0001142750-22-000010 | 10-K | XBRL Viewer | AMN Healthcare Services INC

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Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Current assets:
Cash and cash equivalents	$ 180,928	$ 29,213
Accounts receivable, net of allowances of $6,838 and $7,043 at December 31, 2021 and 2020, respectively	789,131	376,099
Accounts receivable, subcontractor	239,719	73,985
Prepaid expenses	72,460	13,629
Other current assets	66,830	40,809
Total current assets	1,349,068	533,735
Restricted cash, cash equivalents and investments	64,482	61,347
Fixed assets, net of accumulated depreciation of $189,954 and $161,752 at December 31, 2021 and 2020, respectively	127,114	116,174
Operating lease right-of-use assets	27,771	77,735
Other assets	156,670	135,120
Goodwill	892,341	864,485
Intangible assets, net of accumulated amortization of $278,249 and $215,234 at December 31, 2021 and 2020, respectively	514,460	564,911
Total assets	3,131,906	2,353,507
Current liabilities:
Accounts payable and accrued expenses	425,257	167,881
Accrued compensation and benefits	354,381	213,414
Current portion of notes payable	0	4,688
Current portion of operating lease liabilities	11,383	15,032
Deferred revenue	15,950	11,004
Other current liabilities	162,419	10,938
Total current liabilities	969,390	422,957
Notes payable, net of unamortized fees and premium	842,322	857,961
Deferred income taxes, net	47,814	67,205
Operating lease liabilities	13,364	77,800
Other long-term liabilities	96,989	107,907
Total liabilities	1,969,879	1,533,830
Commitments and contingencies
Stockholders’ equity:
Preferred stock, $0.01 par value; 10,000 shares authorized; none issued and outstanding at December 31, 2021 and 2020	0	0
Common stock, $0.01 par value; 200,000 shares authorized; 49,849 issued and 47,263 outstanding at December 31, 2021 and 49,614 issued and 47,053 outstanding at December 31, 2020	498	496
Additional paid-in capital	486,709	468,726
Treasury stock, at cost; 2,586 and 2,561 shares at December 31, 2021 and 2020, respectively	(121,831)	(119,143)
Retained earnings	796,946	469,558
Accumulated other comprehensive income (loss)	(295)	40
Total stockholders’ equity	1,162,027	819,677
Total liabilities and stockholders’ equity	$ 3,131,906	$ 2,353,507

Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Statement of Financial Position [Abstract]
Accounts receivable, allowance	$ 6,838	$ 7,043
Accumulated depreciation	189,954	161,752
Accumulated amortization	$ 278,249	$ 215,234
Preferred stock, par value (in dollars per share)	$ 0.01	$ 0.01
Preferred stock, shares authorized (in shares)	10,000,000	10,000,000
Preferred stock, shares issued (in shares)	0	0
Preferred stock, shares outstanding (in shares)	0	0
Common stock, par value (in dollars per share)	$ 0.01	$ 0.01
Common stock, shares authorized (in shares)	200,000,000	200,000,000
Common stock, shares issued (in shares)	49,849,000	49,614,000
Common stock, shares outstanding (in shares)	47,263,000	47,053,000
Treasury stock (in shares)	2,586,000	2,561,000

Consolidated Statements of Comprehensive Income - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Statement of Comprehensive Income [Abstract]
Revenue	$ 3,984,235	$ 2,393,714	$ 2,222,107
Cost of revenue	2,674,634	1,601,936	1,478,642
Gross profit	1,309,601	791,778	743,465
Operating expenses:
Selling, general and administrative	730,451	549,747	508,030
Depreciation and amortization (exclusive of depreciation included in cost of revenue)	101,152	92,766	58,520
Total operating expenses	831,603	642,513	566,550
Income from operations	477,998	149,265	176,915
Interest expense, net, and other	34,077	57,742	28,427
Income before income taxes	443,921	91,523	148,488
Income tax expense	116,533	20,858	34,500
Net income	327,388	70,665	113,988
Net income	327,388	70,665	113,988
Other comprehensive income (loss):
Foreign currency translation and other	(335)	(112)	1
Other comprehensive income (loss)	(335)	(112)	1
Comprehensive income	$ 327,053	$ 70,553	$ 113,989
Net income per common share:
Net income per common share - basic (in dollars per share)	$ 6.87	$ 1.49	$ 2.44
Net income per common share - diluted (in dollars per share)	$ 6.81	$ 1.48	$ 2.40
Weighted average common shares outstanding:
Weighted average common shares outstanding - basic (in shares)	47,685	47,424	46,704
Weighted average common shares outstanding - diluted (in shares)	48,045	47,690	47,593

Consolidated Statements of Stockholders' Equity - USD ($) $ in Thousands	Total	Cumulative Effect, Period of Adoption, Adjustment	Common Stock	Additional Paid-in Capital	Treasury Stock	Retained Earnings	Retained Earnings Cumulative Effect, Period of Adoption, Adjustment	Accumulated Other Comprehensive Income (Loss)
Beginning balance (in shares) at Dec. 31, 2018			48,809,000		2,166,000
Beginning balance at Dec. 31, 2018	$ 638,990		$ 488	$ 452,730	$ (100,438)	$ 286,059		$ 151
Statement of Stockholders' Equity [Roll Forward]
Repurchase of common stock into treasury (in shares)	(395,000)				(395,000)
Repurchase of common stock into treasury	$ (18,705)				$ (18,705)
Equity awards vested and exercised, net of shares withheld for payroll taxes (in shares)			474,000
Equity awards vested and exercised, net of shares withheld for payroll taxes	$ (13,773)		$ 5	(13,778)
Accounting Standards Update [Extensible Enumeration]	us-gaap:AccountingStandardsUpdate201613Member
Share-based compensation	$ 16,241			16,241
Comprehensive income (loss)	113,989					113,988		1
Ending balance (in shares) at Dec. 31, 2019			49,283,000		2,561,000
Ending balance at Dec. 31, 2019	$ 736,742	$ (1,154)	$ 493	455,193	$ (119,143)	400,047	$ (1,154)	152
Statement of Stockholders' Equity [Roll Forward]
Repurchase of common stock into treasury (in shares)	0
Equity awards vested and exercised, net of shares withheld for payroll taxes (in shares)			331,000
Equity awards vested and exercised, net of shares withheld for payroll taxes	$ (6,929)		$ 3	(6,932)
Share-based compensation	20,465			20,465
Comprehensive income (loss)	70,553					70,665		(112)
Ending balance (in shares) at Dec. 31, 2020			49,614,000		2,561,000
Ending balance at Dec. 31, 2020	$ 819,677		$ 496	468,726	$ (119,143)	469,558		40
Statement of Stockholders' Equity [Roll Forward]
Repurchase of common stock into treasury (in shares)	(25,000)				(25,000)
Repurchase of common stock into treasury	$ (2,688)				$ (2,688)
Equity awards vested and exercised, net of shares withheld for payroll taxes (in shares)			235,000
Equity awards vested and exercised, net of shares withheld for payroll taxes	(7,232)		$ 2	(7,234)
Share-based compensation	25,217			25,217
Comprehensive income (loss)	327,053					327,388		(335)
Ending balance (in shares) at Dec. 31, 2021			49,849,000		2,586,000
Ending balance at Dec. 31, 2021	$ 1,162,027		$ 498	$ 486,709	$ (121,831)	$ 796,946		$ (295)

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Cash flows from operating activities:
Net income	$ 327,388	$ 70,665	$ 113,988
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization (inclusive of depreciation included in cost of revenue)	103,697	94,187	58,520
Non-cash interest expense and other	(4,067)	4,349	1,984
Write-off of fees on credit facilities and senior notes	158	4,956	594
Change in fair value of contingent consideration	0	4,900	7,178
Increase in allowance for credit losses and sales credits	6,263	6,535	6,275
Provision for deferred income taxes	(16,287)	(21,628)	913
Share-based compensation	25,217	20,465	16,241
Net loss on deferred compensation balances	20	1,646	0
Loss on disposal or sale of fixed assets	2,707	4,322	484
Amortization of discount on investments	(52)	(109)	(298)
Non-cash lease expense	3,806	(589)	5
Changes in assets and liabilities, net of effects from acquisitions:
Accounts receivable	(419,533)	(7,338)	28,278
Accounts receivable, subcontractor	(165,734)	(1,271)	(22,571)
Income taxes receivable	6,591	(412)	(4,464)
Prepaid expenses	(58,788)	(1,342)	774
Other current assets	(21,999)	2,322	2,847
Other assets	3,262	3,220	(12,751)
Accounts payable and accrued expenses	256,118	5,562	1,925
Accrued compensation and benefits	129,235	25,856	32,758
Other liabilities	122,685	41,640	(6,090)
Deferred revenue	4,320	(1,119)	(1,806)
Restricted investments balance	349	9	78
Net cash provided by operating activities	305,356	256,826	224,862
Cash flows from investing activities:
Purchase and development of fixed assets	(53,573)	(37,702)	(35,218)
Purchase of investments	(60,719)	(48,311)	(26,309)
Proceeds from sale and maturity of investments	57,660	32,800	32,135
Purchase of equity investments	(500)	0	0
Proceeds from sale of equity investment	78	527	0
Purchase of convertible promissory notes	0	(490)	(779)
Payments to fund deferred compensation plan	(7,565)	(7,171)	(12,507)
Cash paid for initial direct costs	(1,429)	0	0
Cash paid for acquisitions, net of cash and restricted cash received	(41,264)	(476,491)	(247,906)
Cash paid for other intangibles	(90)	(1,400)	(1,240)
Cash received for working capital adjustments for prior year acquisitions	0	66	0
Net cash used in investing activities	(107,402)	(538,172)	(291,824)
Cash flows from financing activities:
Payments on term loans	(21,875)	(228,125)	(150,000)
Proceeds from term loans	0	250,000	150,000
Payments on revolving credit facility	(70,000)	(245,000)	(221,000)
Proceeds from revolving credit facility	70,000	245,000	101,000
Proceeds from senior notes	0	552,000	300,000
Redemption of senior notes	0	(333,330)	0
Repurchase of common stock	(2,688)	0	(18,705)
Payment of financing costs	0	(11,508)	(5,223)
Earn-out payments to settle contingent consideration liabilities for prior acquisitions	(3,100)	(10,622)	(5,700)
Cash paid for shares withheld for taxes	(7,232)	(6,929)	(13,773)
Net cash provided by (used in) financing activities	(34,895)	211,486	136,599
Effect of exchange rate changes on cash	(335)	(112)	1
Net increase (decrease) in cash, cash equivalents and restricted cash	162,724	(69,972)	69,638
Cash, cash equivalents and restricted cash at beginning of year	83,990	153,962	84,324
Cash, cash equivalents and restricted cash at end of year	246,714	83,990	153,962
Supplemental disclosures of cash flow information:
Cash paid for amounts included in the measurement of operating lease liabilities	39,865	20,052	17,817
Cash paid for interest (net of $349, $389 and $536 capitalized in 2021, 2020 and 2019, respectively)	38,085	22,652	23,730
Cash paid for income taxes	106,379	46,258	37,747
Acquisitions:
Fair value of tangible assets acquired in acquisitions, net of cash and restricted cash received	1,906	35,733	29,660
Goodwill	27,193	268,971	157,036
Intangible assets	12,440	228,000	107,580
Liabilities assumed	(275)	(56,213)	(31,148)
Contingent consideration liabilities	0	0	(15,222)
Net cash paid for acquisitions	41,264	476,491	247,906
Supplemental disclosures of non-cash investing and financing activities:
Purchase of fixed assets recorded in accounts payable and accrued expenses	$ 3,719	$ 3,103	$ 2,301

Consolidated Statements of Cash Flows (Parenthetical) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Statement of Cash Flows [Abstract]
Interest capitalized	$ 349	$ 389	$ 536

Summary of Significant Accounting Policies

12 Months Ended

Dec. 31, 2021

Accounting Policies [Abstract]

Summary of Significant Accounting Policies

(a) General

AMN Healthcare Services, Inc. was incorporated in Delaware on November 10, 1997. AMN Healthcare Services, Inc. and its subsidiaries (collectively, the “Company”) provide healthcare workforce solutions and staffing services at acute and sub-acute care hospitals and other healthcare facilities throughout the United States.

(b) Principles of Consolidation

The accompanying consolidated financial statements include the accounts of AMN Healthcare Services, Inc. and its wholly-owned subsidiaries. All significant intercompany balances and transactions have been eliminated in consolidation.

The preparation of financial statements in conformity with accounting principles generally accepted in the United States of America 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 goodwill and indefinite-lived intangible assets, professional liability reserve, contingent liabilities such as legal accruals, and income taxes. The Company bases these estimates on the information that is currently available and on various other assumptions that it believes are reasonable under the circumstances. Actual results could differ from those estimates under different assumptions or conditions. The impact of the novel coronavirus (COVID-19) pandemic did not have a material effect on the Company’s estimates as of December 31, 2021.

(d) Cash and Cash Equivalents

The Company considers all highly liquid investments with an original maturity of three months or less to be cash equivalents. Cash and cash equivalents include currency on hand, deposits with financial institutions, money market funds, commercial paper and other highly liquid investments. See Note (3), “Fair Value Measurement” for additional information.

(e) Restricted Cash, Cash Equivalents and Investments

Restricted cash and cash equivalents primarily includes cash, corporate bonds and commercial paper that serve as collateral for the Company’s captive insurance subsidiary claim payments. See Note (3), “Fair Value Measurement” for additional information.

The following table provides a reconciliation of cash, cash equivalents and restricted cash reported within the accompanying consolidated balance sheets and related notes to the amounts presented in the accompanying consolidated statements of cash flows.


	December 31, 2021		December 31, 2020
Cash and cash equivalents	$	180,928	$	29,213
Restricted cash and cash equivalents (included in other current assets)	29,262		18,626
Restricted cash, cash equivalents and investments	64,482		61,347
Total cash, cash equivalents and restricted cash and investments	274,672		109,186
Less restricted investments	(27,958)		(25,196)
Total cash, cash equivalents and restricted cash	$	246,714	$	83,990

(f) Fixed Assets

The Company records furniture, equipment, leasehold improvements and capitalized software at cost less accumulated amortization and depreciation. The Company records equipment acquired under finance leases at the present value of the future minimum lease payments. The Company capitalizes major additions and improvements, and it expenses maintenance and

repairs when incurred. The Company calculates depreciation on furniture, equipment and software using the straight-line method based on the estimated useful lives of the related assets (three to ten years). The Company depreciates leasehold improvements and equipment obtained under finance leases over the shorter of the term of the lease or their estimated useful lives. The Company includes depreciation of equipment obtained under finance leases with depreciation expense in the accompanying consolidated financial statements.

The Company capitalizes costs it incurs to develop software during the application development stage. Application development stage costs generally include costs associated with software configuration, coding, installation and testing. The Company also capitalizes costs of significant upgrades and enhancements that result in additional functionality, whereas it expenses as incurred costs for maintenance and minor upgrades and enhancements. The Company amortizes capitalized costs using the straight-line method over three to ten years once the software is ready for its intended use.

The Company reviews long-lived assets for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. Recoverability of assets to be held and used is measured by a comparison of the carrying amount of an asset group to the future undiscounted net cash flows that are expected to be generated by the asset group. If such asset group is considered to be impaired, the impairment to be recognized is measured by the amount by which the carrying amount of the asset group exceeds the fair value of the asset group. The Company reports assets to be disposed of at the lower of the carrying amount or fair value less costs to sell.

(g) Leases

The Company recognizes operating lease right-of-use assets and liabilities at commencement date based on the present value of the future minimum lease payments over the lease term. Leases with an initial term of 12 months or less are not recorded on the balance sheet in accordance with the short-term lease recognition exemption. The Company applies the practical expedient to not separate lease and non-lease components for all leases that qualify and uses its incremental borrowing rate as the discount rate to measure its lease liabilities. The incremental borrowing rate is determined for each operating lease based on the Company’s borrowing capabilities over a similar term of the lease arrangement, which is estimated by utilizing the Company’s credit rating and the effects of full collateralization. Lease expense is recognized on a straight-line basis over the lease term.

(h) Goodwill

The Company records as goodwill the portion of the purchase price that exceeds the fair value of net assets of entities acquired. The Company evaluates goodwill annually for impairment at the reporting unit level and whenever circumstances occur indicating that goodwill may be impaired. The Company may first assess qualitative factors to determine whether it is more likely than not that the fair value of a reporting unit is less than its carrying amount. If, after assessing the totality of events and circumstances, the Company determines that it is more likely than not that the fair value of the reporting unit is greater than its carrying amount, the quantitative impairment test is unnecessary. If the reporting unit does not pass the qualitative assessment, then the reporting unit’s carrying value is compared to its fair value. The amount by which the carrying value of the goodwill exceeds its fair value is recognized as an impairment loss.

(i) Intangible Assets

Intangible assets consist of identifiable intangible assets acquired through acquisitions, which include tradenames and trademarks, customer relationships, staffing databases, developed technology and non-compete agreements. The fair value of identifiable intangible assets are determined using either the income approach (relief-from-royalty method or multi-period excess earnings method) or the cost approach (replacement cost method). The Company amortizes intangible assets, other than those with an indefinite life, using the straight-line method over their useful lives. The Company amortizes non-compete agreements using the straight-line method over the lives of the related agreements. The Company reviews for impairment intangible assets with estimable useful lives whenever events or changes in circumstances indicate that the carrying amount may not be recoverable.

The Company does not amortize indefinite-lived intangible assets and instead reviews them for impairment annually. The Company may first perform a qualitative assessment to determine whether it is more likely than not that an indefinite-lived intangible asset is impaired. If, after assessing the totality of events and circumstances, the Company determines that it is more likely than not that the indefinite-lived intangible asset is not impaired, no quantitative fair value measurement is necessary. If a quantitative fair value measurement calculation is required for an indefinite-lived intangible asset, the Company compares its fair value with its carrying amount. If the carrying amount exceeds the fair value, the Company records the excess as an impairment loss.

(j) Insurance Reserves

The Company maintains an accrual for professional liability that is included in accounts payable and accrued expenses and other long-term liabilities in the consolidated balance sheets. The expense is included in the selling, general and administrative expenses in the consolidated statement of comprehensive income. The Company determines the adequacy of this accrual by evaluating its historical experience and trends, loss reserves established by the Company’s insurance carriers, management and third-party administrators, and independent actuarial studies. The Company obtains actuarial studies on a semi-annual basis that use the Company’s actual claims data and industry data to assist the Company in determining the adequacy of its reserves each year. For periods between the actuarial studies, the Company records its accruals based on loss rates provided in the most recent actuarial study and management’s review of loss history and trends. In November 2012, the Company established a captive insurance subsidiary, which primarily provides coverage, on an occurrence basis, for professional liability within its nurse and allied solutions segment. Liabilities include provisions for estimated losses incurred but not yet reported (“IBNR”), as well as provisions for known claims. IBNR reserve estimates involve the use of assumptions that are primarily based upon historical loss experience, industry data and other actuarial assumptions. The Company maintains excess insurance coverage through a commercial carrier for losses above the per occurrence retention.

The Company maintains an accrual for workers compensation, which is included in accrued compensation and benefits and other long-term liabilities in the consolidated balance sheets. The expense relating to healthcare professionals is included in cost of revenue, while the expense relating to corporate employees is included in the selling, general and administrative expenses in the consolidated statement of comprehensive income. The Company determines the adequacy of this accrual by evaluating its historical experience and trends, loss reserves established by the Company’s insurance carriers and third-party administrators, and independent actuarial studies. The Company obtains actuarial studies on a semi-annual basis that use the Company’s payroll and historical claims data, as well as industry data, to determine the appropriate reserve for both reported claims and IBNR claims for each policy year. For periods between the actuarial studies, the Company records its accruals based on loss rates provided in the most recent actuarial study.

The Company maintains legacy liabilities related to its self-insured retention portion of both the workers compensation and locum tenens business professional liability in its captive insurance subsidiary. These legacy liabilities follow the same accounting policies as described in the paragraphs above.

