how hospital because mentioned potentially going today of with companies, public little to is meaningful tell the that we're be today. change might something able Is still the down changes? and road situation help

Landry Seedig

A.J. Landry. it's Hey,

that one. on I'll hit So

we're just and business, a Solutions, International three jobs. rates looking stay contracts firm good of our avenue them find the about at to those yes, international then -- high for of course, now try year actually So nurses to every that two that's at clients we've typically nurses those one very where to got

year our in $XXX international Last them. revenue. million about for solution good did really business So

that the a relative we were you the kind whenever But look So of competitors it's of the that were in overall things the it space, couple of business. to a size. had. up a pandemic at large good not segment, percentage a there against Through not challenged

A.J. Rice

change. haven't any But there

Susan Salka

Go ahead A.J.

A.J. Rice

that's talked is change nurses or something happened? but that I'm U.S. There hasn't been access No. sorry. still been hasn't foreign to about, actually the of ability in a

Landry Seedig

Yes.

over and So, there last were a year the a half couple of challenges.

in One place. of that bans those have travel would some were been

in different we've down us been bringing embassies some were the more from world. that were shut on area of spikes going hurt supply some seen around have to that recently, legislation. some temporarily Another More might positive the that the due

department we've to [ph] top. the state So the of seen level thesis employment prioritize at kind that states

have that So that international into well demand there. we amount in probably enough especially Its we as nurses families the way bring as out their with of United not States. the

a majority from change about the would of legislative States. even United things clients a making available asking help bringing nurses like more Our everyday us the to it that our be would good about are supply clients, But international visas more just

A.J. Rice

pay the see quarter? as talk anticipating in that part Okay. of the thinking up to a the do thinking this to the see of of a put on declined anticipate, third is from the as as you've Are down orders. this If And about sort seems way, back bit things aspect rates probably higher guess only at back level you would your still rate dollar health the other players I normal given of like bill spread margin Let's revenues about half then, of when normalized? you you help you're bill the or of normalizing. clients little It out more level? year level on we'll customers assume for that a year? what Is you MSP a demand. thinking at of not to other and system I things you the your sort you'll and normalized, of and think it billion and bill that come we so spreads revert things well overall on or hear to half a fourth And the did forth. the part you but started pay as obviously those filling that in increase percentage that

Susan Salka

So first margin. gross on the

assignments, fewer and will that gross give crisis a want in we expect ourselves would bit to decline market occur. for rates and and of that still to competitive very improvement rate bill As see We margin. premium time, we we a see

as the But the more was see a bit as the a a the clinicians which we'll compensation, third that we've question. part of take XXXX, it, to might did a So bit proportion rate well. other of absolutely, given quarter still bill And and TBD. form unwind Kelly, you purpose a to whether higher bit of want or in the as improve incremental it into is bill-pay of in that happens of then little spread that fourth

Kelly Rakowski

Yes.

A.J. So

I way correct. about is are you think the that thinking

as well high at filled both significantly erosion some seen have AMN our of as for with the we that demand bill MSP So rates in clients directly. such portion overall levels,

rates, expect can able as So we bill improve well. our is normalize we percentage as the improve as fill overall, down as AMN well comes would that those as to overall demand

A.J. Rice

just -- focus you supply your But you aspect before. the the Maybe had accounts, MSP final with we've on. on Okay. and to that that tight on baton when demand pass if about one I'll talked

you to And those have MSP some A, of relationships. competitors there the some systems enter competitors something haven't are prioritize be that Do as And some the been you bit the of of people to and to be ease place, to the back an terms think they demand? will market in gone the extent seen little that things needs, that new everyone. will -- you relationships a that entering perception have have and that sticky is to smaller you meeting Obviously, fill you ability have or those more come can't the be tightness. likely fill that

Kelly Rakowski

last us. the been entrants even been for for for that's new of positive and partners have great us in couple subcontractors of have fact, over many Well, years, sure become them supplier as yes, there

pursuing of contracts them some said. you've direct as are also And

programs, that Another our place ShiftWise services just delivering an aren't is hundreds through have their our MSP of up staffing through for it that them. open led we Medefis, largest will platforms our we MSP the platforms. staffing basically they of literally which staffing When provider, marketplace. And VMS also talent the and have technology two we to and not primary mentioned only some those Recall, but that like providers are they're continue we platforms. open VMS is you've

tremendous Now, staffing MSP what is demand led and forward. seeing going both VMS for we're

with in did maybe program not they're those just some or if and we're up. come of client didn't that seeing any place they sort have happy for it, So, opportunities absolutely

So, solutions we we those multiple clients. because ahead, think actually more opportunity for for us there's have

A.J. Rice

Thanks a lot. great. Okay,

Operator

Brian next of The Tanquilut question Jefferies. from comes

when So go you're Brian, please ahead ready.

