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Selling, general and administrative

$ 526,842

$ 494,406

$ 1,607,439

$ 1,479,378

Cost of revenue

351,695

334,867

1,083,512

997,051

Gross profit

175,147

159,539

523,927

482,327

Operating expenses:

121,216

100,579

341,488

299,325

Depreciation and amortization

11,296

8,132

29,788

23,759

^[1]

Total operating expenses

132,512

108,711

371,276

323,084

Income from operations

42,635

50,828

152,651

159,243

Interest expense, net, and other

4,649

4,837

16,360

14,895

Income before income taxes

37,986

45,991

136,291

144,348

Income tax expense

10,068

17,863

30,163

52,957

Net income

27,918

28,128

106,128

91,391

^[1]

Other comprehensive income (loss):

Foreign currency translation and other

133

(73)

205

(111)

Cash flow hedge, net of income taxes

(15)

Other comprehensive income (loss)

133

(73)

205

(126)

Comprehensive income

$ 28,051

$ 28,055

$ 106,333

$ 91,265

Net income per common share:

Basic (in dollars per share)

$ 0.59

$ 2.23

$ 1.91

Diluted (in dollars per share)

$ 0.58

$ 0.57

$ 2.17

$ 1.85

Weighted average common shares outstanding:

Basic (shares)

47,286

47,912

47,556

47,870

Diluted (shares)

48,529

49,445

48,859

49,480

[1]	See Note (1) for a summary of adjustments.

Condensed Consolidated Statements of Cash Flows - USD ($)
$ in Thousands

9 Months Ended

Sep. 30, 2018

Sep. 30, 2017

^[1]

Adjustments to reconcile net income to net cash provided by operating activities:

Net income

$ 106,128

$ 91,391

Depreciation and amortization

29,788

23,759

Non-cash interest expense and other

591

1,718

Write-off of fees on the prior credit facilities

574

Change in fair value of contingent consideration

(1,307)

Increase in allowances for doubtful accounts and sales credits

6,240

9,012

Provision for deferred income taxes

(2,384)

(9,512)

Share-based compensation

7,954

7,720

Loss on disposal or sale of fixed assets

130

Amortization of discount on investments

(78)

(112)

Changes in assets and liabilities, net of effects from acquisitions:

Accounts receivable

743

(10,631)

Accounts receivable, subcontractor

(3,879)

12,033

Income taxes receivable

12,997

(1,854)

Prepaid expenses

2,334

(1,643)

Accounts payable and accrued expenses

446

6,100

Other assets

(1,019)

(5,204)

7,311

(20,442)

Accrued compensation and benefits

11,014

3,991

Other liabilities

(10,423)

(5,112)

Deferred revenue

1,062

678

Restricted investments balance

(86)

Cash flows from investing activities:

168,046

102,096

Purchase and development of fixed assets

(23,922)

(17,168)

Purchase of investments

(27,185)

(11,021)

Proceeds from maturity of investments

10,400

17,200

Payments to fund deferred compensation plan

(7,800)

(10,056)

Equity investment

(4,600)

(2,000)

Cash paid for acquisitions, net of cash received

217,361

Cash paid for other intangibles

(1,180)

Cash paid for working capital adjustments and holdback liability for prior year acquisitions

(1,000)

Cash flows from financing activities:

(271,648)

(24,045)

Payments on term loans

(44,063)

Payments on revolving credit facility

(45,000)

Proceeds from revolving credit facility

195,000

Repurchase of common stock

(52,750)

(7,097)

Payment of financing costs

(2,331)

Earn-out payments for prior acquisitions

(1,713)

(3,677)

Proceeds from termination of derivative contract

Cash paid for shares withheld for taxes

(11,432)

(9,072)

Net cash provided by (used in) financing activities

81,774

(63,824)

Effect of exchange rate changes on cash

205

(111)

Net increase (decrease) in cash, cash equivalents and restricted cash

(21,623)

14,116

Cash, cash equivalents and restricted cash at the beginning of period

98,894

51,028

Cash, cash equivalents and restricted cash at the end of period

77,271

65,144

Supplemental disclosures of cash flow information:

Cash paid for interest (net of $368 and $113 capitalized for the nine months ended September 30, 2018 and 2017, respectively)

11,521

9,395

Cash paid for income taxes

21,223

65,998

Acquisitions:

Fair value of tangible assets acquired in acquisitions, net of cash received

24,027

97,703

122,111

(16,380)

(10,100)

Supplemental disclosures of non-cash investing and financing activities:

Purchase of fixed assets recorded in accounts payable and accrued expenses

$ 4,504

$ 3,156

[1]	See Note (1) for a summary of adjustments.

Condensed Consolidated Statements of Cash Flows (Parenthetical) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017
Statement of Cash Flows [Abstract]
Interest capitalized	$ 368	$ 113

Basis of Presentation

9 Months Ended

Sep. 30, 2018

Organization, Consolidation and Presentation of Financial Statements [Abstract]

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, 2017, contained in the Company’s Annual Report on Form 10-K for the fiscal year ended December 31, 2017, filed with the Securities and Exchange Commission on February 16, 2018 (“2017 Annual Report”).

The preparation of financial statements in conformity with 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 asset impairments, accruals for self-insurance, compensation and related benefits, accounts receivable, contingencies and litigation, earn-out liabilities, and income taxes. Actual results could differ from those estimates under different assumptions or conditions.

Recently Adopted Accounting Pronouncements

In May 2014, the Financial Accounting Standards Board (“FASB”) issued Accounting Standard Update ("ASU") 2014-09, Revenue from Contracts with Customers (Topic 606).” The FASB also issued a series of other ASUs, which update ASU 2014-09 (collectively, the “new revenue recognition standard”). This new standard replaces all previous U.S. GAAP guidance on this topic and eliminates all industry-specific guidance. The new revenue recognition standard provides a unified model to determine when and how revenue is recognized. The core principle is that a company should recognize revenue to depict the transfer of promised goods or services to customers in an amount that reflects the consideration for which the entity expects to be entitled in exchange for those goods or services. The Company adopted this standard effective January 1, 2018, using the modified retrospective transition method applied to those contracts which were not completed as of that date. Revenue from substantially all of our contracts with customers continues to be recognized over time as services are rendered. The Company recognized the cumulative effect of adopting this guidance as an adjustment to its opening balance of retained earnings of $2,089, net of tax, primarily related to capitalization of contract costs. Prior period amounts are not retrospectively adjusted and continue to be reported in accordance with the accounting standards in effect for those periods. The impact of the adoption of the new standard was not material to the Company’s condensed consolidated financial statements for the three and nine months ended September 30, 2018. The Company expects the impact to be immaterial on an ongoing basis. See additional information regarding revenue recognition and disaggregated revenue in Note (3), “Revenue Recognition” and Note (5), “Segment Information,” respectively.