(k) Revenue Recognition

Revenue primarily consists of fees earned from the temporary staffing and permanent placement of healthcare professionals, executives, and leaders (clinical and operational). The Company also generates revenue from technology-enabled services, including language interpretation and vendor management systems, and talent planning and acquisition services, including recruitment process outsourcing. The Company recognizes revenue when control of its services is transferred to its customers, in an amount that reflects the consideration the Company expects to be entitled to receive in exchange for those services. Revenue from temporary staffing services is recognized as the services are rendered by clinical and non-clinical healthcare professionals. Under the Company’s managed services program (“MSP”) arrangements, the Company manages all or a part of a customer’s supplemental workforce needs utilizing its own network of healthcare professionals along with those of third-party subcontractors. Revenue and the related direct costs under MSP arrangements are recorded in accordance with the accounting guidance on reporting revenue gross as a principal versus net as an agent. When the Company uses subcontractors and acts as an agent, revenue is recorded net of the related subcontractor’s expense. Revenue from permanent placement and recruitment process outsourcing services is recognized as the services are rendered. Depending on the arrangement, the Company’s technology-enabled service revenue is recognized either as the services are rendered or ratably over the applicable arrangement’s service period. See additional information below regarding the Company’s revenue disaggregated by service type.

The Company’s customers are primarily billed as services are rendered. Any fees billed in advance of being earned are recorded as deferred revenue. While payment terms vary by the type of customer and the services rendered, the term between invoicing and when payment is due is not significant. During the years ended December 31, 2021 and 2020, previously deferred revenue recognized as revenue was $10,660 and $11,729, respectively.

The Company recognizes assets from incremental costs to obtain a contract with a customer and costs incurred to fulfill a contract with a customer, which are deferred and amortized using the portfolio approach on a straight line basis over the average period of benefit consistent with the timing of transfer of services to the customer.

The Company has elected to apply the following practical expedients and optional exemptions related to contract costs and revenue recognition:

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

•Recognize revenue in the amount of consideration that 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 that 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.

(l) Accounts Receivable

The Company records accounts receivable at the invoiced amount. Accounts receivable are non-interest bearing. The Company maintains an allowance for expected credit losses based on the Company’s historical write-off experience, an assessment of its customers’ financial conditions and available information that is relevant to assessing the collectability of cash flows, which includes current conditions and forecasts about future economic conditions.

The following table provides a reconciliation of activity in the allowance for credit losses for accounts receivable:


	2021		2020
Balance as of January 1,	$	7,043	$	3,332
Adoption of the credit loss standard, cumulative-effect adjustment to retained earnings	—		1,334
Provision for expected credit losses	1,206		4,428
Amounts written off charged against the allowance	(1,411)		(2,051)

Balance as of December 31,	$	6,838	$	7,043

(m) Concentration of Credit Risk

The majority of the Company’s business activity is with hospitals located throughout the United States. Credit is extended based on the evaluation of each entity’s financial condition. One customer primarily within the Company’s nurse and allied solutions segment comprised approximately 17%, 14% and 13% of the consolidated revenue of the Company for the fiscal years ended December 31, 2021, 2020 and 2019, respectively.

The Company’s cash and cash equivalents and restricted cash, cash equivalents and investments accounts are financial instruments that are exposed to concentration of credit risk. The Company maintains most of its cash, cash equivalents and investment balances with high-credit quality and federally insured institutions. However, cash equivalents and restricted cash equivalents and investment balances may be invested in non-federally insured money market funds, commercial paper and corporate bonds. As of December 31, 2021 and 2020, there were $274,672 and $109,186, respectively, of cash, cash equivalents and restricted cash, cash equivalents and investments, a portion of which was invested in non-federally insured money market funds, commercial paper and corporate bonds. See Note (3), “Fair Value Measurement,” for additional information.

(n) Income Taxes

The Company records income taxes using the asset and liability method. Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax basis. Deferred tax assets and liabilities are measured using enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in the period the changes are enacted. In assessing the realizability of deferred tax assets, the Company considers whether it is more likely than not that some portion or all of the deferred tax assets will not be realized. The ultimate realization of deferred tax assets is dependent upon the generation of future taxable income during the periods in which those temporary differences become deductible. The Company considers the scheduled reversal of deferred tax liabilities (including the impact of available carryback and carryforward periods), projected future taxable income, and tax-planning strategies in making this assessment. The Company recognizes the effect of income tax positions only if it is more likely than not that such positions will be sustained. Recognized income tax positions are measured at the largest amount that is greater than 50% likely of being realized. Changes in recognition or measurement are reflected in the period in which the change in judgment occurs. The Company records interest and penalties related to unrecognized tax benefits in income tax expense.

(o) Fair Value of Financial Instruments

The carrying amounts of the Company’s cash equivalents and restricted cash equivalents and investments approximate their respective fair values due to the short-term nature and liquidity of these financial instruments. The fair value of the Company’s equity investment is determined by using prices for identical or similar investments of the same issuer, which is more fully described in Note (3), “Fair Value Measurement.” As it relates to the Company’s 2027 Notes and 2029 Notes (as defined in Note (8) and Note (3), respectively, below), fair value disclosure is detailed in Note (3), “Fair Value Measurement.” See Note (8), “Notes Payable and Credit Agreement,” for additional information. The fair value of the long-term portion of the Company’s insurance accruals cannot be estimated because the Company cannot reasonably determine the timing of future payments.

(p) Share-Based Compensation

The Company accounts for its share-based employee compensation plans by expensing the estimated fair value of share-based awards on a straight-line basis over the requisite employee service period, which typically is the vesting period, except for awards granted to retirement-eligible employees, which are expensed on an accelerated basis. Restricted stock units (“RSUs”) typically vest over a three-year period. Share-based compensation cost of RSUs is measured by the market value of the Company’s common stock on the date of grant, and the Company records share-based compensation expense only for those awards that are expected to vest. Performance restricted stock units (“PRSUs”) primarily consist of PRSUs that contain performance conditions dependent on defined targets of the Company’s adjusted EBITDA, with a range of 0% to 200% of the target amount granted to be issued under the award. Share-based compensation cost for these PRSUs is measured by the market value of the Company’s common stock on the date of grant, and the amount recognized is adjusted for estimated achievement of the performance conditions. A limited amount of PRSUs contain a market condition dependent upon the Company’s relative and absolute total stockholder return over a three-year period, with a range of 0% to 175% of the target amount granted to be issued under the award. Share-based compensation cost for these PRSUs is measured using the Monte-Carlo simulation valuation model and is not adjusted for the achievement, or lack thereof, of the market conditions.

(q) Net Income per Common Share

Share-based awards to purchase 33, 41 and 43 shares of common stock for the years ended December 31, 2021, 2020 and 2019, respectively, were not included in the calculation of diluted net income per common share because the effect of these instruments was anti-dilutive.

The following table sets forth the computation of basic and diluted net income per common share for the years ended December 31, 2021, 2020 and 2019, respectively:


	Years Ended December 31,
	2021		2020		2019
Net income	$	327,388	$	70,665	$	113,988

Net income per common share - basic	$	6.87	$	1.49	$	2.44
Net income per common share - diluted	$	6.81	$	1.48	$	2.40

Weighted average common shares outstanding - basic	47,685		47,424		46,704
Plus dilutive effect of potential common shares	360		266		889
Weighted average common shares outstanding - diluted	48,045		47,690		47,593

(r) Segment Information

The Company’s operating segments are identified in the same manner as they are reported internally and used by the Company’s chief operating decision maker for the purpose of evaluating performance and allocating resources. Effective March 8, 2020, the Company modified its reportable segments. The Company previously utilized three reportable segments, which it identified as follows: (1) nurse and allied solutions, (2) locum tenens solutions, and (3) other workforce solutions. In light of the Company’s recent acquisitions and organizational changes to better align its organizational structure with its strategy and operations, the Company’s management reorganized its reportable segments to better reflect how the business is evaluated by the chief operating decision maker. Beginning in the first quarter of 2020, the Company has disclosed the following three reportable segments: (1) nurse and allied solutions, (2) physician and leadership solutions, and (3) technology and workforce solutions. The nurse and allied solutions segment includes the Company’s travel nurse staffing, rapid response nurse staffing

and labor disruption, allied staffing, local staffing, and revenue cycle solutions businesses. The physician and leadership solutions segment includes the Company’s locum tenens staffing, healthcare interim leadership staffing, executive search, and physician permanent placement businesses. The technology and workforce solutions segment includes the Company’s language services, vendor management systems, workforce optimization, telehealth, credentialing, and outsourced solutions businesses.

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

The following table, which includes reclassified amounts for the year ended December 31, 2019 to conform to the new segment reporting structure, provides a reconciliation of revenue and operating income by reportable segment to consolidated results and was derived from each segment’s internal financial information as used for corporate management purposes:


	Years Ended December 31,
	2021		2020		2019
Revenue
Nurse and allied solutions	$	2,990,103	$	1,699,311	$	1,562,588
Physician and leadership solutions	594,243		466,622		562,762
Technology and workforce solutions	399,889		227,781		96,757
	$	3,984,235	$	2,393,714	$	2,222,107
Segment operating income
Nurse and allied solutions	$	461,311	$	232,005	$	219,862
Physician and leadership solutions	81,439		62,342		71,378
Technology and workforce solutions	187,578		93,212		43,899
	730,328		387,559		335,139
Unallocated corporate overhead	123,416		123,642		83,463
Depreciation and amortization	101,152		92,766		58,520
Depreciation (included in cost of revenue)	2,545		1,421		—
Share-based compensation	25,217		20,465		16,241
Interest expense, net, and other	34,077		57,742		28,427
Income before income taxes	$	443,921	$	91,523	$	148,488

The following tables present the Company’s revenue disaggregated by service type:


		Year Ended December 31, 2021
		Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
	Travel nurse staffing	$	2,168,507	$	—	$	—	$	2,168,507
	Labor disruption services	110,520		—		—		110,520
	Local staffing	124,977		—		—		124,977
	Allied staffing	586,099		—		—		586,099
	Locum tenens staffing	—		352,650		—		352,650
	Interim leadership staffing	—		170,236		—		170,236
Temporary staffing		2,990,103		522,886		—		3,512,989
Permanent placement		—		71,357		—		71,357
	Language services	—		—		180,891		180,891
	Vendor management systems	—		—		148,532		148,532
	Other technologies	—		—		29,043		29,043
Technology-enabled services		—		—		358,466		358,466
Talent planning and acquisition		—		—		41,423		41,423
Total revenue		$	2,990,103	$	594,243	$	399,889	$	3,984,235


		Year Ended December 31, 2020
		Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
	Travel nurse staffing	$	1,230,396	$	—	$	—	$	1,230,396
	Labor disruption services	7,137		—		—		7,137
	Local staffing	53,218		—		—		53,218
	Allied staffing	408,560		—		—		408,560
	Locum tenens staffing	—		277,428		—		277,428
	Interim leadership staffing	—		130,800		—		130,800
Temporary staffing		1,699,311		408,228		—		2,107,539
Permanent placement		—		58,394		—		58,394
	Language services	—		—		116,054		116,054
	Vendor management systems	—		—		69,756		69,756
	Other technologies	—		—		23,557		23,557
Technology-enabled services		—		—		209,367		209,367
Talent planning and acquisition		—		—		18,414		18,414
Total revenue		$	1,699,311	$	466,622	$	227,781	$	2,393,714


		Year Ended December 31, 2019
		Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
	Travel nurse staffing	$	1,011,336	$	—	$	—	$	1,011,336
	Labor disruption services	36,371		—		—		36,371
	Local staffing	49,049		—		—		49,049
	Allied staffing	465,832		—		—		465,832
	Locum tenens staffing	—		324,654		—		324,654
	Interim leadership staffing	—		158,330		—		158,330
Temporary staffing		1,562,588		482,984		—		2,045,572
Permanent placement		—		79,778		—		79,778

	Vendor management systems	—		—		59,026		59,026
	Other technologies	—		—		21,635		21,635
Technology-enabled services		—		—		80,661		80,661
Talent planning and acquisition		—		—		16,096		16,096
Total revenue		$	1,562,588	$	562,762	$	96,757	$	2,222,107

(s) Recently Adopted Accounting Pronouncements

In December 2019, the Financial Accounting Standards Board (“FASB”) issued Accounting Standard Update (“ASU”) 2019-12, “Simplifying the Accounting for Income Taxes.” The standard is expected to reduce cost and complexity related to accounting for income taxes. The new guidance eliminates certain exceptions and clarifies and amends existing guidance to promote consistent application among reporting entities. Depending on the amended guidance within this standard, adoption is to be applied on a retrospective, modified retrospective or prospective basis. The Company adopted this standard effective January 1, 2021, and the adoption did not have a material effect on the Company’s consolidated financial statements.

In January 2020, the FASB issued ASU 2020-01, “Clarifying the Interactions between Topic 321, Topic 323, and Topic 815.” The new guidance clarifies the interactions between accounting standards that apply to equity investments without readily determinable fair values. Specifically, it addresses the accounting for the transition into and out of the equity method. The Company adopted this standard effective January 1, 2021 on a prospective basis, and the adoption did not have a material effect on the Company’s consolidated financial statements.

Acquisitions

12 Months Ended

Dec. 31, 2021

Business Combination and Asset Acquisition [Abstract]

Acquisitions

As set forth below, the Company completed five acquisitions from January 1, 2019 through December 31, 2021. The Company accounted for each acquisition using the acquisition method of accounting. Accordingly, the Company recorded the tangible and intangible assets acquired and liabilities assumed at their estimated fair values as of the applicable date of acquisition. Since the applicable date of acquisition, the Company has revised the allocation of the purchase price to the tangible and intangible assets acquired and liabilities assumed based on analysis of information that has been made available through December 31, 2021. The allocations will continue to be updated through the measurement period, if necessary. The Company recognizes acquisition-related costs in selling, general and administrative expenses in the consolidated statements of comprehensive income.

Synzi and SnapMD Acquisition

On April 7, 2021, the Company completed its acquisition of Synzi Holdings, Inc. (“Synzi”) and its wholly-owned subsidiary, SnapMD, LLC (“SnapMD”). Synzi is a virtual care communication platform that enables organizations to conduct virtual visits and use secure messaging, text, and email for clinician-to-patient and clinician-to-clinician communications. SnapMD is a full-service virtual care management company, specializing in providing software to enable healthcare providers to better engage with their patients. The initial purchase price of $42,240 consisted entirely of cash consideration paid upon acquisition. The acquisition was funded primarily through borrowings under the Senior Credit Facility (as defined below). The results of Synzi and SnapMD have been included in the Company’s technology and workforce solutions segment since the date of acquisition. During the second quarter of 2021, $92 was returned to the Company in respect of the final working capital settlement.

The preliminary allocation of the $42,148 purchase price, which was reduced by the final working capital settlement, consisted of (1) $2,790 of fair value of tangible assets acquired, which included $884 cash received, (2) $275 of liabilities assumed, (3) $12,440 of identified intangible assets, and (4) $27,193 of goodwill, of which $6,044 is deductible for tax purposes. The provisional items pending finalization are income tax related matters and the assessment of additional information related to determining the fair value of certain assets acquired and liabilities assumed. The fair value of intangible assets primarily includes $10,890 of developed technology and $1,220 of trademarks with a weighted average useful life of approximately seven years.

Stratus Video Acquisition

On February 14, 2020, the Company completed its acquisition of Stratus Video, a remote video interpreting company that provides healthcare interpretation via remote video, over the phone, and onsite in-person, all supported by proprietary technology platforms. The initial purchase price of $485,568 consisted entirely of cash consideration paid upon acquisition. The acquisition was funded primarily through (1) borrowings under the Company’s $400,000 secured revolving credit facility (the “Senior Credit Facility”), provided for under a credit agreement (the “New Credit Agreement”), and (2) the Second Amendment (as defined in Note (8) below) to the New Credit Agreement, which provided $250,000 of additional available borrowings to the Company. The Senior Credit Facility, New Credit Agreement and Second Amendment are more fully described in Note (8), “Notes Payable and Credit Agreement.” The results of Stratus Video have been included in the Company’s technology and workforce solutions segment since the date of acquisition. During the second quarter of 2020, an additional $99 of cash consideration was paid to the selling shareholders in respect of the final working capital settlement. The Company incurred $11,467 of acquisition-related costs during the year ended December 31, 2020 as a result of its acquisition of Stratus Video.

The allocation of the $485,667 purchase price, which included the additional cash consideration paid for the final working capital settlement and was finalized during the first quarter of 2021, consisted of (1) $44,092 of fair value of tangible assets acquired, which included $9,176 cash received, (2) $56,059 of liabilities assumed, (3) $228,000 of identified intangible assets, and (4) $269,634 of goodwill, of which $10,182 is deductible for tax purposes. The intangible assets acquired have a weighted average useful life of approximately seventeen years. The following table summarizes the fair value and useful life of each intangible asset acquired as of the acquisition date:


		Fair Value		Useful Life
				(in years)
Identifiable intangible assets
	Customer relationships	$	171,000	20
	Tradenames and trademarks	40,000		5 - 10
	Developed technology	16,000		5
	Interpreter database	1,000		4
		$	228,000

During the third quarter of 2020, the Company revised the estimated useful lives for the tradenames and trademarks intangible assets as a result of its plan to rebrand the language interpretation business. Based on this change in circumstances since the date of acquisition, the Company determined that the remaining useful lives of the assets are five years and is amortizing the remaining value on a straight-line basis over the remaining useful life. The Company will continue to evaluate the remaining useful lives of other intangible assets impacted by its brand consolidation efforts.

Approximately $116,054 of revenue and $20,164 of income before income taxes of Stratus Video were included in the consolidated statement of comprehensive income for the year ended December 31, 2020.

Pro Forma Financial Information (Unaudited)

The following summary presents unaudited pro forma consolidated results of operations of the Company as if the acquisitions of Stratus Video and Advanced (as defined below) had occurred on January 1, 2019, which gives effect to certain adjustments, including acquisition-related costs of $25,311, of which $14,468 was reclassified from the year ended December 31, 2020, amortization of intangible assets of $15,014, and interest expense of $6,722 for the year ended December 31, 2019. The unaudited pro forma financial information is not necessarily indicative of the operating results that would have occurred had the acquisitions been consummated as of the date indicated, nor is it necessarily indicative of the Company’s future

operating results.


	Years Ended December 31,
	2020		2019
Revenue	$	2,407,586	$	2,383,405
Income from operations	165,196		145,069
Net income	81,422		85,154

b4health Acquisition

On December 19, 2019, the Company completed its acquisition of B4Health, LLC (“b4health”), an innovative technology company and a leading provider of a web-based internal float pool management solution and vendor management system for healthcare facilities. The initial purchase price of $23,006 included (1) $19,906 cash consideration paid upon acquisition and (2) contingent consideration (earn-out payment) of up to $12,000 with an estimated fair value of $3,100 as of the acquisition date. The contingent earn-out payment is based on the operating results of b4health for the twelve months ending December 31, 2020, which was settled in full during the first quarter of 2021. The results of b4health have been included in the Company’s technology and workforce solutions segment since the date of acquisition. During the first quarter of 2020, $66 was returned to the Company in respect of the final working capital settlement.

The allocation of the $22,940 purchase price, which was reduced by the final working capital settlement and finalized during the fourth quarter of 2020, consisted of (1) $1,169 of fair value of tangible assets acquired, which included $222 cash received, (2) $823 of liabilities assumed, (3) $9,000 of identified intangible assets, and (4) $13,594 of goodwill, all of which is deductible for tax purposes. The fair value of intangible assets includes $3,000 of developed technology, $4,000 of customer relationships, and $2,000 of trademarks with a weighted average useful life of approximately seven years.

