0001142750-22-000027 | 10-Q | XBRL Viewer | AMN Healthcare Services INC

Net Income Per Common Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Earnings Per Share [Abstract]
Net income	$ 92,445	$ 74,023	$ 362,253	$ 211,171
Net income per common share - basic (in dollars per share)	$ 2.11	$ 1.55	$ 8.04	$ 4.43
Net income per common share - diluted (in dollars per share)	$ 2.10	$ 1.54	$ 7.99	$ 4.40
Weighted average common shares outstanding - basic (in shares)	43,785	47,737	45,056	47,666
Plus dilutive effect of potential common shares (in shares)	254	343	276	356
Weighted average common shares outstanding - diluted (in shares)	44,039	48,080	45,332	48,022
Common stock excluded from calculation of EPS (in shares)	14	21	15	26

- Definition

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

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- Definition

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

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- Definition

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

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+ Details

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Statement of Financial Position [Abstract]
Accounts receivable, allowance	$ 15,194	$ 6,838
Accumulated depreciation - fixed assets	212,702	189,954
Accumulated amortization	$ 339,092	$ 278,249
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)	50,087,000	49,849,000
Common stock, shares outstanding (in shares)	43,327,000	47,263,000
Treasury stock (in shares)	6,760,000	2,586,000

Segment Information (Tables)

9 Months Ended

Sep. 30, 2022

Segment Reporting [Abstract]

Reconciliation of Revenue and Segment Operating Income by Reportable Segment

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


	Three Months Ended September 30,				Nine Months Ended September 30,
	2022		2021		2022		2021
Revenue
Nurse and allied solutions	$	828,317	$	627,049	$	3,157,834	$	1,908,195
Physician and leadership solutions	175,152		150,663		530,355		430,523
Technology and workforce solutions	135,117		100,088		429,542		282,472
	$	1,138,586	$	877,800	$	4,117,731	$	2,621,190
Segment operating income
Nurse and allied solutions	$	115,182	$	92,564	$	471,141	$	283,768
Physician and leadership solutions	23,904		19,301		64,280		62,366
Technology and workforce solutions	71,145		47,210		232,526		131,952
	210,231		159,075		767,947		478,086
Unallocated corporate overhead	34,635		23,867		116,356		74,915
Depreciation and amortization	33,239		26,104		96,169		74,098
Depreciation (included in cost of revenue)	1,091		686		2,918		1,773
Share-based compensation	4,898		2,589		24,670		17,895
Interest expense, net, and other	8,961		5,223		28,630		24,278
Income before income taxes	$	127,407	$	100,606	$	499,204	$	285,127

Disaggregation of Revenue

The following tables present the Company’s revenue disaggregated by service type. Prior period amounts have been reclassified to conform with current period presentation. These reclassifications have no impact on total revenue by reportable segment.


	Three Months Ended September 30, 2022
	Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
Travel nurse staffing	$	583,463	$	—	$	—	$	583,463
Labor disruption services	19,479		—		—		19,479
Local staffing	31,814		—		—		31,814
Allied staffing	190,044		—		—		190,044
Locum tenens staffing	—		106,055		—		106,055
Interim leadership staffing	—		47,559		—		47,559
Temporary staffing	824,800		153,614		—		978,414
Permanent placement	3,517		21,538		—		25,055
Language services	—		—		55,502		55,502
Vendor management systems	—		—		60,304		60,304
Other technologies	—		—		7,290		7,290
Technology-enabled services	—		—		123,096		123,096
Talent planning and acquisition	—		—		12,021		12,021
Total revenue	$	828,317	$	175,152	$	135,117	$	1,138,586


	Three Months Ended September 30, 2021
	Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
Travel nurse staffing	$	444,803	$	—	$	—	$	444,803
Labor disruption services	22,573		—		—		22,573
Local staffing	23,272		—		—		23,272
Allied staffing	136,401		—		—		136,401
Locum tenens staffing	—		88,994		—		88,994
Interim leadership staffing	—		43,814		—		43,814
Temporary staffing	627,049		132,808		—		759,857
Permanent placement	—		17,855		—		17,855
Language services	—		—		47,135		47,135
Vendor management systems	—		—		33,467		33,467
Other technologies	—		—		7,819		7,819
Technology-enabled services	—		—		88,421		88,421
Talent planning and acquisition	—		—		11,667		11,667
Total revenue	$	627,049	$	150,663	$	100,088	$	877,800


	Nine Months Ended September 30, 2022
	Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
Travel nurse staffing	$	2,329,240	$	—	$	—	$	2,329,240
Labor disruption services	102,549		—		—		102,549
Local staffing	109,265		—		—		109,265
Allied staffing	611,226		—		—		611,226
Locum tenens staffing	—		324,663		—		324,663
Interim leadership staffing	—		139,519		—		139,519
Temporary staffing	3,152,280		464,182		—		3,616,462
Permanent placement	5,554		66,173		—		71,727
Language services	—		—		158,031		158,031
Vendor management systems	—		—		210,470		210,470
Other technologies	—		—		21,787		21,787
Technology-enabled services	—		—		390,288		390,288
Talent planning and acquisition	—		—		39,254		39,254
Total revenue	$	3,157,834	$	530,355	$	429,542	$	4,117,731


	Nine Months Ended September 30, 2021
	Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
Travel nurse staffing	$	1,400,629	$	—	$	—	$	1,400,629
Labor disruption services	25,126		—		—		25,126
Local staffing	80,932		—		—		80,932
Allied staffing	401,508		—		—		401,508
Locum tenens staffing	—		253,190		—		253,190
Interim leadership staffing	—		126,584		—		126,584
Temporary staffing	1,908,195		379,774		—		2,287,969
Permanent placement	—		50,749		—		50,749
Language services	—		—		133,706		133,706
Vendor management systems	—		—		96,086		96,086
Other technologies	—		—		21,791		21,791
Technology-enabled services	—		—		251,583		251,583
Talent planning and acquisition	—		—		30,889		30,889
Total revenue	$	1,908,195	$	430,523	$	282,472	$	2,621,190

Summary of Goodwill by Reportable Segment

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


	Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
Balance, January 1, 2022	$	339,015	$	152,800	$	400,526	$	892,341


Goodwill adjustment for Synzi and SnapMD acquisition	—		—		33		33
Goodwill from Connetics acquisition	43,301		—		—		43,301
Balance, September 30, 2022	$	382,316	$	152,800	$	400,559	$	935,675
Accumulated impairment loss as of December 31, 2021 and September 30, 2022	$	154,444	$	60,495	$	—	$	214,939

- Definition

Tabular disclosure of goodwill by reportable segment and in total which includes a rollforward schedule.

+ References

Reference 1: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 350
-SubTopic 20
-Section 50
-Paragraph 1
-Subparagraph (h)
-URI https://asc.fasb.org/extlink&oid=121556970&loc=d3e13816-109267

Reference 2: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 350
-SubTopic 20
-Section 50
-Paragraph 1
-Subparagraph (c)
-URI https://asc.fasb.org/extlink&oid=121556970&loc=d3e13816-109267

Reference 3: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 350
-SubTopic 20
-Section 50
-Paragraph 1
-Subparagraph (g)
-URI https://asc.fasb.org/extlink&oid=121556970&loc=d3e13816-109267

Reference 4: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 350
-SubTopic 20
-Section 50
-Paragraph 1
-URI https://asc.fasb.org/extlink&oid=121556970&loc=d3e13816-109267

Reference 5: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 350
-SubTopic 20
-Section 50
-Paragraph 1
-Subparagraph (e)
-URI https://asc.fasb.org/extlink&oid=121556970&loc=d3e13816-109267

Reference 6: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 350
-SubTopic 20
-Section 50
-Paragraph 1
-Subparagraph (d)
-URI https://asc.fasb.org/extlink&oid=121556970&loc=d3e13816-109267

Reference 7: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 350
-SubTopic 20
-Section 50
-Paragraph 1A
-URI https://asc.fasb.org/extlink&oid=121556970&loc=SL108378252-109267

Reference 8: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 350
-SubTopic 20
-Section 50
-Paragraph 1
-Subparagraph (f)
-URI https://asc.fasb.org/extlink&oid=121556970&loc=d3e13816-109267

Reference 9: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 350
-SubTopic 20
-Section 50
-Paragraph 1
-Subparagraph (a)
-URI https://asc.fasb.org/extlink&oid=121556970&loc=d3e13816-109267

Reference 10: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 350
-SubTopic 20
-Section 50
-Paragraph 2
-Subparagraph (b)
-URI https://asc.fasb.org/extlink&oid=121556970&loc=d3e13854-109267

Reference 11: http://www.xbrl.org/2003/role/exampleRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 350
-SubTopic 20
-Section 55
-Paragraph 24
-URI https://asc.fasb.org/extlink&oid=122137925&loc=d3e14258-109268

Reference 12: http://www.xbrl.org/2009/role/commonPracticeRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 350
-SubTopic 20
-Section 50
-Paragraph 1
-Subparagraph (b)
-URI https://asc.fasb.org/extlink&oid=121556970&loc=d3e13816-109267

+ Details

Commitments and Contingencies (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Mar. 31, 2022
Commitments and Contingencies [Line Items]
Future undiscounted lease payments		$ 29,514
Lease term		11 years
Wage and Hour claims \| Pending Litigation
Commitments and Contingencies [Line Items]
Litigation matters accrual	$ 37,225