In January 2016, the FASB issued ASU 2016-01, “Financial Instruments—Overall (Subtopic 825-10), Recognition and Measurement of Financial Assets and Financial Liabilities.” The FASB also subsequently issued ASU 2018-03, which provides amendments to ASU 2016-01. These standards require equity investments, except those accounted for using the equity method of accounting, to be measured at fair value with changes in fair value recognized through net income. The new guidance also provides a measurement alternative for equity investments that do not have readily determinable fair values, which were previously accounted for under the cost method of accounting, to be recorded at cost, less impairment, adjusted for observable price changes from orderly transactions for identical or similar investments of the same issuer. For public entities, these standards are effective for fiscal years beginning after December 15, 2017, and interim periods within those annual periods. The Company adopted the standards prospectively effective January 1, 2018 and elected to use the measurement alternative. See additional information in Note (7), “Fair Value Measurement.”

In August 2016, the FASB issued ASU 2016-15, “Statement of Cash Flows (Topic 230): Classification of Certain Cash Receipts and Cash Payments.” The standard provides guidance on how certain cash receipts and payments are presented and classified in the statement of cash flows. For public entities, ASU 2016-15 is effective for fiscal years beginning after December 15, 2017, and interim periods within those annual periods, and requires a retrospective approach. The Company adopted this standard effective January 1, 2018 and the adoption did not have a material effect on the Company’s consolidated financial statements.

In November 2016, the FASB issued ASU 2016-18, “Statement of Cash Flows (Topic 230): Restricted Cash.” The standard requires that a statement of cash flows explains the change during the period in the total of cash, cash equivalents, and amounts generally described as restricted cash or restricted cash equivalents (collectively, “restricted cash”). Therefore, restricted cash should be included with cash and cash equivalents when reconciling the beginning-of-period and end-of-period total amounts shown on the statement of cash flows. The new guidance is effective for interim and annual periods beginning after December 15, 2017. The Company adopted this standard retrospectively effective January 1, 2018 and included certain restricted cash amounts for the period ended September 30, 2017 within the accompanying condensed consolidated statements of cash flows. These adjustments had no effect on previously reported results of operations or retained earnings. The following table provides a summary of the adjustments from amounts previously reported.



	Nine Months Ended September 30, 2017
	As Previously Reported			Adjustments			As Adjusted
Cash flows from operating activities:
Changes in assets and liabilities:
Other current assets	10,155			(4,055		)	6,100
Restricted cash, cash equivalents and investments balance	(9,761		)	9,769			8
Net cash provided by operating activities	96,382			5,714			102,096

Cash flows from investing activities
Change in restricted cash, cash equivalents and investments balance	601			(601		)	—
Net cash used in investing activities	(23,444		)	(601		)	(24,045		)

Net increase in cash, cash equivalents and restricted cash	$	9,003		$	5,113		$	14,116
Cash, cash equivalents and restricted cash at the beginning of period	10,622			40,406			51,028
Cash, cash equivalents and restricted cash at the end of period	$	19,625		$	45,519		$	65,144

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.



	September 30, 2018			December 31, 2017
Cash and cash equivalents	$	18,614		$	15,147
Restricted cash and cash equivalents (included in other current assets)	22,227			25,506
Restricted cash, cash equivalents and investments	59,453			64,315
Total cash, cash equivalents and restricted cash and investments	100,294			104,968
Less restricted investments	(23,023		)	(6,074		)
Total cash, cash equivalents and restricted cash	$	77,271		$	98,894

There were no other material impacts to the Company's consolidated financial statements as a result of adopting these updated standards.

Reclassification

To conform to the current year presentation, certain reclassifications that are not material have been made to the prior year's balances in Note (10), “Balance Sheet Details."

Acquisitions	9 Months Ended
Acquisitions	Sep. 30, 2018
Business Combinations [Abstract]
ACQUISITIONS	As set forth below, the Company completed two acquisitions during the nine months ended September 30, 2018. The Company accounted for each acquisition using the acquisition method of accounting. Accordingly, it recorded the tangible and intangible assets acquired and liabilities assumed at their estimated fair values as of the applicable date of acquisition. For each acquisition, the Company did not incur any material acquisition-related costs. MedPartners Acquisition On April 9, 2018, the Company completed its acquisition of MedPartners HIM (“MedPartners”), which provides case management, clinical documentation improvement, medical coding and registry services to hospitals and physician medical groups nationwide. The initial purchase price of $200,711 included (1) $196,533 cash consideration paid upon acquisition, funded through borrowings under the Company’s $400,000 secured revolving credit facility (the “Senior Credit Facility”), provided for under a credit agreement (the “New Credit Agreement”), dated as of February 9, 2018, by and among the Company and several lenders, and (2) a contingent earn-out payment of up to $20,000 with an estimated fair value of $4,400 as of the acquisition date. The contingent earn-out payment is based on (A) up to $10,000 based on the operating results of MedPartners for the twelve months ending December 31, 2018, and (B) up to $10,000 based on the operating results of MedPartners for the six months ending June 30, 2019. As the acquisition’s operations are not considered material, pro forma information is not provided. The results of MedPartners have been included in the Company’s other workforce solutions segment since the date of acquisition. During the third quarter of 2018, $222 was returned to the Company for the final working capital settlement. The preliminary allocation of the $200,711 purchase price consisted of (1) $28,425 of fair value of tangible assets acquired, which included $8,403 cash received, (2) $11,809 of liabilities assumed, (3) $103,000 of identified intangible assets, and (4) $81,095 of goodwill, all of which is deductible for tax purposes. The fair value of intangible assets includes $46,000 of trademarks and $57,000 of customer relationships with a weighted average useful life of approximately sixteen years. Phillips DiPisa and Leaders For Today Acquisition On April 6, 2018, the Company completed its acquisition of two related entities, Phillips DiPisa and Leaders For Today (“PDA and LFT”), which offer a range of leadership staffing and permanent placement solutions for the healthcare industry. The initial purchase price of $35,503 included (1) $30,268 cash consideration paid upon acquisition, funded through cash on hand, and (2) a contingent earn-out payment of up to $7,000 with an estimated fair value of $5,700 as of the acquisition date. The contingent earn-out payment is based on the operating results of PDA and LFT for the twelve months ending December 31, 2018. As the acquisition’s operations are not considered material, pro forma information is not provided. The results of PDA and LFT have been included in the Company’s other workforce solutions segment since the date of acquisition. During the third quarter of 2018, $465 was returned to the Company for the final working capital settlement. The preliminary allocation of the $35,503 purchase price consisted of (1) $4,356 of fair value of tangible assets acquired, which included $351 cash received, (2) $4,571 of liabilities assumed, (3) $19,110 of identified intangible assets, and (4) $16,608 of goodwill, all of which is deductible for tax purposes. The fair value of intangible assets includes $5,400 of trademarks, $8,000 of customer relationships and $5,710 of staffing databases with a weighted average useful life of approximately twelve years.

