0001142750-24-000016 | 10-K | XBRL Viewer | AMN Healthcare Services INC

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Notes Payable and Credit Agreement - The Company’s Credit Agreement and Related Credit Facilities (Details) - Line of Credit - USD ($)	Feb. 10, 2023	Nov. 30, 2023	Feb. 09, 2023
Revolving Credit Facility
Debt Instrument [Line Items]
Maximum borrowing capacity	$ 750,000,000	$ 750,000,000	$ 400,000,000
Revolving Credit Facility \| Minimum \| SOFR
Debt Instrument [Line Items]
Basis spread on variable rate	1.00%
Revolving Credit Facility \| Minimum \| Base Rate
Debt Instrument [Line Items]
Basis spread on variable rate	0.00%
Revolving Credit Facility \| Maximum \| SOFR
Debt Instrument [Line Items]
Basis spread on variable rate	1.75%
Revolving Credit Facility \| Maximum \| Base Rate
Debt Instrument [Line Items]
Basis spread on variable rate	0.75%
Revolving Credit Facility, Sublimit
Debt Instrument [Line Items]
Maximum borrowing capacity	$ 125,000,000
Revolving Credit Facility, Swing Line Loan
Debt Instrument [Line Items]
Maximum borrowing capacity	$ 75,000,000

Leases (Tables)

12 Months Ended

Dec. 31, 2023

Leases [Abstract]

Schedule of Components of Lease Expense

The components of lease expense were as follows:


	Years Ended December 31,
	2023		2022		2021
Operating lease cost	$	9,610	$	16,439	$	23,495
Short-term lease cost	3,738		5,787		6,056
Variable and other lease cost	2,789		3,129		2,485
Net lease cost	$	16,137	$	25,355	$	32,036

Schedule of Maturities of Lease Liabilities

The maturities of lease liabilities as of December 31, 2023 were as follows:


	Operating Leases
Year ending December 31, 2024	$	10,584
Year ending December 31, 2025	8,150
Year ending December 31, 2026	6,437
Year ending December 31, 2027	6,494
Year ending December 31, 2028	6,665
Thereafter	16,765
Total lease payments	55,095
Less imputed interest	(9,499)
Present value of lease liabilities	$	45,596

Schedule of Assumptions used for Operating Leases

The weighted average remaining lease term and discount rate as of December 31, 2023 and 2022 were as follows:


	December 31,
	2023		2022
Weighted average remaining lease term	7 years		2 years
Weighted average discount rate	5.3	%	3.1	%

Fair Value Measurement

12 Months Ended

Dec. 31, 2023

Fair Value Disclosures [Abstract]

Fair Value Measurement

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

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

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

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

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

Assets and Liabilities Measured on a Recurring Basis

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

The Company’s restricted cash equivalents and investments that serve as collateral for the Company’s captive insurance company include commercial paper and corporate bonds. The commercial paper is measured at observable market prices for identical securities that are traded in less active markets, which are Level 2 inputs. The corporate bonds 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. The following table presents the fair value of commercial paper and corporate bonds issued and outstanding:


	As of December 31, 2023		As of December 31, 2022
Commercial paper	$	48,206	$	31,536
Corporate bonds	—		—
Total classified as restricted cash equivalents	$	48,206	$	31,536
Commercial paper	$	—	$	—
Corporate bonds	15,563		25,095
Total classified as restricted investments	$	15,563	$	25,095

The fair value of our available-for-sale securities as of December 31, 2023, by remaining contractual maturities, are presented in the following table:


	Fair Value
Due in one year or less	$	5,635
Due after one year through five years	9,928
	$	15,563

Expected maturities may differ from stated due dates because borrowers may have the ability to call or prepay obligations with or without call or prepayment penalties.

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

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


	Fair Value Measurements as of December 31, 2023								Fair Value Measurements as of December 31, 2022
Assets (Liabilities)	Level 1		Level 2		Level 3		Total		Level 1		Level 2		Level 3		Total
Money market funds	$	—	$	—	$	—	$	—	$	36,895	$	—	$	—	$	36,895
Deferred compensation	(165,574)		—		—		(165,574)		(128,465)		—		—		(128,465)
Corporate bonds	—		15,563		—		15,563		—		25,095		—		25,095
Commercial paper	—		48,206		—		48,206		—		31,536		—		31,536
Acquisition contingent consideration liabilities	—		—		—		—		—		—		(5,070)		(5,070)

Assets Measured on a Non-Recurring Basis

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

The fair value of identifiable intangible assets are determined using either the income approach (the relief-from-royalty method, multi-period excess earnings method or with-and-without method) or the cost approach (replacement cost method). These valuation approaches use a combination of assumptions, including Level 3 inputs, such as (i) forecasted revenue, growth rates and customer attrition rates, (ii) forecasted operating expenses and profit margins, and (iii) royalty rates and discount rates used to present value the forecasted cash flows.

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

The Company’s equity investment represents an investment in a non-controlled corporation without a readily determinable market value. The Company has elected to measure the investment at cost minus impairment, if any, plus or minus changes resulting from observable price changes. The fair value is determined by using quoted prices for identical or similar investments of the same issuer, which are Level 2 inputs, and other information available to the Company such as the rights and obligations of the securities. The Company recognizes changes to the fair value of its equity investment in interest expense, net, and other in the consolidated statements of comprehensive income. The balance of the equity investment was $12,503 and $19,204 as of December 31, 2023 and 2022, respectively.

There were no material impairment charges recorded during the years ended December 31, 2023, 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 2027 Notes (as defined in Note (8) below) and 4.000% senior notes due 2029 (the “2029 Notes”) was estimated using quoted market prices in active markets for identical liabilities, which are Level 1 inputs. The carrying amounts and estimated fair value of the 2027 Notes and the 2029 Notes, which are more fully described in Note (8), “Notes Payable and Credit Agreement,” are presented in the following table:


	As of December 31, 2023				As of December 31, 2022
	Carrying Amount		Estimated Fair Value		Carrying Amount		Estimated Fair Value
2027 Notes	$	500,000	$	468,750	$	500,000	$	460,000
2029 Notes	350,000		314,125		350,000		300,125

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

Income Taxes - Income Tax Reconciliation (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income tax reconciliation
Tax expense at federal statutory rate	$ 59,701	$ 127,390	$ 93,223
State taxes, net of federal benefit	14,170	29,711	23,990
Non-deductible expenses	3,010	0	0
Share-based compensation	(944)	(2,383)	(1,460)
Unrecognized tax benefit	1,957	3,245	(680)
Company-owned life insurance policies	(4,428)	4,094	(1,968)
Tax credits	(3,172)	(2,741)	(551)
Other, net	3,316	3,337	3,979
Income tax expense from operations	$ 73,610	$ 162,653	$ 116,533

COVER - USD ($)	12 Months Ended
COVER - USD ($)	Dec. 31, 2023	Feb. 20, 2024	Jun. 30, 2023
Cover [Abstract]
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 31, 2023
Current Fiscal Year End Date	--12-31
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	2999 Olympus Boulevard
Entity Address, Address Line Two	Suite 500
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 Well-known Seasoned Issuer	Yes
Entity Voluntary Filers	No
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
ICFR Auditor Attestation Flag	true
Document Financial Statement Error Correction	false
Entity Shell Company	false
Entity Public Float			$ 4,127,626,484
Entity Common Stock, Shares Outstanding (excluding treasury shares)		37,888,539
Documents Incorporated by Reference	Portions of the registrant’s definitive proxy statement for the annual meeting of stockholders scheduled to be held on April 19, 2024 have been incorporated by reference into Part III of this Form 10-K.
Entity Central Index Key	0001142750
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	FY
Amendment Flag	false

Acquisitions - Schedule of Intangible Assets Acquired (Details) - USD ($) $ in Thousands	Nov. 30, 2023	Jun. 30, 2023	May 13, 2022	Dec. 31, 2021
Tradenames and trademarks
Acquired Finite-Lived Intangible Assets [Line Items]
Useful Life				6 years
MSDR
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 92,000
MSDR \| Customer relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 54,300
MSDR \| Customer relationships \| Minimum
Acquired Finite-Lived Intangible Assets [Line Items]
Useful Life	7 years
MSDR \| Customer relationships \| Maximum
Acquired Finite-Lived Intangible Assets [Line Items]
Useful Life	10 years
MSDR \| Tradenames and trademarks
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 26,400
Useful Life	3 years
MSDR \| Staffing database
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 11,300
Useful Life	5 years
Connetics Communications, LLC
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value		$ 40,200	$ 40,200
Connetics Communications, LLC \| Customer relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value			$ 32,800
Useful Life			15 years
Connetics Communications, LLC \| Tradenames and trademarks
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value			$ 3,200
Useful Life			5 years
Connetics Communications, LLC \| Staffing database
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value			$ 4,200
Useful Life			5 years

Income Taxes - Provision for Income Taxes (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Current income taxes:
Federal	$ 65,877	$ 145,217	$ 98,795
State	20,666	42,051	34,025
Total	86,543	187,268	132,820
Deferred income taxes:
Federal	(10,203)	(20,173)	(12,992)
State	(2,730)	(4,442)	(3,295)
Total	(12,933)	(24,615)	(16,287)
Income tax expense from operations	$ 73,610	$ 162,653	$ 116,533