Segment Information - Summary of Goodwill by Reportable Segment (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2022	Dec. 31, 2021
Goodwill [Roll Forward]
Goodwill, beginning balance	$ 892,341
Goodwill, ending balance	935,675
Accumulated impairment loss	214,939	$ 214,939
Synzi and SnapMD
Goodwill [Roll Forward]
Goodwill adjustment	33
Connetics Communications, LLC
Goodwill [Roll Forward]
Goodwill	43,301
Nurse and Allied Solutions
Goodwill [Roll Forward]
Goodwill, beginning balance	339,015
Goodwill, ending balance	382,316
Accumulated impairment loss	154,444	154,444
Nurse and Allied Solutions \| Synzi and SnapMD
Goodwill [Roll Forward]
Goodwill adjustment	0
Nurse and Allied Solutions \| Connetics Communications, LLC
Goodwill [Roll Forward]
Goodwill	43,301
Physician and Leadership Solutions
Goodwill [Roll Forward]
Goodwill, beginning balance	152,800
Goodwill, ending balance	152,800
Accumulated impairment loss	60,495	60,495
Physician and Leadership Solutions \| Synzi and SnapMD
Goodwill [Roll Forward]
Goodwill adjustment	0
Physician and Leadership Solutions \| Connetics Communications, LLC
Goodwill [Roll Forward]
Goodwill	0
Technology and Workforce Solutions
Goodwill [Roll Forward]
Goodwill, beginning balance	400,526
Goodwill, ending balance	400,559
Accumulated impairment loss	0	$ 0
Technology and Workforce Solutions \| Synzi and SnapMD
Goodwill [Roll Forward]
Goodwill adjustment	33
Technology and Workforce Solutions \| Connetics Communications, LLC
Goodwill [Roll Forward]
Goodwill	$ 0

Balance Sheet Details

9 Months Ended

Sep. 30, 2022

Balance Sheet Related Disclosures [Abstract]

Balance Sheet Details

BALANCE SHEET DETAILS

The consolidated balance sheets detail is as follows:


	September 30, 2022		December 31, 2021
Other current assets:
Restricted cash and cash equivalents	$	27,764	$	29,262
Income taxes receivable	1,426		—
Other	25,314		37,568
Other current assets	$	54,504	$	66,830

Prepaid expenses:
Prepaid payroll deposits	$	—	$	60,014
Other	17,019		12,446
Prepaid expenses	17,019		72,460

Fixed assets:
Furniture and equipment	$	47,618	$	43,134
Software	303,197		265,137
Leasehold improvements	2,882		8,797
	353,697		317,068
Accumulated depreciation	(212,702)		(189,954)
Fixed assets, net	$	140,995	$	127,114

Other assets:
Life insurance cash surrender value	$	110,279	$	115,095
Other	42,691		41,575
Other assets	$	152,970	$	156,670

Accounts payable and accrued expenses:
Trade accounts payable	$	84,334	$	77,325
Subcontractor payable	254,697		261,689
Accrued expenses	89,196		61,220
Loss contingencies	14,933		10,400
Professional liability reserve	7,712		7,127
Other	8,365		7,496
Accounts payable and accrued expenses	$	459,237	$	425,257

Accrued compensation and benefits:
Accrued payroll	$	93,495	$	98,817
Accrued bonuses and commissions	90,640		105,155
Accrued travel expense	2,312		3,058
Health insurance reserve	7,685		6,041
Workers compensation reserve	11,500		12,384
Deferred compensation	116,922		119,617
Other	16,279		9,309
Accrued compensation and benefits	$	338,833	$	354,381

Other current liabilities:
Acquisition related liabilities	$	6,810	$	—
Income taxes payable	—		21,162
Client deposits	61,319		141,102
Other	1,761		155
Other current liabilities	$	69,890	$	162,419


	September 30, 2022		December 31, 2021
Other long-term liabilities:
Workers compensation reserve	$	22,633	$	24,130
Professional liability reserve	38,163		34,544
Unrecognized tax benefits	4,785		4,633


Other	32,647		33,682
Other long-term liabilities	$	98,228	$	96,989

Condensed Consolidated Statements of Cash Flows (Parenthetical) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021
Statement of Cash Flows [Abstract]
Interest capitalized	$ 452	$ 248

Commitments and Contingencies	9 Months Ended
Commitments and Contingencies	Sep. 30, 2022
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	COMMITMENTS AND CONTINGENCIES Legal Proceedings From time to time, the Company is involved in various lawsuits, claims, investigations, and proceedings that arise in the ordinary course of business. These matters typically relate to professional liability, tax, compensation, contract, competitor disputes and employee-related matters and include individual and class action lawsuits, as well as inquiries and investigations by governmental agencies regarding the Company’s employment and compensation practices. Additionally, some of the Company’s clients may also become subject to claims, governmental inquiries and investigations, and legal actions relating to services provided by the Company’s healthcare professionals. Depending upon the particular facts and circumstances, the Company may also be subject to indemnification obligations under its contracts with such clients relating to these matters. The Company 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, 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 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. This case is proceeding in the United States District Court. On May 2, 2019, former travel nurse Sara Woehrle filed a complaint against AMN Services, LLC, and Providence Health System – Southern California in California Superior Court in Los Angeles County. The Company removed the case to the United States District Court for the Central District of California (Case No. 2:19-cv-05282 DSF-KS). The complaint asserts that, due to the Company’s per diem adjustment practices, traveling nurses’ per diem benefits should be included in their regular rate of pay for the purposes of calculating their overtime compensation. The complaint also alleges that the putative class members were denied required meal periods, denied proper overtime compensation, were not compensated for all time worked, including reporting time and training time, and received non-compliant wage statements. The Company has reached an agreement to settle this matter in its entirety and is awaiting court approval. Final approval of the settlement is expected in late 2022 or early 2023. 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 both September 30, 2022 and December 31, 2021 are included in accounts payable and accrued expenses and other long-term liabilities in the consolidated balance sheets. Operating Leases In the first quarter of 2022, the Company entered into a lease agreement for an office building located in Dallas, Texas, with future undiscounted lease payments of approximately $29,514, excluding lease incentives. Because the Company does not control the underlying asset during the construction period, the Company is not considered the owner of the asset under construction for accounting purposes. The lease will commence upon completion of the construction of the office building which is expected be in the first quarter of 2023. The initial term of the lease is approximately eleven years with options to renew the lease during the lease term. A right-of-use asset and lease liability will be recognized in the consolidated balance sheet in the period the lease commences.

Acquisitions - Connetics Acquisition (Details) - USD ($) $ in Thousands	May 13, 2022	Sep. 30, 2022	Dec. 31, 2021
Business Acquisition [Line Items]
Fair value of contingent earn-out		$ 6,810	$ 0
Goodwill		$ 935,675	$ 892,341
Connetics Communications, LLC
Business Acquisition [Line Items]
Initial purchase price	$ 78,764
Cash consideration	70,764
Contingent earn-out based on future operating performance (up to)	12,500
Fair value of contingent earn-out	8,000
Fair value of tangible assets acquired	3,694
Cash received	963
Liabilities assumed	8,431
Identifiable intangible assets	40,200
Goodwill	43,301
Goodwill expected to be deductible for tax purposes	$ 35,317
Intangible assets acquired, weighted average useful life	13 years
Connetics Communications, LLC \| Customer relationships
Business Acquisition [Line Items]
Identifiable intangible assets	$ 32,800
Useful Life	15 years
Connetics Communications, LLC \| Staffing database
Business Acquisition [Line Items]
Identifiable intangible assets	$ 4,200
Useful Life	5 years
Connetics Communications, LLC \| Tradenames and trademarks
Business Acquisition [Line Items]
Identifiable intangible assets	$ 3,200
Useful Life	5 years

Segment Information - Reconciliation of Revenue and Segment Operating Income by Reportable Segment (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	$ 1,138,586	$ 877,800	$ 4,117,731	$ 2,621,190
Segment operating income	136,368	105,829	527,834	309,405
Depreciation and amortization	33,239	26,104	96,169	74,098
Depreciation (included in cost of revenue)	1,091	686	2,918	1,773
Share-based compensation	4,898	2,589	24,670	17,895
Interest expense, net, and other	8,961	5,223	28,630	24,278
Income before income taxes	127,407	100,606	499,204	285,127
Nurse and allied solutions
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	828,317	627,049	3,157,834	1,908,195
Physician and leadership solutions
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	175,152	150,663	530,355	430,523
Technology and workforce solutions
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	135,117	100,088	429,542	282,472
Operating segments
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	1,138,586	877,800	4,117,731	2,621,190
Segment operating income	210,231	159,075	767,947	478,086
Operating segments \| Nurse and allied solutions
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	828,317	627,049	3,157,834	1,908,195
Segment operating income	115,182	92,564	471,141	283,768
Operating segments \| Physician and leadership solutions
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	175,152	150,663	530,355	430,523
Segment operating income	23,904	19,301	64,280	62,366
Operating segments \| Technology and workforce solutions
Segment Reporting, Revenue Reconciling Item [Line Items]
Revenue	135,117	100,088	429,542	282,472
Segment operating income	71,145	47,210	232,526	131,952
Unallocated corporate overhead
Segment Reporting, Revenue Reconciling Item [Line Items]
Unallocated corporate overhead	$ 34,635	$ 23,867	$ 116,356	$ 74,915