Revenue Recognition

9 Months Ended

Sep. 30, 2018

Revenue Recognition and Deferred Revenue [Abstract]

Revenue Recognition

REVENUE RECOGNITION

Revenue primarily consists of fees earned from the temporary and permanent placement of healthcare professionals and executives as well as from the Company’s SaaS-based technology, including its vendor management systems and its scheduling software. Revenue is recognized when control of these services is transferred to the customers, in an amount that reflects the consideration the Company expects to be entitled to in exchange for those services. Revenue from temporary staffing services is recognized as the services are rendered by clinical and non-clinical healthcare professionals. Under the Company’s managed services program arrangements, the Company manages all or a part of a customer’s supplemental workforce needs utilizing its own network of healthcare professionals along with those of third-party subcontractors. Revenue and the related direct costs under MSP arrangements are recorded in accordance with the accounting guidance on reporting revenue gross as a principal versus net as an agent. When the Company uses subcontractors and acts as an agent, revenue is recorded net of the related subcontractor’s expense. Revenue from executive search, physician permanent placement, and recruitment process outsourcing services is recognized as the services are rendered. The Company’s SaaS-based revenue is recognized ratably over the applicable arrangement’s service period.

The Company’s customers are primarily billed as services are rendered. Any fees billed in advance of being earned are recorded as deferred revenue. During the nine months ended September 30, 2018, the amount recognized as revenue that was previously deferred was not material.

Under the new revenue recognition standard, the Company has elected to apply the following practical expedients and optional exemptions:


•	Recognize incremental costs of obtaining a contract with amortization periods of one year or less as expense when incurred. These costs are recorded within selling, general and administrative expenses.


•	Recognize revenue in the amount of consideration to which the Company has a right to invoice the customer if that amount corresponds directly with the value to the customer of the Company’s services completed to date.

•

Exemptions from disclosing the value of unsatisfied performance obligations for (i) contracts with an original expected length of one year or less, (ii) contracts for which revenue is recognized in the amount of consideration to which the Company has a right to invoice for services performed and (iii) contracts for which variable consideration is allocated entirely to a wholly unsatisfied performance obligation or to a wholly unsatisfied promise to transfer a distinct service that forms part of a single performance obligation.

See additional information regarding adoption of the new revenue standard in Note (1), “Basis of Presentation” and additional disclosures required by the new revenue standard in Note (5), “Segment Information.”

Net Income Per Common Share

9 Months Ended

Sep. 30, 2018

Earnings Per Share [Abstract]

NET INCOME PER COMMON SHARE

Basic net income per common share is calculated by dividing net income by the weighted average number of common shares outstanding during the reporting period. The following table sets forth the computation of basic and diluted net income per common share for the three and nine months ended September 30, 2018 and 2017, respectively:



	Three Months Ended September 30,				Nine Months Ended September 30,
	2018		2017		2018		2017
Net income	$	27,918	$	28,128	$	106,128	$	91,391

Net income per common share - basic	$	0.59	$	0.59	$	2.23	$	1.91
Net income per common share - diluted	$	0.58	$	0.57	$	2.17	$	1.85

Weighted average common shares outstanding - basic	47,286		47,912		47,556		47,870
Plus dilutive effect of potential common shares	1,243		1,533		1,303		1,610
Weighted average common shares outstanding - diluted	48,529		49,445		48,859		49,480

Share-based awards to purchase 36 and 27 shares of common stock were not included in the above calculation of diluted net income per common share for the three and nine months ended September 30, 2018, respectively, because the effect of these instruments was anti-dilutive. Share-based awards to purchase 10 and 14 shares of common stock were not included in the above calculation of diluted net income per common share for the three and nine months ended September 30, 2017, respectively, because the effect of these instruments was anti-dilutive.

Segment Information

9 Months Ended

Sep. 30, 2018

Segment Reporting [Abstract]

SEGMENT INFORMATION

The Company has three reportable segments: nurse and allied solutions, locum tenens solutions, and other workforce solutions.

The Company’s chief operating decision maker relies on internal management reporting processes that provide revenue and operating income by reportable segment for making financial decisions and allocating resources. Segment operating income represents income before income taxes plus depreciation, amortization of intangible assets, share-based compensation, interest expense, net, and other, and unallocated corporate overhead. The Company’s management does not evaluate, manage or measure performance of segments using asset information; accordingly, asset information by segment is not prepared or disclosed.

The following table provides a reconciliation of revenue and operating income by reportable segment to consolidated results and was derived from each segment’s internal financial information as used for corporate management purposes:



	Three Months Ended September 30,				Nine Months Ended September 30,
	2018		2017		2018		2017
Revenue
Nurse and allied solutions	$	306,292	$	302,933	$	977,199	$	917,183
Locum tenens solutions	101,102		111,415		311,516		322,473
Other workforce solutions	119,448		80,058		318,724		239,722
	$	526,842	$	494,406	$	1,607,439	$	1,479,378
Segment operating income
Nurse and allied solutions	$	42,165	$	40,807	$	137,906	$	134,638
Locum tenens solutions	10,992		14,438		34,321		39,028
Other workforce solutions	29,010		19,890		77,437		61,788
	82,167		75,135		249,664		235,454
Unallocated corporate overhead	26,427		13,698		59,271		44,732
Depreciation and amortization	11,296		8,132		29,788		23,759
Share-based compensation	1,809		2,477		7,954		7,720
Interest expense, net, and other	4,649		4,837		16,360		14,895
Income before income taxes	$	37,986	$	45,991	$	136,291	$	144,348

The Company offers a comprehensive managed services program, in which the Company manages all or a portion of a client's contingent staffing needs. This service includes both the placement of the Company's own healthcare professionals and the utilization of other staffing agencies to fulfill the client's staffing needs. See additional information in Note (3), “Revenue Recognition.” For the three months ended September 30, 2018 and 2017, revenue under the Company’s managed services program arrangements comprised approximately 61% and 59% for nurse and allied solutions revenue, 17% and 13% for locum tenens solutions revenue and 5% and 7% for other workforce solutions revenue, respectively. For the nine months ended September 30, 2018 and 2017, revenue under the Company’s managed services program arrangements comprised approximately 60% and 57% for nurse and allied solutions revenue, 16% and 12% for locum tenens solutions revenue and 7% and 7% for other workforce solutions revenue, respectively.