- Definition

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

+ References + Details

Notes Payable and Credit Agreement - Senior Notes (Details) - Senior Notes - USD ($)	Aug. 13, 2020	Dec. 31, 2023	Dec. 31, 2022	Oct. 20, 2020	Oct. 01, 2019
2027 Notes
Debt Instrument [Line Items]
Interest rate	4.625%				4.625%
Aggregate principal amount	$ 200,000,000	$ 500,000,000	$ 500,000,000		$ 300,000,000
Issuance price, percentage of principal amount	101.00%
2029 Notes
Debt Instrument [Line Items]
Interest rate				4.00%
Aggregate principal amount		$ 350,000,000	$ 350,000,000	$ 350,000,000

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References

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+ Details

Acquisitions - MSDR Acquisition (Details)	Nov. 30, 2023 USD ($) company	Dec. 31, 2023 USD ($)	Feb. 10, 2023 USD ($)	Feb. 09, 2023 USD ($)	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)
Business Acquisition [Line Items]
Goodwill		$ 1,111,549,000			$ 935,364,000	$ 892,341,000
Revolving Credit Facility \| Line of Credit
Business Acquisition [Line Items]
Maximum borrowing capacity	$ 750,000,000		$ 750,000,000	$ 400,000,000
MSDR
Business Acquisition [Line Items]
Number of companies acquired \| company	2
Purchase price	$ 292,818,000
Fair value of tangible assets acquired	49,584,000
Cash received	643,000
Liabilities assumed	24,536,000
Identified intangible assets	92,000,000
Goodwill	175,770,000
Goodwill expected to be tax deductible	$ 88,961,000
Intangible assets acquired, weighted average useful life	7 years

Notes Payable and Credit Agreement - Debt Balances (Details) - Line of Credit - Revolving Credit Facility $ in Thousands	Dec. 31, 2023 USD ($)
Debt Instrument [Line Items]
Debt collateral	$ 20,758
Available credit	$ 269,242
SOFR
Debt Instrument [Line Items]
Interest rate	6.70%

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References

+ Details

Leases

12 Months Ended

Dec. 31, 2023

Leases [Abstract]

Leases

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

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

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. The lease commenced upon substantial completion of the construction of the office building in June 2023. The initial term of the lease is approximately eleven years with options to renew during the lease term. The Company recognized a right-of-use asset and operating lease liability of $15,782 and $22,713, respectively, at lease commencement, which reflects the utilization of a tenant improvement allowance of $6,931 accounted for as a lease incentive.

The components of lease expense were as follows:


	Years Ended December 31,
	2023		2022		2021
Operating lease cost	$	9,610	$	16,439	$	23,495
Short-term lease cost	3,738		5,787		6,056
Variable and other lease cost	2,789		3,129		2,485
Net lease cost	$	16,137	$	25,355	$	32,036

The maturities of lease liabilities as of December 31, 2023 were as follows:


	Operating Leases
Year ending December 31, 2024	$	10,584
Year ending December 31, 2025	8,150
Year ending December 31, 2026	6,437
Year ending December 31, 2027	6,494
Year ending December 31, 2028	6,665
Thereafter	16,765
Total lease payments	55,095
Less imputed interest	(9,499)
Present value of lease liabilities	$	45,596

The weighted average remaining lease term and discount rate as of December 31, 2023 and 2022 were as follows:


	December 31,
	2023		2022
Weighted average remaining lease term	7 years		2 years
Weighted average discount rate	5.3	%	3.1	%

Share-Based Compensation - Additional Information (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
RSUs and Performance Shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total unrecognized compensation cost	$ 26,499
Unrecognized compensation cost, weighted average remaining period	1 year 9 months 18 days
Aggregate intrinsic value	$ 44,979	$ 68,348
Equity Plan \| RSUs and Performance Shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of equity awards reserved for future issuance (in shares)	2,264,000	2,414,000
Employee Stock Purchase Plan \| Employee Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares authorized for issuance (in shares)	1,000,000
Share-based compensation arrangement by share-based payment award, purchase price of common stock, percent	85.00%
2014 Employee Inducement Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares authorized for issuance (in shares)	200,000
Number of shares of common stock available for future grants (in shares)	181,000

Notes Payable and Credit Agreement

12 Months Ended

Dec. 31, 2023

Debt Disclosure [Abstract]

Notes Payable and Credit Agreement

(a) The Company’s Credit Agreement and Revolving Credit Facility

On February 10, 2023, the Company entered into the third amendment to its credit agreement (the “Third Amendment”). The Third Amendment (together with the credit agreement, the first amendment and the second amendment, collectively, the “Amended Credit Agreement”) provides for, among other things, the following: (i) an extension of the maturity date of the Senior Credit Facility to February 10, 2028, (ii) an increase to the Senior Credit Facility from $400,000 to $750,000, and (iii) a transition from LIBOR to a Secured Overnight Financing Rate (“SOFR”)-based interest rate. The obligations of the Company under the Amended Credit Agreement are secured by substantially all of the assets of the Company.

Borrowings under the Senior Credit Facility bear interest at floating rates, at the Company’s option, based upon either SOFR plus a spread of 1.00% to 1.75% or a base rate plus a spread of 0.00% to 0.75%. The applicable spread is determined quarterly based upon the Company’s consolidated net leverage ratio (as calculated per the Amended Credit Agreement). The Senior Credit Facility, which includes a $125,000 sublimit for the issuance of letters of credit and a $75,000 sublimit for swingline loans, is available for working capital, capital expenditures, permitted acquisitions and general corporate purposes.

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

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

On October 20, 2020, the Company completed the issuance of $350,000 aggregate principal amount of the 2029 Notes, which mature on April 15, 2029. The 2029 Notes are unsecured obligations of the Company and the interest is fixed at 4.000% and payable semi-annually in arrears on April 15 and October 15 of each year, commencing April 15, 2021.

(d) Debt Balances

Outstanding debt balances as of December 31, 2023 and 2022 consisted of the following:


	As of December 31,
	2023		2022

Senior Credit Facility	$	460,000	$	—

2027 Notes	500,000		500,000
2029 Notes	350,000		350,000
Total debt outstanding	1,310,000		850,000
Less unamortized fees and premium	(5,312)		(6,495)

Long-term portion of notes payable	$	1,304,688	$	843,505

At December 31, 2023, with $20,758 of outstanding letters of credit collateralized by the Senior Credit Facility, there was $269,242 of available credit under the Senior Credit Facility. The interest rate for the outstanding borrowings under the Senior Credit Facility was 6.7% on a SOFR basis as of December 31, 2023.

(e) Letters of Credit

At December 31, 2023, the Company maintained outstanding standby letters of credit totaling $21,312 as collateral in relation to its workers’ compensation insurance agreements and a corporate office lease agreement. Of the $21,312 outstanding letters of credit, the Company has collateralized $554 in cash and cash equivalents and the remaining $20,758 is collateralized by the Senior Credit Facility. Outstanding standby letters of credit at December 31, 2022 totaled $21,962.

- Definition

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

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1B
-Subparagraph (h)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1B

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 235
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(c))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480678/235-10-S99-1

Reference 3: http://fasb.org/us-gaap/role/ref/legacyRef
-Topic 470
-Name Accounting Standards Codification
-Publisher FASB
-URI https://asc.fasb.org//470/tableOfContent

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1B
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1B

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1B
-Subparagraph (g)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1B

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1B
-Subparagraph (i)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1B

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1C
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1C

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1C
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1C

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1C
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1C

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1E
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1E

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1I
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1I

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1I
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1I

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1I
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1I

+ Details

Acquisitions

12 Months Ended

Dec. 31, 2023

Business Combination and Asset Acquisition [Abstract]

Acquisitions

The Company accounted for each acquisition set forth below using the acquisition method of accounting. Accordingly, the Company recorded the tangible and intangible assets acquired and liabilities assumed at their estimated fair values as of the applicable date of acquisition. Since the applicable date of acquisition, the Company has revised the allocation of the purchase price to the tangible and intangible assets acquired and liabilities assumed based on analysis of information that has been made available through December 31, 2023. 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. The Company recognizes acquisition-related costs in selling, general and administrative expenses in the consolidated statements of comprehensive income. For each acquisition, the Company did not incur any material acquisition-related costs.

MSDR Acquisition

On November 30, 2023, the Company completed its acquisition of MSI Systems Corp. and DrWanted.com LLC (together, “MSDR”), two healthcare staffing companies that specialize in locum tenens and advanced practice. The initial purchase price of $292,818 consisted entirely of cash consideration paid upon acquisition. The acquisition was funded through borrowings under the Company’s $750,000 secured revolving credit facility (the “Senior Credit Facility”), provided for under the Amended Credit Agreement (as defined in Note (8) below). The results of MSDR have been included in the Company’s physician and leadership solutions segment since the date of acquisition.

The preliminary allocation of the $292,818 purchase price consisted of (1) $49,584 of fair value of tangible assets acquired, which included $643 cash received, (2) $24,536 of liabilities assumed, (3) $92,000 of identified intangible assets, and (4) $175,770 of goodwill, of which $88,961 is deductible for tax purposes. The provisional items include the final working capital settlement and the assessment of additional information to finalize the measurement of certain assets acquired and liabilities assumed, which primarily consist of income tax matters, operating leases, accrued expenses and insurance reserves. The intangible assets acquired have a weighted average useful life of approximately seven 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	$	54,300	7 - 10
	Tradenames and trademarks	26,400		3
	Staffing databases	11,300		5
		$	92,000

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, which resulted in a payment of $7,500 in the third quarter of 2023. The results of Connetics have been included in the Company’s nurse and allied solutions segment since the date of acquisition. During the fourth quarter of 2022, $231 was returned to the Company in respect of the final working capital settlement.