Fair Value Measurement - Reconciliation of Changes in Contingent Consideration Liabilities (Details) - Level 3 - Acquisition contingent consideration liabilities - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Fair Value, Measurements, Recurring
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Beginning balance	$ (8,580)	$ 0	$ 0	$ (8,000)
Ending balance	(6,810)	0	(6,810)	0
b4health
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Settlement of b4health contingent consideration liability for year ended December 31, 2020	0	0	0	8,000
Connetics Communications, LLC
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Contingent consideration liability from Connetics acquisition on May 13, 2022	0	0	(8,000)	0
Change in fair value of contingent consideration liability from Connetics acquisition	$ 1,770	$ 0	$ 1,190	$ 0

Basis of Presentation - Reconciliation of Activity in Allowance for Credit Losses for Accounts Receivable (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance	$ 6,838	$ 7,043
Provision for expected credit losses	10,129	325
Amounts written off charged against the allowance	(1,773)	(1,220)
Ending balance	$ 15,194	$ 6,148

Segment Information - Narrative (Details)	9 Months Ended
Segment Information - Narrative (Details)	Sep. 30, 2022 segment
Segment Reporting [Abstract]
Number of reportable segments	3

Net Income Per Common Share (Tables)

9 Months Ended

Sep. 30, 2022

Earnings Per Share [Abstract]

Computation of Basic and Diluted Net Income Per Common Share

The following table sets forth the computation of basic and diluted net income per common share:


	Three Months Ended September 30,				Nine Months Ended September 30,
	2022		2021		2022		2021
Net income	$	92,445	$	74,023	$	362,253	$	211,171

Net income per common share - basic	$	2.11	$	1.55	$	8.04	$	4.43
Net income per common share - diluted	$	2.10	$	1.54	$	7.99	$	4.40

Weighted average common shares outstanding - basic	43,785		47,737		45,056		47,666
Plus dilutive effect of potential common shares	254		343		276		356
Weighted average common shares outstanding - diluted	44,039		48,080		45,332		48,022

Segment Information

9 Months Ended

Sep. 30, 2022

Segment Reporting [Abstract]

Segment Information

SEGMENT INFORMATION

The Company’s operating segments are identified in the same manner as they are reported internally and used by the Company’s chief operating decision maker for the purpose of evaluating performance and allocating resources. The Company has three reportable segments: (1) nurse and allied solutions, (2) physician and leadership solutions, and (3) technology and workforce solutions. The nurse and allied solutions segment includes the Company’s travel nurse staffing (including international nurse staffing and rapid response nurse staffing), labor disruption staffing, local staffing, international nurse and allied permanent placement, allied 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, virtual care, credentialing solutions, 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.


	Three Months Ended September 30,				Nine Months Ended September 30,
	2022		2021		2022		2021
Revenue
Nurse and allied solutions	$	828,317	$	627,049	$	3,157,834	$	1,908,195
Physician and leadership solutions	175,152		150,663		530,355		430,523
Technology and workforce solutions	135,117		100,088		429,542		282,472
	$	1,138,586	$	877,800	$	4,117,731	$	2,621,190
Segment operating income
Nurse and allied solutions	$	115,182	$	92,564	$	471,141	$	283,768
Physician and leadership solutions	23,904		19,301		64,280		62,366
Technology and workforce solutions	71,145		47,210		232,526		131,952
	210,231		159,075		767,947		478,086
Unallocated corporate overhead	34,635		23,867		116,356		74,915
Depreciation and amortization	33,239		26,104		96,169		74,098
Depreciation (included in cost of revenue)	1,091		686		2,918		1,773
Share-based compensation	4,898		2,589		24,670		17,895
Interest expense, net, and other	8,961		5,223		28,630		24,278
Income before income taxes	$	127,407	$	100,606	$	499,204	$	285,127


	Three Months Ended September 30, 2022
	Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
Travel nurse staffing	$	583,463	$	—	$	—	$	583,463
Labor disruption services	19,479		—		—		19,479
Local staffing	31,814		—		—		31,814
Allied staffing	190,044		—		—		190,044
Locum tenens staffing	—		106,055		—		106,055
Interim leadership staffing	—		47,559		—		47,559
Temporary staffing	824,800		153,614		—		978,414
Permanent placement	3,517		21,538		—		25,055
Language services	—		—		55,502		55,502
Vendor management systems	—		—		60,304		60,304
Other technologies	—		—		7,290		7,290
Technology-enabled services	—		—		123,096		123,096
Talent planning and acquisition	—		—		12,021		12,021
Total revenue	$	828,317	$	175,152	$	135,117	$	1,138,586


	Three Months Ended September 30, 2021
	Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
Travel nurse staffing	$	444,803	$	—	$	—	$	444,803
Labor disruption services	22,573		—		—		22,573
Local staffing	23,272		—		—		23,272
Allied staffing	136,401		—		—		136,401
Locum tenens staffing	—		88,994		—		88,994
Interim leadership staffing	—		43,814		—		43,814
Temporary staffing	627,049		132,808		—		759,857
Permanent placement	—		17,855		—		17,855
Language services	—		—		47,135		47,135
Vendor management systems	—		—		33,467		33,467
Other technologies	—		—		7,819		7,819
Technology-enabled services	—		—		88,421		88,421
Talent planning and acquisition	—		—		11,667		11,667
Total revenue	$	627,049	$	150,663	$	100,088	$	877,800


	Nine Months Ended September 30, 2022
	Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
Travel nurse staffing	$	2,329,240	$	—	$	—	$	2,329,240
Labor disruption services	102,549		—		—		102,549
Local staffing	109,265		—		—		109,265
Allied staffing	611,226		—		—		611,226
Locum tenens staffing	—		324,663		—		324,663
Interim leadership staffing	—		139,519		—		139,519
Temporary staffing	3,152,280		464,182		—		3,616,462
Permanent placement	5,554		66,173		—		71,727
Language services	—		—		158,031		158,031
Vendor management systems	—		—		210,470		210,470
Other technologies	—		—		21,787		21,787
Technology-enabled services	—		—		390,288		390,288
Talent planning and acquisition	—		—		39,254		39,254
Total revenue	$	3,157,834	$	530,355	$	429,542	$	4,117,731


	Nine Months Ended September 30, 2021
	Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
Travel nurse staffing	$	1,400,629	$	—	$	—	$	1,400,629
Labor disruption services	25,126		—		—		25,126
Local staffing	80,932		—		—		80,932
Allied staffing	401,508		—		—		401,508
Locum tenens staffing	—		253,190		—		253,190
Interim leadership staffing	—		126,584		—		126,584
Temporary staffing	1,908,195		379,774		—		2,287,969
Permanent placement	—		50,749		—		50,749
Language services	—		—		133,706		133,706
Vendor management systems	—		—		96,086		96,086
Other technologies	—		—		21,791		21,791
Technology-enabled services	—		—		251,583		251,583
Talent planning and acquisition	—		—		30,889		30,889
Total revenue	$	1,908,195	$	430,523	$	282,472	$	2,621,190

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


	Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
Balance, January 1, 2022	$	339,015	$	152,800	$	400,526	$	892,341


Goodwill adjustment for Synzi and SnapMD acquisition	—		—		33		33
Goodwill from Connetics acquisition	43,301		—		—		43,301
Balance, September 30, 2022	$	382,316	$	152,800	$	400,559	$	935,675
Accumulated impairment loss as of December 31, 2021 and September 30, 2022	$	154,444	$	60,495	$	—	$	214,939

- Definition

The entire disclosure for reporting segments including data and tables. Reportable segments include those that meet any of the following quantitative thresholds a) it's reported revenue, including sales to external customers and intersegment sales or transfers is 10 percent or more of the combined revenue, internal and external, of all operating segments b) the absolute amount of its reported profit or loss is 10 percent or more of the greater, in absolute amount of 1) the combined reported profit of all operating segments that did not report a loss or 2) the combined reported loss of all operating segments that did report a loss c) its assets are 10 percent or more of the combined assets of all operating segments.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 31
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8924-108599

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 34
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8981-108599

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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-Paragraph 21
-Subparagraph (a)
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8721-108599

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
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-Paragraph 40
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e9031-108599

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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-Paragraph 32
-Subparagraph (f)
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Reference 6: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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-Subparagraph (e)
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Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
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Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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-Subparagraph (d)
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Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8736-108599

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-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8657-108599

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 21
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-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8721-108599

Reference 14: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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-URI https://asc.fasb.org/topic&trid=2134510

+ Details

Fair Value Measurement - Narrative (Details) - USD ($)	9 Months Ended
Fair Value Measurement - Narrative (Details) - USD ($)	Sep. 30, 2022	Sep. 30, 2021	Dec. 31, 2021	Oct. 20, 2020	Aug. 13, 2020
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Asset impairment charges	$ 0	$ 0
2027 Notes \| Senior Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate					4.625%
2029 Notes \| Senior Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate				4.00%
Fair Value, Measurements, Nonrecurring \| Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Equity investment balance	22,633,000		$ 22,633,000
Commercial paper \| Fair Value, Measurements, Recurring
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	29,296,000		80,596,000
Commercial paper \| Fair Value, Measurements, Recurring \| 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	29,296,000		80,596,000
Securities classified as available-for-sale	0		0
Corporate bonds \| Fair Value, Measurements, Recurring \| 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	26,841,000		29,159,000
Securities classified as available-for-sale	$ 26,841,000		$ 27,958,000