The following table summarizes the activity related to the carrying value of goodwill by reportable segment:



	Nurse and Allied Solutions		Locum Tenens Solutions		Other Workforce Solutions		Total
Balance, January 1, 2018	$	103,107	$	19,743	$	217,746	$	340,596
Goodwill from MedPartners acquisition	—		—		81,095		81,095
Goodwill from PDA and LFT acquisition	—		—		16,608		16,608
Balance, September 30, 2018	$	103,107	$	19,743	$	315,449	$	438,299
Accumulated impairment loss as of December 31, 2017 and September 30, 2018	$	154,444	$	53,940	$	6,555	$	214,939

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

Fair Value Measurement

9 Months Ended

Sep. 30, 2018

Fair Value Disclosures [Abstract]

FAIR VALUE MEASUREMENT

The Company’s valuation techniques and inputs used to measure fair value and the definition of the three levels (Level 1, Level 2, and Level 3) of the fair value hierarchy are disclosed in Part II, Item 8, “Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note 4—Fair Value Measurement” of the 2017 Annual Report. The Company has not changed the valuation techniques or inputs it uses for its fair value measurement, except for its adoption of ASU 2016-01, “Financial Instruments—Overall (Subtopic 825-10), Recognition and Measurement of Financial Assets and Financial Liabilities," during the nine months ended September 30, 2018. See additional information regarding adoption of the new standard in Note (1), “Basis of Presentation” and additional disclosures below.

Assets and Liabilities Measured on a Recurring Basis

The Company’s restricted cash equivalents that serve as collateral for the Company’s outstanding letters of credit

typically consist of money market funds that are measured at fair value based on quoted prices, which are Level 1 inputs.

The Company’s restricted cash equivalents and investments that serve as collateral for the Company’s captive insurance company primarily consist of commercial paper that is measured at observable market prices for identical securities that are traded in less active markets, which are Level 2 inputs. Of the $61,567 commercial paper issued and outstanding as of September 30, 2018, $23,023 had original maturities greater than three months, which were considered available-for-sale securities. As of December 31, 2017, the Company had $28,708 commercial paper issued and outstanding, of which $6,074 had original maturities greater than three months and were considered available-for-sale securities. The increase in commercial paper issued and outstanding is due to additional restricted investments related to the captive insurance company.

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 September 30, 2018
	Total			Quoted Prices in Active Markets for Identical Assets (Level 1)		Significant Other Observable Inputs (Level 2)		Significant Unobservable Inputs (Level 3)
Money market funds	$	2,739		$	2,739	$	—	$	—
Commercial paper	61,567			—		61,567		—
Acquisition contingent consideration liabilities	(8,793		)	—		—		(8,793		)



	Fair Value Measurements as of December 31, 2017
	Total			Quoted Prices in Active Markets for Identical Assets (Level 1)		Significant Other Observable Inputs (Level 2)		Significant Unobservable Inputs (Level 3)
Money market funds	$	2,713		$	2,713	$	—	$	—
Commercial paper	28,708			—		28,708		—
Acquisition contingent consideration liabilities	(2,070		)	—		—		(2,070		)

Level 3 Information

The following tables set forth a reconciliation of changes in the fair value of contingent consideration liabilities classified as Level 3 in the fair value hierarchy:



	Three Months Ended September 30,
	2018			2017
Balance as of July 1,	$	(10,119	)	$	(1,932	)
Change in fair value of contingent consideration liability from HealthSource Global Stafffing (“HSG”) acquisition	—			(20		)
Change in fair value of contingent consideration liability from PDA and LFT acquisition	(1,194		)	—
Change in fair value of contingent consideration liability from MedPartners acquisition	2,520			—
Balance as of September 30,	$	(8,793	)	$	(1,952	)



	Nine Months Ended September 30,
	2018			2017
Balance as of January 1,	$	(2,070	)	$	(6,816	)
Settlement of The First String Healthcare contingent consideration liability for year ended December 31, 2016	—			3,000
Settlement of HSG contingent consideration liability for year ended December 31, 2016	70			1,930
Settlement of HSG contingent consideration liability for year ended December 31, 2017	2,000			—
Contingent consideration liability from PDA and LFT acquisition on April 6, 2018	(5,700		)	—
Contingent consideration liability from MedPartners acquisition on April 9, 2018	(4,400		)	—
Change in fair value of contingent consideration liability from HSG acquisition	—			(66		)
Change in fair value of contingent consideration liability from PDA and LFT acquisition	(1,213		)	—
Change in fair value of contingent consideration liability from MedPartners acquisition	2,520			—
Balance as of September 30,	$	(8,793	)	$	(1,952	)

Assets Measured on a Non-Recurring Basis

The Company applies fair value techniques on a non-recurring basis associated with valuing potential impairment losses related to its goodwill, indefinite-lived intangible assets, long-lived assets, and equity investments.

The Company evaluates goodwill and indefinite-lived intangible assets annually for impairment and whenever circumstances occur indicating that goodwill might be impaired. The Company determines the fair value of its reporting units based on a combination of inputs, including the market capitalization of the Company, as well as Level 3 inputs such as discounted cash flows, which are not observable from the market, directly or indirectly. The Company determines the fair value of its indefinite-lived intangible assets using the income approach (relief-from-royalty method) based on Level 3 inputs.

The Company’s equity investment represents an investment in a non-controlled corporation without a readily determinable market value. The Company has elected to measure the investment at cost minus impairment, if any, plus or minus changes resulting from observable price changes. The fair value is determined by using quoted prices for identical or similar investments of the same issuer, which are Level 2 inputs. The Company recognizes changes to the fair value of its equity investment in interest expense, net, and other in the condensed consolidated statements of comprehensive income.

The following tables set forth a reconciliation of changes in the balance of the equity investment classified as Level 2 in the fair value hierarchy:



	Three Months Ended September 30,
	2018		2017
Balance as of July 1,	$	2,000	$	2,000
Additional investment	4,600		—
Change in fair value	1,359		—
Balance as of September 30,	$	7,959	$	2,000



	Nine Months Ended September 30,
	2018		2017
Balance as of January 1,	$	2,000	$	—
Initial investment	—		2,000
Additional investment	4,600		—
Change in fair value	1,359		—
Balance as of September 30,	$	7,959	$	2,000

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 nine months ended September 30, 2018 and 2017.

Fair Value of Financial Instruments

The Company is required to disclose the fair value of financial instruments for which it is practicable to estimate the value, even though these instruments are not recognized at fair value in the consolidated balance sheets. As of September 30, 2018, the Company's senior notes have a carrying amount of $325,000 and an estimated fair value of $314,438. As of December 31, 2017, the senior notes had a carrying amount of $325,000 and an estimated fair value of $335,156. Quoted market prices in active markets for identical liabilities based inputs (Level 1) were used to estimate fair value. The senior notes were issued in October 2016 and have a fixed rate of 5.125%. See additional information in “Item 8. Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note (8), Notes Payable and Credit Agreement” of our 2017 Annual Report.