Advanced Acquisition

On June 14, 2019, the Company completed its acquisition of Advanced Medical Personnel Services, Inc. (“Advanced”), a national healthcare staffing company that specializes in placing therapists and nurses across multiple settings. The initial purchase price of $211,743 included (1) $201,121 cash consideration paid upon acquisition and (2) contingent consideration (earn-out payment) of up to $20,000 with an estimated fair value of $10,622 as of the acquisition date. The contingent earn-out payment is based on the operating results of Advanced for the twelve months ending December 31, 2019, which was settled in full during the first quarter of 2020. The acquisition was funded primarily through (1) borrowings under the Senior Credit Facility and (2) the First Amendment (as defined in Note (8) below) to the New Credit Agreement, which provided $150,000 of additional available borrowings to the Company. The results of Advanced have been included in the Company’s nurse and allied solutions segment since the date of acquisition. During the third quarter of 2019, an additional $73 of cash consideration was paid to the selling shareholders in respect of the final working capital settlement.

The allocation of the $211,816 purchase price, which included the additional cash consideration paid for the final working capital settlement and was finalized during the second quarter of 2020, consisted of (1) $29,020 of fair value of tangible assets acquired, which included $2,497 cash and restricted cash received, (2) $28,772 of liabilities assumed, (3) $91,700 of identified intangible assets, and (4) $119,868 of goodwill, of which $57,236 is deductible for tax purposes. The intangible assets acquired have a weighted average useful life of approximately nine years. The following table summarizes the fair value and useful life of each intangible asset acquired:


		Fair Value		Useful Life
				(in years)
Identifiable intangible assets
	Customer relationships	$	68,000	10
	Tradenames and trademarks	10,000		5
	Staffing database	10,300		10
	Developed technology	3,400		3
		$	91,700

Silversheet Acquisition

On January 30, 2019, the Company completed its acquisition of Silversheet, Inc. (“Silversheet”), which provides innovative software and services to reduce the complexities and challenges of the credentialing process for clinicians and healthcare organizations. The initial purchase price of $31,676 included (1) $30,176 cash consideration paid upon acquisition, funded primarily through borrowings under the Senior Credit Facility, and (2) contingent consideration (earn-out payment) of up to $25,000 with an estimated fair value of $1,500 as of the acquisition date. The contingent earn-out payment is based on (A) up to $6,000 based on the operating results of Silversheet for the twelve months ending December 31, 2019, which resulted in no earn-out payment, and (B) up to $19,000 based on the operating results of Silversheet for the twelve months ending December 31, 2020, which resulted in no earn-out payment. The results of Silversheet have been included in the Company’s technology and workforce solutions segment since the date of acquisition.

The allocation of the $31,676 purchase price, which was finalized during the first quarter of 2020, consisted of (1) $2,826 of fair value of tangible assets acquired, which included $651 cash received, (2) $1,567 of liabilities assumed, (3) $6,880 of identified intangible assets, and (4) $23,537 of goodwill, none of which is deductible for tax purposes. The fair value of intangible assets primarily includes $5,300 of developed technology and $1,500 of trademarks with a weighted average useful life of approximately eight years.

Fair Value Measurement

12 Months Ended

Dec. 31, 2021

Fair Value Disclosures [Abstract]

Fair Value Measurement

Fair value represents the price that would be received for an asset or paid to transfer a liability (an exit price) in the principal or most advantageous market for the asset or liability in an orderly transaction between market participants on the measurement date. When determining fair value, the Company considers the principal or most advantageous market in which the Company would conduct a transaction, in addition to the assumptions that market participants would use when pricing the related assets or liabilities, including non-performance risk.

A three-level hierarchy prioritizes the inputs to valuation techniques used to measure fair value and requires an entity to maximize the use of observable inputs and minimize the use of unobservable inputs when measuring fair value. The three levels of the fair value hierarchy are as follows:

Level 1—Quoted prices in active markets for identical assets or liabilities.

Level 2—Observable inputs other than Level 1 prices such as quoted prices for similar assets or liabilities; quoted prices in markets that are not active; or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the assets or liabilities.

Level 3—Unobservable inputs that are supported by little or no market activity and that are significant to the fair value of the assets or liabilities.

Assets and Liabilities Measured on a Recurring Basis

The Company’s restricted cash equivalents that serve as collateral for the Company’s outstanding letters of credit typically consist of money market funds that are measured at fair value based on quoted prices, which are Level 1 inputs.

The Company’s obligation under its deferred compensation plan is measured at fair value based on quoted market prices of the participants’ elected investments, which are Level 1 inputs. The deferred compensation plan is more fully described in Note (9), “Retirement Plans.”

The Company’s restricted cash equivalents and investments that serve as collateral for the Company’s captive insurance company include commercial paper that is measured at observable market prices for identical securities that are traded in less active markets, which are Level 2 inputs. The Company’s cash equivalents also include commercial paper classified as Level 2 in the fair value hierarchy. Of the $80,596 commercial paper issued and outstanding as of December 31, 2021, none had original maturities greater than three months and were considered available-for-sale securities. As of December 31, 2020, the Company had $58,345 commercial paper issued and outstanding, of which $25,196 had original maturities greater than three months and were considered available-for-sale securities.

The Company’s restricted cash equivalents and investments that serve as collateral for the Company’s captive insurance company also include corporate bonds that are measured using readily available pricing sources that utilize observable market data, including the current interest rate for comparable instruments, which are Level 2 inputs. Of the $29,159 corporate bonds issued and outstanding as of December 31, 2021, $27,958 had original maturities greater than three months, which were considered available-for-sale securities. The Company did not have corporate bonds as of December 31, 2020.

The fair value of our available-for-sale securities as of December 31, 2021, by remaining contractual maturities, are presented in the following table:


	Fair Value
Due in one year or less	$	5,528
Due after one year through five years	22,430
	$	27,958

The Company’s contingent consideration liabilities are measured at fair value using 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 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 December 31, 2021
Assets (Liabilities)	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	$	91,454	$	91,454	$	—	$	—
Deferred compensation	(119,617)		(119,617)		—		—
Corporate bonds	29,159		—		29,159		—
Commercial paper	80,596		—		80,596		—


	Fair Value Measurements as of December 31, 2020
Assets (Liabilities)	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	$	2,198	$	2,198	$	—	$	—
Deferred compensation	(97,184)		(97,184)		—		—
Commercial paper	58,345		—		58,345		—
Acquisition contingent consideration liabilities	(8,000)		—		—		(8,000)

Level 3 Information

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


	2021		2020
Balance as of January 1,	$	(8,000)	$	(23,100)
Settlement of Advanced contingent consideration liability for year ended December 31, 2019	—		20,000
Settlement of b4health contingent consideration liability for year ended December 31, 2020	8,000		—
Change in fair value of contingent consideration liability from b4health acquisition	—		(4,900)
Balance as of December 31,	$	—	$	(8,000)

As of December 31, 2020, the fair value measurement of contingent consideration liability for b4health was based on actual operating results of the acquired company.

Assets Measured on a Non-Recurring Basis

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

The Company evaluates goodwill and indefinite-lived intangible assets annually for impairment and whenever events or changes in circumstances indicate that it is more likely than not that an impairment exists. The Company determines the fair value of its reporting units based on a combination of inputs, including the market capitalization of the Company, as well as Level 3 inputs such as discounted cash flows, which are not observable from the market, directly or indirectly. The Company determines the fair value of 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, and other information available to the Company such as the rights and obligations of the securities. The Company recognizes changes to the fair value of its equity investment in interest expense, net, and other in the consolidated statements of comprehensive income. The balance of the equity investment was $22,633 and $15,449 as of December 31, 2021 and 2020, respectively.

There were no triggering events identified, no indication of impairment of the Company’s goodwill, indefinite-lived intangible assets, long-lived assets, or equity investments, and no impairment charges recorded during the three years ended December 31, 2021 requiring such measurements.

Fair Value of Financial Instruments

The Company is required to disclose the fair value of financial instruments for which it is practicable to estimate the value, even though these instruments are not recognized at fair value in the consolidated balance sheets. The fair value of the Company’s 2027 Notes (as defined in Note (8) below) and 4.000% senior notes due 2029 (the “2029 Notes”) was estimated using quoted market prices in active markets for identical liabilities, which are Level 1 inputs. The carrying amounts and estimated fair value of the 2027 Notes and the 2029 Notes, which are more fully described in Note (8), “Notes Payable and Credit Agreement,” are presented in the following table:


	As of December 31, 2021		As of December 31, 2020
	Carrying Amount	Estimated Fair Value	Carrying Amount	Estimated Fair Value
2027 Notes	500,000	517,500	500,000	521,250
2029 Notes	350,000	353,500	350,000	357,000

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.

- Definition

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

Goodwill and Identifiable Intangible Assets

12 Months Ended

Dec. 31, 2020

Goodwill and Intangible Assets Disclosure [Abstract]

Goodwill and Identifiable Intangible Assets

As of December 31, 2021 and 2020, the Company had the following acquired intangible assets:


	As of December 31, 2021						As of December 31, 2020
	Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount		Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount
Intangible assets subject to amortization:
Staffing databases	$	36,836	$	(19,857)	$	16,979	$	36,836	$	(16,706)	$	20,130
Customer relationships	445,169		(150,255)		294,914		444,839		(122,105)		322,734
Tradenames and trademarks	256,889		(81,522)		175,367		166,269		(58,299)		107,970
Non-compete agreements	6,495		(4,621)		1,874		6,371		(3,402)		2,969
Acquired technology	47,320		(21,994)		25,326		36,430		(14,722)		21,708
	$	792,709	$	(278,249)	$	514,460	$	690,745	$	(215,234)	$	475,511
Intangible assets not subject to amortization:
Tradenames and trademarks					$	—					$	89,400
					$	514,460					$	564,911

As a result of recent developments in its brand consolidation efforts, the Company reassessed the useful lives of its tradenames and trademarks intangible assets during the fourth quarter of 2021. This assessment included tradenames and trademarks related to the Company's locums tenens, interim leadership, local staffing, physician permanent placement, allied, and VMS businesses. As a result, the Company concluded (a) that the useful lives for $89,400 of tradenames and trademarks that were previously not subject to amortization were no longer considered to be indefinite and (b) to revise the estimated useful lives for $19,766 of tradenames and trademarks. Prior to assigning useful lives to the previously indefinite-lived intangible assets, the Company tested the assets for impairment, concluding that they were not impaired. Effective December 31, 2021, these tradenames and trademarks intangible assets were assigned a weighted average useful life of approximately six years and the Company will amortize their carrying values on a straight-line basis over the remaining useful lives.

Aggregate amortization expense for intangible assets was $63,015 and $63,817 for the years ended December 31, 2021 and 2020, respectively. Based on the current amount of intangibles subject to amortization, the estimated future amortization expense as of December 31, 2021 is as follows:


	Amount
Year ending December 31, 2022	$	79,001
Year ending December 31, 2023	77,333
Year ending December 31, 2024	70,783
Year ending December 31, 2025	57,772
Year ending December 31, 2026	48,050
Thereafter	181,521
	$	514,460

In connection with the reorganization of its reportable segments effective March 8, 2020, the Company reassigned the goodwill balances to the reporting units, the composition of which changed under the reorganized reportable segments, using the relative fair value reallocation approach. The Company performed a goodwill impairment test at the reporting unit level both immediately before and after the reorganization. The Company determined the fair values of its reporting units using a combination of the income approach (using discounted future cash flows) and the market valuation approach. Based on the results of this testing, the Company determined that the fair values of its reporting units were each greater than their respective carrying values both before and after the reorganization. Therefore, there was no impairment loss recognized during the year ended December 31, 2020.

The following table, which includes reclassified prior period amounts to conform to the new segment reporting structure, summarizes the activity related to the carrying value of goodwill by reportable segment:


	Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
Balance, January 1, 2020	$	344,316	$	163,348	$	87,887	$	595,551
Goodwill adjustment for Advanced acquisition	29		—		—		29
Goodwill adjustment for b4health acquisition	—		—		(66)		(66)
Goodwill from Stratus Video acquisition	—		—		268,971		268,971
Reallocation due to change in segments	(5,330)		(10,548)		15,878		—
Balance, December 31, 2020	339,015		152,800		372,670		864,485
Goodwill adjustment for Stratus Video acquisition	—		—		663		663
Goodwill from Synzi and SnapMD acquisition	—		—		27,193		27,193
Balance, December 31, 2021	$	339,015	$	152,800	$	400,526	$	892,341
Accumulated impairment loss as of December 31, 2020 and 2021	$	154,444	$	60,495	$	—	$	214,939

Leases

12 Months Ended

Dec. 31, 2021

Leases [Abstract]

Leases

The Company leases certain office facilities, data centers, and equipment under various operating leases. The Company’s short-term leases (with initial lease terms of 12 months or less) are primarily related to housing arrangements for healthcare professionals on assignment. Most leases include one or more options to renew, with renewal terms that can extend the lease term up to 10 years. Certain leases also include options to terminate the leases within 2 years.

During the third quarter of 2021, the Company entered into an arrangement to terminate the lease agreement (as amended to date) for its office space in San Diego. The termination will occur in two phases: the first phase terminates the Company’s right to use certain floors effective February 28, 2022 and the second phase reduces the remaining lease term to December 31, 2024 from its original termination date of July 31, 2027. As a result of the arrangement, which was accounted for as a modification, the Company paid a termination fee of $17,000, remeasured the lease liability using its incremental borrowing rate as the discount rate, and recorded decreases to its operating lease liabilities and right-of-use assets of $27,340 during the third quarter of 2021. Prior to the modification, the total remaining lease payments for this office lease were $62,487. Under the modified lease terms, the total remaining lease payments (excluding the termination fee paid during the third quarter of 2021) were $9,564 as of the modification date.

The components of lease expense were as follows:


	Years Ended December 31,
	2021		2020		2019
Operating lease cost	$	23,495	$	20,176	$	18,725
Short-term lease cost	6,056		8,702		20,112
Variable and other lease cost	2,485		2,526		2,880
Net lease cost	$	32,036	$	31,404	$	41,717

The maturities of lease liabilities as of December 31, 2021 were as follows:


	Operating Leases
Years ending December 31,
2022	$	11,867
2023	6,468
2024	5,348
2025	1,876
2026	112
Thereafter	—
Total lease payments	25,671
Less imputed interest	(924)
Present value of lease liabilities	$	24,747

Supplemental cash flow information related to leases was as follows:


	Years Ended December 31,
	2021		2020		2019
Cash paid for amounts included in the measurement of operating lease liabilities (operating cash flows)	$	39,865	$	20,052	$	17,817

The weighted average remaining lease term and discount rate as of December 31, 2021 and 2020 were as follows:


	December 31,
	2021		2020
Weighted average remaining lease term	3 years		6 years
Weighted average discount rate	2.6	%	4.8	%

Balance Sheet Details

12 Months Ended

Dec. 31, 2021

Balance Sheet Related Disclosures [Abstract]

Balance Sheet Details

The consolidated balance sheets detail is as follows:


	December 31,
	2021		2020
Other current assets:
Restricted cash and cash equivalents	$	29,262	$	18,626

Other	37,568		22,183
Other current assets	$	66,830	$	40,809

Prepaid expenses:
Prepaid payroll deposits	$	60,014	$	—
Other	12,446		13,629
Current assets	$	72,460	$	13,629

Fixed assets:
Furniture and equipment	$	43,134	$	47,355
Software	265,137		220,971
Leasehold improvements	8,797		9,600
	317,068		277,926
Accumulated depreciation	(189,954)		(161,752)
Fixed assets, net	$	127,114	$	116,174

Accounts payable and accrued expenses:
Trade accounts payable	$	77,325	$	28,089
Subcontractor payable	261,689		79,364
Accrued expenses	61,220		37,849
Loss contingencies	10,400		7,613
Professional liability reserve	7,127		8,897
Other	7,496		6,069
Accounts payable and accrued expenses	$	425,257	$	167,881

Accrued compensation and benefits:
Accrued payroll	$	98,817	$	59,721
Accrued bonuses and commissions	105,155		34,514
Accrued travel expense	3,058		1,998
Health insurance reserve	6,041		5,590
Workers compensation reserve	12,384		10,244
Deferred compensation	119,617		97,184
Other	9,309		4,163
Accrued compensation and benefits	$	354,381	$	213,414

Other current liabilities:
Income taxes payable	$	21,162	$	—
Acquisition related liabilities	—		8,000
Client deposits	141,102		1,636
Other	155		1,302
Other current liabilities	$	162,419	$	10,938

Other long-term liabilities:
Workers compensation reserve	$	24,130	$	20,930
Professional liability reserve	34,544		31,997

Unrecognized tax benefits	4,633		5,447
Other	33,682		49,533
Other long-term liabilities	$	96,989	$	107,907

Income Taxes

12 Months Ended

Dec. 31, 2021

Income Tax Disclosure [Abstract]

Income Taxes

The provision for income taxes from operations for the years ended December 31, 2021, 2020 and 2019 consists of the following:


	Years Ended December 31,
	2021		2020		2019
Current income taxes:
Federal	$	98,795	$	32,673	$	25,255
State	34,025		9,813		8,332
Total	132,820		42,486		33,587
Deferred income taxes:
Federal	(12,992)		(15,092)		625
State	(3,295)		(6,536)		288
Total	(16,287)		(21,628)		913
Provision for income taxes from operations	$	116,533	$	20,858	$	34,500

The Company’s income tax expense differs from the amount that would have resulted from applying the federal statutory rate of 21% for 2021, 2020 and 2019 to pretax income from operations because of the effect of the following items during the years ended December 31, 2021, 2020 and 2019:


	Years Ended December 31,
	2021		2020		2019
Tax expense at federal statutory rate	$	93,223	$	19,220	$	31,253
State taxes, net of federal benefit	23,990		4,161		6,810
Non-deductible expenses	—		3,621		3,840
Share-based compensation	(1,460)		(2,311)		(4,770)

Unrecognized tax benefit	(680)		(78)		(207)
Other, net	1,460		(3,755)		(2,426)
Income tax expense from operations	$	116,533	$	20,858	$	34,500

Certain reclassifications have been made to the prior year’s presentation of deferred tax assets in order to conform to the current year presentation. There is no change to the prior year total deferred tax assets. The tax effects of temporary differences that give rise to significant portions of deferred tax assets and liabilities are presented below as of December 31, 2021 and 2020:


	December 31,
	2021		2020
Deferred tax assets:
Stock compensation	$	6,954	$	6,198
Deferred compensation	30,513		24,604
Accrued bonus	24,636		7,607
Accrued payroll taxes	6,427		12,445
Accrued expenses	19,899		13,371

Operating lease liabilities	6,472		23,826
Net operating losses	8,815		9,557
Loss contingencies	8,528		6,459
Workers compensation insurance	6,476		4,814
Other	2,731		989
Total deferred tax assets	$	121,451	$	109,870
Deferred tax liabilities:
Intangibles	$	(126,535)	$	(126,833)
Fixed assets	(28,824)		(25,252)
Operating lease right-of-use assets	(7,269)		(19,933)
Other	(6,637)		(5,057)
Total deferred tax liabilities	$	(169,265)	$	(177,075)

Net deferred tax liabilities	$	(47,814)	$	(67,205)

In assessing the realizability of deferred tax assets, management considers whether it is more likely than not that some portion or all of the deferred tax assets will not be realized. Management believes it is more likely than not that the Company will realize the benefits of its deferred tax assets.

The amount of federal net operating losses (“NOL”) carryforward that is available for use in years subsequent to December 31, 2021 is $35,046, primarily related to the Stratus Video acquisition, which begins to expire by 2030. The amount of state NOL carryforward that is available for use in years subsequent to December 31, 2021 is $29,437, primarily related to the Stratus Video and Synzi acquisitions, which begins to expire by 2022. The Stratus Video and Synzi acquisitions are more fully described in Note (2), “Acquisitions.”

A summary of the changes in the amount of unrecognized tax benefits (excluding interest and penalties) for 2021, 2020 and 2019 is as follows:


	2021		2020		2019
Beginning balance of unrecognized tax benefits	$	4,916	$	4,937	$	4,393
Additions based on tax positions related to the current year	504		667		588
Additions based on tax positions of prior years	—		255		990
Reductions for tax positions of prior years	(301)		—		—
Reductions due to lapse of applicable statute of limitation	(1,052)		(943)		(1,034)

Ending balance of unrecognized tax benefits	$	4,067	$	4,916	$	4,937

At December 31, 2021, if recognized, approximately $3,936 net of $697 of temporary differences would affect the effective tax rate (including interest and penalties).