Basis of Presentation - Reconciliation of Cash, Cash Equivalents and Restricted Cash (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021	Sep. 30, 2021	Dec. 31, 2020
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Cash and cash equivalents	$ 155,723	$ 180,928
Restricted cash and cash equivalents (included in other current assets)	27,764	29,262
Restricted cash, cash equivalents and investments	64,883	64,482
Total cash, cash equivalents and restricted cash and investments	248,370	274,672
Less restricted investments	(26,841)	(27,958)
Total cash, cash equivalents and restricted cash	$ 221,529	$ 246,714	$ 201,104	$ 83,990

Acquisitions - Narrative (Details)	21 Months Ended
Acquisitions - Narrative (Details)	Sep. 30, 2022 acquisition
Business Combination and Asset Acquisition [Abstract]
Number of acquisitions	2

Balance Sheet Details (Tables)

9 Months Ended

Sep. 30, 2022

Balance Sheet Related Disclosures [Abstract]

Schedule of Supplemental Balance Sheet Disclosures

The consolidated balance sheets detail is as follows:


	September 30, 2022		December 31, 2021
Other current assets:
Restricted cash and cash equivalents	$	27,764	$	29,262
Income taxes receivable	1,426		—
Other	25,314		37,568
Other current assets	$	54,504	$	66,830

Prepaid expenses:
Prepaid payroll deposits	$	—	$	60,014
Other	17,019		12,446
Prepaid expenses	17,019		72,460

Fixed assets:
Furniture and equipment	$	47,618	$	43,134
Software	303,197		265,137
Leasehold improvements	2,882		8,797
	353,697		317,068
Accumulated depreciation	(212,702)		(189,954)
Fixed assets, net	$	140,995	$	127,114

Other assets:
Life insurance cash surrender value	$	110,279	$	115,095
Other	42,691		41,575
Other assets	$	152,970	$	156,670

Accounts payable and accrued expenses:
Trade accounts payable	$	84,334	$	77,325
Subcontractor payable	254,697		261,689
Accrued expenses	89,196		61,220
Loss contingencies	14,933		10,400
Professional liability reserve	7,712		7,127
Other	8,365		7,496
Accounts payable and accrued expenses	$	459,237	$	425,257

Accrued compensation and benefits:
Accrued payroll	$	93,495	$	98,817
Accrued bonuses and commissions	90,640		105,155
Accrued travel expense	2,312		3,058
Health insurance reserve	7,685		6,041
Workers compensation reserve	11,500		12,384
Deferred compensation	116,922		119,617
Other	16,279		9,309
Accrued compensation and benefits	$	338,833	$	354,381

Other current liabilities:
Acquisition related liabilities	$	6,810	$	—
Income taxes payable	—		21,162
Client deposits	61,319		141,102
Other	1,761		155
Other current liabilities	$	69,890	$	162,419


	September 30, 2022		December 31, 2021
Other long-term liabilities:
Workers compensation reserve	$	22,633	$	24,130
Professional liability reserve	38,163		34,544
Unrecognized tax benefits	4,785		4,633


Other	32,647		33,682
Other long-term liabilities	$	98,228	$	96,989

Acquisitions (Tables)

9 Months Ended

Sep. 30, 2022

Business Combination and Asset Acquisition [Abstract]

Finite-Lived and Indefinite-Lived Intangible Assets Acquired as Part of Business Combination

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	$	32,800	15
	Staffing database	4,200		5
	Tradenames and trademarks	3,200		5
		$	40,200

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Current assets:
Cash and cash equivalents	$ 155,723	$ 180,928
Accounts receivable, net of allowances of $15,194 and $6,838 at September 30, 2022 and December 31, 2021, respectively	724,966	789,131
Accounts receivable, subcontractor	253,954	239,719
Prepaid expenses	17,019	72,460
Other current assets	54,504	66,830
Total current assets	1,206,166	1,349,068
Restricted cash, cash equivalents and investments	64,883	64,482
Fixed assets, net of accumulated depreciation of $212,702 and $189,954 at September 30, 2022 and December 31, 2021, respectively	140,995	127,114
Operating lease right-of-use assets	18,505	27,771
Other assets	152,970	156,670
Goodwill	935,675	892,341
Intangible assets, net of accumulated amortization of $339,092 and $278,249 at September 30, 2022 and December 31, 2021, respectively	499,067	514,460
Total assets	3,018,261	3,131,906
Current liabilities:
Accounts payable and accrued expenses	459,237	425,257
Accrued compensation and benefits	338,833	354,381
Current portion of operating lease liabilities	8,226	11,383
Deferred revenue	15,060	15,950
Other current liabilities	69,890	162,419
Total current liabilities	891,246	969,390
Notes payable, net of unamortized fees and premium	843,210	842,322
Deferred income taxes, net	42,159	47,814
Operating lease liabilities	10,785	13,364
Other long-term liabilities	98,228	96,989
Total liabilities	1,885,628	1,969,879
Commitments and contingencies
Stockholders’ equity:
Preferred stock, $0.01 par value; 10,000 shares authorized; none issued and outstanding at September 30, 2022 and December 31, 2021	0	0
Common stock, $0.01 par value; 200,000 shares authorized; 50,087 issued and 43,327 outstanding at September 30, 2022 and 49,849 issued and 47,263 outstanding at December 31, 2021	501	498
Additional paid-in capital	497,744	486,709
Treasury stock, at cost; 6,760 and 2,586 shares at September 30, 2022 and December 31, 2021, respectively	(523,722)	(121,831)
Retained earnings	1,159,199	796,946
Accumulated other comprehensive loss	(1,089)	(295)
Total stockholders’ equity	1,132,633	1,162,027
Total liabilities and stockholders’ equity	$ 3,018,261	$ 3,131,906

Income Taxes	9 Months Ended
Income Taxes	Sep. 30, 2022
Income Tax Disclosure [Abstract]
Income Taxes	INCOME TAXES The Company is subject to taxation in the U.S. and various states and foreign jurisdictions. With few exceptions, as of September 30, 2022, 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. The Company believes its liability 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 2021 and the other half is to be paid by the end of 2022, which is included in accrued compensation and benefits in the consolidated balance sheets as of both September 30, 2022 and December 31, 2021. The Company claimed an employee retention 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

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 740
-SubTopic 10
-Section 50
-Paragraph 21
-URI https://asc.fasb.org/extlink&oid=121826272&loc=d3e32857-109319

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
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Reference 7: http://www.xbrl.org/2003/role/disclosureRef
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Reference 8: http://www.xbrl.org/2003/role/disclosureRef
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
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-Subparagraph (SX 210.4-08(h)(2))
-URI https://asc.fasb.org/extlink&oid=120395691&loc=d3e23780-122690

+ Details

Fair Value Measurement (Tables)

9 Months Ended

Sep. 30, 2022

Fair Value Disclosures [Abstract]

Schedule of Financial Assets and Liabilities Measured at Fair Value on Recurring Basis

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


	Fair Value Measurements as of September 30, 2022								Fair Value Measurements as of December 31, 2021
Assets (Liabilities)	Level 1		Level 2		Level 3		Total		Level 1		Level 2		Level 3		Total
Money market funds	$	125,859	$	—	$	—	$	125,859	$	91,454	$	—	$	—	$	91,454
Deferred compensation	(116,922)		—		—		(116,922)		(119,617)		—		—		(119,617)
Corporate bonds	—		26,841		—		26,841		—		29,159		—		29,159
Commercial paper	—		29,296		—		29,296		—		80,596		—		80,596
Acquisition contingent consideration liabilities	—		—		(6,810)		(6,810)		—		—		—		—

Reconciliations of Changes in the Fair Value of Contingent Consideration Liabilities

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


	Three Months Ended September 30,				Nine Months Ended September 30,
	2022		2021		2022		2021
Beginning balance	$	(8,580)	$	—	$	—	$	(8,000)
Settlement of b4health contingent consideration liability for year ended December 31, 2020	—		—		—		8,000
Contingent consideration liability from Connetics acquisition on May 13, 2022	—		—		(8,000)		—
Change in fair value of contingent consideration liability from Connetics acquisition	1,770		—		1,190		—
Ending balance	$	(6,810)	$	—	$	(6,810)	$	—

Schedule of Fair Value of Financial Instruments

See additional information regarding the 2027 Notes and the 2029 Notes in Part II, Item 8, “Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note (8), Notes Payable and Credit Agreement” of the 2021 Annual Report.