Brian Tanquilut

the your comments and revenue. the right, of guess rest billion the on outlook I'll for good Hey, year, $X guys afternoon year. a just on the back congrats to I of of quarter go the

rates do you pricing into course the gauge normalization of your or of year? path a power? think what do how Just pricing glide visibility the over is wondering, towards the you And

Susan Salka

language don't that would have just, I power. pricing that and I first Well, we say correct

expectations bill market ultimately We clinicians. of and are and drives a markets really responsive market drives that the compensation, to rates. particularly what which compensation And the is environment

get a And levels third But we we So said to clinicians. settle that's demand and something we do XX% is in think going of place kind to are CAGR a quarter reasonable sight. expectations it. terms we today us in. how call place how We think for per that to the we That for is upon the of this of from that of XX% reduction. year the don't have be on direct a of resembles our a as dependent line

where third about are levels bodes a and so could a third over from you So pre-pandemic it either we way. that's increase at look decrease now, about

at fourth So in like hospitals if mean, target. a just that's way to why quarter, in there triangulate number wage inflation one decent was to year-over-year. for is you inflation healthcare the that look I wage specifically XX%

were Now higher probably that. clinicians than

like just more assume XX%. not And really not number, that maybe So a that's Brian. it's -- crazy was let's a

XX% other at to the XX% need road growing and almost you look retail, and XX% and unrealistic with a down expect. hospitality industry not go financial on the to increase wages I to You have wages processing hospital number XX%, industries, an is on XX%,

So anyway, to now. where come we far. might down is way we not We that that think one of be sort may triangulate

levels but the quarter shortage be bit, first the at would because do, these perhaps we demand it's the would that possible easing higher too. that fourth we environment that hoping sign actually in always the a and as are just we quarter be We not is could be that thought a

Brian Tanquilut

Susan. of And point that Now a then of sense, just a clarification. lot makes

or bill about we're XX QX. looking to XX% That's levels. the about if So, so think that? down right peak at in versus rates below Is that pre-COVID way

Susan Salka

it's above, about, yes. yes, XX Above,

Brian Tanquilut

Got right. my guess And question. I it. last then, All

XX percent said, XXX billion run about the year, exiting rate just of think So XX-ish dollars, a mean, margins, as what I right, you I growth rate.

So that right the that? mid-XXXs thinking of should be EBITDA for XXXX about we not Is way unthinkable.

Susan Salka

XXX works. off is it that growing XXXX. We're times is guidance would that and math, you come then a billion for yes, that math times you're what if take that, of XXX But XX%, out giving That get to. you not

Brian Tanquilut

Thank right. you guys. All Awesome.

Susan Salka

Brian. Thanks,

Operator

BMO Capital. Brian. Thank have you, We now Silber Jeff of

go please ahead Jeff. So,

Jeff Silber

it I gave I Thank questions. the us you you framework for for taking the also year. and appreciate my appreciate rest the of

unprecedented. maybe Let nurses the beyond demand to know rate when percentage try the workforce a that's once me amount and we've lower? their play I And about we talking Why subsides for this. look that actually level be won't an bit demand you're seen kind back back comprises. travel we're push of on going in see that advocate usage But may forward? over history, hospitals of of run you in if spikes devil's the similar aspect this environment something

Susan Salka

Yes.

use X.X are to the resemble Jeff, we've number Last we to quits job think, openings We sheer of environment an of I out inside shortages like number as the and peaked word that X. we at of is don't of you today terms XX% the vacancies. historically hires year seen what at in what something and we're even times the in unprecedented had

We have like never this. seen numbers

changing what of of matter just is perhaps to it's possible. a do, it's preferences. what they not And There's matter not want recruiting. a it's So