The fair value of the Company’s long-term self-insurance accruals cannot be estimated as the Company cannot reasonably determine the timing of future payments.

Balance Sheet Related Disclosures [Abstract]

The entire disclosure for the fair value of financial instruments (as defined), including financial assets and financial liabilities (collectively, as defined), and the measurements of those instruments as well as disclosures related to the fair value of non-financial assets and liabilities. Such disclosures about the financial instruments, assets, and liabilities would include: (1) the fair value of the required items together with their carrying amounts (as appropriate); (2) for items for which it is not practicable to estimate fair value, disclosure would include: (a) information pertinent to estimating fair value (including, carrying amount, effective interest rate, and maturity, and (b) the reasons why it is not practicable to estimate fair value; (3) significant concentrations of credit risk including: (a) information about the activity, region, or economic characteristics identifying a concentration, (b) the maximum amount of loss the entity is exposed to based on the gross fair value of the related item, (c) policy for requiring collateral or other security and information as to accessing such collateral or security, and (d) the nature and brief description of such collateral or security; (4) quantitative information about market risks and how such risks are managed; (5) for items measured on both a recurring and nonrecurring basis information regarding the inputs used to develop the fair value measurement; and (6) for items presented in the financial statement for which fair value measurement is elected: (a) information necessary to understand the reasons for the election, (b) discussion of the effect of fair value changes on earnings, (c) a description of [similar groups] items for which the election is made and the relation thereof to the balance sheet, the aggregate carrying value of items included in the balance sheet that are not eligible for the election; (7) all other required (as defined) and desired information.

+ References + Details

Income Taxes	9 Months Ended
Income Taxes	Sep. 30, 2018
Income Tax Disclosure [Abstract]
INCOME TAXES	INCOME TAXES The Company is subject to taxation in the U.S. and various states and foreign jurisdictions. With few exceptions, as of September 30, 2018, the Company is no longer subject to state, local or foreign examinations by tax authorities for tax years before 2009, and the Company is no longer subject to U.S. federal income or payroll tax examinations for tax years before 2015. The IRS conducted, completed, and settled audits of the Company’s 2011-2012 and 2013 tax years related to income and employment tax issues for the Company’s treatment of certain non-taxable per diem allowances and travel benefits in November 2017 and May 2018, respectively. The Company believes its reserve for unrecognized tax benefits and contingent tax issues is adequate with respect to all open years. Notwithstanding the foregoing, the Company could adjust its provision for income taxes and contingent tax liability based on future developments. Immaterial Tax Correction Related to Prior Periods During the first quarter of 2018, the Company identified an error related to the income tax treatment of fair value changes in the cash surrender value of its Company Owned Life Insurance (COLI) for prior years. These fair value changes had not previously been included as a net tax benefit in the provision for prior periods. In accordance with ASC 250, Accounting Changes and Error Corrections, management evaluated the materiality of the error from qualitative and quantitative perspectives, and concluded that the error was not material to the consolidated financial statements of prior years, nor is it believed to be material to 2018’s full year consolidated financial statements. As a result, the Company recorded a net tax benefit of $2,501 in the first quarter of 2018 to adjust for this immaterial error correction. Tax Cuts and Jobs Act On December 22, 2017, the U.S. government enacted comprehensive tax legislation commonly referred to as the Tax Cuts and Jobs Act (the “Tax Act”). The Tax Act makes broad and complex changes to the U.S. tax code, including, but not limited to, reducing the U.S. federal corporate tax rate from 35% to 21%. The Tax Act changes that affected the Company in 2017 are primarily tax rate changes on certain deferred tax assets (“DTAs”) and deferred tax liabilities (“DTLs”). The staff of the Securities and Exchange Commission issued Staff Accounting Bulletin No. 118 (“SAB 118”), which provides guidance on accounting for the tax effects of the Tax Act. SAB 118 provides a measurement period that should not extend beyond one year from the Tax Act enactment date for companies to complete the accounting under ASC 740. To the extent that a company’s accounting for certain income tax effects of the Tax Act is incomplete but it is able to determine a reasonable estimate, it must record a provisional estimate in the financial statements. The Tax Act also establishes new tax laws that will affect 2018 and beyond, including, but not limited to, (1) reduction of the U.S. federal corporate tax rate; (2) the repeal of the domestic production activity deduction; (3) limitations on the deductibility of certain executive compensation; and (4) limitations on various entertainment and meals deductions. The Company's accounting for the Tax Act is incomplete, primarily relating to executive compensation. However, the Company was able to make reasonable estimates of these elements and, therefore, recorded provisional adjustments for these items. Final adjustments will be made in the quarter ended December 31, 2018 and are not expected to be material.

Commitments and Contingencies: Legal Proceedings	9 Months Ended
Commitments and Contingencies: Legal Proceedings	Sep. 30, 2018
Commitments and Contingencies Disclosure [Abstract]
COMMITMENTS AND CONTINGENCIES: LEGAL PROCEEDINGS	COMMITMENTS AND CONTINGENCIES: LEGAL PROCEEDINGS From time to time, the Company is involved in various lawsuits, claims, investigations, and proceedings that arise in the ordinary course of business. These matters typically relate to professional liability, tax, compensation, contract, competitor disputes and employee-related matters and include individual and class action lawsuits, as well as inquiries and investigations by governmental agencies regarding the Company’s employment and compensation practices. Additionally, some of the Company’s clients may also become subject to claims, governmental inquiries and investigations, and legal actions relating to services provided by the Company’s healthcare professionals. Depending upon the particular facts and circumstances, the Company may also be subject to indemnification obligations under its contracts with such clients relating to these matters. The Company records a liability when management believes an adverse outcome from a loss contingency is both probable and the amount, or a range, can be reasonably estimated. Significant judgment is required to determine both probability of loss and the estimated amount. The Company reviews its loss contingencies at least quarterly and adjusts its accruals and/or disclosures to reflect the impact of negotiations, settlements, rulings, advice of legal counsel, or other new information, as deemed necessary. The most significant matters for which the Company has established loss contingencies are class actions related to wage and hour claims under California and Federal law. Specifically, among other claims in these lawsuits, it is alleged that employees were not afforded required breaks or compensated for all time worked, employees' wage statements are not sufficiently clear, and certain expense reimbursements should be included in the regular rate of pay for purposes of calculating overtime rates. The Company believes that its wage and hour practices conform with law in all material respects, but litigation is always subject to inherent uncertainty. As a result, the Company entered into settlement agreements relating to claims in two wage and hour class actions during September and October 2018. The settlement agreements are subject to court approval, which is considered probable. The Company recorded increases to its accruals established in connection with these matters amounting to $12,140 during the three months ended September 30, 2018. With regard to outstanding loss contingencies as of September 30, 2018, which are included in accounts payable and accrued expenses in the condensed consolidated balance sheet, the Company believes that such matters will not, either individually or in the aggregate, have a material adverse effect on its business, consolidated financial position, results of operations, or cash flows.