	As of September 30, 2022				As of December 31, 2021
	Carrying Amount		Estimated Fair Value		Carrying Amount		Estimated Fair Value
2027 Notes	$	500,000	$	447,500	$	500,000	$	517,500
2029 Notes	350,000		294,000		350,000		353,500

Acquisitions - Synzi and SnapMD Acquisition (Details) - USD ($)			3 Months Ended
	May 13, 2022	Apr. 07, 2021	Jun. 30, 2022	Jun. 30, 2021	Sep. 30, 2022	Dec. 31, 2021	Feb. 09, 2018
Business Acquisition [Line Items]
Goodwill					$ 935,675,000	$ 892,341,000
Synzi
Business Acquisition [Line Items]
Cash consideration		$ 42,240,000
Cash returned to the Company for final working capital settlement				$ 92,000
Purchase price, net of working capital adjustment			$ 42,148,000
Fair value of tangible assets acquired			2,757,000
Cash received			884,000
Liabilities assumed			275,000
Identifiable intangible assets			12,440,000
Goodwill			27,226,000
Goodwill expected to be deductible for tax purposes			$ 6,044,000
Intangible assets acquired, weighted average useful life			7 years
Synzi \| Developed Technology Rights
Business Acquisition [Line Items]
Identifiable intangible assets			$ 10,890,000
Synzi \| Trademarks
Business Acquisition [Line Items]
Identifiable intangible assets			$ 1,220,000
Connetics Communications, LLC
Business Acquisition [Line Items]
Cash consideration	$ 70,764,000
Cash received	963,000
Liabilities assumed	8,431,000
Identifiable intangible assets	40,200,000
Goodwill	43,301,000
Goodwill expected to be deductible for tax purposes	$ 35,317,000
Intangible assets acquired, weighted average useful life	13 years
Revolving Credit Facility \| Line of Credit
Business Acquisition [Line Items]
Maximum borrowing capacity							$ 400,000,000

Fair Value Measurement - Fair Value of Financial Instruments (Details) - Senior Notes - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
2027 Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Carrying Amount	$ 500,000	$ 500,000
Estimated Fair Value	447,500	517,500
2029 Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Carrying Amount	350,000	350,000
Estimated Fair Value	$ 294,000	$ 353,500

Cover Page - shares	9 Months Ended
Cover Page - shares	Sep. 30, 2022	Nov. 02, 2022
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2022
Document Transition Report	false
Entity File Number	001-16753
Entity Registrant Name	AMN HEALTHCARE SERVICES, INC.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	06-1500476
Entity Address, Address Line One	8840 Cypress Waters Boulevard
Entity Address, Address Line Two	Suite 300
Entity Address, City or Town	Dallas
Entity Address, State or Province	TX
Entity Address, Postal Zip Code	75019
City Area Code	866
Local Phone Number	871-8519
Title of 12(b) Security	Common Stock, $0.01 par value
Trading Symbol	AMN
Security Exchange Name	NYSE
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding (excluding treasury shares)		43,335,911
Entity Central Index Key	0001142750
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2022
Document Fiscal Period Focus	Q3
Amendment Flag	false

Condensed Consolidated Statements of Comprehensive Income - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Statement of Comprehensive Income [Abstract]
Revenue	$ 1,138,586	$ 877,800	$ 4,117,731	$ 2,621,190
Cost of revenue	753,560	571,935	2,776,300	1,745,914
Gross profit	385,026	305,865	1,341,431	875,276
Operating expenses:
Selling, general and administrative	215,419	173,932	717,428	491,773
Depreciation and amortization (exclusive of depreciation included in cost of revenue)	33,239	26,104	96,169	74,098
Total operating expenses	248,658	200,036	813,597	565,871
Income from operations	136,368	105,829	527,834	309,405
Interest expense, net, and other	8,961	5,223	28,630	24,278
Income before income taxes	127,407	100,606	499,204	285,127
Income tax expense	34,962	26,583	136,951	73,956
Net income	92,445	74,023	362,253	211,171
Other comprehensive income (loss):
Unrealized gains (losses) on available-for-sale securities, net, and other	(219)	11	(794)	(10)
Other comprehensive income (loss)	(219)	11	(794)	(10)
Comprehensive income	$ 92,226	$ 74,034	$ 361,459	$ 211,161
Net income per common share:
Basic (in dollars per share)	$ 2.11	$ 1.55	$ 8.04	$ 4.43
Diluted (in dollars per share)	$ 2.10	$ 1.54	$ 7.99	$ 4.40
Weighted average common shares outstanding:
Basic (in shares)	43,785	47,737	45,056	47,666
Diluted (in shares)	44,039	48,080	45,332	48,022

Income Taxes (Details) $ in Thousands	Sep. 30, 2022 USD ($)
Income Tax Disclosure [Abstract]
Deferred payroll taxes, CARES Act	$ 48,452
Employee retention tax credit, CARES Act	$ 1,756

Revenue Recognition	9 Months Ended
Revenue Recognition	Sep. 30, 2022
Revenue from Contract with Customer [Abstract]
Revenue Recognition	REVENUE RECOGNITION Revenue primarily consists of fees earned from the temporary staffing and permanent placement of healthcare professionals, executives, and leaders (clinical and operational). The Company also generates revenue from 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. 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. 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. See Note (5), “Segment Information,” for additional information regarding the Company’s revenue disaggregated by service type.

- Definition

The entire disclosure of revenue from contract with customer to transfer good or service and to transfer nonfinancial asset. Includes, but is not limited to, disaggregation of revenue, credit loss recognized from contract with customer, judgment and change in judgment related to contract with customer, and asset recognized from cost incurred to obtain or fulfill contract with customer. Excludes insurance and lease contracts.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-URI https://asc.fasb.org/topic&trid=49130388

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 10
-URI https://asc.fasb.org/extlink&oid=126920106&loc=SL49130551-203045

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 13
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-URI https://asc.fasb.org/extlink&oid=126920106&loc=SL49130556-203045

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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Reference 6: http://www.xbrl.org/2003/role/disclosureRef
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-URI https://asc.fasb.org/extlink&oid=126920106&loc=SL49130554-203045

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-Publisher FASB
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-Topic 606
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-Subparagraph (a)
-URI https://asc.fasb.org/extlink&oid=126920106&loc=SL49130554-203045

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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-URI https://asc.fasb.org/extlink&oid=126920106&loc=SL49130554-203045

+ Details

Acquisitions

9 Months Ended

Sep. 30, 2022

Business Combination and Asset Acquisition [Abstract]

Acquisitions

ACQUISITIONS

As set forth below, the Company completed two acquisitions during the period of January 1, 2021 through September 30, 2022, which were accounted for using the acquisition method of accounting. Accordingly, the Company recorded the tangible and intangible assets acquired and liabilities assumed at their estimated fair values as of the 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 September 30, 2022. The allocations will continue to be updated through the measurement period, if necessary. The goodwill recognized for these acquisitions is attributable to expected growth as the Company leverages its brand and diversifies its services offered to clients, including potential revenue growth and margin expansion. For each acquisition, the Company did not incur any material acquisition-related costs.

Connetics Acquisition

On May 13, 2022, the Company completed its acquisition of Connetics Communications, LLC (“Connetics”), which specializes in the direct hire recruitment and permanent placement of international nurse and allied health professionals with healthcare facilities in the United States. The initial purchase price of $78,764 included (1) $70,764 cash consideration paid upon acquisition, funded through cash on hand, and (2) contingent consideration (earn-out payment) of up to $12,500 with an estimated fair value of $8,000 as of the acquisition date. The contingent earn-out payment is based on the operating results of Connetics for the twelve months ending May 31, 2023. The results of Connetics have been included in the Company’s nurse and allied solutions segment since the date of acquisition.

The preliminary allocation of the $78,764 consisted of (1) $3,694 of fair value of tangible assets acquired, which included $963 cash received, (2) $8,431 of liabilities assumed, (3) $40,200 of identified intangible assets, and (4) $43,301 of goodwill, of which $35,317 is deductible for tax purposes. The intangible assets acquired have a weighted average useful life of approximately thirteen 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	$	32,800	15
	Staffing database	4,200		5
	Tradenames and trademarks	3,200		5
		$	40,200

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 Company’s $400,000 senior secured revolving credit facility (the “Senior Credit Facility”). See additional information regarding the Senior Credit Facility in Part II, Item 8, “Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note (8), Notes Payable and Credit Agreement” of the 2021 Annual Report. 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 allocation of the $42,148 purchase price, which was reduced by the final working capital settlement and was finalized during the second quarter of 2022, consisted of (1) $2,757 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) $27,226 of goodwill, of which $6,044 is deductible for tax purposes. 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.