The allocation of the $78,533 purchase price, which was reduced by the final working capital settlement and was finalized during the second quarter of 2023, consisted of (1) $3,172 of fair value of tangible assets acquired, which included $963 cash received, (2) $8,244 of liabilities assumed, (3) $40,200 of identified intangible assets, and (4) $43,405 of goodwill, of which $42,905 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 Senior Credit Facility. 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.

In the fourth quarter of 2023, the Company determined that it will wind down the operations of Synzi and SnapMD during 2024. As a result of this decision, the Company recorded an immaterial impairment charge to reduce the carrying value of intangible assets and shortened their remaining useful lives. The wind down is not expected to have a material effect on the Company’s consolidated financial statements.

Summary of Significant Accounting Policies (Policies)	12 Months Ended
Summary of Significant Accounting Policies (Policies)	Dec. 31, 2023
Accounting Policies [Abstract]
Principles of Consolidation	Principles of Consolidation The accompanying consolidated financial statements include the accounts of AMN Healthcare Services, Inc. and its wholly-owned subsidiaries. All significant intercompany balances and transactions have been eliminated in consolidation.
Use of Estimates	Use of Estimates The preparation of financial statements in conformity with accounting principles generally accepted in the United States of America requires management to make a number of estimates and assumptions relating to the reporting of assets and liabilities and the disclosure of contingent assets and liabilities at the dates of the financial statements and the reported amounts of revenue and expenses during the reporting periods. On an ongoing basis, the Company evaluates its estimates, including those related to goodwill and indefinite-lived intangible assets, professional liability reserve, contingent liabilities such as legal accruals, and income taxes. The Company bases these estimates on the information that is currently available and on various other assumptions that it believes are reasonable under the circumstances. Actual results could differ from those estimates under different assumptions or conditions.
Cash and Cash Equivalents	Cash and Cash Equivalents The Company considers all highly liquid investments with an original maturity of three months or less to be cash equivalents. Cash and cash equivalents include currency on hand, deposits with financial institutions, money market funds, and other highly liquid investments. See Note (3), “Fair Value Measurement” for additional information.
Restricted Cash, Cash Equivalents and Investments	Restricted Cash, Cash Equivalents and Investments Restricted cash and cash equivalents primarily includes cash, corporate bonds and commercial paper that serve as collateral for the Company’s captive insurance subsidiary claim payments. See Note (3), “Fair Value Measurement” for additional information.
Fixed Assets	Fixed Assets The Company records furniture, equipment, leasehold improvements and capitalized software at cost less accumulated amortization and depreciation. The Company records equipment acquired under finance leases at the present value of the future minimum lease payments. The Company capitalizes major additions and improvements, and it expenses maintenance and repairs when incurred. The Company calculates depreciation on furniture, equipment and software using the straight-line method based on the estimated useful lives of the related assets (typically three to ten years). The Company depreciates leasehold improvements and equipment obtained under finance leases over the shorter of the term of the lease or their estimated useful lives. The Company includes depreciation of equipment obtained under finance leases with depreciation expense in the accompanying consolidated financial statements. The Company capitalizes costs it incurs to develop software during the application development stage. Application development stage costs generally include costs associated with software configuration, coding, installation and testing. The Company also capitalizes costs of significant upgrades and enhancements that result in additional functionality, whereas it expenses as incurred costs for maintenance and minor upgrades and enhancements. The Company amortizes capitalized costs using the straight-line method over three to ten years once the software is ready for its intended use. The Company reviews long-lived assets for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. Recoverability of assets to be held and used is measured by a comparison of the carrying amount of an asset group to the future undiscounted net cash flows that are expected to be generated by the asset group. If such asset group is considered to be impaired, the impairment to be recognized is measured by the amount by which the carrying amount of the asset group exceeds the fair value of the asset group. The Company reports assets to be disposed of at the lower of the carrying amount or fair value less costs to sell.
Leases	Leases The Company recognizes operating lease right-of-use assets and liabilities at commencement date based on the present value of the future minimum lease payments over the lease term. Leases with an initial term of 12 months or less are not recorded on the balance sheet in accordance with the short-term lease recognition exemption. The Company applies the practical expedient to not separate lease and non-lease components for all leases that qualify. The rates implicit in the Company’s lease arrangements are generally not readily determinable and as such, the Company uses its incremental borrowing rate as the discount rate to measure its lease liabilities. The incremental borrowing rate is determined for each operating lease based on the Company’s borrowing capabilities over a similar term of the lease arrangement, which is estimated by utilizing the Company’s credit rating and the effects of full collateralization. Lease expense is recognized on a straight-line basis over the lease term. Operating lease right-of-use assets are included in other assets, and operating lease liabilities are included in other current liabilities and other long-term liabilities in the consolidated balance sheets.
Goodwill	Goodwill The Company records as goodwill the portion of the purchase price that exceeds the fair value of net assets of entities acquired. The Company evaluates goodwill annually for impairment at the reporting unit level and whenever circumstances occur indicating that goodwill may be impaired. The Company may first assess qualitative factors to determine whether it is more likely than not that the fair value of a reporting unit is less than its carrying amount. If, after assessing the totality of events and circumstances, the Company determines that it is more likely than not that the fair value of the reporting unit is greater than its carrying amount, the quantitative impairment test is unnecessary. If the reporting unit does not pass the qualitative assessment, then the reporting unit’s carrying value is compared to its fair value. The amount by which the carrying value of the goodwill exceeds its fair value is recognized as an impairment loss.
Intangible Assets	Intangible Assets Intangible assets consist of identifiable intangible assets acquired through acquisitions, which include tradenames and trademarks, customer relationships, staffing databases, developed technology and non-compete agreements. The Company amortizes intangible assets, other than those with an indefinite life, using the straight-line method over their useful lives. The Company amortizes non-compete agreements using the straight-line method over the lives of the related agreements. The Company reviews for impairment intangible assets with estimable useful lives whenever events or changes in circumstances indicate that the carrying amount may not be recoverable. The Company does not amortize indefinite-lived intangible assets and instead reviews them for impairment annually. The Company may first perform a qualitative assessment to determine whether it is more likely than not that an indefinite-lived intangible asset is impaired. If, after assessing the totality of events and circumstances, the Company determines that it is more likely than not that the indefinite-lived intangible asset is not impaired, no quantitative fair value measurement is necessary. If a quantitative fair value measurement calculation is required for an indefinite-lived intangible asset, the Company compares its fair value with its carrying amount. If the carrying amount exceeds the fair value, the Company records the excess as an impairment loss.
Insurance Reserves	Insurance Reserves The Company maintains an accrual for professional liability that is included in accounts payable and accrued expenses and other long-term liabilities in the consolidated balance sheets. The expense is included in the selling, general and administrative expenses in the consolidated statement of comprehensive income. The Company determines the adequacy of this accrual by evaluating its historical experience and trends, loss reserves established by the Company’s insurance carriers, management and third-party administrators, and independent actuarial studies. The Company obtains actuarial studies on a semi-annual basis that use the Company’s actual claims data and industry data to assist the Company in determining the adequacy of its reserves each year. For periods between the actuarial studies, the Company records its accruals based on loss rates provided in the most recent actuarial study and management’s review of loss history and trends. Liabilities include provisions for estimated incurred but not yet reported (“IBNR”) losses, as well as provisions for known claims. IBNR reserve estimates involve the use of assumptions that are primarily based upon historical loss experience, industry data and other actuarial assumptions. The Company maintains insurance programs through its wholly-owned captive insurance subsidiary, which primarily provides coverage, on an occurrence basis, for professional liability within its nurse and allied solutions segment. In addition, the Company maintains excess insurance coverage through a commercial carrier for losses above the per occurrence retention. Losses covered by excess insurance are included in the accrual for professional liability, as the Company remains liable to the extent commercial carriers do not meet their obligations. The Company maintains an accrual for workers’ compensation, which is included in accrued compensation and benefits and other long-term liabilities in the consolidated balance sheets. The expense relating to healthcare professionals is included in cost of revenue, while the expense relating to corporate employees is included in the selling, general and administrative expenses in the consolidated statement of comprehensive income. The Company determines the adequacy of this accrual by evaluating its historical experience and trends, loss reserves established by the Company’s insurance carriers and third-party administrators, and independent actuarial studies. The Company obtains actuarial studies on a semi-annual basis that use the Company’s payroll and historical claims data, as well as industry data, to determine the appropriate reserve for both reported claims and IBNR claims for each policy year. For periods between the actuarial studies, the Company records its accruals based on loss rates provided in the most recent actuarial study.
Revenue Recognition	Revenue Recognition Revenue primarily consists of fees earned from the temporary staffing and permanent placement of healthcare professionals, executives, and leaders (clinical and operational). The Company also generates revenue from technology-enabled services, including language interpretation and vendor management systems, and talent planning and acquisition services, including recruitment process outsourcing. The Company recognizes revenue when control of its services is transferred to its customers, in an amount that reflects the consideration the Company expects to be entitled to receive in exchange for those services. Revenue from temporary staffing services is recognized as the services are rendered by clinical and non-clinical healthcare professionals. Under the Company’s managed services program (“MSP”) arrangements, the Company manages all or a part of a customer’s supplemental workforce needs utilizing its own network of healthcare professionals along with those of third-party subcontractors. Revenue and the related direct costs under MSP arrangements are recorded in accordance with the accounting guidance on reporting revenue gross as a principal versus net as an agent. When the Company uses subcontractors and acts as an agent, revenue is recorded net of the related subcontractor’s expense. Revenue from permanent placement and recruitment process outsourcing services is recognized as the services are rendered. Depending on the arrangement, the Company’s technology-enabled service revenue is recognized either as the services are rendered or ratably over the applicable arrangement’s service period. See additional information below regarding the Company’s revenue disaggregated by service type. The Company’s customers are primarily billed as services are rendered. Any fees billed in advance of being earned are recorded as deferred revenue. While payment terms vary by the type of customer and the services rendered, the term between invoicing and when payment is due is not significant. The Company recognizes assets from incremental costs to obtain a contract with a customer and costs incurred to fulfill a contract with a customer, which are deferred and amortized using the portfolio approach on a straight line basis over the average period of benefit consistent with the timing of transfer of services to the customer. The Company has elected to apply the following practical expedients and optional exemptions related to contract costs and revenue recognition: •Recognize incremental costs of obtaining a contract with amortization periods of one year or less as expense when incurred. These costs are recorded within selling, general and administrative expenses. •Recognize revenue in the amount of consideration that the Company has a right to invoice the customer if that amount corresponds directly with the value to the customer of the Company’s services completed to date. •Exemptions from disclosing the value of unsatisfied performance obligations for (i) contracts with an original expected length of one year or less, (ii) contracts for which revenue is recognized in the amount of consideration that the Company has a right to invoice for services performed and (iii) contracts for which variable consideration is allocated entirely to a wholly unsatisfied performance obligation or to a wholly unsatisfied promise to transfer a distinct service that forms part of a single performance obligation.
Accounts Receivable	Accounts Receivable The Company records accounts receivable at the invoiced amount. Accounts receivable are non-interest bearing. The Company maintains an allowance for expected credit losses based on the Company’s historical write-off experience, an assessment of its customers’ financial conditions and available information that is relevant to assessing the collectability of cash flows, which includes current conditions and forecasts about future economic conditions.
Concentration of Credit Risk	Concentration of Credit Risk The majority of the Company’s business activity is with hospitals located throughout the United States. Credit is extended based on the evaluation of each entity’s financial condition. The Company’s cash and cash equivalents and restricted cash, cash equivalents and investments accounts are financial instruments that are exposed to concentration of credit risk. The Company maintains most of its cash, cash equivalents and investment balances with high-credit quality and federally insured institutions. However, cash equivalents and restricted cash equivalents and investment balances may be invested in non-federally insured money market funds, commercial paper and corporate bonds.
Income Taxes	Income Taxes The Company records income taxes using the asset and liability method. Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax basis. Deferred tax assets and liabilities are measured using enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in the period the changes are enacted. In assessing the realizability of deferred tax assets, the Company considers whether it is more likely than not that some portion or all of the deferred tax assets will not be realized. The ultimate realization of deferred tax assets is dependent upon the generation of future taxable income during the periods in which those temporary differences become deductible. The Company considers the scheduled reversal of deferred tax liabilities (including the impact of available carryback and carryforward periods), projected future taxable income, and tax-planning strategies in making this assessment. The Company recognizes the effect of income tax positions only if it is more likely than not that such positions will be sustained. Recognized income tax positions are measured at the largest amount that is greater than 50% likely of being realized. Changes in recognition or measurement are reflected in the period in which the change in judgment occurs. The Company records interest and penalties related to unrecognized tax benefits in income tax expense.
Fair Value of Financial Instruments	Fair Value of Financial Instruments The carrying amounts of the Company’s cash equivalents and restricted cash equivalents and investments approximate their respective fair values due to the short-term nature and liquidity of these financial instruments. The fair value of the Company’s equity investment is determined by using prices for identical or similar investments of the same issuer, which is more fully described in Note (3), “Fair Value Measurement.” As it relates to the Company’s 2027 Notes and 2029 Notes (as defined in Note (8) and Note (3), respectively, below), fair value disclosure is detailed in Note (3), “Fair Value Measurement.” See Note (8), “Notes Payable and Credit Agreement,” for additional information. The fair value of the Company’s long-term self-insurance accruals cannot be estimated because the Company cannot reasonably determine the timing of future payments.
Share-Based Compensation	Share-Based Compensation The Company accounts for its share-based employee compensation plans by expensing the estimated fair value of share-based awards on a straight-line basis over the requisite employee service period, which typically is the vesting period, except for awards granted to retirement-eligible employees, which are expensed on an accelerated basis. Restricted stock units (“RSUs”) typically vest over a three-year period. Share-based compensation cost of RSUs is measured by the market value of the Company’s common stock on the date of grant, and the Company records share-based compensation expense only for those awards that are expected to vest. Performance restricted stock units (“PRSUs”) primarily consist of PRSUs that contain performance conditions dependent on defined targets of the Company’s adjusted EBITDA, with a range of 0% to 200% of the target amount granted to be issued under the award. Share-based compensation cost for these PRSUs is measured by the market value of the Company’s common stock on the date of grant, and the amount recognized is adjusted for estimated achievement of the performance conditions. A limited amount of PRSUs contain a market condition dependent upon the Company’s relative and absolute total stockholder return over a three-year period, with a range of 0% to 175% of the target amount granted to be issued under the award. Share-based compensation cost for these PRSUs is measured using the Monte-Carlo simulation valuation model and is not adjusted for the achievement, or lack thereof, of the market conditions. Share-based compensation cost for purchase rights granted under the Company’s employee stock purchase plan is measured using the Black-Scholes model and the related employee contributions are included in accrued compensation and benefits in the consolidated balance sheets. See Note (11), “Share-Based Compensation,” for additional information.
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, and allied staffing (including 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 (“VMS”), workforce optimization, 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.
Reclassifications	ReclassificationsTo conform to the current year presentation, certain reclassifications have been made to prior year balances in the consolidated balance sheets and accompanying Note (6 ), “Balance Sheet Details.”
Recently Adopted Accounting Pronouncements	Recently Adopted Accounting Pronouncements In October 2021, the Financial Accounting Standards Board issued Accounting Standards Update (“ASU”) 2021-08, “Business Combinations (Topic 805): Accounting for Contract Assets and Contract Liabilities from Contracts with Customers.” The new guidance requires companies to apply the definition of a performance obligation under Accounting Standards Codification (“ASC”) Topic 606, Revenue from Contracts with Customers, to recognize and measure contract assets and contract liabilities, such as deferred revenue, relating to contracts with customers that are acquired in a business combination. Under prior guidance, an acquirer generally recognized assets acquired and liabilities assumed in a business combination, including contract assets and contract liabilities arising from revenue contracts with customers, at their acquisition-date fair values in accordance with ASC Subtopic 820-10, Fair Value Measurements—Overall. Generally, this new guidance will result in the acquirer recognizing acquired contract assets and liabilities on the same basis that would have been recorded by the acquiree prior to the acquisition under ASC Topic 606. The Company adopted this standard effective January 1, 2023 on a prospective basis, and the adoption did not have a material effect on the Company’s consolidated financial statements.