The Company recognizes interest related to unrecognized tax benefits in income tax expense. The Company had approximately $564, $530 and $493 of accrued interest related to unrecognized tax benefits at December 31, 2021, 2020 and 2019, respectively. The amount of interest expense recognized in 2021, 2020 and 2019 was $34, $37 and $26, respectively.

The Company is subject to taxation in the U.S. and various states and foreign jurisdictions. With few exceptions, as of December 31, 2021, the Company is no longer subject to state, local or foreign examinations by tax authorities for tax years before 2011, and the Company is no longer subject to U.S. federal income or payroll tax examinations for tax years before 2018. Prior to the Company’s acquisition of Advanced, on June 14, 2019, Advanced was under an IRS audit for the years 2011-2013 for various payroll tax matters related to the treatment of certain non-taxable per diem allowances and travel benefits. This audit was completed and an assessment was issued for $8,300 in July 2018. The Company received a final determination from the IRS in November 2019 for $1,300. The Company is indemnified by Advanced for the potential contingent liability for all pre-acquisition open years. The Advanced acquisition is more fully described in Note (2), “Acquisitions.”

The Company believes its reserve for unrecognized tax benefits and contingent tax issues is adequate with respect to all open years. Notwithstanding the foregoing, the Company could adjust its provision for income taxes and contingent tax liability based on future developments.

CARES Act

On March 27, 2020, the Coronavirus Aid, Relief, and Economic Security Act (the “CARES Act”) was enacted and signed into law in response to the COVID-19 pandemic. Among other things, the CARES Act contains significant business tax provisions, including a deferral of payment of employer payroll taxes and an employer retention credit for employer payroll taxes.

The Company deferred payment of the employer’s share of payroll taxes of $48,452. Approximately half of such taxes was paid during the fourth quarter of 2021, which was included in accrued compensation and benefits in the consolidated balance sheet as of December 31, 2020, and the other half is to be paid by the end of 2022, which is included in accrued compensation and benefits and other long-term liabilities in the consolidated balance sheets as of December 31, 2021 and 2020, respectively. The Company claimed an employee retention employment tax credit of $1,756.

- Definition

The entire disclosure for income taxes. Disclosures may include net deferred tax liability or asset recognized in an enterprise's statement of financial position, net change during the year in the total valuation allowance, approximate tax effect of each type of temporary difference and carryforward that gives rise to a significant portion of deferred tax liabilities and deferred tax assets, utilization of a tax carryback, and tax uncertainties information.

+ References

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+ Details

Notes Payable and Credit Agreement

12 Months Ended

Dec. 31, 2021

Debt Disclosure [Abstract]

Notes Payable and Credit Agreement

(a) The Company’s Credit Agreement and Related Credit Facilities

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. On June 14, 2019, the Company entered into the first amendment to the New Credit Agreement (the “First Amendment”) to provide for, among other things, a $150,000 secured term loan credit facility (the “Term Loan”). The Company used the proceeds from the Term Loan, together with a drawdown of a portion of the Senior Credit Facility, to complete its acquisition of Advanced, as more fully described in Note (2), “Acquisitions.” The Company fully repaid all amounts under the Term Loan in 2019.

On February 14, 2020, the Company entered into the second amendment to the New Credit Agreement (the “Second Amendment”) to provide for, among other things, a $250,000 secured term loan credit facility (the “Additional Term Loan”). The Second Amendment (together with the New Credit Agreement and the First Amendment, collectively, the “Amended Credit Agreement”) extended the maturity date of the Senior Credit Facility to be coterminous with the Additional Term Loan. The obligations of the Company under the Amended Credit Agreement are secured by substantially all of the assets of the Company. The Company used the proceeds from the Additional Term Loan, together with a drawdown of a portion of the Senior Credit Facility, to complete its acquisition of Stratus Video, as more fully described in Note (2), “Acquisitions.” The Company fully repaid all amounts under the Additional Term Loan in the first quarter of 2021.

In connection with the Second Amendment, the Company incurred $4,144 in fees paid to lenders and other third parties, which were capitalized and are being amortized to interest expense over the term of the Credit Facilities (as defined below). In addition, $1,681 of unamortized financing fees incurred in connection with obtaining the New Credit Agreement and First Amendment will continue to be amortized to interest expense over the term of the Credit Facilities.

Borrowings under the Senior Credit Facility (together with the Additional Term Loan, collectively, the “Credit Facilities”) bears interest at floating rates, at the Company’s option, based upon either LIBOR plus a spread of 1.00% to 1.75% or a base rate plus a spread of 0.00% to 0.75%. The applicable spread is determined quarterly based upon the Company’s consolidated net leverage ratio (as calculated per the Amended Credit Agreement). The Additional Term Loan was subject to amortization of principal of 2.50% per year for the first year of the term and 5.00% per year thereafter, payable in equal quarterly installments. The Senior Credit Facility, which includes a $75,000 sublimit for the issuance of letters of credit and a $75,000 sublimit for swingline loans, is available for working capital, capital expenditures, permitted acquisitions and general corporate purposes. The maturity date of the Credit Facilities is February 14, 2025.

At December 31, 2021, with $21,408 of outstanding letters of credit collateralized by the Senior Credit Facility, there was $378,592 of available credit under the Senior Credit Facility.

(b) The Company’s 4.625% Senior Notes Due 2027

On August 13, 2020, the Company completed the issuance of an additional $200,000 aggregate principal amount of 4.625% senior notes due 2027 (the “New 2027 Notes”), which were issued at a price of 101.000% of the aggregate principal amount. The New 2027 Notes were issued pursuant to the existing indenture, dated as of October 1, 2019, under which the Company previously issued $300,000 aggregate principal amount of 4.625% senior notes due 2027 (the “Existing 2027 Notes” and together with the New 2027 Notes, the “2027 Notes”). The New 2027 Notes will be treated as a single series with the Existing 2027 Notes and will have the same terms (other than issue price, issue date and the date from which interest accrues) as those of the Existing 2027 Notes. The 2027 Notes are unsecured obligations of the Company and the interest is fixed at 4.625% and payable semi-annually in arrears on April 1 and October 1 of each year, commencing October 1, 2020 with respect to the New 2027 Notes. The aggregate principal amount of the 2027 Notes matures on October 1, 2027.

With proceeds from the New 2027 Notes and cash on hand, the Company (1) repaid $200,000 of its indebtedness under the Additional Term Loan and (2) paid $2,620 of fees and expenses related to the issuance of the New 2027 Notes, which were recorded as a reduction of the notes payable balance and are being amortized to interest expense over the remaining term of the 2027 Notes.

On October 20, 2020, the Company completed the issuance of $350,000 aggregate principal amount of the 2029 Notes, which mature on April 15, 2029. The 2029 Notes are unsecured obligations of the Company and the interest is fixed at 4.000% and payable semi-annually in arrears on April 15 and October 15 of each year, commencing April 15, 2021. With the proceeds from the 2029 Notes and cash generated from operations, the Company (1) redeemed all of its outstanding $325,000 aggregate principal amount of the 5.125% senior notes due 2024 (the “2024 Notes”) on November 4, 2020, (2) paid $9,857 consisting of the associated redemption premium and accrued and unpaid interest on the 2024 Notes, (3) repaid $40,000 under the Senior Credit Facility and (4) incurred $4,744 in fees and expenses related to the issuance and sale of the 2029 Notes, which were recorded as a reduction of the notes payable balance and are being amortized to interest expense over the term of the 2029 Notes. In addition, the Company wrote off $2,992 of unamortized financing fees incurred in connection with the issuance of the 2024 Notes, which was recognized in interest expense, net, and other in the consolidated statements of comprehensive income for the year ended December 31, 2020.

(d) Debt Balances

Outstanding debt balances as of December 31, 2021 and 2020 consisted of the following:


	As of December 31,
	2021		2020
Additional Term Loan	$	—	$	21,875


2027 Notes	500,000		500,000
2029 Notes	350,000		350,000
Total debt outstanding	850,000		871,875
Less unamortized fees and premium	(7,678)		(9,226)
Less current portion of notes payable	—		(4,688)
Long-term portion of notes payable	$	842,322	$	857,961

(e) Letters of Credit

At December 31, 2021, the Company maintained outstanding standby letters of credit totaling $23,562 as collateral in relation to its workers compensation insurance agreements and a corporate office lease agreement. Of the $23,562 outstanding letters of credit, the Company has collateralized $2,154 in cash and cash equivalents and the remaining $21,408 is collateralized by the Senior Credit Facility. Outstanding standby letters of credit at December 31, 2020 totaled $24,064.

- Definition

The entire disclosure for information about short-term and long-term debt arrangements, which includes amounts of borrowings under each line of credit, note payable, commercial paper issue, bonds indenture, debenture issue, own-share lending arrangements and any other contractual agreement to repay funds, and about the underlying arrangements, rationale for a classification as long-term, including repayment terms, interest rates, collateral provided, restrictions on use of assets and activities, whether or not in compliance with debt covenants, and other matters important to users of the financial statements, such as the effects of refinancing and noncompliance with debt covenants.

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-Name Accounting Standards Codification
-Topic 470
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-Section 50
-Paragraph 1B
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+ Details

Retirement Plans	12 Months Ended
Retirement Plans	Dec. 31, 2021
Retirement Benefits [Abstract]
Retirement Plans	Retirement Plans The Company maintains the AMN Services 401(k) Retirement Savings Plan (the “AMN Plan”), which the Company believes complies with the IRC Section 401(k) provisions. The AMN Plan covers all employees that meet certain age and other eligibility requirements. A discretionary matching contribution is determined by the Company each year. Employer contribution expenses incurred under the AMN Plan were $13,157, $4,256 and $5,516 for the years ended December 31, 2021, 2020 and 2019, respectively. The Company has a deferred compensation plan for certain executives and employees (the “Plan”). The Plan is not intended to be tax qualified and is an unfunded plan. The Plan is composed of deferred compensation and all related income and losses attributable thereto. Discretionary matching contributions to the Plan are made that vest incrementally so that the employee is fully vested in the match following five years of employment with the Company. Under the Plan, participants can defer up to 80% of their base salary, 90% of their bonus and 100% of their vested RSUs or vested PRSUs. A discretionary matching contribution is determined by the Company each year. Employer contributions under the Plan were $8,951, $2,845 and $5,551 for the years ended December 31, 2021, 2020 and 2019, respectively. In connection with the administration of the Plan, the Company has purchased company-owned life insurance policies insuring the lives of certain officers and employees. The cash surrender value of these policies was $115,095 and $98,161 at December 31, 2021 and 2020, respectively. The cash surrender value of these insurance policies is included in other assets in the consolidated balance sheets.

- Definition

The entire disclosure for retirement benefits.

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+ Details

Capital Stock	12 Months Ended
Capital Stock	Dec. 31, 2021
Equity [Abstract]
Capital Stock	Capital Stock (a) Preferred Stock The Company has 10,000 shares of preferred stock authorized for issuance in one or more series (including preferred stock designated as Series A Conditional Convertible Preferred Stock), at a par value of $0.01 per share. At December 31, 2021 and 2020, no shares of preferred stock were outstanding. (b) Treasury Stock On November 1, 2016, the Company’s board of directors approved a share repurchase program under which the Company may repurchase up to $150,000 of its outstanding common stock. On November 10, 2021, the Company announced an increase to the share repurchase program of up to an additional $150,000 of repurchases of its outstanding common stock. The amount and timing of the purchases will depend on a number of factors including the price of the Company’s shares, trading volume, Company performance, Company liquidity, general economic and market conditions and other factors that the Company’s management believes are relevant. The share repurchase program does not require the purchase of any minimum number of shares and may be suspended or discontinued at any time. The Company intends to make all repurchases and to administer the plan in accordance with applicable laws and regulatory guidelines, including Rule 10b-18 of the Exchange Act, and in compliance with its debt instruments. Repurchases may be made from cash on hand, free cash flow generated from the Company’s business or from the Company’s Senior Credit Facility. Repurchases may be made from time to time through open market purchases or privately negotiated transactions. Repurchases may also be made pursuant to one or more plans established pursuant to Rule 10b5-1 under the Exchange Act that would permit shares to be repurchased when the Company might otherwise be precluded from doing so under the Company’s securities trading policy. During the year ended December 31, 2021, the Company repurchased 25 shares of its common stock at an average price of $108.97 per share excluding broker’s fees, resulting in an aggregate purchase price of $2,688. During the year ended December 31, 2020, the Company did not repurchase any shares of its common stock. During the year ended December 31, 2019, the Company repurchased 395 shares of its common stock at an average price of $47.30 per share excluding broker’s fees, resulting in an aggregate purchase price of $18,705. On February 15, 2022, the Company’s board of directors approved an increase to the share repurchase program of up to an additional $300,000 of repurchases of its outstanding common stock. As of February 15, 2022, the Company has repurchased 701 shares of its common stock at an average price of $97.97 per share excluding broker’s fees, resulting in an aggregate purchase price of $68,739, since December 31, 2021.

- Definition

The entire disclosure for shareholders' equity comprised of portions attributable to the parent entity and noncontrolling interest, including other comprehensive income. Includes, but is not limited to, balances of common stock, preferred stock, additional paid-in capital, other capital and retained earnings, accumulated balance for each classification of other comprehensive income and amount of comprehensive income.

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+ Details

Share-Based Compensation

12 Months Ended

Dec. 31, 2021

Share-based Payment Arrangement [Abstract]

Share-Based Compensation

(a) Equity Award Plans

Equity Plan

The Company established the AMN Healthcare Equity Plan (as amended or amended and restated from time to time, the “Equity Plan”), which has been approved by the Company’s stockholders. At the time of the Equity Plan’s original adoption in 2006, equity awards, based on the Company’s common stock, could be issued for a maximum of 723 shares plus the number of

shares of common stock underlying any grants under the Stock Option Plan (under which there are no longer any outstanding awards) that were forfeited, canceled or terminated (other than by exercise) from and after the effective date of the Equity Plan. Pursuant to the Equity Plan, stock options and stock appreciation rights (“SARs”) granted have a maximum contractual life of ten years and have exercise prices that will be determined at the time of grant, which will be no less than fair market value of the underlying common stock on the date of grant. Any shares to be issued under the Equity Plan will be issued by the Company from authorized but unissued common stock or shares of common stock reacquired by the Company. On April 18, 2007, April 9, 2009, April 18, 2012 and April 19, 2017, the Company amended the Equity Plan, with stockholder approval, to increase the number of shares authorized under the Equity Plan by 3,000, 1,850, 2,400 and 1,400, respectively. As of December 31, 2021 and 2020, 2,548 and 2,830 shares of common stock were reserved for future grants under the Equity Plan, respectively.

Other Plans

From time to time, the Company grants, and has granted, key employees inducement awards outside of the Equity Plan (collectively, “Other Plans”), which have recently consisted of RSUs. Although these awards are not made under the Equity Plan, the key terms and conditions of the grant are typically the same as equity awards made under the Equity Plan.

Additionally, in February 2014, the Company established the 2014 Employment Inducement Plan, which reserves for issuance 200 shares of common stock for prospective employees of the Company. As of December 31, 2021, 181 shares of common stock remained available for future grants under the 2014 Employment Inducement Plan.

(b) Share-Based Compensation

Restricted Stock Units

RSUs and PRSUs (subject to performance conditions being achieved) granted under the Equity Plan generally entitle the holder to receive, at the end of a vesting period, a specified number of shares of the Company’s common stock. The following table summarizes RSU and PRSU activity for non-vested awards for the years ended December 31, 2021, 2020 and 2019:


	Number of Shares	Weighted Average Grant Date Fair Value per Share
Unvested at January 1, 2018	818	$	43.84
Granted—RSUs	191	$	54.99
Granted—PRSUs (1)	201	$	48.32
Vested	(400)	$	35.46
Canceled/forfeited	(52)	$	41.09
Unvested at December 31, 2019	758	$	52.45
Granted—RSUs	271	$	60.02
Granted—PRSUs (1)	155	$	64.59
Vested	(283)	$	49.18
Canceled/forfeited	(184)	$	53.84
Unvested at December 31, 2020	717	$	58.88
Granted—RSUs	290	$	85.30
Granted—PRSUs (1)	186	$	97.46
Vested	(280)	$	56.05
Canceled/forfeited	(158)	$	65.69
Unvested at December 31, 2021	755	$	78.13

(1) PRSUs granted included both the PRSUs granted during the year at the target amount and the additional shares of prior period granted PRSUs vested during the year in excess of the target shares.

As of December 31, 2021, there was $26,788 unrecognized compensation cost related to unvested RSUs and PRSUs. The Company expects to recognize such cost over a period of 1.7 years. As of December 31, 2021 and 2020, the aggregate intrinsic value of the RSUs and PRSUs outstanding was $92,346 and $48,945, respectively.

Stock Options and SARs

Stock options entitle the holder to purchase, at the end of a vesting period, a specified number of shares of the Company’s common stock at a price per share set at the date of grant. SARs entitle the holder to receive, at the end of a vesting period, shares of the Company’s common stock equal in value to the difference between the exercise price of the SAR, which is set at the date of grant, and the fair market value of the Company’s common stock on the date of exercise.

A summary of stock option and SAR activity under the Equity Plan and Other Plans are as follows:



	Number Outstanding	Weighted- Average Exercise Price per Share
Outstanding at December 31, 2018	227	$	8.61
Granted	—	$	—
Exercised	(215)	$	8.67
Canceled/forfeited/expired	—	$	—
Outstanding at December 31, 2019	12	$	7.51
Granted	—	$	—
Exercised	(12)	$	7.51
Canceled/forfeited/expired	—	$	—
Outstanding at December 31, 2020	—	$	—




Vested and expected to vest at December 31, 2020 and 2021	—	$	—
Exercisable at December 31, 2020 and 2021	—	$	—

As of December 31, 2020, there were no stock options or SARs outstanding. The total intrinsic value of stock options and SARs exercised was $828 and $9,177 for 2020 and 2019, respectively.