Balance Sheet Details

9 Months Ended

Sep. 30, 2018

BALANCE SHEET DETAILS

The consolidated balance sheets detail is as follows as of September 30, 2018 and December 31, 2017:



	September 30, 2018			December 31, 2017
Other current assets:
Restricted cash and cash equivalents	$	22,227		$	25,506
Income tax receivable	2,901			15,898
Other	10,230			9,589
Other current assets	$	35,358		$	50,993

Fixed assets:
Furniture and equipment	$	32,814		$	29,494
Software	155,534			132,770
Leasehold improvements	8,315			9,056
	196,663			171,320
Accumulated depreciation	(109,846		)	(97,889		)
Fixed assets, net	$	86,817		$	73,431

Other assets:
Life insurance cash surrender value	$	58,576		$	48,145
Other	34,630			26,221
Other assets	$	93,206		$	74,366

Accounts payable and accrued expenses:
Trade accounts payable	$	21,217		$	31,420
Subcontractor payable	46,276			41,786
Accrued expenses	37,802			29,238
Loss contingencies	25,042			12,548
Professional liability reserve	8,510			7,672
Other	3,696			7,655
Accounts payable and accrued expenses	$	142,543		$	130,319

Accrued compensation and benefits:
Accrued payroll	$	39,665		$	33,923
Accrued bonuses	18,795			19,489
Accrued travel expense	3,618			3,256
Health insurance reserve	3,820			3,658
Workers compensation reserve	7,789			8,553
Deferred compensation	59,502			49,330
Other	2,443			3,214
Accrued compensation and benefits	$	135,632		$	121,423

Other long-term liabilities:
Workers compensation reserve	$	19,387		$	19,074
Professional liability reserve	37,847			38,964
Deferred rent	15,053			14,744
Unrecognized tax benefits	4,221			5,270
Deferred revenue	994			960
Other	25			267
Other long-term liabilities	$	77,527		$	79,279

Basis of Presentation (Policies)

9 Months Ended

Sep. 30, 2018

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Use of Estimates

Recently Adopted Accounting Pronouncements



	Nine Months Ended September 30, 2017
	As Previously Reported			Adjustments			As Adjusted
Cash flows from operating activities:
Changes in assets and liabilities:
Other current assets	10,155			(4,055		)	6,100
Restricted cash, cash equivalents and investments balance	(9,761		)	9,769			8
Net cash provided by operating activities	96,382			5,714			102,096

Cash flows from investing activities
Change in restricted cash, cash equivalents and investments balance	601			(601		)	—
Net cash used in investing activities	(23,444		)	(601		)	(24,045		)

Net increase in cash, cash equivalents and restricted cash	$	9,003		$	5,113		$	14,116
Cash, cash equivalents and restricted cash at the beginning of period	10,622			40,406			51,028
Cash, cash equivalents and restricted cash at the end of period	$	19,625		$	45,519		$	65,144



	September 30, 2018			December 31, 2017
Cash and cash equivalents	$	18,614		$	15,147
Restricted cash and cash equivalents (included in other current assets)	22,227			25,506
Restricted cash, cash equivalents and investments	59,453			64,315
Total cash, cash equivalents and restricted cash and investments	100,294			104,968
Less restricted investments	(23,023		)	(6,074		)
Total cash, cash equivalents and restricted cash	$	77,271		$	98,894

There were no other material impacts to the Company's consolidated financial statements as a result of adopting these updated standards.

Revenue Recognition

Under the new revenue recognition standard, the Company has elected to apply the following practical expedients and optional exemptions:


•	Recognize incremental costs of obtaining a contract with amortization periods of one year or less as expense when incurred. These costs are recorded within selling, general and administrative expenses.


•	Recognize revenue in the amount of consideration to which the Company has a right to invoice the customer if that amount corresponds directly with the value to the customer of the Company’s services completed to date.

•

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

Fair Value of Financial Instruments

Assets Measured on a Non-Recurring Basis

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.

Fair Value of Financial Instruments

The fair value of the Company’s long-term self-insurance accruals cannot be estimated as the Company cannot reasonably determine the timing of future payments.

Basis of Presentation (Tables)

9 Months Ended

Sep. 30, 2018

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Schedule of Error Corrections and Prior Period Adjustments [Table Text Block]

These adjustments had no effect on previously reported results of operations or retained earnings. The following table provides a summary of the adjustments from amounts previously reported.



	Nine Months Ended September 30, 2017
	As Previously Reported			Adjustments			As Adjusted
Cash flows from operating activities:
Changes in assets and liabilities:
Other current assets	10,155			(4,055		)	6,100
Restricted cash, cash equivalents and investments balance	(9,761		)	9,769			8
Net cash provided by operating activities	96,382			5,714			102,096

Cash flows from investing activities
Change in restricted cash, cash equivalents and investments balance	601			(601		)	—
Net cash used in investing activities	(23,444		)	(601		)	(24,045		)

Net increase in cash, cash equivalents and restricted cash	$	9,003		$	5,113		$	14,116
Cash, cash equivalents and restricted cash at the beginning of period	10,622			40,406			51,028
Cash, cash equivalents and restricted cash at the end of period	$	19,625		$	45,519		$	65,144



	September 30, 2018			December 31, 2017
Cash and cash equivalents	$	18,614		$	15,147
Restricted cash and cash equivalents (included in other current assets)	22,227			25,506
Restricted cash, cash equivalents and investments	59,453			64,315
Total cash, cash equivalents and restricted cash and investments	100,294			104,968
Less restricted investments	(23,023		)	(6,074		)
Total cash, cash equivalents and restricted cash	$	77,271		$	98,894

Net Income Per Common Share (Tables)

9 Months Ended

Sep. 30, 2018

Earnings Per Share [Abstract]

Computation of basic and diluted net income per common share

The following table sets forth the computation of basic and diluted net income per common share for the three and nine months ended September 30, 2018 and 2017, respectively:



	Three Months Ended September 30,				Nine Months Ended September 30,
	2018		2017		2018		2017
Net income	$	27,918	$	28,128	$	106,128	$	91,391

Net income per common share - basic	$	0.59	$	0.59	$	2.23	$	1.91
Net income per common share - diluted	$	0.58	$	0.57	$	2.17	$	1.85