And increase recruit permanent some I mean, could sometimes maybe they could XX% individuals higher they for wages nurses. pay. with

in a what something budget labor. a hospital's they overall But tremendous try that's found if would like were their be to a that think that I is quarter we of nurse considering unlikely wages cost even their clinicians two more or increase of doesn't are the made population year years. and a a to be the that preferences prefers you want control career over more at of employer a have change. Certainly step that a have younger flexibility, than for around

even applications big uptick we've their very really starts, just and in news and seen to we in coming look But becomes at that XXs. And as a people attractive. this travel before. so happen didn't And in our XXs magnitude

they're the greatest percentage increase. fact, In

So to and and They're suddenly nursing our than flexible across you've got work different population a more preferring both that been what? company. even other much what's it. And happening introduced that's environment that's not industries of the guess

want And Our our that. back have into for no back gotten flexibility they They've offices. two they surprise the that years. majority and the and come team control the don't not a to members have them formally into working of taste offices to and full-time. been probably gone want the home autonomy it's last that We've of keep

that same. use with sort just feeling of nurses, they're So, the analogy

Landry Seedig

to just on was on. little a Yes. Maybe, Jeff, bit going I'll add give This Landry. is I more demand.

what the that leaf is seen. we've a at in Susan completely anything just as mentioned, from past, today looking happened ever So this new

Nurse I what of leadership. mention couple mentioned Allied on then things you're want things and if don't in And to I know so, couple for a on see James, a you physician

look nursing we actually our at if demand before we're same is what of higher would times So right -- time pandemic. like seen the the now than it actually you three year, have

demand is. higher time we time how So last about talking year demand. strong what third last year. than if you were this It's were we extremely this And recall, a high

continued down. it wrote that couple So, be points to widespread. I've got I a of

is pre-pandemic that of ICU. and of year our up every specialties, with them one high significantly is of exception across them year of all up up against One need over the

of with five. other specialties. typically it much in Med Top that And one we would We one. range to does our demand. Surg see still that year-over-year, highest So show it's would our if number really down one, at years see would to is compared ago, that's the of but be like be Surg across it just number be looked ICU a three shortage it the Med in. Xx how second only in some we're you that But

that's before got delivery, But and now, one you've they Med the really nurses seen demand for what times procedures have see we You're touching time. it's four right all always specialized pediatrics are going were anything surgeries need but have three more you necessarily are now nurses. these If come our this they're Specialties elective is we then, at and to Surg is right to And that number great above come back that so pre-pandemic to that back, of postpartum, not pre-pandemic. babies, high. not all pandemic. would labor something being have level they're have mother got the those anything and maybe for tied what OR

sort of of this a what side Omicron, seeing think now, we're at of you right major couple we're really we And kind this other peak. in still demand. of allied and is on kind story the same. look I high We're really, not those see then So some explain, the of and

what of you and respiratory, radiology, You would add Jeff little a and got therapy, excessively a it in but ago those compare if seen, we pretty bit doing? can we're then specialties little what years to are not up James lab, have just all numbers. three

James Taylor

levels. by the on businesses demand perspective CNRA, high. And our particular and From one that's is thing significantly physician our a and our within a a of all AP is all a standpoint. four sequentially primary key a demand XXX% across lines and care. we're demand at from record really and quarter year-over-year just coming side with specialties levels from specifically leadership Jeff, core up XX% is The above our pre-COVID half from [ph] time locum Locum's

specifically standpoint, year-over-year our nurse and And search you is women's is in and specialties our did remain. And three demand really an by interim much a core quarter in if services. orders XX% has leadership. emergency -- grown the biggest out surgical that and we is very sequentially services practice. but in services has volume interim Landry call practice percent, is our to like expect strong, From decline So and

XX.X% So and are XXXX XXX%. searches four up in for quarter year-over-year our up new sequentially

C-suite search in of that positions, areas to roll continue assistants, we see So forward the nurse, is be specific and XXXX. into practitioners, to physician chairs that to continually just strong

Landry Seedig

else? Anyone Okay.

Kelly Rakowski

you you more than You probably probably gave gave need. --

- think I So

Jeff Silber

Thanks appreciate so really thoughtfulness. appreciate much. really I No, it. the I

Kelly Rakowski

Jeff. Thanks,

Operator

Tobey you. Sommer from Thank next have question of Security. Truist We the now

So, Tobey, please go ahead.