Share-Based Compensation

Total share-based compensation expense for the years ended December 31, 2021, 2020 and 2019 was as follows:


	Years Ended December 31,
	2021		2020		2019
Share-based employee compensation, before tax	$	25,217	$	20,465	$	16,241
Related income tax benefits	(6,556)		(5,321)		(4,223)
Share-based employee compensation, net of tax	$	18,661	$	15,144	$	12,018

Commitments and Contingencies	12 Months Ended
Commitments and Contingencies	Dec. 31, 2021
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and ContingenciesFrom time to time, the Company is involved in various lawsuits, claims, investigations, and proceedings that arise in the ordinary course of business. These matters typically relate to professional liability, tax, compensation, contract, competitor disputes and employee-related matters and include individual and class action lawsuits, as well as inquiries and investigations by governmental agencies regarding the Company’s employment and compensation practices. Additionally, some of the Company’s clients may also become subject to claims, governmental inquiries and investigations, and legal actions relating to services provided by the Company’s healthcare professionals. Depending upon the particular facts and circumstances, the Company may also be subject to indemnification obligations under its contracts with such clients relating to these matters. The Company accrues for contingencies and records a liability when management believes an adverse outcome from a loss contingency is both probable and the amount, or a range, can be reasonably estimated. Significant judgment is required to determine both probability of loss and the estimated amount. The Company reviews its loss contingencies at least quarterly and adjusts its accruals and/or disclosures to reflect the impact of negotiations, settlements, rulings, advice of legal counsel, or other new information, as deemed necessary. The most significant matters for which the Company has established loss contingencies are class actions related to wage and hour claims under California and Federal law. Specifically, among other claims in these lawsuits, it is alleged that certain expense reimbursements should be considered wages and included in the regular rate of pay for purposes of calculating overtime rates. On May 26, 2016, former travel nurse Verna Maxwell Clarke filed a complaint against AMN Services, LLC, in California Superior Court in Los Angeles County. The Company removed the case to the United States District Court for the Central District of California (Case No. 2:16-cv-04132-DSF-KS) (the “Clarke Matter”). The complaint asserts that, due to the Company’s per diem adjustment practices, traveling nurses’ per diem benefits should be included in their regular rate of pay for the purposes of calculating their overtime compensation. On June 26, 2018, the district court denied the plaintiffs’ Motion for Summary Judgment in its entirety, and granted the Company’s Motion for Summary Judgment with respect to the plaintiffs’ per diem and overtime claims. The plaintiffs filed an appeal of the judgment relating to the per diem claims with the Ninth Circuit Court of Appeals (the “Ninth Circuit”). On February 8, 2021, a three-judge panel of the Ninth Circuit issued an opinion that reversed the district court’s granting of the Company’s Motion for Summary Judgment and remanded the matter to the district court instructing the district to enter partial summary judgment in favor of the plaintiffs. On May 7, 2021, the Ninth Circuit issued an order denying the Company’s petition for rehearing. On August 26, 2021, the Company filed a Petition for Writ of Certiorari in the United States Supreme Court seeking review of the Ninth Circuit’s decision, which was denied on December 13, 2021. The United States District Court lifted the stay on this matter on December 17, 2021, and litigation in the District Court has resumed. On May 2, 2019, former travel nurse Sara Woehrle filed a complaint against AMN Services, LLC, and Providence Health System – Southern California in California Superior Court in Los Angeles County. The Company removed the case to the United States District Court for the Central District of California (Case No. 2:19-cv-05282 DSF-KS). The complaint asserts that, due to the Company’s per diem adjustment practices, traveling nurses’ per diem benefits should be included in their regular rate of pay for the purposes of calculating their overtime compensation. The Complaint also alleges that the putative class members were denied required meal periods, denied proper overtime compensation, were not compensated for all time worked, including reporting time and training time, and received non-compliant wage statements. The Company has reached a preliminary agreement to settle this matter in its entirety. Final settlement is not expected until the fourth quarter of 2022. The Company believes that its current wage and hour practices conform with the applicable law in all material respects. Because of the inherent uncertainty of litigation, the Company is not able to reasonably predict if any matter will be resolved in a manner that is materially adverse to the Company. The Company has recorded accruals in connection with the matters described above amounting to $37,225. The Company is currently unable to estimate the possible loss or range of loss beyond amounts already accrued. Loss contingencies accrued as of December 31, 2021 are included in accounts payable and accrued expenses and other long-term liabilities in the consolidated balance sheets.

Summary of Significant Accounting Policies (Policies)	12 Months Ended
Summary of Significant Accounting Policies (Policies)	Dec. 31, 2021
Accounting Policies [Abstract]
Principles of Consolidation	Principles of Consolidation The accompanying consolidated financial statements include the accounts of AMN Healthcare Services, Inc. and its wholly-owned subsidiaries. All significant intercompany balances and transactions have been eliminated in consolidation.
Use of Estimates	Use of Estimates The preparation of financial statements in conformity with accounting principles generally accepted in the United States of America 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 goodwill and indefinite-lived intangible assets, professional liability reserve, contingent liabilities such as legal accruals, and income taxes. The Company bases these estimates on the information that is currently available and on various other assumptions that it believes are reasonable under the circumstances. Actual results could differ from those estimates under different assumptions or conditions.
Cash and Cash Equivalents	Cash and Cash Equivalents The Company considers all highly liquid investments with an original maturity of three months or less to be cash equivalents. Cash and cash equivalents include currency on hand, deposits with financial institutions, money market funds, commercial paper and other highly liquid investments. See Note (3), “Fair Value Measurement” for additional information.
Restricted Cash, Cash Equivalents, and Investments	Restricted Cash, Cash Equivalents and Investments Restricted cash and cash equivalents primarily includes cash, corporate bonds and commercial paper that serve as collateral for the Company’s captive insurance subsidiary claim payments. See Note (3), “Fair Value Measurement” for additional information.
Fixed Assets	Fixed Assets The Company records furniture, equipment, leasehold improvements and capitalized software at cost less accumulated amortization and depreciation. The Company records equipment acquired under finance leases at the present value of the future minimum lease payments. The Company capitalizes major additions and improvements, and it expenses maintenance and repairs when incurred. The Company calculates depreciation on furniture, equipment and software using the straight-line method based on the estimated useful lives of the related assets (three to ten years). The Company depreciates leasehold improvements and equipment obtained under finance leases over the shorter of the term of the lease or their estimated useful lives. The Company includes depreciation of equipment obtained under finance leases with depreciation expense in the accompanying consolidated financial statements. The Company capitalizes costs it incurs to develop software during the application development stage. Application development stage costs generally include costs associated with software configuration, coding, installation and testing. The Company also capitalizes costs of significant upgrades and enhancements that result in additional functionality, whereas it expenses as incurred costs for maintenance and minor upgrades and enhancements. The Company amortizes capitalized costs using the straight-line method over three to ten years once the software is ready for its intended use. The Company reviews long-lived assets for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. Recoverability of assets to be held and used is measured by a comparison of the carrying amount of an asset group to the future undiscounted net cash flows that are expected to be generated by the asset group. If such asset group is considered to be impaired, the impairment to be recognized is measured by the amount by which the carrying amount of the asset group exceeds the fair value of the asset group. The Company reports assets to be disposed of at the lower of the carrying amount or fair value less costs to sell.
Leases	LeasesThe Company recognizes operating lease right-of-use assets and liabilities at commencement date based on the present value of the future minimum lease payments over the lease term. Leases with an initial term of 12 months or less are not recorded on the balance sheet in accordance with the short-term lease recognition exemption. The Company applies the practical expedient to not separate lease and non-lease components for all leases that qualify and uses its incremental borrowing rate as the discount rate to measure its lease liabilities. The incremental borrowing rate is determined for each operating lease based on the Company’s borrowing capabilities over a similar term of the lease arrangement, which is estimated by utilizing the Company’s credit rating and the effects of full collateralization. Lease expense is recognized on a straight-line basis over the lease term.
Goodwill	Goodwill The Company records as goodwill the portion of the purchase price that exceeds the fair value of net assets of entities acquired. The Company evaluates goodwill annually for impairment at the reporting unit level and whenever circumstances occur indicating that goodwill may be impaired. The Company may first assess qualitative factors to determine whether it is more likely than not that the fair value of a reporting unit is less than its carrying amount. If, after assessing the totality of events and circumstances, the Company determines that it is more likely than not that the fair value of the reporting unit is greater than its carrying amount, the quantitative impairment test is unnecessary. If the reporting unit does not pass the qualitative assessment, then the reporting unit’s carrying value is compared to its fair value. The amount by which the carrying value of the goodwill exceeds its fair value is recognized as an impairment loss.
Intangible Assets	Intangible Assets Intangible assets consist of identifiable intangible assets acquired through acquisitions, which include tradenames and trademarks, customer relationships, staffing databases, developed technology and non-compete agreements. The fair value of identifiable intangible assets are determined using either the income approach (relief-from-royalty method or multi-period excess earnings method) or the cost approach (replacement cost method). The Company amortizes intangible assets, other than those with an indefinite life, using the straight-line method over their useful lives. The Company amortizes non-compete agreements using the straight-line method over the lives of the related agreements. The Company reviews for impairment intangible assets with estimable useful lives whenever events or changes in circumstances indicate that the carrying amount may not be recoverable. The Company does not amortize indefinite-lived intangible assets and instead reviews them for impairment annually. The Company may first perform a qualitative assessment to determine whether it is more likely than not that an indefinite-lived intangible asset is impaired. If, after assessing the totality of events and circumstances, the Company determines that it is more likely than not that the indefinite-lived intangible asset is not impaired, no quantitative fair value measurement is necessary. If a quantitative fair value measurement calculation is required for an indefinite-lived intangible asset, the Company compares its fair value with its carrying amount. If the carrying amount exceeds the fair value, the Company records the excess as an impairment loss.
Insurance Reserves	Insurance Reserves The Company maintains an accrual for professional liability that is included in accounts payable and accrued expenses and other long-term liabilities in the consolidated balance sheets. The expense is included in the selling, general and administrative expenses in the consolidated statement of comprehensive income. The Company determines the adequacy of this accrual by evaluating its historical experience and trends, loss reserves established by the Company’s insurance carriers, management and third-party administrators, and independent actuarial studies. The Company obtains actuarial studies on a semi-annual basis that use the Company’s actual claims data and industry data to assist the Company in determining the adequacy of its reserves each year. For periods between the actuarial studies, the Company records its accruals based on loss rates provided in the most recent actuarial study and management’s review of loss history and trends. In November 2012, the Company established a captive insurance subsidiary, which primarily provides coverage, on an occurrence basis, for professional liability within its nurse and allied solutions segment. Liabilities include provisions for estimated losses incurred but not yet reported (“IBNR”), as well as provisions for known claims. IBNR reserve estimates involve the use of assumptions that are primarily based upon historical loss experience, industry data and other actuarial assumptions. The Company maintains excess insurance coverage through a commercial carrier for losses above the per occurrence retention. The Company maintains an accrual for workers compensation, which is included in accrued compensation and benefits and other long-term liabilities in the consolidated balance sheets. The expense relating to healthcare professionals is included in cost of revenue, while the expense relating to corporate employees is included in the selling, general and administrative expenses in the consolidated statement of comprehensive income. The Company determines the adequacy of this accrual by evaluating its historical experience and trends, loss reserves established by the Company’s insurance carriers and third-party administrators, and independent actuarial studies. The Company obtains actuarial studies on a semi-annual basis that use the Company’s payroll and historical claims data, as well as industry data, to determine the appropriate reserve for both reported claims and IBNR claims for each policy year. For periods between the actuarial studies, the Company records its accruals based on loss rates provided in the most recent actuarial study. The Company maintains legacy liabilities related to its self-insured retention portion of both the workers compensation and locum tenens business professional liability in its captive insurance subsidiary. These legacy liabilities follow the same accounting policies as described in the paragraphs above.
Revenue Recognition	Revenue Recognition Revenue primarily consists of fees earned from the temporary staffing and permanent placement of healthcare professionals, executives, and leaders (clinical and operational). The Company also generates revenue from technology-enabled services, including language interpretation and vendor management systems, and talent planning and acquisition services, including recruitment process outsourcing. The Company recognizes revenue when control of its services is transferred to its customers, in an amount that reflects the consideration the Company expects to be entitled to receive in exchange for those services. Revenue from temporary staffing services is recognized as the services are rendered by clinical and non-clinical healthcare professionals. Under the Company’s managed services program (“MSP”) arrangements, the Company manages all or a part of a customer’s supplemental workforce needs utilizing its own network of healthcare professionals along with those of third-party subcontractors. Revenue and the related direct costs under MSP arrangements are recorded in accordance with the accounting guidance on reporting revenue gross as a principal versus net as an agent. When the Company uses subcontractors and acts as an agent, revenue is recorded net of the related subcontractor’s expense. Revenue from permanent placement and recruitment process outsourcing services is recognized as the services are rendered. Depending on the arrangement, the Company’s technology-enabled service revenue is recognized either as the services are rendered or ratably over the applicable arrangement’s service period. See additional information below regarding the Company’s revenue disaggregated by service type. The Company’s customers are primarily billed as services are rendered. Any fees billed in advance of being earned are recorded as deferred revenue. While payment terms vary by the type of customer and the services rendered, the term between invoicing and when payment is due is not significant. During the years ended December 31, 2021 and 2020, previously deferred revenue recognized as revenue was $10,660 and $11,729, respectively. The Company recognizes assets from incremental costs to obtain a contract with a customer and costs incurred to fulfill a contract with a customer, which are deferred and amortized using the portfolio approach on a straight line basis over the average period of benefit consistent with the timing of transfer of services to the customer. The Company has elected to apply the following practical expedients and optional exemptions related to contract costs and revenue recognition: •Recognize incremental costs of obtaining a contract with amortization periods of one year or less as expense when incurred. These costs are recorded within selling, general and administrative expenses. •Recognize revenue in the amount of consideration that 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 that 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.
Accounts Receivable	Accounts Receivable The Company records accounts receivable at the invoiced amount. Accounts receivable are non-interest bearing. The Company maintains an allowance for expected credit losses based on the Company’s historical write-off experience, an assessment of its customers’ financial conditions and available information that is relevant to assessing the collectability of cash flows, which includes current conditions and forecasts about future economic conditions.
Concentration of Credit Risk	Concentration of Credit Risk The majority of the Company’s business activity is with hospitals located throughout the United States. Credit is extended based on the evaluation of each entity’s financial condition. The Company’s cash and cash equivalents and restricted cash, cash equivalents and investments accounts are financial instruments that are exposed to concentration of credit risk. The Company maintains most of its cash, cash equivalents and investment balances with high-credit quality and federally insured institutions. However, cash equivalents and restricted cash equivalents and investment balances may be invested in non-federally insured money market funds, commercial paper and corporate bonds.
Income Taxes	Income Taxes The Company records income taxes using the asset and liability method. Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax basis. Deferred tax assets and liabilities are measured using enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in the period the changes are enacted. In assessing the realizability of deferred tax assets, the Company considers whether it is more likely than not that some portion or all of the deferred tax assets will not be realized. The ultimate realization of deferred tax assets is dependent upon the generation of future taxable income during the periods in which those temporary differences become deductible. The Company considers the scheduled reversal of deferred tax liabilities (including the impact of available carryback and carryforward periods), projected future taxable income, and tax-planning strategies in making this assessment. The Company recognizes the effect of income tax positions only if it is more likely than not that such positions will be sustained. Recognized income tax positions are measured at the largest amount that is greater than 50% likely of being realized. Changes in recognition or measurement are reflected in the period in which the change in judgment occurs. The Company records interest and penalties related to unrecognized tax benefits in income tax expense.
Fair Value of Financial Instruments	Fair Value of Financial Instruments The carrying amounts of the Company’s cash equivalents and restricted cash equivalents and investments approximate their respective fair values due to the short-term nature and liquidity of these financial instruments. The fair value of the Company’s equity investment is determined by using prices for identical or similar investments of the same issuer, which is more fully described in Note (3), “Fair Value Measurement.” As it relates to the Company’s 2027 Notes and 2029 Notes (as defined in Note (8) and Note (3), respectively, below), fair value disclosure is detailed in Note (3), “Fair Value Measurement.” See Note (8), “Notes Payable and Credit Agreement,” for additional information. The fair value of the long-term portion of the Company’s insurance accruals cannot be estimated because the Company cannot reasonably determine the timing of future payments.
Share-Based Compensation	Share-Based Compensation The Company accounts for its share-based employee compensation plans by expensing the estimated fair value of share-based awards on a straight-line basis over the requisite employee service period, which typically is the vesting period, except for awards granted to retirement-eligible employees, which are expensed on an accelerated basis. Restricted stock units (“RSUs”) typically vest over a three-year period. Share-based compensation cost of RSUs is measured by the market value of the Company’s common stock on the date of grant, and the Company records share-based compensation expense only for those awards that are expected to vest. Performance restricted stock units (“PRSUs”) primarily consist of PRSUs that contain performance conditions dependent on defined targets of the Company’s adjusted EBITDA, with a range of 0% to 200% of the target amount granted to be issued under the award. Share-based compensation cost for these PRSUs is measured by the market value of the Company’s common stock on the date of grant, and the amount recognized is adjusted for estimated achievement of the performance conditions. A limited amount of PRSUs contain a market condition dependent upon the Company’s relative and absolute total stockholder return over a three-year period, with a range of 0% to 175% of the target amount granted to be issued under the award. Share-based compensation cost for these PRSUs is measured using the Monte-Carlo simulation valuation model and is not adjusted for the achievement, or lack thereof, of the market conditions.
Segment Information	Segment Information The Company’s operating segments are identified in the same manner as they are reported internally and used by the Company’s chief operating decision maker for the purpose of evaluating performance and allocating resources. Effective March 8, 2020, the Company modified its reportable segments. The Company previously utilized three reportable segments, which it identified as follows: (1) nurse and allied solutions, (2) locum tenens solutions, and (3) other workforce solutions. In light of the Company’s recent acquisitions and organizational changes to better align its organizational structure with its strategy and operations, the Company’s management reorganized its reportable segments to better reflect how the business is evaluated by the chief operating decision maker. Beginning in the first quarter of 2020, the Company has disclosed the following three reportable segments: (1) nurse and allied solutions, (2) physician and leadership solutions, and (3) technology and workforce solutions. The nurse and allied solutions segment includes the Company’s travel nurse staffing, rapid response nurse staffing and labor disruption, allied staffing, local staffing, and revenue cycle solutions businesses. The physician and leadership solutions segment includes the Company’s locum tenens staffing, healthcare interim leadership staffing, executive search, and physician permanent placement businesses. The technology and workforce solutions segment includes the Company’s language services, vendor management systems, workforce optimization, telehealth, credentialing, and outsourced solutions businesses. The Company’s chief operating decision maker relies on internal management reporting processes that provide revenue and operating income by reportable segment for making financial decisions and allocating resources. Segment operating income represents income before income taxes plus depreciation, amortization of intangible assets, share-based compensation, interest expense, net, and other, and unallocated corporate overhead. The Company’s management does not evaluate, manage or measure performance of segments using asset information; accordingly, asset information by segment is not prepared or disclosed.
Recently Adopted Accounting Pronouncements	Recently Adopted Accounting Pronouncements In December 2019, the Financial Accounting Standards Board (“FASB”) issued Accounting Standard Update (“ASU”) 2019-12, “Simplifying the Accounting for Income Taxes.” The standard is expected to reduce cost and complexity related to accounting for income taxes. The new guidance eliminates certain exceptions and clarifies and amends existing guidance to promote consistent application among reporting entities. Depending on the amended guidance within this standard, adoption is to be applied on a retrospective, modified retrospective or prospective basis. The Company adopted this standard effective January 1, 2021, and the adoption did not have a material effect on the Company’s consolidated financial statements. In January 2020, the FASB issued ASU 2020-01, “Clarifying the Interactions between Topic 321, Topic 323, and Topic 815.” The new guidance clarifies the interactions between accounting standards that apply to equity investments without readily determinable fair values. Specifically, it addresses the accounting for the transition into and out of the equity method. The Company adopted this standard effective January 1, 2021 on a prospective basis, and the adoption did not have a material effect on the Company’s consolidated financial statements.