Weighted average common shares outstanding - basic	47,286		47,912		47,556		47,870
Plus dilutive effect of potential common shares	1,243		1,533		1,303		1,610
Weighted average common shares outstanding - diluted	48,529		49,445		48,859		49,480

Segment Information (Tables)

9 Months Ended

Sep. 30, 2018

Segment Reporting [Abstract]

Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results



	Three Months Ended September 30,				Nine Months Ended September 30,
	2018		2017		2018		2017
Revenue
Nurse and allied solutions	$	306,292	$	302,933	$	977,199	$	917,183
Locum tenens solutions	101,102		111,415		311,516		322,473
Other workforce solutions	119,448		80,058		318,724		239,722
	$	526,842	$	494,406	$	1,607,439	$	1,479,378
Segment operating income
Nurse and allied solutions	$	42,165	$	40,807	$	137,906	$	134,638
Locum tenens solutions	10,992		14,438		34,321		39,028
Other workforce solutions	29,010		19,890		77,437		61,788
	82,167		75,135		249,664		235,454
Unallocated corporate overhead	26,427		13,698		59,271		44,732
Depreciation and amortization	11,296		8,132		29,788		23,759
Share-based compensation	1,809		2,477		7,954		7,720
Interest expense, net, and other	4,649		4,837		16,360		14,895
Income before income taxes	$	37,986	$	45,991	$	136,291	$	144,348

Summary of goodwill by reportable segment

The following table summarizes the activity related to the carrying value of goodwill by reportable segment:



	Nurse and Allied Solutions		Locum Tenens Solutions		Other Workforce Solutions		Total
Balance, January 1, 2018	$	103,107	$	19,743	$	217,746	$	340,596
Goodwill from MedPartners acquisition	—		—		81,095		81,095
Goodwill from PDA and LFT acquisition	—		—		16,608		16,608
Balance, September 30, 2018	$	103,107	$	19,743	$	315,449	$	438,299
Accumulated impairment loss as of December 31, 2017 and September 30, 2018	$	154,444	$	53,940	$	6,555	$	214,939

Fair Value Measurement (Tables)

9 Months Ended

Sep. 30, 2018

Fair Value Disclosures [Abstract]

Schedule of financial assets and liabilities measured at fair value on recurring basis

The following tables present information about the above-referenced assets and liabilities and indicate the fair value hierarchy of the valuation techniques utilized to determine such fair value:



	Fair Value Measurements as of September 30, 2018
	Total			Quoted Prices in Active Markets for Identical Assets (Level 1)		Significant Other Observable Inputs (Level 2)		Significant Unobservable Inputs (Level 3)
Money market funds	$	2,739		$	2,739	$	—	$	—
Commercial paper	61,567			—		61,567		—
Acquisition contingent consideration liabilities	(8,793		)	—		—		(8,793		)



	Fair Value Measurements as of December 31, 2017
	Total			Quoted Prices in Active Markets for Identical Assets (Level 1)		Significant Other Observable Inputs (Level 2)		Significant Unobservable Inputs (Level 3)
Money market funds	$	2,713		$	2,713	$	—	$	—
Commercial paper	28,708			—		28,708		—
Acquisition contingent consideration liabilities	(2,070		)	—		—		(2,070		)

Reconciliations of changes in the fair value of contingent consideration liabilities

The following tables set forth a reconciliation of changes in the fair value of contingent consideration liabilities classified as Level 3 in the fair value hierarchy:



	Three Months Ended September 30,
	2018			2017
Balance as of July 1,	$	(10,119	)	$	(1,932	)
Change in fair value of contingent consideration liability from HealthSource Global Stafffing (“HSG”) acquisition	—			(20		)
Change in fair value of contingent consideration liability from PDA and LFT acquisition	(1,194		)	—
Change in fair value of contingent consideration liability from MedPartners acquisition	2,520			—
Balance as of September 30,	$	(8,793	)	$	(1,952	)

Reconciliations of equity investments included in net income

The following tables set forth a reconciliation of changes in the balance of the equity investment classified as Level 2 in the fair value hierarchy:



	Three Months Ended September 30,
	2018		2017
Balance as of July 1,	$	2,000	$	2,000
Additional investment	4,600		—
Change in fair value	1,359		—
Balance as of September 30,	$	7,959	$	2,000



	Nine Months Ended September 30,
	2018		2017
Balance as of January 1,	$	2,000	$	—
Initial investment	—		2,000
Additional investment	4,600		—
Change in fair value	1,359		—
Balance as of September 30,	$	7,959	$	2,000

Balance Sheet Details (Tables)

9 Months Ended

Sep. 30, 2018

Balance Sheet Related Disclosures [Abstract]

Schedule of Supplemental Balance Sheet Disclosures

The consolidated balance sheets detail is as follows as of September 30, 2018 and December 31, 2017:



	September 30, 2018			December 31, 2017
Other current assets:
Restricted cash and cash equivalents	$	22,227		$	25,506
Income tax receivable	2,901			15,898
Other	10,230			9,589
Other current assets	$	35,358		$	50,993

Fixed assets:
Furniture and equipment	$	32,814		$	29,494
Software	155,534			132,770
Leasehold improvements	8,315			9,056
	196,663			171,320
Accumulated depreciation	(109,846		)	(97,889		)
Fixed assets, net	$	86,817		$	73,431

Other assets:
Life insurance cash surrender value	$	58,576		$	48,145
Other	34,630			26,221
Other assets	$	93,206		$	74,366

Accounts payable and accrued expenses:
Trade accounts payable	$	21,217		$	31,420
Subcontractor payable	46,276			41,786
Accrued expenses	37,802			29,238
Loss contingencies	25,042			12,548
Professional liability reserve	8,510			7,672
Other	3,696			7,655
Accounts payable and accrued expenses	$	142,543		$	130,319

Accrued compensation and benefits:
Accrued payroll	$	39,665		$	33,923
Accrued bonuses	18,795			19,489
Accrued travel expense	3,618			3,256
Health insurance reserve	3,820			3,658
Workers compensation reserve	7,789			8,553
Deferred compensation	59,502			49,330
Other	2,443			3,214
Accrued compensation and benefits	$	135,632		$	121,423

Other long-term liabilities:
Workers compensation reserve	$	19,387		$	19,074
Professional liability reserve	37,847			38,964
Deferred rent	15,053			14,744
Unrecognized tax benefits	4,221			5,270
Deferred revenue	994			960
Other	25			267
Other long-term liabilities	$	77,527		$	79,279

Basis of Presentation Basis of Presentation - Recently Adopted Accounting Pronouncements (Details) - USD ($)
$ in Thousands

9 Months Ended

Sep. 30, 2018

Sep. 30, 2017

Jan. 01, 2018

Dec. 31, 2017

Revenue, Initial Application Period Cumulative Effect Transition [Line Items]