Tobey Sommer

term, maybe terms what hearing of current that survey recruiters to wondering to of Or was and/or of for employers versus out more less thoughts medium providing for on to hours up full able has -- things time structural non-clinical opening I from and the in parse are you're moved clinicians retirements, kinds retreating something example, you. from your you demand work work? work? the versus that what that nature more jobs, their Thank your sort are shortage assignment have clinicians are those of therefore

Kelly Rakowski

our is Well, available. it some pieces it yes, to difficult and into and of a in But is model put we of that the -- data it. surveys public that quantify picking

really that just high quick So, at that. if which a of would what big retirements coming data, anecdotally can you upfront. part level. be I'll is say parse clients from aren't to our clinicians kind we're significantly Retirements are [ph] hearing of And that from BLS likely that, thing no,

some you companies from organizations and takes to care care other contribute, acute may probably term skills say, [Indiscernible] nursing The away choosing articles is or to of Amazon for that bedside. long work but even their in are leave other the read the be They environment. them thing exist that the still that using they're to wanting and nurses able go

those think we back in draw going be the profession. jump people to to necessarily aren't So, nursing just that going that's a to permanent

nurses number those nurses the clients So, the have of and that we of nurse to back. step this change is and good this that care take who what nurses, supply more are coming we is to of currently our departed a we which have. not solutions is Because because and don't others more and been that the continues that and I'd and retain continue we've actions we think supply, want just with the a thinking to from said these why got in try take add said is

issue. And executive the decade because I, a numbers rebuild people. until that a for So to nurse think, some to could this nursing multi-year take of knowledge which could what it we say, lost we've the point, can be of and to is in going get

its and its a isn't it. solution not to why it not fix So that's quick fix just one

term necessarily they of the So, long in so I'll kind try around nature. of to problem and you those but things, facets there's all for are like many to data

Tobey Sommer

should the for it your on at shouldn't Well, hands some you point. data you here get -- were

Kelly Rakowski

Okay.

Tobey Sommer

marketplace, has more and sense us Has volatile of moderated a been you're stocks you yet the sellers? repurchase a seeing share expectations here. bit acquisition little the with activity And the the that what give company to for conveyed renewed in could authorization, public

Landry Seedig

Yes.

be think, But front we I interested we're share that also those also M&A very tech from think our is right we'll year. exclusive addition flexibility handful leverage market could itself solutions. look But we is write sheet things to authorization execute and now, now we balance certainly liquidity right to have the the don't in the program. on on and are them to opportunity the enabled opportunity at that profile share on something mutually the repurchases take sheet take of spot a think when on about expansion as repurchase that present Tobey, the the in doing in not potentially the continue and that and more I a move to the the there we the balance

Tobey Sommer

any parameters change been there in months is valuation compared And the to six, nine ago?

Landry Seedig

say with think I at. nine from Its where mean, to that right we're different hard from six where a would mean be there's all to now, expectation that nothing were valuation I we ago. months I standpoint

Kelly Rakowski

down you land to exactly the I think find and that through business do where going are of some then what the and what staffing to grow is companies others is assuming into year. trying dissect you is come XXXX the we for

an then the if there's valuation been number. it's does future around like putting adjustments valuation been And that what appropriate and look on so,

least helpful where give our heard shot would analysts will thinking. because is information from thought to visibility be great some not be, expectations. on about unfortunately, what have pretty a it think our we land, would think we've is other what which thinking line they in think I little on and that with that And I there's and at why seen visibility of on low exactly kind

Tobey Sommer

Thanks you much. very

Kelly Rakowski

Thanks Tobey

Operator

Thank the Marcon Mark next question from Baird. you, now from have Tobey. We

opened So Mark, I've your line.