Summary of Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2021

Accounting Policies [Abstract]

Reconciliation of cash, cash equivalents and restricted cash


	December 31, 2021		December 31, 2020
Cash and cash equivalents	$	180,928	$	29,213
Restricted cash and cash equivalents (included in other current assets)	29,262		18,626
Restricted cash, cash equivalents and investments	64,482		61,347
Total cash, cash equivalents and restricted cash and investments	274,672		109,186
Less restricted investments	(27,958)		(25,196)
Total cash, cash equivalents and restricted cash	$	246,714	$	83,990

Reconciliation of activity in the allowance for credit losses

The following table provides a reconciliation of activity in the allowance for credit losses for accounts receivable:


	2021		2020
Balance as of January 1,	$	7,043	$	3,332
Adoption of the credit loss standard, cumulative-effect adjustment to retained earnings	—		1,334
Provision for expected credit losses	1,206		4,428
Amounts written off charged against the allowance	(1,411)		(2,051)

Balance as of December 31,	$	6,838	$	7,043

Schedule of 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 years ended December 31, 2021, 2020 and 2019, respectively:


	Years Ended December 31,
	2021		2020		2019
Net income	$	327,388	$	70,665	$	113,988

Net income per common share - basic	$	6.87	$	1.49	$	2.44
Net income per common share - diluted	$	6.81	$	1.48	$	2.40

Weighted average common shares outstanding - basic	47,685		47,424		46,704
Plus dilutive effect of potential common shares	360		266		889
Weighted average common shares outstanding - diluted	48,045		47,690		47,593

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


	Years Ended December 31,
	2021		2020		2019
Revenue
Nurse and allied solutions	$	2,990,103	$	1,699,311	$	1,562,588
Physician and leadership solutions	594,243		466,622		562,762
Technology and workforce solutions	399,889		227,781		96,757
	$	3,984,235	$	2,393,714	$	2,222,107
Segment operating income
Nurse and allied solutions	$	461,311	$	232,005	$	219,862
Physician and leadership solutions	81,439		62,342		71,378
Technology and workforce solutions	187,578		93,212		43,899
	730,328		387,559		335,139
Unallocated corporate overhead	123,416		123,642		83,463
Depreciation and amortization	101,152		92,766		58,520
Depreciation (included in cost of revenue)	2,545		1,421		—
Share-based compensation	25,217		20,465		16,241
Interest expense, net, and other	34,077		57,742		28,427
Income before income taxes	$	443,921	$	91,523	$	148,488

Schedule of revenue disaggregated by service type

The following tables present the Company’s revenue disaggregated by service type:


		Year Ended December 31, 2021
		Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
	Travel nurse staffing	$	2,168,507	$	—	$	—	$	2,168,507
	Labor disruption services	110,520		—		—		110,520
	Local staffing	124,977		—		—		124,977
	Allied staffing	586,099		—		—		586,099
	Locum tenens staffing	—		352,650		—		352,650
	Interim leadership staffing	—		170,236		—		170,236
Temporary staffing		2,990,103		522,886		—		3,512,989
Permanent placement		—		71,357		—		71,357
	Language services	—		—		180,891		180,891
	Vendor management systems	—		—		148,532		148,532
	Other technologies	—		—		29,043		29,043
Technology-enabled services		—		—		358,466		358,466
Talent planning and acquisition		—		—		41,423		41,423
Total revenue		$	2,990,103	$	594,243	$	399,889	$	3,984,235


		Year Ended December 31, 2020
		Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
	Travel nurse staffing	$	1,230,396	$	—	$	—	$	1,230,396
	Labor disruption services	7,137		—		—		7,137
	Local staffing	53,218		—		—		53,218
	Allied staffing	408,560		—		—		408,560
	Locum tenens staffing	—		277,428		—		277,428
	Interim leadership staffing	—		130,800		—		130,800
Temporary staffing		1,699,311		408,228		—		2,107,539
Permanent placement		—		58,394		—		58,394
	Language services	—		—		116,054		116,054
	Vendor management systems	—		—		69,756		69,756
	Other technologies	—		—		23,557		23,557
Technology-enabled services		—		—		209,367		209,367
Talent planning and acquisition		—		—		18,414		18,414
Total revenue		$	1,699,311	$	466,622	$	227,781	$	2,393,714


		Year Ended December 31, 2019
		Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
	Travel nurse staffing	$	1,011,336	$	—	$	—	$	1,011,336
	Labor disruption services	36,371		—		—		36,371
	Local staffing	49,049		—		—		49,049
	Allied staffing	465,832		—		—		465,832
	Locum tenens staffing	—		324,654		—		324,654
	Interim leadership staffing	—		158,330		—		158,330
Temporary staffing		1,562,588		482,984		—		2,045,572
Permanent placement		—		79,778		—		79,778

	Vendor management systems	—		—		59,026		59,026
	Other technologies	—		—		21,635		21,635
Technology-enabled services		—		—		80,661		80,661
Talent planning and acquisition		—		—		16,096		16,096
Total revenue		$	1,562,588	$	562,762	$	96,757	$	2,222,107

Acquisitions (Tables)

12 Months Ended

Dec. 31, 2021

Business Combination and Asset Acquisition [Abstract]

Schedule of fair value and useful life of intangible assets acquired

The following table summarizes the fair value and useful life of each intangible asset acquired as of the acquisition date:


		Fair Value		Useful Life
				(in years)
Identifiable intangible assets
	Customer relationships	$	171,000	20
	Tradenames and trademarks	40,000		5 - 10
	Developed technology	16,000		5
	Interpreter database	1,000		4
		$	228,000

The following table summarizes the fair value and useful life of each intangible asset acquired:


		Fair Value		Useful Life
				(in years)
Identifiable intangible assets
	Customer relationships	$	68,000	10
	Tradenames and trademarks	10,000		5
	Staffing database	10,300		10
	Developed technology	3,400		3
		$	91,700

Schedule of pro forma financial information

The unaudited pro forma financial information is not necessarily indicative of the operating results that would have occurred had the acquisitions been consummated as of the date indicated, nor is it necessarily indicative of the Company’s future operating results.


	Years Ended December 31,
	2020		2019
Revenue	$	2,407,586	$	2,383,405
Income from operations	165,196		145,069
Net income	81,422		85,154

Fair Value Measurement (Tables)

12 Months Ended

Dec. 31, 2021

Fair Value Disclosures [Abstract]

Schedule of available-for-sale securities

The fair value of our available-for-sale securities as of December 31, 2021, by remaining contractual maturities, are presented in the following table:


	Fair Value
Due in one year or less	$	5,528
Due after one year through five years	22,430
	$	27,958

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 December 31, 2021
Assets (Liabilities)	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	$	91,454	$	91,454	$	—	$	—
Deferred compensation	(119,617)		(119,617)		—		—
Corporate bonds	29,159		—		29,159		—
Commercial paper	80,596		—		80,596		—


	Fair Value Measurements as of December 31, 2020
Assets (Liabilities)	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	$	2,198	$	2,198	$	—	$	—
Deferred compensation	(97,184)		(97,184)		—		—
Commercial paper	58,345		—		58,345		—
Acquisition contingent consideration liabilities	(8,000)		—		—		(8,000)

Reconciliation of changes in fair value of contingent consideration liabilities

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


	2021		2020
Balance as of January 1,	$	(8,000)	$	(23,100)
Settlement of Advanced contingent consideration liability for year ended December 31, 2019	—		20,000
Settlement of b4health contingent consideration liability for year ended December 31, 2020	8,000		—
Change in fair value of contingent consideration liability from b4health acquisition	—		(4,900)
Balance as of December 31,	$	—	$	(8,000)

Schedule of carrying amounts and estimated fair value of Notes

The carrying amounts and estimated fair value of the 2027 Notes and the 2029 Notes, which are more fully described in Note (8), “Notes Payable and Credit Agreement,” are presented in the following table:


	As of December 31, 2021		As of December 31, 2020
	Carrying Amount	Estimated Fair Value	Carrying Amount	Estimated Fair Value
2027 Notes	500,000	517,500	500,000	521,250
2029 Notes	350,000	353,500	350,000	357,000

Goodwill and Identifiable Intangible Assets (Tables)

12 Months Ended

Dec. 31, 2021

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of acquired intangible assets by major class

As of December 31, 2021 and 2020, the Company had the following acquired intangible assets:


	As of December 31, 2021						As of December 31, 2020
	Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount		Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount
Intangible assets subject to amortization:
Staffing databases	$	36,836	$	(19,857)	$	16,979	$	36,836	$	(16,706)	$	20,130
Customer relationships	445,169		(150,255)		294,914		444,839		(122,105)		322,734
Tradenames and trademarks	256,889		(81,522)		175,367		166,269		(58,299)		107,970
Non-compete agreements	6,495		(4,621)		1,874		6,371		(3,402)		2,969
Acquired technology	47,320		(21,994)		25,326		36,430		(14,722)		21,708
	$	792,709	$	(278,249)	$	514,460	$	690,745	$	(215,234)	$	475,511
Intangible assets not subject to amortization:
Tradenames and trademarks					$	—					$	89,400
					$	514,460					$	564,911

Schedule of estimated amortization expense

Based on the current amount of intangibles subject to amortization, the estimated future amortization expense as of December 31, 2021 is as follows:


	Amount
Year ending December 31, 2022	$	79,001
Year ending December 31, 2023	77,333
Year ending December 31, 2024	70,783
Year ending December 31, 2025	57,772
Year ending December 31, 2026	48,050
Thereafter	181,521
	$	514,460

Schedule of goodwill


	Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
Balance, January 1, 2020	$	344,316	$	163,348	$	87,887	$	595,551
Goodwill adjustment for Advanced acquisition	29		—		—		29
Goodwill adjustment for b4health acquisition	—		—		(66)		(66)
Goodwill from Stratus Video acquisition	—		—		268,971		268,971
Reallocation due to change in segments	(5,330)		(10,548)		15,878		—
Balance, December 31, 2020	339,015		152,800		372,670		864,485
Goodwill adjustment for Stratus Video acquisition	—		—		663		663
Goodwill from Synzi and SnapMD acquisition	—		—		27,193		27,193
Balance, December 31, 2021	$	339,015	$	152,800	$	400,526	$	892,341
Accumulated impairment loss as of December 31, 2020 and 2021	$	154,444	$	60,495	$	—	$	214,939

Leases (Tables)

12 Months Ended

Dec. 31, 2021

Leases [Abstract]

Schedule of components of lease expense and supplemental cash flow information

The components of lease expense were as follows:


	Years Ended December 31,
	2021		2020		2019
Operating lease cost	$	23,495	$	20,176	$	18,725
Short-term lease cost	6,056		8,702		20,112
Variable and other lease cost	2,485		2,526		2,880
Net lease cost	$	32,036	$	31,404	$	41,717

Supplemental cash flow information related to leases was as follows:


	Years Ended December 31,
	2021		2020		2019
Cash paid for amounts included in the measurement of operating lease liabilities (operating cash flows)	$	39,865	$	20,052	$	17,817

Schedule of maturities of lease liabilities

The maturities of lease liabilities as of December 31, 2021 were as follows:


	Operating Leases
Years ending December 31,
2022	$	11,867
2023	6,468
2024	5,348
2025	1,876
2026	112
Thereafter	—
Total lease payments	25,671
Less imputed interest	(924)
Present value of lease liabilities	$	24,747

Schedule of assumptions used for operating leases

The weighted average remaining lease term and discount rate as of December 31, 2021 and 2020 were as follows:


	December 31,
	2021		2020
Weighted average remaining lease term	3 years		6 years
Weighted average discount rate	2.6	%	4.8	%

Balance Sheet Details (Tables)

12 Months Ended

Dec. 31, 2021

Balance Sheet Related Disclosures [Abstract]

Consolidated balance sheet details

The consolidated balance sheets detail is as follows:


	December 31,
	2021		2020
Other current assets:
Restricted cash and cash equivalents	$	29,262	$	18,626

Other	37,568		22,183
Other current assets	$	66,830	$	40,809

Prepaid expenses:
Prepaid payroll deposits	$	60,014	$	—
Other	12,446		13,629
Current assets	$	72,460	$	13,629

Fixed assets:
Furniture and equipment	$	43,134	$	47,355
Software	265,137		220,971
Leasehold improvements	8,797		9,600
	317,068		277,926
Accumulated depreciation	(189,954)		(161,752)
Fixed assets, net	$	127,114	$	116,174

Accounts payable and accrued expenses:
Trade accounts payable	$	77,325	$	28,089
Subcontractor payable	261,689		79,364
Accrued expenses	61,220		37,849
Loss contingencies	10,400		7,613
Professional liability reserve	7,127		8,897
Other	7,496		6,069
Accounts payable and accrued expenses	$	425,257	$	167,881

Accrued compensation and benefits:
Accrued payroll	$	98,817	$	59,721
Accrued bonuses and commissions	105,155		34,514
Accrued travel expense	3,058		1,998
Health insurance reserve	6,041		5,590
Workers compensation reserve	12,384		10,244
Deferred compensation	119,617		97,184
Other	9,309		4,163
Accrued compensation and benefits	$	354,381	$	213,414

Other current liabilities:
Income taxes payable	$	21,162	$	—
Acquisition related liabilities	—		8,000
Client deposits	141,102		1,636
Other	155		1,302
Other current liabilities	$	162,419	$	10,938

Other long-term liabilities:
Workers compensation reserve	$	24,130	$	20,930
Professional liability reserve	34,544		31,997

Unrecognized tax benefits	4,633		5,447
Other	33,682		49,533
Other long-term liabilities	$	96,989	$	107,907

Income Taxes (Tables)

12 Months Ended

Dec. 31, 2021

Income Tax Disclosure [Abstract]

Schedule of provision for income taxes from continuing operations

The provision for income taxes from operations for the years ended December 31, 2021, 2020 and 2019 consists of the following:


	Years Ended December 31,
	2021		2020		2019
Current income taxes:
Federal	$	98,795	$	32,673	$	25,255
State	34,025		9,813		8,332
Total	132,820		42,486		33,587
Deferred income taxes:
Federal	(12,992)		(15,092)		625
State	(3,295)		(6,536)		288
Total	(16,287)		(21,628)		913
Provision for income taxes from operations	$	116,533	$	20,858	$	34,500

Schedule of income tax reconciliation


	Years Ended December 31,
	2021		2020		2019
Tax expense at federal statutory rate	$	93,223	$	19,220	$	31,253
State taxes, net of federal benefit	23,990		4,161		6,810
Non-deductible expenses	—		3,621		3,840
Share-based compensation	(1,460)		(2,311)		(4,770)

Unrecognized tax benefit	(680)		(78)		(207)
Other, net	1,460		(3,755)		(2,426)
Income tax expense from operations	$	116,533	$	20,858	$	34,500

Schedule of deferred tax assets and liabilities

The tax effects of temporary differences that give rise to significant portions of deferred tax assets and liabilities are presented below as of December 31, 2021 and 2020:


	December 31,
	2021		2020
Deferred tax assets:
Stock compensation	$	6,954	$	6,198
Deferred compensation	30,513		24,604
Accrued bonus	24,636		7,607
Accrued payroll taxes	6,427		12,445
Accrued expenses	19,899		13,371

Operating lease liabilities	6,472		23,826
Net operating losses	8,815		9,557
Loss contingencies	8,528		6,459
Workers compensation insurance	6,476		4,814
Other	2,731		989
Total deferred tax assets	$	121,451	$	109,870
Deferred tax liabilities:
Intangibles	$	(126,535)	$	(126,833)
Fixed assets	(28,824)		(25,252)
Operating lease right-of-use assets	(7,269)		(19,933)
Other	(6,637)		(5,057)
Total deferred tax liabilities	$	(169,265)	$	(177,075)

Net deferred tax liabilities	$	(47,814)	$	(67,205)

Schedule of unrecognized tax benefits

A summary of the changes in the amount of unrecognized tax benefits (excluding interest and penalties) for 2021, 2020 and 2019 is as follows:


	2021		2020		2019
Beginning balance of unrecognized tax benefits	$	4,916	$	4,937	$	4,393
Additions based on tax positions related to the current year	504		667		588
Additions based on tax positions of prior years	—		255		990
Reductions for tax positions of prior years	(301)		—		—
Reductions due to lapse of applicable statute of limitation	(1,052)		(943)		(1,034)

Ending balance of unrecognized tax benefits	$	4,067	$	4,916	$	4,937

Notes Payable and Credit Agreement (Tables)

12 Months Ended

Dec. 31, 2021

Debt Disclosure [Abstract]

Schedule of outstanding debt

Outstanding debt balances as of December 31, 2021 and 2020 consisted of the following:


	As of December 31,
	2021		2020
Additional Term Loan	$	—	$	21,875


2027 Notes	500,000		500,000
2029 Notes	350,000		350,000
Total debt outstanding	850,000		871,875
Less unamortized fees and premium	(7,678)		(9,226)
Less current portion of notes payable	—		(4,688)
Long-term portion of notes payable	$	842,322	$	857,961

Share-Based Compensation (Tables)

12 Months Ended

Dec. 31, 2021

Share-based Payment Arrangement [Abstract]

Schedule of RSU and PRSU activity for non-vested awards

The following table summarizes RSU and PRSU activity for non-vested awards for the years ended December 31, 2021, 2020 and 2019:


	Number of Shares	Weighted Average Grant Date Fair Value per Share
Unvested at January 1, 2018	818	$	43.84
Granted—RSUs	191	$	54.99
Granted—PRSUs (1)	201	$	48.32
Vested	(400)	$	35.46
Canceled/forfeited	(52)	$	41.09
Unvested at December 31, 2019	758	$	52.45
Granted—RSUs	271	$	60.02
Granted—PRSUs (1)	155	$	64.59
Vested	(283)	$	49.18
Canceled/forfeited	(184)	$	53.84
Unvested at December 31, 2020	717	$	58.88
Granted—RSUs	290	$	85.30
Granted—PRSUs (1)	186	$	97.46
Vested	(280)	$	56.05
Canceled/forfeited	(158)	$	65.69
Unvested at December 31, 2021	755	$	78.13

(1) PRSUs granted included both the PRSUs granted during the year at the target amount and the additional shares of prior period granted PRSUs vested during the year in excess of the target shares.

Schedule of stock option and SAR activity

A summary of stock option and SAR activity under the Equity Plan and Other Plans are as follows:



	Number Outstanding	Weighted- Average Exercise Price per Share
Outstanding at December 31, 2018	227	$	8.61
Granted	—	$	—
Exercised	(215)	$	8.67
Canceled/forfeited/expired	—	$	—
Outstanding at December 31, 2019	12	$	7.51
Granted	—	$	—
Exercised	(12)	$	7.51
Canceled/forfeited/expired	—	$	—
Outstanding at December 31, 2020	—	$	—




Vested and expected to vest at December 31, 2020 and 2021	—	$	—
Exercisable at December 31, 2020 and 2021	—	$	—

Schedule of share-based compensation expense

Total share-based compensation expense for the years ended December 31, 2021, 2020 and 2019 was as follows:


	Years Ended December 31,
	2021		2020		2019
Share-based employee compensation, before tax	$	25,217	$	20,465	$	16,241
Related income tax benefits	(6,556)		(5,321)		(4,223)
Share-based employee compensation, net of tax	$	18,661	$	15,144	$	12,018

Summary of Significant Accounting Policies - Restricted Cash, Cash Equivalents and Investments (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Accounting Policies [Abstract]
Cash and cash equivalents	$ 180,928	$ 29,213
Restricted cash and cash equivalents (included in other current assets)	29,262	18,626
Restricted cash, cash equivalents and investments	64,482	61,347
Total cash, cash equivalents and restricted cash and investments	274,672	109,186
Less restricted investments	(27,958)	(25,196)
Total cash, cash equivalents and restricted cash	$ 246,714	$ 83,990	$ 153,962	$ 84,324

Summary of Significant Accounting Policies - Fixed Assets (Details)	12 Months Ended
	Dec. 31, 2021
Furniture, Equipment and Technology and Software \| Minimum
Property, Plant and Equipment [Line Items]
Fixed assets, useful life	3 years
Furniture, Equipment and Technology and Software \| Maximum
Property, Plant and Equipment [Line Items]
Fixed assets, useful life	10 years
Software Development \| Minimum
Property, Plant and Equipment [Line Items]
Fixed assets, useful life	3 years
Software Development \| Maximum
Property, Plant and Equipment [Line Items]
Fixed assets, useful life	10 years

Summary of Significant Accounting Policies - Revenue Recognition (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Accounting Policies [Abstract]
Previously deferred revenue recognized during period	$ 10,660	$ 11,729

Summary of Significant Accounting Policies - Allowance for Credit Losses (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance	$ 7,043	$ 3,332
Accounting Standards Update [Extensible Enumeration]			us-gaap:AccountingStandardsUpdate201613Member
Provision for expected credit losses	1,206	4,428
Amounts written off charged against the allowance	(1,411)	(2,051)
Ending balance	$ 6,838	7,043	$ 3,332
Cumulative Effect, Period of Adoption, Adjustment
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance		$ 1,334
Ending balance			$ 1,334

- Definition

Indicates amendment to accounting standards.