Basis of Presentation (Tables)

9 Months Ended

Sep. 30, 2022

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Reconciliation of Cash, Cash Equivalents and Restricted Cash

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


	September 30, 2022		December 31, 2021
Cash and cash equivalents	$	155,723	$	180,928
Restricted cash and cash equivalents (included in other current assets)	27,764		29,262
Restricted cash, cash equivalents and investments	64,883		64,482
Total cash, cash equivalents and restricted cash and investments	248,370		274,672
Less restricted investments	(26,841)		(27,958)
Total cash, cash equivalents and restricted cash	$	221,529	$	246,714

Reconciliation of Activity in Allowance for Credit Losses for Accounts Receivable

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


	2022		2021
Balance as of January 1,	$	6,838	$	7,043

Provision for expected credit losses	10,129		325
Amounts written off charged against the allowance	(1,773)		(1,220)

Balance as of September 30,	$	15,194	$	6,148

Balance Sheet Details (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Other current assets:
Restricted cash and cash equivalents	$ 27,764	$ 29,262
Income taxes receivable	1,426	0
Other	25,314	37,568
Other current assets	54,504	66,830
Prepaid expenses:
Prepaid payroll deposits	0	60,014
Other	17,019	12,446
Prepaid expenses	17,019	72,460
Fixed assets:
Furniture and equipment	47,618	43,134
Software	303,197	265,137
Leasehold improvements	2,882	8,797
Fixed assets, gross	353,697	317,068
Accumulated depreciation	(212,702)	(189,954)
Fixed assets, net	140,995	127,114
Other assets:
Life insurance cash surrender value	110,279	115,095
Other	42,691	41,575
Other assets	152,970	156,670
Accounts payable and accrued expenses:
Trade accounts payable	84,334	77,325
Subcontractor payable	254,697	261,689
Accrued expenses	89,196	61,220
Loss contingencies	14,933	10,400
Professional liability reserve	7,712	7,127
Other	8,365	7,496
Accounts payable and accrued expenses	459,237	425,257
Accrued compensation and benefits:
Accrued payroll	93,495	98,817
Accrued bonuses and commissions	90,640	105,155
Accrued travel expense	2,312	3,058
Health insurance reserve	7,685	6,041
Workers compensation reserve	11,500	12,384
Deferred compensation	116,922	119,617
Other	16,279	9,309
Accrued compensation and benefits	338,833	354,381
Other current liabilities:
Acquisition related liabilities	6,810	0
Income taxes payable	0	21,162
Client deposits	61,319	141,102
Other	1,761	155
Other current liabilities	69,890	162,419
Other long-term liabilities:
Workers compensation reserve	22,633	24,130
Professional liability reserve	38,163	34,544
Unrecognized tax benefits	4,785	4,633
Other	32,647	33,682
Other long-term liabilities	$ 98,228	$ 96,989

Fair Value Measurement

9 Months Ended

Sep. 30, 2022

Fair Value Disclosures [Abstract]

Fair Value Measurement

FAIR VALUE MEASUREMENT

The Company’s valuation techniques and inputs used to measure fair value and the definition of the three levels (Level 1, Level 2, and Level 3) of the fair value hierarchy are disclosed in Part II, Item 8, “Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note (3), Fair Value Measurement” of the 2021 Annual Report. The Company has not changed the valuation techniques or inputs it uses for its fair value measurement during the nine months ended September 30, 2022.

Assets and Liabilities Measured on a Recurring Basis

The Company invests a portion of its cash and cash equivalents in non-federally insured money market funds that are measured at fair value based on quoted prices, which are Level 1 inputs.

The Company has a deferred compensation plan for certain executives and employees, which is composed of deferred compensation and all related income and losses attributable thereto. The Company’s obligation under its deferred compensation plan is measured at fair value based on quoted market prices of the participants’ elected investments, which are Level 1 inputs.

The Company’s restricted cash equivalents and investments that serve as collateral for the Company’s captive insurance company 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 $29,296 commercial paper issued and outstanding as of September 30, 2022, none had original maturities greater than three months and were considered available-for-sale securities. As of December 31, 2021, the Company had $80,596 commercial paper issued and outstanding, of which none 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. As of September 30, 2022, the Company had $26,841 corporate bonds issued and outstanding, all of which had original maturities greater than three months and were considered available-for-sale securities. As of December 31, 2021, the Company had $29,159 corporate bonds issued and outstanding, of which $27,958 had original maturities greater than three months and were considered available-for-sale securities.

The Company’s contingent consideration liabilities associated with acquisitions are measured at fair value using a probability-weighted discounted cash flow analysis or a simulation-based methodology for the acquired companies, which are Level 3 inputs. The Company recognizes changes to the fair value of its contingent consideration liabilities in selling, general and administrative expenses in the condensed consolidated statements of comprehensive income.

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


	Fair Value Measurements as of September 30, 2022								Fair Value Measurements as of December 31, 2021
Assets (Liabilities)	Level 1		Level 2		Level 3		Total		Level 1		Level 2		Level 3		Total
Money market funds	$	125,859	$	—	$	—	$	125,859	$	91,454	$	—	$	—	$	91,454
Deferred compensation	(116,922)		—		—		(116,922)		(119,617)		—		—		(119,617)
Corporate bonds	—		26,841		—		26,841		—		29,159		—		29,159
Commercial paper	—		29,296		—		29,296		—		80,596		—		80,596
Acquisition contingent consideration liabilities	—		—		(6,810)		(6,810)		—		—		—		—

Level 3 Information

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


	Three Months Ended September 30,				Nine Months Ended September 30,
	2022		2021		2022		2021
Beginning balance	$	(8,580)	$	—	$	—	$	(8,000)
Settlement of b4health contingent consideration liability for year ended December 31, 2020	—		—		—		8,000
Contingent consideration liability from Connetics acquisition on May 13, 2022	—		—		(8,000)		—
Change in fair value of contingent consideration liability from Connetics acquisition	1,770		—		1,190		—
Ending balance	$	(6,810)	$	—	$	(6,810)	$	—

Assets Measured on a Non-Recurring Basis

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

The Company evaluates goodwill and indefinite-lived intangible assets annually for impairment and whenever events or changes in circumstances indicate that it is more likely than not that an impairment exists. The Company determines the fair value of its reporting units based on a combination of inputs, including the market capitalization of the Company, as well as Level 3 inputs such as discounted cash flows, which are not observable from the market, directly or indirectly. The Company determines the fair value of its indefinite-lived intangible assets using the income approach (relief-from-royalty method) based on Level 3 inputs.

The Company’s equity investment represents an investment in a non-controlled corporation without a readily determinable market value. The Company has elected to measure the investment at cost minus impairment, if any, plus or minus changes resulting from observable price changes. The fair value is determined by using quoted prices for identical or similar investments of the same issuer, which are Level 2 inputs, 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 condensed consolidated statements of comprehensive income. The balance of the equity investment was $22,633 as of both September 30, 2022 and December 31, 2021.

There were no triggering events identified, no indication of impairment of the Company’s goodwill, indefinite-lived intangible assets, long-lived assets, or equity investments, and no impairment charges recorded during the nine months ended September 30, 2022 and 2021.

Fair Value of Financial Instruments

The Company is required to disclose the fair value of financial instruments for which it is practicable to estimate the value, even though these instruments are not recognized at fair value in the consolidated balance sheets. The fair value of the Company’s 4.625% senior notes due 2027 (the “2027 Notes”) and 4.000% senior notes due 2029 (the “2029 Notes”) was estimated using quoted market prices in active markets for identical liabilities, which are Level 1 inputs. The carrying amounts and estimated fair value of the 2027 Notes and the 2029 Notes are presented in the following table. See additional information regarding the 2027 Notes and the 2029 Notes in Part II, Item 8, “Financial Statements and Supplementary Data—Notes to Consolidated Financial Statements—Note (8), Notes Payable and Credit Agreement” of the 2021 Annual Report.


	As of September 30, 2022				As of December 31, 2021
	Carrying Amount		Estimated Fair Value		Carrying Amount		Estimated Fair Value
2027 Notes	$	500,000	$	447,500	$	500,000	$	517,500
2029 Notes	350,000		294,000		350,000		353,500

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

Basis of Presentation

9 Months Ended

Sep. 30, 2022

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Basis of Presentation

BASIS OF PRESENTATION

The condensed consolidated balance sheets and related condensed consolidated statements of comprehensive income and cash flows contained in this Quarterly Report on Form 10-Q (this “Quarterly Report”), which are unaudited, include the accounts of AMN Healthcare Services, Inc. and its wholly-owned subsidiaries (collectively, the “Company”). All significant intercompany balances and transactions have been eliminated in consolidation. In the opinion of management, all entries necessary for a fair presentation of such unaudited condensed consolidated financial statements have been included. These entries consisted of all normal recurring items. The results of operations for the interim period are not necessarily indicative of the results to be expected for any other interim period or for the entire fiscal year or for any future period.

The unaudited condensed consolidated financial statements do not include all information and notes necessary for a complete presentation of financial position, results of operations and cash flows in conformity with accounting principles generally accepted in the United States (“U.S. GAAP”). Please refer to the Company’s audited consolidated financial statements and the related notes for the fiscal year ended December 31, 2021, contained in the Company’s Annual Report on Form 10-K for the fiscal year ended December 31, 2021, filed with the Securities and Exchange Commission on February 24, 2022 (the “2021 Annual Report”).

The preparation of financial statements in conformity with U.S. GAAP requires management to make a number of estimates and assumptions relating to the reporting of assets and liabilities and the disclosure of contingent assets and liabilities at the dates of the financial statements and the reported amounts of revenue and expenses during the reporting periods. On an ongoing basis, the Company evaluates its estimates, including those related to intangible assets purchased in a business combination, asset impairments, accruals for self-insurance, compensation and related benefits, accounts receivable, contingencies and litigation, contingent consideration liabilities associated with acquisitions, and income taxes. Actual results could differ from those estimates under different assumptions or conditions.

Cash, Cash Equivalents and Restricted Cash

The Company considers all highly liquid investments with an original maturity of three months or less to be cash equivalents. Cash and cash equivalents include currency on hand, deposits with financial institutions, money market funds, commercial paper and other highly liquid 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 (6), “Fair Value Measurement” for additional information.