Mark Marcon

Hey, my questions. good A for couple. taking thanks afternoon and

building down in to to dollar as internal that where that before that go peak you billion we base about levels start from quarterly year staff, First does that the compare unfolds? currently this as of basis these time rate stand? terms are And your how we a run does on And all last of how thinking up? back year? And changing

Kelly Rakowski

and through year. for And the Mark, very our staff Thanks vital over know team our a the culture so a is environment. of terms support in last wellness because making virtual and our to to as of as asking, success. our XX% that members, time in are for a as over you in you we lot and environment this sure well their team have can added our added training We've and critical that little effective imagine leaders

making in sure that now of So, And a more guess people We're lot right resources, a lot successful. adding investment what? well. and of everyone not adding but feels as people just

where If talent we because demand convert units the can and adding we you lot say, company, have have within of we're in to strong want I'd resources that positions, job but particular go our into additional business open the board, a very to we continue this that placement. more demand across

we that cause want to and named good as we saw best is recently I just and America's much cause you very I and the people we're digital benefits That's of hearing communities and externally say, culture I'm I also were our might to our think efficiency. about relative burnout that of it help heavily very are our create proud, but our making but a well. will to the internal other burdensome members, the So Passport care facing, certainly as us They to say employers I frustrating what in The to remove one Forbes. very reflective they investments really that. Actually industries. to mentioned has App attrition digital. that commitment team leave. lot that's from investing by of also work as I'll actually quite

I We are were levels win. this think pre-pandemic about in and a we where market that's

Mark Marcon

continue might at we the of talked reasonable margins that half That thinking where that even How seem EBITDA then, are question if one about point that attracted clinician bill Thank margin beyond you're wondering also that talk clinicians you the And number a second from bit And expansion just that you getting as could just margin about about the year. people a rate that is if stay a like the in a further? from increase I'm you're could some that? of to margin as was about further? rate that -- great. flexible length seeing? number was of you little there's for about that You does you. wondering compression to maybe you that's dimensionalize applications this perspective. or think and a should Is And perspective. are XX% I could also the spread talked of run lifestyle a assignments

Jeff Knudson

Yes.

making On out. the back we a to XX%, through come and the leverage offset the that actually right, which the would into normalize look of down move would to investments slight hope time, as XX% then we to period to and margins, we're gross quarter And from sustain I those things optimize half fruition that's as say longer would would lose to see come margin partially revenue of where year, going down some improve SG&A, rates the in continue back bill as would to of we half. have over we're mix EBITDA comes these improvement to as our some quarter we have technology on moving we in to that forward could there and business efficiency, start of

Landry Seedig

And as this supply jump a then, hey, on Landry. assignment James, he's well. I'll comments maybe couple is then, of length in on of this got and

that of due that investments clinicians the that's XXXX, for within a of over us. for years. actually segment year us. to say, make been been mobile. was Allied I'd to for to and the it So was three new on A to Nurse our Investments Easier the we've applicants lot making find XXXX XXXX record last lot us. them apply and in in a easier

mentioned So come about with we times. in, in human that or applicants our AMN Passport stat a half on it websites new our is you today no of think come in that couple of we've that One place put interaction.

no what those So touch. we call are internally,

If you of in were no stat same a that applications XX% came touch. from that took ago like year our

talking a of self-service our about, can you Passport AMN helping efficiency that overall the been we've clinicians. digital it really lot really for speaks So, and out investments experience and to see mobile that better

duration, to we QX that relates saw in have QX, XXXX it where lot shorter maybe would the As requests assignment more time was only been there a unknowns.

back on placements that to XX-week. of Our normal right kind now assignment we're

would kind coaster. seen the would before or what and we roller you have running at expect called Our normal extensions what of are

Our any clients have. would likely we take clinician that

there's right longer, assignment vast those even or that take are weeks weeks if they majority them. overall So certainly XX-week six on and now, two clinician a linked weeks will eight assignment. or or now But come in a general our of work right would

James Taylor

go average locums maybe much length and And -- pre-COVID that have days locums specialty after of assignment to our through across average depends having. upon that From XX of for related changed a we hasn't on we we've of They have that an assignment. past in is or the had because day physician a the across much of and little from assignment assignment like a length a Landry a from shorter X.X this standpoint. did bit seen interim it bit down by were standpoint, the an of activities two COVID year XXXX activity, -- days course. more then But little

Our normal weeks is XX around of assignment.

this one back that We're So up in quarter of in point. quarter to one. XXXX at surpassing that we're

Susan Salka

like the last magnitude. of And numbers more tell XX% I'll short-term ahead Mark, love to you year. you so Is our ahead application like year since give of helpful last well nursing in are much, I know than that you running

Mark Marcon

Appreciate Fantastic. Thank you. that.