+ References

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+ Details

Summary of Significant Accounting Policies - Concentration of Credit Risk (Details)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
One Customer \| Consolidated Revenue \| Customer Concentration Risk
Concentration Risk [Line Items]
Concentration risk percentage	17.00%	14.00%	13.00%

Summary of Significant Accounting Policies - Share-Based Compensation (Details)	12 Months Ended
	Dec. 31, 2021
Restricted Stock Units (RSUs)
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period	3 years
Performance Shares, Shareholder Return-Based
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Period for relative and absolute shareholder return	3 years
Minimum \| Performance Shares, EBITDA-Based
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percent of target amount granted to be issued	0.00%
Minimum \| Performance Shares, Shareholder Return-Based
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percent of target amount granted to be issued	0.00%
Maximum \| Performance Shares, EBITDA-Based
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percent of target amount granted to be issued	200.00%
Maximum \| Performance Shares, Shareholder Return-Based
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percent of target amount granted to be issued	175.00%

Summary of Significant Accounting Policies - Net Income per Common Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Accounting Policies [Abstract]
Common stock excluded from calculation of EPS (in shares)	33	41	43
Computation of Basic and Diluted Net Income Per Common Share [Abstract]
Net income	$ 327,388	$ 70,665	$ 113,988
Net income - diluted	$ 327,388	$ 70,665	$ 113,988
Net income per common share - basic (in dollars per share)	$ 6.87	$ 1.49	$ 2.44
Net income per common share - diluted (in dollars per share)	$ 6.81	$ 1.48	$ 2.40
Weighted average common shares outstanding - basic (in shares)	47,685	47,424	46,704
Plus dilutive effect of potential common shares (in shares)	360	266	889
Weighted average common shares outstanding - diluted (in shares)	48,045	47,690	47,593

Summary of Significant Accounting Policies - Segment Information (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2021 USD ($) segment	Dec. 31, 2020 USD ($)	Dec. 31, 2019 USD ($) segment
Accounting Policies [Abstract]
Number of reportable segments \| segment	3		3
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	$ 3,984,235	$ 2,393,714	$ 2,222,107
Segment operating income	477,998	149,265	176,915
Depreciation and amortization	101,152	92,766	58,520
Depreciation (included in cost of revenue)	2,545	1,421	0
Share-based compensation	25,217	20,465	16,241
Interest expense, net, and other	34,077	57,742	28,427
Income before income taxes	443,921	91,523	148,488
Travel nurse staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	2,168,507	1,230,396	1,011,336
Labor disruption services
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	110,520	7,137	36,371
Local staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	124,977	53,218	49,049
Allied staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	586,099	408,560	465,832
Locum tenens staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	352,650	277,428	324,654
Interim leadership staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	170,236	130,800	158,330
Temporary staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	3,512,989	2,107,539	2,045,572
Permanent placement
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	71,357	58,394	79,778
Language services
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	180,891	116,054
Vendor management systems
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	148,532	69,756	59,026
Other technologies
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	29,043	23,557	21,635
Technology-enabled services
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	358,466	209,367	80,661
Talent planning and acquisition
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	41,423	18,414	16,096
Nurse and Allied Solutions
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	2,990,103	1,699,311	1,562,588
Nurse and Allied Solutions \| Travel nurse staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	2,168,507	1,230,396	1,011,336
Nurse and Allied Solutions \| Labor disruption services
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	110,520	7,137	36,371
Nurse and Allied Solutions \| Local staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	124,977	53,218	49,049
Nurse and Allied Solutions \| Allied staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	586,099	408,560	465,832
Nurse and Allied Solutions \| Locum tenens staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Nurse and Allied Solutions \| Interim leadership staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Nurse and Allied Solutions \| Temporary staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	2,990,103	1,699,311	1,562,588
Nurse and Allied Solutions \| Permanent placement
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Nurse and Allied Solutions \| Language services
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0
Nurse and Allied Solutions \| Vendor management systems
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Nurse and Allied Solutions \| Other technologies
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Nurse and Allied Solutions \| Technology-enabled services
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Nurse and Allied Solutions \| Talent planning and acquisition
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Physician and Leadership Solutions
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	594,243	466,622	562,762
Physician and Leadership Solutions \| Travel nurse staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Physician and Leadership Solutions \| Labor disruption services
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Physician and Leadership Solutions \| Local staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Physician and Leadership Solutions \| Allied staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Physician and Leadership Solutions \| Locum tenens staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	352,650	277,428	324,654
Physician and Leadership Solutions \| Interim leadership staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	170,236	130,800	158,330
Physician and Leadership Solutions \| Temporary staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	522,886	408,228	482,984
Physician and Leadership Solutions \| Permanent placement
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	71,357	58,394	79,778
Physician and Leadership Solutions \| Language services
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0
Physician and Leadership Solutions \| Vendor management systems
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Physician and Leadership Solutions \| Other technologies
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Physician and Leadership Solutions \| Technology-enabled services
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Physician and Leadership Solutions \| Talent planning and acquisition
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Technology and Workforce Solutions
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	399,889	227,781	96,757
Technology and Workforce Solutions \| Travel nurse staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Technology and Workforce Solutions \| Labor disruption services
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Technology and Workforce Solutions \| Local staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Technology and Workforce Solutions \| Allied staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Technology and Workforce Solutions \| Locum tenens staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Technology and Workforce Solutions \| Interim leadership staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Technology and Workforce Solutions \| Temporary staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Technology and Workforce Solutions \| Permanent placement
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Technology and Workforce Solutions \| Language services
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	180,891	116,054
Technology and Workforce Solutions \| Vendor management systems
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	148,532	69,756	59,026
Technology and Workforce Solutions \| Other technologies
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	29,043	23,557	21,635
Technology and Workforce Solutions \| Technology-enabled services
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	358,466	209,367	80,661
Technology and Workforce Solutions \| Talent planning and acquisition
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	41,423	18,414	16,096
Operating Segments
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	3,984,235	2,393,714	2,222,107
Segment operating income	730,328	387,559	335,139
Operating Segments \| Nurse and Allied Solutions
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	2,990,103	1,699,311	1,562,588
Segment operating income	461,311	232,005	219,862
Operating Segments \| Physician and Leadership Solutions
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	594,243	466,622	562,762
Segment operating income	81,439	62,342	71,378
Operating Segments \| Technology and Workforce Solutions
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	399,889	227,781	96,757
Segment operating income	187,578	93,212	43,899
Corporate, Non-Segment
Segment Reporting Information, Profit (Loss) [Abstract]
Unallocated corporate overhead	$ 123,416	$ 123,642	$ 83,463

Acquisitions - Additional Information (Details)	36 Months Ended
Acquisitions - Additional Information (Details)	Dec. 31, 2021 acquisition
Business Combination and Asset Acquisition [Abstract]
Number of acquisitions	5

Acquisitions - Synzi and SnapMD Acquisition (Details) - USD ($) $ in Thousands			3 Months Ended	12 Months Ended
	Dec. 31, 2021	Apr. 07, 2021	Jun. 30, 2021	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Business Acquisition [Line Items]
Cash consideration				$ 41,264	$ 476,491	$ 247,906
Goodwill	$ 892,341			892,341	$ 864,485	$ 595,551
Synzi
Business Acquisition [Line Items]
Cash consideration		$ 42,240
Cash returned to the Company for final working capital settlement			$ 92
Purchase price, net of working capital adjustment	42,148
Fair value of tangible assets acquired	2,790			2,790
Cash received	884			884
Liabilities assumed	275			275
Identified intangible assets	12,440			12,440
Goodwill	27,193			27,193
Goodwill expected to be tax deductible	$ 6,044			$ 6,044
Weighted average useful life of intangible assets		7 years
Synzi \| Developed technology
Business Acquisition [Line Items]
Identified intangible assets		$ 10,890
Synzi \| Trademarks
Business Acquisition [Line Items]
Identified intangible assets		$ 1,220

Acquisitions - Stratus Video Acquisition (Details) - USD ($)			3 Months Ended			12 Months Ended
	Dec. 31, 2021	Feb. 14, 2020	Sep. 30, 2021	Mar. 31, 2021	Jun. 30, 2020	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019	Jun. 14, 2019
Business Acquisition [Line Items]
Cash consideration						$ 41,264,000	$ 476,491,000	$ 247,906,000
Term loan	$ 842,322,000					842,322,000	857,961,000
Goodwill	$ 892,341,000					892,341,000	864,485,000	595,551,000
Revenue						3,984,235,000	2,393,714,000	2,222,107,000
Aggregate amortization expense, intangible assets						63,015,000	63,817,000
Interest expense						$ 34,077,000	57,742,000	28,427,000
Tradenames and trademarks
Business Acquisition [Line Items]
Useful life	6 years
Secured Debt \| Term Loan Credit Facility
Business Acquisition [Line Items]
Term loan									$ 150,000,000
Term loan		$ 250,000,000
Stratus Video
Business Acquisition [Line Items]
Cash consideration		485,568,000			$ 99,000
Acquisition related costs							11,467,000
Purchase price, net of working capital adjustment				$ 485,667,000
Fair value of tangible assets acquired				44,092,000
Cash and restricted cash received				9,176,000
Liabilities assumed				56,059,000
Identified intangible assets		$ 228,000,000		228,000,000
Goodwill				269,634,000
Goodwill expected to be tax deductible				$ 10,182,000
Weighted average useful life of intangible assets		17 years
Revenue							116,054,000
Income before income taxes							20,164,000
Stratus Video \| Tradenames and trademarks
Business Acquisition [Line Items]
Identified intangible assets		$ 40,000,000
Useful life			5 years
Stratus Video and Advanced
Business Acquisition [Line Items]
Acquisition related costs							$ 14,468,000
Incremental acquisition-related costs								25,311,000
Aggregate amortization expense, intangible assets								15,014,000
Interest expense								$ 6,722,000

Acquisitions - Schedule of Intangible Assets Acquired (Details) - USD ($) $ in Thousands				3 Months Ended
	Dec. 31, 2021	Feb. 14, 2020	Jun. 14, 2019	Sep. 30, 2021	Mar. 31, 2021	Jun. 30, 2020
Tradenames and trademarks
Acquired Finite-Lived Intangible Assets [Line Items]
Useful Life	6 years
Stratus Video
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value		$ 228,000			$ 228,000
Stratus Video \| Customer relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value		$ 171,000
Useful Life		20 years
Stratus Video \| Tradenames and trademarks
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value		$ 40,000
Useful Life				5 years
Stratus Video \| Tradenames and trademarks \| Minimum
Acquired Finite-Lived Intangible Assets [Line Items]
Useful Life		5 years
Stratus Video \| Tradenames and trademarks \| Maximum
Acquired Finite-Lived Intangible Assets [Line Items]
Useful Life		10 years
Stratus Video \| Developed technology
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value		$ 16,000
Useful Life		5 years
Stratus Video \| Interpreter database
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value		$ 1,000
Useful Life		4 years
Advanced Acquisition
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value			$ 91,700			$ 91,700
Advanced Acquisition \| Customer relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value			$ 68,000
Useful Life			10 years
Advanced Acquisition \| Tradenames and trademarks
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value			$ 10,000
Useful Life			5 years
Advanced Acquisition \| Staffing database
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value			$ 10,300
Useful Life			10 years
Advanced Acquisition \| Developed technology
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value			$ 3,400
Useful Life			3 years

Acquisitions - Business Acquisition, Pro Forma Financial Information (Details) - Stratus Video and Advanced - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Business Acquisition [Line Items]
Revenue	$ 2,407,586	$ 2,383,405
Income from operations	165,196	145,069
Net income	$ 81,422	$ 85,154

Acquisitions - b4health Acquisition (Details) - USD ($)		3 Months Ended		12 Months Ended
Acquisitions - b4health Acquisition (Details) - USD ($)	Dec. 19, 2019	Dec. 31, 2020	Mar. 31, 2020	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Business Acquisition [Line Items]
Cash consideration				$ 41,264,000	$ 476,491,000	$ 247,906,000
Goodwill		$ 864,485,000		$ 892,341,000	864,485,000	$ 595,551,000
b4health acquisition
Business Acquisition [Line Items]
Purchase price	$ 23,006,000
Cash consideration	19,906,000
Contingent earn-out based on future operating performance (up to)	12,000,000
Fair value of contingent earn-out	$ 3,100,000
Working capital returned to Company for working capital settlement			$ 66,000
Purchase price, net of working capital adjustment		22,940,000
Fair value of tangible assets acquired		1,169,000			1,169,000
Cash and restricted cash received		222,000			222,000
Liabilities assumed		823,000			823,000
Identified intangible assets		9,000,000			9,000,000
Goodwill		13,594,000			13,594,000
Weighted average useful life of intangible assets	7 years
b4health acquisition \| Developed technology
Business Acquisition [Line Items]
Identified intangible assets		3,000,000			3,000,000
b4health acquisition \| Customer relationships
Business Acquisition [Line Items]
Identified intangible assets		4,000,000			4,000,000
b4health acquisition \| Trademarks
Business Acquisition [Line Items]
Identified intangible assets		$ 2,000,000			$ 2,000,000

Acquisitions - Advanced Acquisition (Details) - USD ($)		3 Months Ended		12 Months Ended
Acquisitions - Advanced Acquisition (Details) - USD ($)	Jun. 14, 2019	Jun. 30, 2020	Sep. 30, 2019	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Business Acquisition [Line Items]
Cash consideration				$ 41,264,000	$ 476,491,000	$ 247,906,000
Goodwill				$ 892,341,000	$ 864,485,000	$ 595,551,000
Secured Debt \| Term Loan Credit Facility
Business Acquisition [Line Items]
Term loan	$ 150,000,000
Advanced Acquisition
Business Acquisition [Line Items]
Purchase price	211,743,000
Cash consideration	201,121,000		$ 73,000
Contingent earn-out based on future operating performance (up to)	20,000,000
Fair value of contingent earn-out	10,622,000
Purchase price, net of working capital adjustment		$ 211,816,000
Fair value of tangible assets acquired		29,020,000
Cash and restricted cash received		2,497,000
Liabilities assumed		28,772,000
Identified intangible assets	$ 91,700,000	91,700,000
Goodwill		119,868,000
Goodwill expected to be tax deductible		$ 57,236,000
Weighted average useful life of intangible assets	9 years

Acquisitions - Silversheet Acquisition (Details) - USD ($)		3 Months Ended	12 Months Ended
	Jan. 30, 2019	Mar. 31, 2020	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Business Acquisition [Line Items]
Cash consideration			$ 41,264,000	$ 476,491,000	$ 247,906,000
Goodwill			$ 892,341,000	$ 864,485,000	$ 595,551,000
Silversheet, Inc.
Business Acquisition [Line Items]
Purchase price	$ 31,676,000
Cash consideration	30,176,000
Contingent earn-out based on future operating performance (up to)	25,000,000
Fair value of contingent earn-out	$ 1,500,000
Purchase price, net of working capital adjustment		$ 31,676,000
Fair value of tangible assets acquired		2,826,000
Cash and restricted cash received		651,000
Liabilities assumed		1,567,000
Identified intangible assets		6,880,000
Goodwill		23,537,000
Goodwill expected to be tax deductible		$ 0
Weighted average useful life of intangible assets	8 years
Silversheet, Inc. \| Developed technology
Business Acquisition [Line Items]
Identified intangible assets	$ 5,300,000
Silversheet, Inc. \| Trademarks
Business Acquisition [Line Items]
Identified intangible assets	1,500,000
Silversheet, Inc. \| Based on operating results for the twelve months ending December 31, 2019
Business Acquisition [Line Items]
Contingent earn-out based on future operating performance (up to)	6,000,000
Silversheet, Inc. \| Based on operating results for the twelve months ending December 31, 2020
Business Acquisition [Line Items]
Contingent earn-out based on future operating performance (up to)	$ 19,000,000

Fair Value Measurement - Additional Information (Details) - USD ($)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019	Oct. 20, 2020
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Asset impairment charges	$ 0	$ 0	$ 0
Fair Value, Nonrecurring \| Significant Other Observable Inputs (Level 2)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Equity investment balance	22,633,000	15,449,000
Commercial paper \| Fair Value, Recurring
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	80,596,000	58,345,000
Commercial paper \| Fair Value, Recurring \| Significant Other Observable Inputs (Level 2)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	80,596,000	58,345,000
Securities classified as available-for-sale	0	$ 25,196,000
Corporate bonds \| Fair Value, Recurring \| Significant Other Observable Inputs (Level 2)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	29,159,000
Securities classified as available-for-sale	$ 27,958,000
2029 Notes \| Senior Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate				4.00%

Fair Value Measurement - Schedule of Available-for-sale Securities (Details) $ in Thousands	Dec. 31, 2021 USD ($)
Debt Securities, Available-for-sale, Maturity, Allocated and Single Maturity Date, Fair Value [Abstract]
Due in one year or less	$ 5,528
Due after one year through five years	22,430
Total	$ 27,958

Fair Value Measurement - Reconciliation of Changes in Contingent Consideration Liabilities (Details) - Level 3 - Contingent consideration liability - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Beginning balance	$ (8,000)	$ (23,100)
Ending balance	0	(8,000)
Advanced
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Settlement of contingent liability	0	20,000
b4health
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Settlement of contingent liability	8,000	0
Change in fair value of contingent consideration liability	$ 0	$ (4,900)

Fair Value Measurement - Fair Value of Financial Instruments (Details) - Senior Notes - USD ($)	Dec. 31, 2021	Dec. 31, 2020	Oct. 20, 2020	Aug. 13, 2020	Oct. 01, 2019
2027 Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Carrying Amount	$ 500,000,000	$ 500,000,000		$ 200,000,000	$ 300,000,000
Estimated Fair Value	517,500,000	521,250,000
2029 Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Carrying Amount	350,000,000	350,000,000	$ 350,000,000
Estimated Fair Value	$ 353,500,000	$ 357,000,000

Goodwill and Identifiable Intangible Assets - Acquired Intangible Assets (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	$ 792,709	$ 690,745
Accumulated Amortization	(278,249)	(215,234)
Net Carrying Amount	514,460	475,511
Acquired Indefinite-lived Intangible Assets [Line Items]
Intangible assets excluding goodwill	514,460	564,911
Tradenames and trademarks
Acquired Indefinite-lived Intangible Assets [Line Items]
Intangible assets not subject to amortization	0	89,400
Staffing databases
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	36,836	36,836
Accumulated Amortization	(19,857)	(16,706)
Net Carrying Amount	16,979	20,130
Customer relationships
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	445,169	444,839
Accumulated Amortization	(150,255)	(122,105)
Net Carrying Amount	294,914	322,734
Tradenames and trademarks
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	256,889	166,269
Accumulated Amortization	(81,522)	(58,299)
Net Carrying Amount	175,367	107,970
Non-compete agreements
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	6,495	6,371
Accumulated Amortization	(4,621)	(3,402)
Net Carrying Amount	1,874	2,969
Acquired technology
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	47,320	36,430
Accumulated Amortization	(21,994)	(14,722)
Net Carrying Amount	$ 25,326	$ 21,708

Goodwill and Identifiable Intangible Assets - Additional Information (Details) - USD ($)		3 Months Ended	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2021	Dec. 31, 2021	Dec. 31, 2020
Finite-Lived Intangible Assets [Line Items]
Aggregate amortization expense, intangible assets			$ 63,015,000	$ 63,817,000
Goodwill, impairment loss				$ 0
Tradenames and trademarks
Finite-Lived Intangible Assets [Line Items]
Intangible asset, no longer considered infinite-lived		$ 89,400,000
Finite-lived intangible assets, amount with estimated useful lives revised		$ 19,766,000
Useful life	6 years

Goodwill and Identifiable Intangible Assets - Estimated Future Amortization (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Finite-Lived Intangible Assets, Net, Amortization Expense, Fiscal Year Maturity [Abstract]
Year ending December 31, 2022	$ 79,001
Year ending December 31, 2023	77,333
Year ending December 31, 2024	70,783
Year ending December 31, 2025	57,772
Year ending December 31, 2026	48,050
Thereafter	181,521
Net Carrying Amount	$ 514,460	$ 475,511