Leases - Components of Lease Expense (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Leases [Abstract]
Operating lease cost	$ 9,610	$ 16,439	$ 23,495
Short-term lease cost	3,738	5,787	6,056
Variable and other lease cost	2,789	3,129	2,485
Net lease cost	$ 16,137	$ 25,355	$ 32,036

Summary of Significant Accounting Policies - Net Income per Common Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Accounting Policies [Abstract]
Common stock excluded from calculation of EPS (in shares)	88	19	33
Computation of Basic and Diluted Net Income Per Common Share [Abstract]
Net income	$ 210,679	$ 444,050	$ 327,388
Net income	$ 210,679	$ 444,050	$ 327,388
Net income per common share - basic (in dollars per share)	$ 5.38	$ 9.96	$ 6.87
Net income per common share - diluted (in dollars per share)	$ 5.36	$ 9.90	$ 6.81
Weighted average common shares outstanding - basic (in shares)	39,173	44,591	47,685
Plus dilutive effect of potential common shares (in shares)	168	279	360
Weighted average common shares outstanding - diluted (in shares)	39,341	44,870	48,045

Income Taxes - CARES Act (Details) $ in Thousands	Dec. 31, 2022 USD ($)
Income Tax Disclosure [Abstract]
Deferred payroll taxes, CARES Act	$ 48,452

CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Statement of Comprehensive Income [Abstract]
Revenue	$ 3,789,254	$ 5,243,242	$ 3,984,235
Cost of revenue	2,539,673	3,526,558	2,674,634
Gross profit	1,249,581	1,716,684	1,309,601
Operating expenses:
Selling, general and administrative	756,238	936,576	730,451
Depreciation and amortization (exclusive of depreciation included in cost of revenue)	154,914	133,007	101,152
Total operating expenses	911,152	1,069,583	831,603
Income from operations	338,429	647,101	477,998
Interest expense, net, and other	54,140	40,398	34,077
Income before income taxes	284,289	606,703	443,921
Income tax expense	73,610	162,653	116,533
Net income	210,679	444,050	327,388
Other comprehensive income (loss):
Unrealized gains (losses) on available-for-sale securities, net, and other	516	(644)	(335)
Other comprehensive income (loss)	516	(644)	(335)
Comprehensive income	$ 211,195	$ 443,406	$ 327,053
Net income per common share:
Basic (in dollars per share)	$ 5.38	$ 9.96	$ 6.87
Diluted (in dollars per share)	$ 5.36	$ 9.90	$ 6.81
Weighted average common shares outstanding:
Basic (in shares)	39,173	44,591	47,685
Diluted (in shares)	39,341	44,870	48,045

Capital Stock (Tables)

12 Months Ended

Dec. 31, 2023

Equity [Abstract]

Schedule of Share Repurchases

The total number of shares repurchased, average price per share (excluding broker’s fees), and total cost (excluding the effect of excise taxes) for the years ended December 31, 2023, 2022 and 2021 were as follows:


	Years Ended December 31,
	2023		2022		2021
Number of shares repurchased	4,383		5,644		25
Average price per share	$	96.90	$	102.16	$	108.97
Total cost of share repurchases	$	424,744	$	576,767	$	2,688

Summary of Significant Accounting Policies - Segment Information (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2023 USD ($) segment	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)
Accounting Policies [Abstract]
Number of reportable segments \| segment	3
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	$ 3,789,254	$ 5,243,242	$ 3,984,235
Segment operating income	338,429	647,101	477,998
Depreciation and amortization	154,914	133,007	101,152
Depreciation (included in cost of revenue)	6,013	4,104	2,545
Share-based compensation	18,020	30,066	25,217
Interest expense, net, and other	54,140	40,398	34,077
Income before income taxes	284,289	606,703	443,921
Travel nurse staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	1,806,653	2,912,677	2,168,507
Labor disruption services
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	13,303	112,160	110,520
Local staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	76,553	142,724	124,977
Allied staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	709,632	806,491	586,099
Locum tenens staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	464,797	428,133	352,650
Interim leadership staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	136,953	184,819	170,236
Temporary staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	3,207,891	4,587,004	3,512,989
Permanent placement
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	86,319	93,395	71,357
Language services
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	260,121	216,120	180,891
Vendor management systems
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	169,370	265,525	148,532
Other technologies
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	24,222	29,553	29,043
Technology-enabled services
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	453,713	511,198	358,466
Talent planning and acquisition
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	41,331	51,645	41,423
Nurse and Allied Solutions
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	2,624,509	3,982,453	2,990,103
Nurse and Allied Solutions \| Travel nurse staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	1,806,653	2,912,677	2,168,507
Nurse and Allied Solutions \| Labor disruption services
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	13,303	112,160	110,520
Nurse and Allied Solutions \| Local staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	76,553	142,724	124,977
Nurse and Allied Solutions \| Allied staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	709,632	806,491	586,099
Nurse and Allied Solutions \| Locum tenens staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Nurse and Allied Solutions \| Interim leadership staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Nurse and Allied Solutions \| Temporary staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	2,606,141	3,974,052	2,990,103
Nurse and Allied Solutions \| Permanent placement
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	18,368	8,401	0
Nurse and Allied Solutions \| Language services
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Nurse and Allied Solutions \| Vendor management systems
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Nurse and Allied Solutions \| Other technologies
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Nurse and Allied Solutions \| Technology-enabled services
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Nurse and Allied Solutions \| Talent planning and acquisition
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Physician and Leadership Solutions
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	669,701	697,946	594,243
Physician and Leadership Solutions \| Travel nurse staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Physician and Leadership Solutions \| Labor disruption services
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Physician and Leadership Solutions \| Local staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Physician and Leadership Solutions \| Allied staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Physician and Leadership Solutions \| Locum tenens staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	464,797	428,133	352,650
Physician and Leadership Solutions \| Interim leadership staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	136,953	184,819	170,236
Physician and Leadership Solutions \| Temporary staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	601,750	612,952	522,886
Physician and Leadership Solutions \| Permanent placement
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	67,951	84,994	71,357
Physician and Leadership Solutions \| Language services
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Physician and Leadership Solutions \| Vendor management systems
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Physician and Leadership Solutions \| Other technologies
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Physician and Leadership Solutions \| Technology-enabled services
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Physician and Leadership Solutions \| Talent planning and acquisition
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Technology and Workforce Solutions
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	495,044	562,843	399,889
Technology and Workforce Solutions \| Travel nurse staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Technology and Workforce Solutions \| Labor disruption services
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Technology and Workforce Solutions \| Local staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Technology and Workforce Solutions \| Allied staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Technology and Workforce Solutions \| Locum tenens staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Technology and Workforce Solutions \| Interim leadership staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Technology and Workforce Solutions \| Temporary staffing
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Technology and Workforce Solutions \| Permanent placement
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	0	0	0
Technology and Workforce Solutions \| Language services
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	260,121	216,120	180,891
Technology and Workforce Solutions \| Vendor management systems
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	169,370	265,525	148,532
Technology and Workforce Solutions \| Other technologies
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	24,222	29,553	29,043
Technology and Workforce Solutions \| Technology-enabled services
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	453,713	511,198	358,466
Technology and Workforce Solutions \| Talent planning and acquisition
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	41,331	51,645	41,423
Operating Segments
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	3,789,254	5,243,242	3,984,235
Segment operating income	671,860	967,947	730,328
Operating Segments \| Nurse and Allied Solutions
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	2,624,509	3,982,453	2,990,103
Segment operating income	362,158	576,226	461,311
Operating Segments \| Physician and Leadership Solutions
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	669,701	697,946	594,243
Segment operating income	94,966	92,331	81,439
Operating Segments \| Technology and Workforce Solutions
Segment Reporting Information, Profit (Loss) [Abstract]
Revenue	495,044	562,843	399,889
Segment operating income	214,736	299,390	187,578
Corporate, Non-Segment
Segment Reporting Information, Profit (Loss) [Abstract]
Unallocated corporate overhead	$ 154,484	$ 153,669	$ 123,416

Fair Value Measurement - Additional Information (Details) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Oct. 20, 2020
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Asset impairment charges	$ 0	$ 0	$ 0
2029 Notes \| Senior Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate				4.00%
Fair Value, Nonrecurring \| Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Equity investment balance	$ 12,503,000	$ 19,204,000

Capital Stock - Schedule of Share Repurchases (Details) - USD ($)
$ / shares in Units, shares in Thousands, $ in Thousands

12 Months Ended

Dec. 31, 2023

Dec. 31, 2022

Dec. 31, 2021

Equity [Abstract]

Number of shares repurchased (in shares)

4,383

5,644

Average price per share (in dollars per share)

$ 96.90

$ 102.16

$ 108.97

Total cost of share repurchases

^[1]

$ 424,744

$ 576,767

$ 2,688

[1]	The difference between the amount reported for the year ended December 31, 2023 and the corresponding amount presented in the consolidated statements of stockholders’ equity is due to accrued excise tax payable on share repurchases which is recorded within treasury stock.

CONSOLIDATED STATEMENTS OF CASH FLOWS (Parenthetical) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Statement of Cash Flows [Abstract]
Interest capitalized	$ 1,229	$ 703	$ 349

Leases - Additional Information (Details) $ in Thousands	12 Months Ended
Leases - Additional Information (Details) $ in Thousands	Dec. 31, 2023 USD ($) option	Dec. 31, 2021 USD ($) phase	Jun. 30, 2023 USD ($)	Dec. 31, 2022 USD ($)	Mar. 31, 2022 USD ($)
Operating Leased Assets [Line Items]
Option to renew (or more) \| option	1
Option to extend, term (up to)	10 years
Option to terminate, term (within)	2 years
Number of phases of lease termination agreement \| phase		2
Payments of lease termination fee		$ 17,000
Operating lease, right-of-use asset, decrease from modification		27,340
Operating lease, liability, decrease from modification		27,340
Remaining lease payments, premodification		62,487
Remaining lease payments, postmodification		$ 9,564
Operating lease right-of-use assets	$ 34,543			$ 16,266
Operating lease, liability	$ 45,596
Office Building
Operating Leased Assets [Line Items]
Future undiscounted lease payments					$ 29,514
Lease term			11 years
Operating lease right-of-use assets			$ 15,782
Operating lease, liability			22,713
Lease incentive			$ 6,931

Capital Stock

12 Months Ended

Dec. 31, 2023

Equity [Abstract]

Capital Stock

(a) Preferred Stock

The Company has 10,000 shares of preferred stock authorized for issuance in one or more series (including preferred stock designated as Series A Conditional Convertible Preferred Stock), at a par value of $0.01 per share. At December 31, 2023 and 2022, no shares of preferred stock were outstanding.