	September 30, 2022		December 31, 2021
Cash and cash equivalents	$	155,723	$	180,928
Restricted cash and cash equivalents (included in other current assets)	27,764		29,262
Restricted cash, cash equivalents and investments	64,883		64,482
Total cash, cash equivalents and restricted cash and investments	248,370		274,672
Less restricted investments	(26,841)		(27,958)
Total cash, cash equivalents and restricted cash	$	221,529	$	246,714

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:


	2022		2021
Balance as of January 1,	$	6,838	$	7,043

Provision for expected credit losses	10,129		325
Amounts written off charged against the allowance	(1,773)		(1,220)

Balance as of September 30,	$	15,194	$	6,148

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021
Cash flows from operating activities:
Net income	$ 362,253	$ 211,171
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization (inclusive of depreciation included in cost of revenue)	99,087	75,871
Non-cash interest expense and other	1,427	(4,541)
Write-off of fees on credit facilities and senior notes	0	158
Change in fair value of contingent consideration	(1,190)	0
Increase in allowance for credit losses and sales credits	22,199	2,103
Provision for deferred income taxes	(5,364)	(4,328)
Share-based compensation	24,670	17,895
Loss on disposal or sale of fixed assets	571	386
Net loss (gain) on investments in available-for-sale securities	652	(41)
Net loss (gain) on deferred compensation balances	(1,324)	96
Non-cash lease expense	4,818	(257)
Changes in assets and liabilities, net of effects from acquisitions:
Accounts receivable	44,532	(196,342)
Accounts receivable, subcontractor	(14,235)	(67,641)
Income taxes receivable	(1,426)	5,472
Prepaid expenses	55,495	(5,695)
Other current assets	12,399	3,411
Other assets	(608)	780
Accounts payable and accrued expenses	31,855	112,183
Accrued compensation and benefits	2,937	96,666
Other liabilities	(99,534)	(26,268)
Deferred revenue	(809)	6,276
Restricted investments balance	0	16
Net cash provided by operating activities	538,405	227,371
Cash flows from investing activities:
Purchase and development of fixed assets	(51,229)	(38,710)
Purchase of investments	(13,152)	(32,437)
Proceeds from sale and maturity of investments	12,549	40,000
Purchase of equity investment	0	(500)
Proceeds from sale of equity investment	68	78
Payments to fund deferred compensation plan	(21,411)	(6,094)
Cash paid for acquisitions, net of cash and restricted cash received	(69,801)	(41,264)
Cash paid for other intangibles	(5,091)	(90)
Net cash used in investing activities	(148,067)	(79,017)
Cash flows from financing activities:
Payments on term loans	0	(21,875)
Payments on revolving credit facility	0	(70,000)
Proceeds from revolving credit facility	0	70,000
Repurchase of common stock	(401,891)	0
Earn-out payments to settle contingent consideration liabilities for prior acquisitions	0	(3,100)
Cash paid for shares withheld for taxes	(13,632)	(6,255)
Net cash used in financing activities	(415,523)	(31,230)
Effect of exchange rate changes on cash	0	(10)
Net increase (decrease) in cash, cash equivalents and restricted cash	(25,185)	117,114
Cash, cash equivalents and restricted cash at beginning of period	246,714	83,990
Cash, cash equivalents and restricted cash at end of period	221,529	201,104
Supplemental disclosures of cash flow information:
Cash paid for amounts included in the measurement of operating lease liabilities	10,700	35,066
Cash paid for interest (net of $452 and $248 capitalized for the nine months ended September 30, 2022 and 2021, respectively)	18,950	19,301
Cash paid for income taxes	164,757	72,863
Acquisitions:
Fair value of tangible assets acquired in acquisitions, net of cash and restricted cash received	2,731	1,906
Goodwill	43,301	28,135
Intangible assets	40,200	12,440
Liabilities assumed	(8,431)	(1,217)
Contingent consideration liabilities	(8,000)	0
Supplemental disclosures of non-cash investing and financing activities:
Purchase of fixed assets recorded in accounts payable and accrued expenses	$ 5,187	$ 5,080

Net Income Per Common Share

9 Months Ended

Sep. 30, 2022

Earnings Per Share [Abstract]

Net Income Per Common Share

NET INCOME PER COMMON SHARE

Basic net income per common share is calculated by dividing net income by the weighted average number of common shares outstanding during the reporting period. The following table sets forth the computation of basic and diluted net income per common share:


	Three Months Ended September 30,				Nine Months Ended September 30,
	2022		2021		2022		2021
Net income	$	92,445	$	74,023	$	362,253	$	211,171

Net income per common share - basic	$	2.11	$	1.55	$	8.04	$	4.43
Net income per common share - diluted	$	2.10	$	1.54	$	7.99	$	4.40

Weighted average common shares outstanding - basic	43,785		47,737		45,056		47,666
Plus dilutive effect of potential common shares	254		343		276		356
Weighted average common shares outstanding - diluted	44,039		48,080		45,332		48,022

Share-based awards to purchase 14 and 15 shares of common stock were not included in the above calculation of diluted net income per common share for the three and nine months ended September 30, 2022, respectively, because the effect of these instruments was anti-dilutive. Share-based awards to purchase 21 and 26 shares of common stock were not included in the above calculation of diluted net income per common share for the three and nine months ended September 30, 2021, respectively, because the effect of these instruments was anti-dilutive.

Basis of Presentation (Policies)

9 Months Ended

Sep. 30, 2022

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Use of Estimates

Cash, Cash Equivalents and Restricted Cash

Accounts Receivable

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.

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.

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.

Net Income per Common Share

Basic net income per common share is calculated by dividing net income by the weighted average number of common shares outstanding during the reporting period.

Segment Information

Fair Value of Assets and Liabilities

Assets and Liabilities Measured on a Recurring Basis

The Company invests a portion of its cash and cash equivalents in non-federally insured money market funds that are measured at fair value based on quoted prices, which are Level 1 inputs.

Assets Measured on a Non-Recurring Basis

Fair Value of Financial Instruments


	As of September 30, 2022				As of December 31, 2021
	Carrying Amount		Estimated Fair Value		Carrying Amount		Estimated Fair Value
2027 Notes	$	500,000	$	447,500	$	500,000	$	517,500
2029 Notes	350,000		294,000		350,000		353,500

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

Disclosure of accounting policy for revenue from contract with customer.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 17
-URI https://asc.fasb.org/extlink&oid=126920106&loc=SL49130561-203045

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 20
-Subparagraph (d)
-URI https://asc.fasb.org/extlink&oid=126920106&loc=SL49130566-203045

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 18
-Subparagraph (b)
-URI https://asc.fasb.org/extlink&oid=126920106&loc=SL49130563-203045

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-URI https://asc.fasb.org/topic&trid=49130388

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 20
-Subparagraph (c)
-URI https://asc.fasb.org/extlink&oid=126920106&loc=SL49130566-203045

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 18
-Subparagraph (a)
-URI https://asc.fasb.org/extlink&oid=126920106&loc=SL49130563-203045

Reference 7: http://www.xbrl.org/2003/role/exampleRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 235
-SubTopic 10
-Section 50
-Paragraph 4
-Subparagraph (e)
-URI https://asc.fasb.org/extlink&oid=126899994&loc=d3e18823-107790

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 20
-Subparagraph (b)
-URI https://asc.fasb.org/extlink&oid=126920106&loc=SL49130566-203045

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 19
-URI https://asc.fasb.org/extlink&oid=126920106&loc=SL49130564-203045

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 20
-Subparagraph (a)
-URI https://asc.fasb.org/extlink&oid=126920106&loc=SL49130566-203045