Goodwill and Identifiable Intangible Assets - Changes in the Carrying Amount of Goodwill (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Goodwill [Roll Forward]
Beginning balance	$ 864,485	$ 595,551
Reallocation due to change in segments		0
Ending balance	892,341	864,485
Accumulated impairment loss	214,939	214,939
Nurse and Allied Solutions
Goodwill [Roll Forward]
Beginning balance	339,015	344,316
Reallocation due to change in segments		(5,330)
Ending balance	339,015	339,015
Accumulated impairment loss	154,444	154,444
Physician and Leadership Solutions
Goodwill [Roll Forward]
Beginning balance	152,800	163,348
Reallocation due to change in segments		(10,548)
Ending balance	152,800	152,800
Accumulated impairment loss	60,495	60,495
Technology and Workforce Solutions
Goodwill [Roll Forward]
Beginning balance	372,670	87,887
Reallocation due to change in segments		15,878
Ending balance	400,526	372,670
Accumulated impairment loss	0	0
Advanced
Goodwill [Roll Forward]
Goodwill adjustment for acquisition		29
Advanced \| Nurse and Allied Solutions
Goodwill [Roll Forward]
Goodwill adjustment for acquisition		29
Advanced \| Physician and Leadership Solutions
Goodwill [Roll Forward]
Goodwill adjustment for acquisition		0
Advanced \| Technology and Workforce Solutions
Goodwill [Roll Forward]
Goodwill adjustment for acquisition		0
b4health
Goodwill [Roll Forward]
Beginning balance	13,594
Goodwill adjustment for acquisition		(66)
Ending balance		13,594
b4health \| Nurse and Allied Solutions
Goodwill [Roll Forward]
Goodwill adjustment for acquisition		0
b4health \| Physician and Leadership Solutions
Goodwill [Roll Forward]
Goodwill adjustment for acquisition		0
b4health \| Technology and Workforce Solutions
Goodwill [Roll Forward]
Goodwill adjustment for acquisition		(66)
Stratus Video
Goodwill [Roll Forward]
Goodwill adjustment for acquisition	663
Goodwill from acquisition		268,971
Stratus Video \| Nurse and Allied Solutions
Goodwill [Roll Forward]
Goodwill adjustment for acquisition	0
Goodwill from acquisition		0
Stratus Video \| Physician and Leadership Solutions
Goodwill [Roll Forward]
Goodwill adjustment for acquisition	0
Goodwill from acquisition		0
Stratus Video \| Technology and Workforce Solutions
Goodwill [Roll Forward]
Goodwill adjustment for acquisition	663
Goodwill from acquisition		$ 268,971
Synzi and SnapMD
Goodwill [Roll Forward]
Goodwill from acquisition	27,193
Synzi and SnapMD \| Nurse and Allied Solutions
Goodwill [Roll Forward]
Goodwill from acquisition	0
Synzi and SnapMD \| Physician and Leadership Solutions
Goodwill [Roll Forward]
Goodwill from acquisition	0
Synzi and SnapMD \| Technology and Workforce Solutions
Goodwill [Roll Forward]
Goodwill from acquisition	$ 27,193

Leases - Narrative (Details) $ in Thousands	3 Months Ended	12 Months Ended
Leases - Narrative (Details) $ in Thousands	Sep. 30, 2021 USD ($) phase	Dec. 31, 2021
Leases [Abstract]
Option to extend, term (up to)		10 years
Option to terminate, term (within)		2 years
Number of phases of lease termination agreement \| phase	2
Payments of lease termination fee	$ 17,000
Operating lease, right-of-use asset, decrease from modification	27,340
Operating lease, liability, decrease from modification	27,340
Remaining lease payments, premodification	62,487
Remaining lease payments, postmodification	$ 9,564

Leases - Components of Lease Expense (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Leases [Abstract]
Operating lease cost	$ 23,495	$ 20,176	$ 18,725
Short-term lease cost	6,056	8,702	20,112
Variable and other lease cost	2,485	2,526	2,880
Net lease cost	$ 32,036	$ 31,404	$ 41,717

Leases - Maturity of Lease Liabilities (Details) $ in Thousands	Dec. 31, 2021 USD ($)
December 31,
2022	$ 11,867
2023	6,468
2024	5,348
2025	1,876
2026	112
Thereafter	0
Total lease payments	25,671
Less imputed interest	(924)
Present value of lease liabilities	$ 24,747

Leases - Supplemental Cash Flow Information Regarding Leases (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Leases [Abstract]
Cash paid for amounts included in the measurement of operating lease liabilities	$ 39,865	$ 20,052	$ 17,817

Leases - Assumptions Used for Operating Leases (Details)	Dec. 31, 2021	Dec. 31, 2020
Leases [Abstract]
Weighted average remaining lease term	3 years	6 years
Weighted average discount rate	2.60%	4.80%

Balance Sheet Details (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Other current assets:
Restricted cash and cash equivalents	$ 29,262	$ 18,626
Other	37,568	22,183
Other current assets	66,830	40,809
Prepaid expenses:
Prepaid payroll deposits	60,014	0
Other	12,446	13,629
Current assets	72,460	13,629
Fixed assets:
Furniture and equipment	43,134	47,355
Software	265,137	220,971
Leasehold improvements	8,797	9,600
Fixed assets, gross	317,068	277,926
Accumulated depreciation	(189,954)	(161,752)
Fixed assets, net	127,114	116,174
Accounts payable and accrued expenses:
Trade accounts payable	77,325	28,089
Subcontractor payable	261,689	79,364
Accrued expenses	61,220	37,849
Loss contingencies	10,400	7,613
Professional liability reserve	7,127	8,897
Other	7,496	6,069
Accounts payable and accrued expenses	425,257	167,881
Accrued compensation and benefits:
Accrued payroll	98,817	59,721
Accrued bonuses and commissions	105,155	34,514
Accrued travel expense	3,058	1,998
Health insurance reserve	6,041	5,590
Workers compensation reserve	12,384	10,244
Deferred compensation	119,617	97,184
Other	9,309	4,163
Accrued compensation and benefits	354,381	213,414
Other current liabilities:
Income taxes payable	21,162	0
Acquisition related liabilities	0	8,000
Client deposits	141,102	1,636
Other	155	1,302
Other current liabilities	162,419	10,938
Other long-term liabilities:
Workers compensation reserve	24,130	20,930
Professional liability reserve	34,544	31,997
Unrecognized tax benefits	4,633	5,447
Other	33,682	49,533
Other long-term liabilities	$ 96,989	$ 107,907

Income Taxes - Provision for Income Taxes (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Current income taxes:
Federal	$ 98,795	$ 32,673	$ 25,255
State	34,025	9,813	8,332
Total	132,820	42,486	33,587
Deferred income taxes:
Federal	(12,992)	(15,092)	625
State	(3,295)	(6,536)	288
Total	(16,287)	(21,628)	913
Income tax expense from operations	$ 116,533	$ 20,858	$ 34,500

- Definition

Amount of current income tax expense (benefit) and deferred income tax expense (benefit) pertaining to continuing operations.

+ References + Details

Income Taxes - Income Tax Reconciliation (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Income tax reconciliation
Tax expense at federal statutory rate	$ 93,223	$ 19,220	$ 31,253
State taxes, net of federal benefit	23,990	4,161	6,810
Non-deductible expenses	0	3,621	3,840
Share-based compensation	(1,460)	(2,311)	(4,770)
Unrecognized tax benefit	(680)	(78)	(207)
Other, net	1,460	(3,755)	(2,426)
Income tax expense from operations	$ 116,533	$ 20,858	$ 34,500

- Definition

Amount of current income tax expense (benefit) and deferred income tax expense (benefit) pertaining to continuing operations.

+ References + Details

Income Taxes - Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Deferred tax assets:
Stock compensation	$ 6,954	$ 6,198
Deferred compensation	30,513	24,604
Accrued bonus	24,636	7,607
Accrued payroll taxes	6,427	12,445
Accrued expenses	19,899	13,371
Operating lease liabilities	6,472	23,826
Net operating losses	8,815	9,557
Loss contingencies	8,528	6,459
Workers compensation insurance	6,476	4,814
Other	2,731	989
Total deferred tax assets	121,451	109,870
Deferred tax liabilities:
Intangibles	(126,535)	(126,833)
Fixed assets	(28,824)	(25,252)
Operating lease right-of-use assets	(7,269)	(19,933)
Other	(6,637)	(5,057)
Total deferred tax liabilities	(169,265)	(177,075)
Net deferred tax liabilities	$ (47,814)	$ (67,205)

Income Taxes - Operating Loss Carryforwards (Details) $ in Thousands	Dec. 31, 2021 USD ($)
Federal
Operating Loss Carryforwards
Operating loss carryforwards	$ 35,046
State
Operating Loss Carryforwards
Operating loss carryforwards	$ 29,437

Income Taxes - Unrecognized Tax Benefits (Details) - USD ($) $ in Thousands	1 Months Ended		12 Months Ended
	Nov. 30, 2019	Jul. 31, 2018	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Reconciliation of Unrecognized Tax Benefits, Excluding Amounts Pertaining to Examined Tax Returns [Roll Forward]
Beginning balance of unrecognized tax benefits			$ 4,916	$ 4,937	$ 4,393
Additions based on tax positions related to the current year			504	667	588
Additions based on tax positions of prior years			0	255	990
Reductions for tax positions of prior years			(301)	0	0
Reductions due to lapse of applicable statute of limitation			(1,052)	(943)	(1,034)
Ending balance of unrecognized tax benefits			4,067	4,916	4,937
Unrecognized tax benefits that would affect the effective tax rate, net of temporary differences			3,936
Temporary differences that would affect the effective tax rate			697
Accrued interest and penalties related to uncertain tax positions			564	530	493
Interest and penalties recognized			$ 34	$ 37	$ 26
Business Acquisition [Line Items]
Income tax assessment	$ 1,300	$ 8,300

Income Taxes - CARES Act (Details) $ in Thousands	Dec. 31, 2021 USD ($)
Income Tax Disclosure [Abstract]
Deferred payroll taxes, CARES Act	$ 48,452
Employee retention employment tax credit, CARES Act	$ 1,756

Notes Payable and Credit Agreement - The Company’s Credit Agreement and Related Credit Facilities (Details) - USD ($)	Feb. 14, 2020	Dec. 31, 2021	Dec. 31, 2020	Jun. 14, 2019	Feb. 09, 2018
Debt Instrument [Line Items]
Term loan		$ 842,322,000	$ 857,961,000
Term Loan Credit Facility
Debt Instrument [Line Items]
Debt issuance fees incurred	$ 4,144,000
Unamortized debt issuance costs	1,681,000
Senior Credit Facility \| Line of Credit
Debt Instrument [Line Items]
Maximum borrowing capacity	75,000,000				$ 400,000,000
Debt collateral		21,408,000
Available credit		$ 378,592,000
Secured Debt \| Term Loan Credit Facility
Debt Instrument [Line Items]
Maximum borrowing capacity				$ 150,000,000
Term loan	$ 250,000,000
Annual amortization percentage, first year	2.50%
Annual amortization percentage, after first year	5.00%
Revolving Credit Facility and Secured Debt \| Term Loan Credit Facility \| Minimum \| LIBOR
Debt Instrument [Line Items]
Basis spread on variable rate	1.00%
Revolving Credit Facility and Secured Debt \| Term Loan Credit Facility \| Minimum \| Base Rate
Debt Instrument [Line Items]
Basis spread on variable rate	0.00%
Revolving Credit Facility and Secured Debt \| Term Loan Credit Facility \| Maximum \| LIBOR
Debt Instrument [Line Items]
Basis spread on variable rate	1.75%
Revolving Credit Facility and Secured Debt \| Term Loan Credit Facility \| Maximum \| Base Rate
Debt Instrument [Line Items]
Basis spread on variable rate	0.75%
Revolving Credit Facility, Swing Line Loan \| Line of Credit
Debt Instrument [Line Items]
Maximum borrowing capacity	$ 75,000,000

Notes Payable and Credit Agreement - Senior Notes (Details) - USD ($)				2 Months Ended	12 Months Ended
	Nov. 04, 2020	Oct. 20, 2020	Aug. 13, 2020	Sep. 30, 2020	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019	Oct. 01, 2019
Debt Instrument [Line Items]
Repayments of line of credit					$ 70,000,000	$ 245,000,000	$ 221,000,000
Term Loan Credit Facility \| Secured Debt
Debt Instrument [Line Items]
Extinguishment of debt				$ 200,000,000
2027 Notes \| Senior Notes
Debt Instrument [Line Items]
Interest rate			4.625%					4.625%
Aggregate principal amount			$ 200,000,000		500,000,000	500,000,000		$ 300,000,000
Issuance price, percentage of principal amount			101.00%
Payment of debt issuance fees and expenses				$ 2,620,000
2029 Notes \| Senior Notes
Debt Instrument [Line Items]
Interest rate		4.00%
Aggregate principal amount		$ 350,000,000			$ 350,000,000	350,000,000
Payment of debt issuance fees and expenses		4,744,000
2029 Notes \| Senior Notes \| Revolving Credit Facility
Debt Instrument [Line Items]
Repayments of line of credit		$ 40,000,000
2024 Notes \| Senior Notes
Debt Instrument [Line Items]
Interest rate	5.125%
Extinguishment of debt	$ 325,000,000
Payments for redemption premium and accrued and unpaid interest	$ 9,857,000
Write off of unamortized financing fees						$ 2,992,000

Notes Payable and Credit Agreement - Debt Balances (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019	Feb. 14, 2020
Debt Instrument [Line Items]
Total debt outstanding	$ 850,000	$ 871,875
Less unamortized fees and premium	(7,678)	(9,226)
Less current portion of notes payable	0	(4,688)
Long-term portion of notes payable	842,322	857,961
Proceeds from line of credit	70,000	245,000	$ 101,000
Senior Notes \| 2027 Notes
Debt Instrument [Line Items]
Total debt outstanding	500,000	500,000
Senior Notes \| 2029 Notes
Debt Instrument [Line Items]
Total debt outstanding	350,000	350,000
Secured Debt \| Term Loan Credit Facility
Debt Instrument [Line Items]
Total debt outstanding	$ 0	$ 21,875
Long-term portion of notes payable				$ 250,000

Notes Payable and Credit Agreement - Letters of Credit (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Standby Letters of Credit
Line of Credit Facility [Line Items]
Letters of credit, amount outstanding	$ 23,562	$ 24,064
Debt collateral	2,154
Senior Credit Facility \| Line of Credit
Line of Credit Facility [Line Items]
Debt collateral	$ 21,408

Retirement Plans - 401(k) Retirement Savings Plan (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Retirement Benefits [Abstract]
Employer contributions, net of forfeitures	$ 13,157	$ 4,256	$ 5,516

Retirement Plans - Deferred Compensation Plan (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Deferred Compensation Arrangement with Individual, Postretirement Benefits [Line Items]
Cash surrender value of life insurance	$ 115,095	$ 98,161
Key Executives and Key Employees
Deferred Compensation Arrangement with Individual, Postretirement Benefits [Line Items]
Service vesting period	5 years
Maximum percent of base salary deferrable	80.00%
Maximum percent of bonus deferrable	90.00%
Maximum percent of vested RSUs and PRSUs deferrable	100.00%
Employer contributions	$ 8,951	$ 2,845	$ 5,551

Capital Stock (Details) - USD ($)	2 Months Ended	12 Months Ended
Capital Stock (Details) - USD ($)	Feb. 15, 2022	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019	Nov. 10, 2021	Nov. 01, 2016
Preferred Stock, Number of Shares, Par Value and Other Disclosures [Abstract]
Preferred stock, shares authorized (in shares)		10,000,000	10,000,000
Preferred stock, par value (in dollars per share)		$ 0.01	$ 0.01
Preferred stock, shares outstanding (in shares)		0	0
Treasury Stock, Number of Shares and Restriction Disclosures [Abstract]
Stock repurchase program, authorized amount (up to)						$ 150,000,000
Stock repurchase program, additional authorized amount (up to)					$ 150,000,000
Treasury stock acquired (in shares)		25,000	0	395,000
Treasury stock acquired (in dollars per share)		$ 108.97		$ 47.30
Aggregate purchase price of treasury stock		$ 2,688,000		$ 18,705,000
Subsequent Event
Treasury Stock, Number of Shares and Restriction Disclosures [Abstract]
Stock repurchase program, additional authorized amount (up to)	$ 300,000,000
Treasury stock acquired (in shares)	701,000
Treasury stock acquired (in dollars per share)	$ 97.97
Aggregate purchase price of treasury stock	$ 68,739,000

Share-Based Compensation - Narrative (Details) - USD ($) $ in Thousands					12 Months Ended
	Apr. 19, 2017	Apr. 18, 2012	Apr. 09, 2009	Apr. 18, 2007	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019	Feb. 28, 2014	Dec. 31, 2006
RSUs and Performance Shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total unrecognized compensation cost					$ 26,788
Unrecognized compensation cost, weighted average remaining period					1 year 8 months 12 days
Aggregate intrinsic value					$ 92,346	$ 48,945
Stock Options and Stock Appreciation Rights
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Awards outstanding (in shares)					0
Total intrinsic value of share-based payment award exercised						$ 828	$ 9,177
Equity Plan \| RSUs and Performance Shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares authorized for issuance (in shares)									723,000
Additional number of shares authorized (in shares)	1,400,000	2,400,000	1,850,000	3,000,000
Number of equity awards reserved for future issuance (in shares)					2,548,000	2,830,000
Equity Plan \| Stock Options and Stock Appreciation Rights
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Contractual life					10 years
2014 Employee Inducement Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares authorized for issuance (in shares)								200,000
Number of shares of common stock available for future grants (in shares)					181,000

Share-Based Compensation - Restricted Stock Units (Details) - $ / shares shares in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Number of Shares
Unvested, beginning balance (in shares)	717	758	818
Vested (in shares)	(280)	(283)	(400)
Canceled/forfeited/expired (in shares)	(158)	(184)	(52)
Unvested, ending balance (in shares)	755	717	758
Weighted Average Grant Date Fair Value per Share
Unvested, beginning balance (in dollars per share)	$ 58.88	$ 52.45	$ 43.84
Vested (in dollars per share)	56.05	49.18	35.46
Canceled/forfeited/expired (in dollars per share)	65.69	53.84	41.09
Unvested, ending balance (in dollars per share)	$ 78.13	$ 58.88	$ 52.45
Restricted Stock Units (RSUs)
Number of Shares
Granted (in shares)	290	271	191
Weighted Average Grant Date Fair Value per Share
Granted (in dollars per share)	$ 85.30	$ 60.02	$ 54.99
Performance Restricted Stock Units (PRSUs)
Number of Shares
Granted (in shares)	186	155	201
Weighted Average Grant Date Fair Value per Share
Granted (in dollars per share)	$ 97.46	$ 64.59	$ 48.32

Share-Based Compensation - Summary of Stock Option and SAR Activity (Details) - Equity Plan and Other Plans - Stock Options and Stock Appreciation Rights - $ / shares shares in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2021
Equity Plan and Other Plans, Number Outstanding
Outstanding, beginning balance (in shares)	12	227
Granted (in shares)	0	0
Exercised (in shares)	(12)	(215)
Canceled/forfeited/expired (in shares)	0	0
Outstanding, ending balance (in shares)	0	12
Vested and expected to vest (in shares)	0		0
Exercisable (in shares)	0		0
Equity Plan and Other Plans, Weighted-Average Exercise Price per Share
Outstanding, beginning balance (in dollars per share)	$ 7.51	$ 8.61
Granted (in dollars per share)	0	0
Exercised (in dollars per share)	7.51	8.67
Canceled/forfeited/expired (in dollars per share)	0	0
Outstanding, ending balance (in dollars per share)	0	$ 7.51
Vested and expected to vest (in dollars per share)	0		$ 0
Exercisable (in dollars per share)	$ 0		$ 0

Share-Based Compensation - Share Based Compensation Expense (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Share-based Payment Arrangement [Abstract]
Share-based employee compensation, before tax	$ 25,217	$ 20,465	$ 16,241
Related income tax benefits	(6,556)	(5,321)	(4,223)
Share-based employee compensation, net of tax	$ 18,661	$ 15,144	$ 12,018

Commitments and Contingencies (Details) $ in Thousands	Dec. 31, 2021 USD ($)
Pending Litigation \| Wage and Hour Claims
Loss Contingencies [Line Items]
Litigation matters accrual	$ 37,225