(b) Treasury Stock

On November 1, 2016, the Company’s board of directors approved a share repurchase program under which the Company may repurchase up to $150,000 of its outstanding common stock. On November 10, 2021, February 17, 2022 and June 15, 2022 the Company announced increases to the share repurchase program totaling $700,000. Additionally, on February 16, 2023, the Company announced an increase of $500,000 for a total of $1,350,000 of repurchase authorization, of which $226,658

remained on the repurchase program as of December 31, 2023. The amount and timing of the purchases will depend on a number of factors including the price of the Company’s shares, trading volume, Company performance, Company liquidity, general economic and market conditions and other factors that the Company’s management believes are relevant. The share repurchase program does not require the purchase of any minimum number of shares and may be suspended or discontinued at any time.

The Company intends to make all repurchases and to administer the plan in accordance with applicable laws and regulatory guidelines, including Rule 10b-18 of the Exchange Act, and in compliance with its debt instruments. Repurchases may be made from cash on hand, free cash flow generated from the Company’s business or from the Company’s Senior Credit Facility. Repurchases may be made from time to time through open market purchases or privately negotiated transactions. Repurchases may also be made pursuant to one or more plans established pursuant to Rule 10b5-1 under the Exchange Act that would permit shares to be repurchased when the Company might otherwise be precluded from doing so under the Company’s securities trading policy.

On May 8, 2023, the Company entered into an accelerated share repurchase (“ASR”) agreement with a counterparty whereupon the Company prepaid $200,000 and received an initial delivery of 1,760 shares of its common stock, which was 80% of the prepayment amount based on a price of $90.89 per share. On August 10, 2023, the Company received a final delivery of approximately 261 additional shares of its common stock, representing the remaining 20% of the prepayment amount and final settlement of the ASR agreement. The total number of shares received and average price per share of $98.97 was based on the volume-weighted average price over the term of the ASR agreement, less an agreed upon discount. The Company recognized the shares delivered pursuant to the ASR as increases to treasury stock in the consolidated statements of stockholders’ equity during the year ended December 31, 2023.

During the year ended December 31, 2023, the Company also repurchased 2,362 shares of its common stock through the open market at an average price of $95.13 per share excluding broker’s fees, resulting in an aggregate purchase price of $224,744 excluding the effect of excise taxes.


	Years Ended December 31,
	2023		2022		2021
Number of shares repurchased	4,383		5,644		25
Average price per share	$	96.90	$	102.16	$	108.97
Total cost of share repurchases	$	424,744	$	576,767	$	2,688

- Definition

The entire disclosure for equity.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 13
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481112/505-10-50-13

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
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-Section 50
-Paragraph 13
-Subparagraph (h)
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-URI https://asc.fasb.org//1943274/2147481112/505-10-50-13

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
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-Name Accounting Standards Codification
-Section 50
-Paragraph 14
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481112/505-10-50-14

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
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-Section 50
-Paragraph 2
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481062/946-235-50-2

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 235
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481062/946-235-50-2

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 505
-Name Accounting Standards Codification
-Section 50
-Paragraph 6
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-URI https://asc.fasb.org//1943274/2147481004/946-505-50-6

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 815
-SubTopic 40
-Name Accounting Standards Codification
-Section 50
-Paragraph 6
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480237/815-40-50-6

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
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-Paragraph 1
-Subparagraph (SX 210.3-04)
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-URI https://asc.fasb.org//1943274/2147480008/505-10-S99-1

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 235
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(e)(1))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480678/235-10-S99-1

Reference 10: http://fasb.org/us-gaap/role/ref/legacyRef
-Topic 505
-Name Accounting Standards Codification
-Publisher FASB
-URI https://asc.fasb.org//505/tableOfContent

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 13
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481112/505-10-50-13

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 13
-Subparagraph (g)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481112/505-10-50-13

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 13
-Subparagraph (i)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481112/505-10-50-13

Reference 14: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 14
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481112/505-10-50-14

Reference 15: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
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Reference 16: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
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-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481112/505-10-50-16

Reference 17: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 18
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481112/505-10-50-18

Reference 18: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 18
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481112/505-10-50-18

Reference 19: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 18
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481112/505-10-50-18

+ Details

CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Statement of Financial Position [Abstract]
Accounts receivable, allowance	$ 32,233	$ 31,910
Accumulated depreciation	285,081	227,617
Accumulated amortization	$ 442,052	$ 361,327
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)	50,423,000	50,109,000
Common stock, shares outstanding (in shares)	37,810,000	41,879,000
Treasury stock (in shares)	12,613,000	8,230,000

Summary of Significant Accounting Policies - Fixed Assets (Details)	Dec. 31, 2023
Furniture, Equipment and Technology and Software \| Minimum
Property, Plant and Equipment [Line Items]
Fixed assets, useful life	3 years
Furniture, Equipment and Technology and Software \| Maximum
Property, Plant and Equipment [Line Items]
Fixed assets, useful life	10 years
Software Development \| Minimum
Property, Plant and Equipment [Line Items]
Fixed assets, useful life	3 years
Software Development \| Maximum
Property, Plant and Equipment [Line Items]
Fixed assets, useful life	10 years

Balance Sheet Details

12 Months Ended

Dec. 31, 2023

Balance Sheet Related Disclosures [Abstract]

Balance Sheet Details

The consolidated balance sheets detail is as follows:


	December 31,
	2023		2022
Other current assets:
Restricted cash and cash equivalents	$	22,056	$	37,225
Income taxes receivable	5,350		8,875
Other	18,264		19,937
Other current assets	$	45,670	$	66,037






Fixed assets:
Furniture and equipment	$	71,815	$	51,408
Software	388,812		323,418
Leasehold improvements	15,839		2,067
	476,466		376,893
Accumulated depreciation	(285,081)		(227,617)
Fixed assets, net	$	191,385	$	149,276

Other assets:
Life insurance cash surrender value	$	162,780	$	117,139
Operating lease right-of-use assets	34,543		16,266
Other	39,473		38,611
Other assets	$	236,796	$	172,016

Accounts payable and accrued expenses:
Trade accounts payable	$	54,128	$	78,057
Subcontractor payable	122,983		295,259
Accrued expenses	82,257		73,885
Loss contingencies	69,837		14,638
Professional liability reserve	7,761		7,756
Other	6,881		6,857
Accounts payable and accrued expenses	$	343,847	$	476,452

Accrued compensation and benefits:
Accrued payroll	$	53,633	$	63,857
Accrued bonuses and commissions	31,236		96,760

ESPP contributions	950		—
Workers compensation reserve	12,130		12,113
Deferred compensation	165,574		128,465
Other	15,013		32,049
Accrued compensation and benefits	$	278,536	$	333,244


	December 31,
	2023		2022
Other current liabilities:
Deferred revenue	$	11,303	$	11,825

Acquisition related liabilities	—		5,070
Client deposits	8,707		21,466
Operating lease liabilities	7,993		8,090
Other	5,735		1,786
Other current liabilities	$	33,738	$	48,237

Other long-term liabilities:
Workers compensation reserve	$	21,169	$	23,841
Professional liability reserve	36,891		36,214


Operating lease liabilities	37,603		9,360
Other	13,316		51,151
Other long-term liabilities	$	108,979	$	120,566

Retirement Plans	12 Months Ended
Retirement Plans	Dec. 31, 2023
Retirement Benefits [Abstract]
Retirement Plans	Retirement Plans The Company maintains the AMN Services 401(k) Retirement Savings Plan (the “AMN Plan”), which the Company believes complies with the IRC Section 401(k) provisions. The AMN Plan covers all employees that meet certain age and other eligibility requirements. A discretionary matching contribution is determined by the Company each year. Employer contribution expenses incurred under the AMN Plan were $5,673, $31,409 and $13,157 for the years ended December 31, 2023, 2022 and 2021, respectively. Employer contribution expenses for the year ended December 31, 2022 include one-time contributions and a temporary increase to the discretionary matching contribution for a portion of the year. The Company has a deferred compensation plan for certain executives and employees (the “Plan”). The Plan is not intended to be tax qualified and is an unfunded plan. The Plan is composed of deferred compensation and all related income and losses attributable thereto. Discretionary matching contributions to the Plan are made that vest incrementally so that the employee is fully vested in the match following five years of employment with the Company. Under the Plan, participants can defer up to 80% of their base salary, 90% of their variable compensation and 100% of their vested RSUs or vested PRSUs. A discretionary matching contribution is determined by the Company each year. Employer contributions under the Plan were $10,822, $18,023 and $8,951 for the years ended December 31, 2023, 2022 and 2021, respectively. Employer contribution expenses for the year ended December 31, 2022 include one-time contributions and a temporary increase to the discretionary matching contribution for a portion of the year.. In connection with the administration of the Plan, the Company has purchased company-owned life insurance policies insuring the lives of certain officers and employees. The cash surrender value of these policies was $162,780 and $117,139 at December 31, 2023 and 2022, respectively. The cash surrender value of these insurance policies is included in other assets in the consolidated balance sheets.