Retained earnings

$ 250,446

$ 142,229

Restricted cash, cash equivalents and investments balance

446

$ 6,100

^[1]

(86)

^[1]

Cash flows from investing activities

168,046

102,096

^[1]

Change in restricted cash, cash equivalents and investments balance

Net increase in cash, cash equivalents and restricted cash

(271,648)

(24,045)

^[1]

(21,623)

14,116

^[1]

Cash, cash equivalents and restricted cash at the beginning of period

98,894

51,028

^[1]

Cash, cash equivalents and restricted cash at the end of period

77,271

65,144

^[1]

Cash and cash equivalents

18,614

15,147

Restricted cash and cash equivalents (included in other current assets)

22,227

25,506

Restricted cash, cash equivalents and investments

59,453

64,315

Total cash, cash equivalents and restricted cash and investments

100,294

104,968

Less restricted investments

$ (23,023)

$ (6,074)

Accounting Standards Update 2014-09 | Difference between Revenue Guidance in Effect before and after Topic 606

Revenue, Initial Application Period Cumulative Effect Transition [Line Items]

Retained earnings

$ 2,089

As Previously Reported

Restricted cash, cash equivalents and investments balance

10,155

(9,761)

Cash flows from investing activities

96,382

Change in restricted cash, cash equivalents and investments balance

601

Net increase in cash, cash equivalents and restricted cash

(23,444)

9,003

Cash, cash equivalents and restricted cash at the beginning of period

10,622

Cash, cash equivalents and restricted cash at the end of period

19,625

Adjustments | Accounting Standards Update 2016-18 [Member]

Restricted cash, cash equivalents and investments balance

(4,055)

9,769

Cash flows from investing activities

5,714

Change in restricted cash, cash equivalents and investments balance

(601)

Net increase in cash, cash equivalents and restricted cash

(601)

5,113

Cash, cash equivalents and restricted cash at the beginning of period

40,406

Cash, cash equivalents and restricted cash at the end of period

$ 45,519

[1]	See Note (1) for a summary of adjustments.

Acquisitions (Details)

3 Months Ended

9 Months Ended

Apr. 09, 2018

USD ($)

Apr. 06, 2018

USD ($)

Sep. 30, 2018

USD ($)

Sep. 30, 2018

USD ($)

aquisition

Sep. 30, 2017

USD ($)

^[1]

Feb. 09, 2018

USD ($)

Dec. 31, 2017

USD ($)

Number of acquisitions | aquisition

Proceeds from line of credit

$ 195,000,000

$ 0

Goodwill

$ 438,299,000

$ 340,596,000

MedPartners

Initial purchase price

$ 200,711,000

Cash consideration

196,533,000

Estimated fair value of contingent earn-out payment

20,000,000

4,400,000

Working capital settlement received

222,000

Tangible assets acquired, including cash received

28,425,000

Cash received

8,403,000

Liabilities assumed

11,809,000

Intangible assets, weighted-average useful life (in years)

103,000,000

Goodwill

$ 81,095,000

16 years

MedPartners | Based on operating results for the twelve months ending December 31, 2018

MedPartners | Based on operating results for the six months ending June 30, 2019

$ 10,000,000

10,000,000

MedPartners | Trademarks

MedPartners | Customer Relationships

46,000,000

$ 57,000,000

PDA and LFT

Initial purchase price

$ 35,503,000

Cash consideration

30,268,000

Estimated fair value of contingent earn-out payment

7,000,000

5,700,000

Working capital settlement received

$ 465,000

Tangible assets acquired, including cash received

4,356,000

Cash received

351,000

Liabilities assumed

4,571,000

Intangible assets, weighted-average useful life (in years)

19,110,000

Goodwill

$ 16,608,000

12 years

PDA and LFT | Trademarks

PDA and LFT | Customer Relationships

$ 5,400,000

PDA and LFT | Staffing Databases

8,000,000

Revolving Credit Facility | Line of Credit

$ 5,710,000

Maximum borrowing capacity

$ 400,000,000

[1]	See Note (1) for a summary of adjustments.

Net Income Per Common Share (Details) - USD ($)
$ / shares in Units, shares in Thousands, $ in Thousands

3 Months Ended

9 Months Ended

Sep. 30, 2018

Sep. 30, 2017

Sep. 30, 2018

Sep. 30, 2017

Computation of basic and diluted net income per common share

Net income

$ 27,918

$ 28,128

$ 106,128

$ 91,391

^[1]

Net income per common share - basic (in dollars per share)

$ 0.59

$ 2.23

$ 1.91

Net income per common share - diluted (in dollars per share)

$ 0.58

$ 0.57

$ 2.17

$ 1.85

Weighted average common shares outstanding - basic (in shares)

47,286

47,912

47,556

47,870

Plus dilutive effect of potential common shares (in shares)

1,243

1,533

1,303

1,610

Weighted average common shares outstanding - diluted (in shares)

48,529

49,445

48,859

49,480

Common stock excluded from calculation of EPS (in shares)

[1]	See Note (1) for a summary of adjustments.

The amount of net income (loss) for the period per each share of common stock or unit outstanding during the reporting period.

+ References

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+ Details

The amount of net income (loss) for the period available to each share of common stock or common unit outstanding during the reporting period and to each share or unit that would have been outstanding assuming the issuance of common shares or units for all dilutive potential common shares or units outstanding during the reporting period.

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+ Details

Segment Reporting, Revenue Reconciling Item [Line Items]

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

+ References + Details

Segment Information (Details)
$ in Thousands

3 Months Ended

9 Months Ended

Sep. 30, 2018

USD ($)

Sep. 30, 2017

USD ($)

Sep. 30, 2018

USD ($)

segment

Sep. 30, 2017

USD ($)

Number of reportable segments | segment

Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results

$ 526,842

$ 494,406

$ 1,607,439

$ 1,479,378

Depreciation and amortization

42,635

50,828

152,651

159,243

11,296

8,132

29,788

23,759

^[1]

Share-based compensation

1,809

2,477

7,954

7,720

^[1]

Interest expense, net, and other

4,649

4,837

16,360

14,895

Income before income taxes

37,986

45,991

136,291

144,348

Operating segments

Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results

526,842

494,406

1,607,439

1,479,378

Operating segments | Nurse and Allied Solutions

82,167

75,135

249,664

235,454

Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results

306,292

302,933

977,199

917,183

Operating segments | Locum Tenens Solutions

42,165

40,807

137,906

134,638

Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results

101,102

111,415

311,516

322,473

Operating segments | Other Workforce Solutions

10,992

14,438

34,321

39,028

Schedule of reconciliation of revenue and segment operating income by reportable segment to consolidated results

119,448

80,058

318,724

239,722