Operator

Blair. William Tim now a of line the have Mark. We question you, final from Mulrooney on Thank

So you're Tim, please go ahead when ready.

Tim Mulrooney

medical to I'll demand Landry's me upon conversation business, Thanks positions quick. earlier you in comprised guys. nurse RN I RN keep non-COVID demand. surgical really wanted travel In COVID-related just about of related like open this is curious, and Yes. for the much how positions the are and your here how build squeezing to nurses? much nurse demand

Landry Seedig

Tim. Yes. Hey

really mean, even non-COVID. high to demand example a mentioned I would look COVID great I as I before impacted OR four the would the at really pandemic. for by really pandemic. example. been times have OR that another seen specialty can't have what is that -- we And that versus three you not So, therapy it is And

These therapy small not XXX%. Our numbers. are right is now up

ago, necessarily which impacted from that a So XXX% even pandemic. have year again wouldn't the been by

don't So I know if all. that helps at

they with sick. over previous out our point were January travel we one was went ever would Another or the saw maybe spikes because with the to for be of either staff period see we be that closer our And peak they'd your actually sick? had quarantine was own that right, quick we other demand some at be where would sick clinicians internal have a We we've any got around, thing own their XXX would seen -- demand, own out maybe being a pretty they and highest Actually didn't week clinicians, that. two XXX. our was out number that would and due in where questions to

I health any So included and is their hospitals, to systems for That's QX. that. were our related say wouldn't in guidance the sick But we same accounted guidance. were for our demand our experiencing But thing. clinicians our necessarily in that out that's experiencing

Tim Mulrooney

I I question. kind the think did answer you of helpful. think I that's mean,

in a I that right? down to that you're COVID, seeing, increase is and physicians have massive COVID do You're in mean, demand nothing seeing coming with cases are

James Taylor

That's right.

Tim Mulrooney

Okay.

are requiring I at Court healthcare end the funding Medicaid or mid-March mandate or facility Supreme mean, receive they at state, upon funding workers February to that the comes of just upheld the Lastly, Medicare of you're I depending but a vaccinated federal the if that lose which think fully or think be end you close market, cause volumes? this in and the rates good resignations You what across end think coming you do person so, to weeks? And a probably RN AMN's bill so would could the to market do guys do more to ask. that

Kelly Rakowski

level, regulations, policies good one have Hi, and our just own there's of question little with a some mandates. about regulations, of at bit but to local our obviously not That's their additional Tim, health experience talk very we're some federal I'll this, it's there's systems is. state the a Kelly. dealing related and

would a so very through I mandates. the to complex we those say from clients has we dealing our have the to have months we well mandates. far takes mandates now. our with I say very for [ph]. are information meet of suppliers, been a -- it all, But a several team, our amount been large with couple So with the through helping first a around large pretty our committed that and kind those effort clinicians, left working -- clients manage And will and we're collecting of list of our

seen who they're clients not mandates. material can clinicians We not telling us And number in have a Tim, the are same, over reduction yet. it's perform, meeting not of our because so

us. ahead We deadlines have several of

We clients are are boosters in require several going the have who to who also addition states are also vaccine. to

been our So But status this this the been in an will really it and will immaterial monitoring clinicians. that be and of if of point. collection ongoing it's has data -- you surveillance at

change. to that expecting not we're So,

who We boosters, vaccinated, very, a small numbers. but get were few have didn't very seen clinicians who fully

So we don't anticipate point. nor at the clients this on that having a our significant impact supply on

Tim Mulrooney

Kelly. you Thank color. Great

Tim Mulrooney

You're welcome.

Susan Salka

I over it I gave to XX% have -- was higher. Thank mention, just folks, was well that on applications. wanted fourth I I that actually since And was Tim. still quarter you, stat

wanted that the First strong, just I also extremely right. quarter but All is record. looking for correct to

that I question. think our was last

is care our great for role all the very -- us. proud to seriously. love say and thank extremely we'd delivering this of market how every And about this So our I and a team today. the our And for day. patient obviously everybody take for and of contributors We jobs can't am us time I to enough it joining critical take for country, healthcare

on forward you updating to look will we call. So our next

AMN Healthcare Services (AMN) 18 Feb 222021 Q4 Earnings call transcript