- Definition

The entire disclosure for retirement benefits.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-SubTopic 70
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480794/715-70-50-1

Reference 2: http://www.xbrl.org/2003/role/exampleRef
-Topic 715
-SubTopic 20
-Name Accounting Standards Codification
-Section 55
-Paragraph 17
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480482/715-20-55-17

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (d)(iv)(03)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480506/715-20-50-1

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (d)(i)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480506/715-20-50-1

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (q)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480506/715-20-50-1

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (l)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480506/715-20-50-1

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-Name Accounting Standards Codification
-Publisher FASB
-URI https://asc.fasb.org//715/tableOfContent

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (d)(iii)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480506/715-20-50-1

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (o)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480506/715-20-50-1

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (p)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480506/715-20-50-1

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (r)(1)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480506/715-20-50-1

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (r)(2)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480506/715-20-50-1

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-SubTopic 20
-Name Accounting Standards Codification
-Section S99
-Paragraph 2
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480126/715-20-S99-2

Reference 14: http://www.xbrl.org/2003/role/disclosureRef
-Topic 715
-SubTopic 60
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480266/715-60-50-3

+ Details

Income Taxes (Tables)

12 Months Ended

Dec. 31, 2023

Income Tax Disclosure [Abstract]

Schedule of Provision For Income Taxes From Continuing Operations

The provision for income taxes from operations for the years ended December 31, 2023, 2022 and 2021 consists of the following:


	Years Ended December 31,
	2023		2022		2021
Current income taxes:
Federal	$	65,877	$	145,217	$	98,795
State	20,666		42,051		34,025
Total	86,543		187,268		132,820
Deferred income taxes:
Federal	(10,203)		(20,173)		(12,992)
State	(2,730)		(4,442)		(3,295)
Total	(12,933)		(24,615)		(16,287)
Provision for income taxes from operations	$	73,610	$	162,653	$	116,533

Schedule of Income Tax Reconciliation

The Company’s income tax expense differs from the amount that would have resulted from applying the federal statutory rate of 21% for 2023, 2022 and 2021 to pretax income from operations because of the effect of the following items during the years ended December 31, 2023, 2022 and 2021:


	Years Ended December 31,
	2023		2022		2021
Tax expense at federal statutory rate	$	59,701	$	127,390	$	93,223
State taxes, net of federal benefit	14,170		29,711		23,990
Non-deductible expenses	3,010		—		—
Share-based compensation	(944)		(2,383)		(1,460)

Unrecognized tax benefit	1,957		3,245		(680)
Company-owned life insurance policies	(4,428)		4,094		(1,968)
Tax credits	(3,172)		(2,741)		(551)
Other, net	3,316		3,337		3,979
Income tax expense from operations	$	73,610	$	162,653	$	116,533

Schedule of Deferred Tax Assets and Liabilities

The tax effects of temporary differences that give rise to significant portions of deferred tax assets and liabilities are presented below as of December 31, 2023 and 2022:


	December 31,
	2023		2022
Deferred tax assets:
Share-based compensation	$	5,461	$	7,556
Deferred compensation	41,976		32,962
Accrued bonus	2,585		22,437

Accrued expenses	11,426		14,452

Operating lease liabilities	11,296		4,532
Net operating losses	4,809		5,803
Loss contingencies	813		10,857
Workers compensation insurance	5,997		6,661
Professional services expenses	16,242		419
Provision for expected credit losses	9,161		9,074
Sales credits	6,896		6,233
Other	1,516		3,749
Total deferred tax assets	$	118,178	$	124,735
Deferred tax liabilities:
Intangible assets	$	(111,590)	$	(114,967)
Fixed assets	(14,947)		(21,739)
Operating lease right-of-use assets	(8,539)		(4,228)
Other	(6,452)		(6,514)
Total deferred tax liabilities	$	(141,528)	$	(147,448)

Net deferred tax liabilities	$	(23,350)	$	(22,713)

Schedule of Unrecognized Tax Benefits

A summary of the changes in the amount of unrecognized tax benefits (excluding interest and penalties) for 2023, 2022 and 2021 is as follows:


	2023		2022		2021
Beginning balance of unrecognized tax benefits	$	6,980	$	4,067	$	4,916
Additions based on tax positions related to the current year	1,873		1,464		504
Additions based on tax positions of prior years	491		1,966		—
Reductions for tax positions of prior years	—		—		(301)
Reductions due to lapse of applicable statute of limitation	(655)		(517)		(1,052)

Ending balance of unrecognized tax benefits	$	8,689	$	6,980	$	4,067

Acquisitions (Tables)

12 Months Ended

Dec. 31, 2023

Business Combination and Asset Acquisition [Abstract]

Schedule of Fair Value and Useful life of Intangible Assets Acquired

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


		Fair Value		Useful Life
				(in years)
Identifiable intangible assets
	Customer relationships	$	54,300	7 - 10
	Tradenames and trademarks	26,400		3
	Staffing databases	11,300		5
		$	92,000

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

Goodwill and Identifiable Intangible Assets - Estimated Future Amortization (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Finite-Lived Intangible Assets, Net, Amortization Expense, Fiscal Year Maturity [Abstract]
Year ending December 31, 2024	$ 92,766
Year ending December 31, 2025	75,637
Year ending December 31, 2026	67,111
Year ending December 31, 2027	56,070
Year ending December 31, 2028	35,891
Thereafter	146,659
Net Carrying Amount	$ 474,134	$ 476,832

Acquisitions - Connetics Acquisition (Details) - USD ($) $ in Thousands		3 Months Ended			12 Months Ended
	May 13, 2022	Sep. 30, 2023	Jun. 30, 2023	Dec. 31, 2022	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Business Acquisition [Line Items]
Fair value of contingent earn-out				$ 5,070	$ 0	$ 5,070
Payment to settle contingent consideration liabilities					7,500	0	$ 3,100
Goodwill				935,364	$ 1,111,549	$ 935,364	$ 892,341
Connetics Communications, LLC
Business Acquisition [Line Items]
Purchase price	$ 78,764		$ 78,533
Cash consideration	70,764
Contingent earn-out based on future operating performance (up to)	12,500
Fair value of contingent earn-out	8,000
Payment to settle contingent consideration liabilities		$ 7,500
Cash returned to the Company for final working capital settlement				$ 231
Fair value of tangible assets acquired			3,172
Cash received			963
Liabilities assumed			8,244
Identified intangible assets	$ 40,200		40,200
Goodwill			43,405
Goodwill expected to be tax deductible			$ 42,905
Intangible assets acquired, weighted average useful life			13 years

Summary of Significant Accounting Policies - Concentration of Credit Risk (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Concentration Risk [Line Items]
Total cash, cash equivalents and restricted cash and investments	$ 123,836	$ 162,967
One Customer \| Consolidated Revenue \| Customer Concentration Risk
Concentration Risk [Line Items]
Concentration risk percentage	17.00%	18.00%	17.00%

Goodwill and Identifiable Intangible Assets - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2023	Dec. 31, 2022
Finite-Lived Intangible Assets [Line Items]
Aggregate amortization expense, intangible assets		$ 89,756	$ 83,078
Tradenames and trademarks
Finite-Lived Intangible Assets [Line Items]
Intangible asset, no longer considered infinite-lived	$ 89,400
Finite-lived intangible assets, amount with estimated useful lives revised	$ 19,766
Useful life	6 years

Fair Value Measurement (Tables)

12 Months Ended

Dec. 31, 2023

Fair Value Disclosures [Abstract]

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

The following table presents the fair value of commercial paper and corporate bonds issued and outstanding:


	As of December 31, 2023		As of December 31, 2022
Commercial paper	$	48,206	$	31,536
Corporate bonds	—		—
Total classified as restricted cash equivalents	$	48,206	$	31,536
Commercial paper	$	—	$	—
Corporate bonds	15,563		25,095
Total classified as restricted investments	$	15,563	$	25,095

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


	Fair Value Measurements as of December 31, 2023								Fair Value Measurements as of December 31, 2022
Assets (Liabilities)	Level 1		Level 2		Level 3		Total		Level 1		Level 2		Level 3		Total
Money market funds	$	—	$	—	$	—	$	—	$	36,895	$	—	$	—	$	36,895
Deferred compensation	(165,574)		—		—		(165,574)		(128,465)		—		—		(128,465)
Corporate bonds	—		15,563		—		15,563		—		25,095		—		25,095
Commercial paper	—		48,206		—		48,206		—		31,536		—		31,536
Acquisition contingent consideration liabilities	—		—		—		—		—		—		(5,070)		(5,070)

Schedule of Available-for-Sale Securities

The fair value of our available-for-sale securities as of December 31, 2023, by remaining contractual maturities, are presented in the following table:


	Fair Value
Due in one year or less	$	5,635
Due after one year through five years	9,928
	$	15,563

Schedule of Carrying Amounts and Estimated Fair Value of Notes

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


	As of December 31, 2023				As of December 31, 2022
	Carrying Amount		Estimated Fair Value		Carrying Amount		Estimated Fair Value
2027 Notes	$	500,000	$	468,750	$	500,000	$	460,000
2029 Notes	350,000		314,125		350,000		300,125

Fair Value Measurement - Fair Value of Financial Instruments (Details) - Senior Notes - USD ($)	Dec. 31, 2023	Dec. 31, 2022	Oct. 20, 2020	Aug. 13, 2020	Oct. 01, 2019
2027 Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Carrying Amount	$ 500,000,000	$ 500,000,000		$ 200,000,000	$ 300,000,000
Estimated Fair Value	468,750,000	460,000,000
2029 Notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Carrying Amount	350,000,000	350,000,000	$ 350,000,000
Estimated Fair Value	$ 314,125,000	$ 300,125,000

Balance Sheet Details (Tables)

12 Months Ended

Dec. 31, 2023

Balance Sheet Related Disclosures [Abstract]