+ Details

Segment Information - Disaggregation of Revenue (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Segment Reporting Information [Line Items]
Revenue	$ 1,138,586	$ 877,800	$ 4,117,731	$ 2,621,190
Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	828,317	627,049	3,157,834	1,908,195
Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	175,152	150,663	530,355	430,523
Technology and Workforce Solutions
Segment Reporting Information [Line Items]
Revenue	135,117	100,088	429,542	282,472
Travel nurse staffing
Segment Reporting Information [Line Items]
Revenue	583,463	444,803	2,329,240	1,400,629
Travel nurse staffing \| Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	583,463	444,803	2,329,240	1,400,629
Travel nurse staffing \| Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Travel nurse staffing \| Technology and Workforce Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Labor disruption services
Segment Reporting Information [Line Items]
Revenue	19,479	22,573	102,549	25,126
Labor disruption services \| Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	19,479	22,573	102,549	25,126
Labor disruption services \| Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Labor disruption services \| Technology and Workforce Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Local staffing
Segment Reporting Information [Line Items]
Revenue	31,814	23,272	109,265	80,932
Local staffing \| Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	31,814	23,272	109,265	80,932
Local staffing \| Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Local staffing \| Technology and Workforce Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Allied staffing
Segment Reporting Information [Line Items]
Revenue	190,044	136,401	611,226	401,508
Allied staffing \| Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	190,044	136,401	611,226	401,508
Allied staffing \| Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Allied staffing \| Technology and Workforce Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Locum tenens staffing
Segment Reporting Information [Line Items]
Revenue	106,055	88,994	324,663	253,190
Locum tenens staffing \| Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Locum tenens staffing \| Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	106,055	88,994	324,663	253,190
Locum tenens staffing \| Technology and Workforce Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Interim leadership staffing
Segment Reporting Information [Line Items]
Revenue	47,559	43,814	139,519	126,584
Interim leadership staffing \| Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Interim leadership staffing \| Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	47,559	43,814	139,519	126,584
Interim leadership staffing \| Technology and Workforce Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Temporary staffing
Segment Reporting Information [Line Items]
Revenue	978,414	759,857	3,616,462	2,287,969
Temporary staffing \| Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	824,800	627,049	3,152,280	1,908,195
Temporary staffing \| Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	153,614	132,808	464,182	379,774
Temporary staffing \| Technology and Workforce Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Permanent placement
Segment Reporting Information [Line Items]
Revenue	25,055	17,855	71,727	50,749
Permanent placement \| Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	3,517	0	5,554	0
Permanent placement \| Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	21,538	17,855	66,173	50,749
Permanent placement \| Technology and Workforce Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Language services
Segment Reporting Information [Line Items]
Revenue	55,502	47,135	158,031	133,706
Language services \| Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Language services \| Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Language services \| Technology and Workforce Solutions
Segment Reporting Information [Line Items]
Revenue	55,502	47,135	158,031	133,706
Vendor management systems
Segment Reporting Information [Line Items]
Revenue	60,304	33,467	210,470	96,086
Vendor management systems \| Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Vendor management systems \| Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Vendor management systems \| Technology and Workforce Solutions
Segment Reporting Information [Line Items]
Revenue	60,304	33,467	210,470	96,086
Other technologies
Segment Reporting Information [Line Items]
Revenue	7,290	7,819	21,787	21,791
Other technologies \| Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Other technologies \| Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Other technologies \| Technology and Workforce Solutions
Segment Reporting Information [Line Items]
Revenue	7,290	7,819	21,787	21,791
Technology-enabled services
Segment Reporting Information [Line Items]
Revenue	123,096	88,421	390,288	251,583
Technology-enabled services \| Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Technology-enabled services \| Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Technology-enabled services \| Technology and Workforce Solutions
Segment Reporting Information [Line Items]
Revenue	123,096	88,421	390,288	251,583
Talent planning and acquisition
Segment Reporting Information [Line Items]
Revenue	12,021	11,667	39,254	30,889
Talent planning and acquisition \| Nurse and Allied Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Talent planning and acquisition \| Physician and Leadership Solutions
Segment Reporting Information [Line Items]
Revenue	0	0	0	0
Talent planning and acquisition \| Technology and Workforce Solutions
Segment Reporting Information [Line Items]
Revenue	$ 12,021	$ 11,667	$ 39,254	$ 30,889

Condensed Consolidated Statements of Stockholders' Equity - USD ($) shares in Thousands, $ in Thousands	Total	Common Stock	Additional Paid-in Capital	Treasury Stock	Retained Earnings	Accumulated Other Comprehensive Income
Beginning balance (in shares) at Dec. 31, 2020		49,614
Beginning balance at Dec. 31, 2020	$ 819,677	$ 496	$ 468,726	$ (119,143)	$ 469,558	$ 40
Beginning balance (in shares) at Dec. 31, 2020				(2,561)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Equity awards vested, net of shares withheld for taxes (in shares)		132
Equity awards vested, net of shares withheld for taxes	(5,258)	$ 1	(5,259)
Share-based compensation	9,287		9,287
Comprehensive income (loss)	70,354				70,378	(24)
Ending balance (in shares) at Mar. 31, 2021		49,746
Ending balance at Mar. 31, 2021	894,060	$ 497	472,754	$ (119,143)	539,936	16
Ending balance (in shares) at Mar. 31, 2021				(2,561)
Beginning balance (in shares) at Dec. 31, 2020		49,614
Beginning balance at Dec. 31, 2020	819,677	$ 496	468,726	$ (119,143)	469,558	40
Beginning balance (in shares) at Dec. 31, 2020				(2,561)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Comprehensive income (loss)	211,161
Ending balance (in shares) at Sep. 30, 2021		49,836
Ending balance at Sep. 30, 2021	1,042,478	$ 498	480,364	$ (119,143)	680,729	30
Ending balance (in shares) at Sep. 30, 2021				(2,561)
Beginning balance (in shares) at Mar. 31, 2021		49,746
Beginning balance at Mar. 31, 2021	894,060	$ 497	472,754	$ (119,143)	539,936	16
Beginning balance (in shares) at Mar. 31, 2021				(2,561)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Equity awards vested, net of shares withheld for taxes (in shares)		78
Equity awards vested, net of shares withheld for taxes	(470)	$ 1	(471)
Share-based compensation	6,019		6,019
Comprehensive income (loss)	66,773				66,770	3
Ending balance (in shares) at Jun. 30, 2021		49,824
Ending balance at Jun. 30, 2021	966,382	$ 498	478,302	$ (119,143)	606,706	19
Ending balance (in shares) at Jun. 30, 2021				(2,561)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Equity awards vested, net of shares withheld for taxes (in shares)		12
Equity awards vested, net of shares withheld for taxes	(527)		(527)
Share-based compensation	2,589		2,589
Comprehensive income (loss)	74,034				74,023	11
Ending balance (in shares) at Sep. 30, 2021		49,836
Ending balance at Sep. 30, 2021	$ 1,042,478	$ 498	480,364	$ (119,143)	680,729	30
Ending balance (in shares) at Sep. 30, 2021				(2,561)
Beginning balance (in shares) at Dec. 31, 2021	47,263	49,849
Beginning balance at Dec. 31, 2021	$ 1,162,027	$ 498	486,709	$ (121,831)	796,946	(295)
Beginning balance (in shares) at Dec. 31, 2021	(2,586)			(2,586)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Repurchase of common stock into treasury (in shares)				(2,298)
Repurchase of common stock into treasury	$ (228,024)			$ (228,024)
Equity awards vested, net of shares withheld for taxes (in shares)		164
Equity awards vested, net of shares withheld for taxes	(9,431)	$ 2	(9,433)
Share-based compensation	11,259		11,259
Comprehensive income (loss)	145,101				146,008	(907)
Ending balance (in shares) at Mar. 31, 2022		50,013
Ending balance at Mar. 31, 2022	$ 1,080,932	$ 500	488,535	$ (349,855)	942,954	(1,202)
Ending balance (in shares) at Mar. 31, 2022				(4,884)
Beginning balance (in shares) at Dec. 31, 2021	47,263	49,849
Beginning balance at Dec. 31, 2021	$ 1,162,027	$ 498	486,709	$ (121,831)	796,946	(295)
Beginning balance (in shares) at Dec. 31, 2021	(2,586)			(2,586)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Comprehensive income (loss)	$ 361,459
Ending balance (in shares) at Sep. 30, 2022	43,327	50,087
Ending balance at Sep. 30, 2022	$ 1,132,633	$ 501	497,744	$ (523,722)	1,159,199	(1,089)
Ending balance (in shares) at Sep. 30, 2022	(6,760)			(6,760)
Beginning balance (in shares) at Mar. 31, 2022		50,013
Beginning balance at Mar. 31, 2022	$ 1,080,932	$ 500	488,535	$ (349,855)	942,954	(1,202)
Beginning balance (in shares) at Mar. 31, 2022				(4,884)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Repurchase of common stock into treasury (in shares)				(1,876)
Repurchase of common stock into treasury	(173,867)			$ (173,867)
Equity awards vested, net of shares withheld for taxes (in shares)		19
Equity awards vested, net of shares withheld for taxes	(366)		(366)
Share-based compensation	8,513		8,513
Comprehensive income (loss)	124,132				123,800	332
Ending balance (in shares) at Jun. 30, 2022		50,032
Ending balance at Jun. 30, 2022	1,039,344	$ 500	496,682	$ (523,722)	1,066,754	(870)
Ending balance (in shares) at Jun. 30, 2022				(6,760)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Equity awards vested, net of shares withheld for taxes (in shares)		55
Equity awards vested, net of shares withheld for taxes	(3,835)	$ 1	(3,836)
Share-based compensation	4,898		4,898
Comprehensive income (loss)	$ 92,226				92,445	(219)
Ending balance (in shares) at Sep. 30, 2022	43,327	50,087
Ending balance at Sep. 30, 2022	$ 1,132,633	$ 501	$ 497,744	$ (523,722)	$ 1,159,199	$ (1,089)
Ending balance (in shares) at Sep. 30, 2022	(6,760)			(6,760)

Fair Value Measurement - Financial Assets and Liabilities (Details) - Fair Value, Measurements, Recurring - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Deferred compensation
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	$ (116,922)	$ (119,617)
Deferred compensation \| Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	(116,922)	(119,617)
Deferred compensation \| 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	0	0
Deferred compensation \| Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	0	0
Acquisition contingent consideration liabilities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	(6,810)	0
Acquisition contingent consideration liabilities \| Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	0	0
Acquisition contingent consideration liabilities \| 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	0	0
Acquisition contingent consideration liabilities \| Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	(6,810)	0
Money market funds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	125,859	91,454
Money market funds \| Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	125,859	91,454
Money market funds \| 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	0	0
Money market funds \| Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	0	0
Corporate bonds
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	26,841	29,159
Corporate bonds \| Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	0	0
Corporate bonds \| 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	26,841	29,159
Corporate bonds \| Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	0	0
Commercial paper
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	29,296	80,596
Commercial paper \| Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	0	0
Commercial paper \| 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	29,296	80,596
Commercial paper \| Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	$ 0	$ 0