Schedule of Supplemental Balance Sheet Disclosures

The consolidated balance sheets detail is as follows:


	December 31,
	2023		2022
Other current assets:
Restricted cash and cash equivalents	$	22,056	$	37,225
Income taxes receivable	5,350		8,875
Other	18,264		19,937
Other current assets	$	45,670	$	66,037






Fixed assets:
Furniture and equipment	$	71,815	$	51,408
Software	388,812		323,418
Leasehold improvements	15,839		2,067
	476,466		376,893
Accumulated depreciation	(285,081)		(227,617)
Fixed assets, net	$	191,385	$	149,276

Other assets:
Life insurance cash surrender value	$	162,780	$	117,139
Operating lease right-of-use assets	34,543		16,266
Other	39,473		38,611
Other assets	$	236,796	$	172,016

Accounts payable and accrued expenses:
Trade accounts payable	$	54,128	$	78,057
Subcontractor payable	122,983		295,259
Accrued expenses	82,257		73,885
Loss contingencies	69,837		14,638
Professional liability reserve	7,761		7,756
Other	6,881		6,857
Accounts payable and accrued expenses	$	343,847	$	476,452

Accrued compensation and benefits:
Accrued payroll	$	53,633	$	63,857
Accrued bonuses and commissions	31,236		96,760

ESPP contributions	950		—
Workers compensation reserve	12,130		12,113
Deferred compensation	165,574		128,465
Other	15,013		32,049
Accrued compensation and benefits	$	278,536	$	333,244


	December 31,
	2023		2022
Other current liabilities:
Deferred revenue	$	11,303	$	11,825

Acquisition related liabilities	—		5,070
Client deposits	8,707		21,466
Operating lease liabilities	7,993		8,090
Other	5,735		1,786
Other current liabilities	$	33,738	$	48,237

Other long-term liabilities:
Workers compensation reserve	$	21,169	$	23,841
Professional liability reserve	36,891		36,214


Operating lease liabilities	37,603		9,360
Other	13,316		51,151
Other long-term liabilities	$	108,979	$	120,566

Income Taxes - Unrecognized Tax Benefits (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Reconciliation of Unrecognized Tax Benefits, Excluding Amounts Pertaining to Examined Tax Returns [Roll Forward]
Beginning balance of unrecognized tax benefits	$ 6,980	$ 4,067	$ 4,916
Additions based on tax positions related to the current year	1,873	1,464	504
Additions based on tax positions of prior years	491	1,966	0
Reductions for tax positions of prior years	0	0	(301)
Reductions due to lapse of applicable statute of limitation	(655)	(517)	(1,052)
Ending balance of unrecognized tax benefits	8,689	6,980	4,067
Unrecognized tax benefits that would affect the effective tax rate, net of temporary differences	9,138
Temporary differences that would affect the effective tax rate	1,495
Accrued interest and penalties related to uncertain tax positions	1,942	1,390	564
Interest and penalties recognized	$ 552	$ 826	$ 34

Share-Based Compensation (Tables)

12 Months Ended

Dec. 31, 2023

Share-Based Payment Arrangement [Abstract]

Schedule of RSU and PRSU Activity for Non-vested Awards

The following table summarizes RSU and PRSU activity for the years ended December 31, 2023, 2022 and 2021:


	Number of Shares	Weighted Average Grant Date Fair Value per Share
Unvested at January 1, 2020	717	$	58.88
Granted—RSUs	290	$	85.30
Granted—PRSUs (1)	186	$	97.46
Vested	(280)	$	56.05
Canceled/forfeited	(158)	$	65.69
Unvested at December 31, 2021	755	$	78.13
Granted—RSUs	200	$	109.66
Granted—PRSUs (1)	190	$	92.65
Vested	(405)	$	72.43
Canceled/forfeited	(75)	$	82.13
Unvested at December 31, 2022	665	$	94.79
Granted—RSUs	196	$	95.67
Granted—PRSUs (1)	176	$	109.74
Vested	(349)	$	89.76
Canceled/forfeited	(87)	$	104.14
Unvested at December 31, 2023	601	$	101.01

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

Schedule of Share-based Compensation Expense

Total share-based compensation expense for the years ended December 31, 2023, 2022 and 2021 was as follows:


	Years Ended December 31,
	2023		2022		2021
Share-based employee compensation, before tax	$	18,020	$	30,066	$	25,217
Related income tax benefits	(4,685)		(7,817)		(6,556)
Share-based employee compensation, net of tax	$	13,335	$	22,249	$	18,661

Goodwill and Identifiable Intangible Assets (Tables)

12 Months Ended

Dec. 31, 2023

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of Acquired Intangible Assets By Major Class

As of December 31, 2023 and 2022, the Company had the following acquired intangible assets:


	As of December 31, 2023						As of December 31, 2022
	Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount		Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount
Intangible assets subject to amortization:
Staffing databases	$	52,336	$	(33,398)	$	18,938	$	41,036	$	(24,784)	$	16,252
Customer relationships	532,048		(210,606)		321,442		478,122		(179,795)		298,327
Tradenames and trademarks	284,488		(161,656)		122,832		260,140		(121,576)		138,564
Non-compete agreements	9,399		(6,727)		2,672		7,555		(6,035)		1,520
Acquired technology	37,915		(29,665)		8,250		51,306		(29,137)		22,169
	$	916,186	$	(442,052)	$	474,134	$	838,159	$	(361,327)	$	476,832

Schedule of Estimated Amortization Expense

Based on the net carrying amount of intangible assets subject to amortization, the estimated future amortization expense as of December 31, 2023 is as follows:


	Amount
Year ending December 31, 2024	$	92,766
Year ending December 31, 2025	75,637
Year ending December 31, 2026	67,111
Year ending December 31, 2027	56,070
Year ending December 31, 2028	35,891
Thereafter	146,659
	$	474,134

Schedule of Goodwill

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	42,990		—		—		42,990
Balance, December 31, 2022	382,005		152,800		400,559		935,364
Goodwill adjustment for Connetics acquisition	415		—		—		415
Goodwill from MSDR acquisition	—		175,770		—		175,770
Balance, December 31, 2023	$	382,420	$	328,570	$	400,559	$	1,111,549
Accumulated impairment loss as of December 31, 2022 and 2023	$	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/2003/role/exampleRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 55
-Paragraph 24
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482548/350-20-55-24

Reference 2: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1

Reference 3: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (h)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1

Reference 4: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1

Reference 5: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1

Reference 6: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1

Reference 7: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1

Reference 8: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (e)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1

Reference 9: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (f)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1

Reference 10: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (g)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1

Reference 11: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1A
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482573/350-20-50-1A

Reference 12: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482573/350-20-50-2

+ Details

Insider Trading Arrangements	3 Months Ended
Insider Trading Arrangements	Dec. 31, 2023
Trading Arrangements, by Individual
Rule 10b5-1 Arrangement Adopted	false
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false

Summary of Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2023

Accounting Policies [Abstract]

Schedule of 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 consolidated balance sheets and related notes to the amounts presented in the accompanying consolidated statements of cash flows.


	December 31, 2023		December 31, 2022
Cash and cash equivalents	$	32,935	$	64,524
Restricted cash and cash equivalents (included in other current assets)	22,056		37,225
Restricted cash, cash equivalents and investments	68,845		61,218
Total cash, cash equivalents and restricted cash and investments	123,836		162,967
Less restricted investments	(15,563)		(25,095)
Total cash, cash equivalents and restricted cash	$	108,273	$	137,872

Schedule of Reconciliation of Activity in the Allowance For Credit Losses

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


	2023		2022
Balance as of January 1,	$	31,910	$	6,838

Provision for expected credit losses	5,544		27,622
Amounts written off charged against the allowance	(5,221)		(2,550)

Balance as of December 31,	$	32,233	$	31,910

Schedule of Computation of Basic and Diluted Net income Per Common Share

The following table sets forth the computation of basic and diluted net income per common share for the years ended December 31, 2023, 2022 and 2021, respectively:


	Years Ended December 31,
	2023		2022		2021
Net income	$	210,679	$	444,050	$	327,388

Net income per common share - basic	$	5.38	$	9.96	$	6.87
Net income per common share - diluted	$	5.36	$	9.90	$	6.81

Weighted average common shares outstanding - basic	39,173		44,591		47,685
Plus dilutive effect of potential common shares	168		279		360
Weighted average common shares outstanding - diluted	39,341		44,870		48,045

Schedule of Reconciliation of Revenue and Segment Operating Income by Reportable Segment to Consolidated Results

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:


	Years Ended December 31,
	2023		2022		2021
Revenue
Nurse and allied solutions	$	2,624,509	$	3,982,453	$	2,990,103
Physician and leadership solutions	669,701		697,946		594,243
Technology and workforce solutions	495,044		562,843		399,889
	$	3,789,254	$	5,243,242	$	3,984,235
Segment operating income
Nurse and allied solutions	$	362,158	$	576,226	$	461,311
Physician and leadership solutions	94,966		92,331		81,439
Technology and workforce solutions	214,736		299,390		187,578
	671,860		967,947		730,328
Unallocated corporate overhead	154,484		153,669		123,416
Depreciation and amortization	154,914		133,007		101,152
Depreciation (included in cost of revenue)	6,013		4,104		2,545
Share-based compensation	18,020		30,066		25,217
Interest expense, net, and other	54,140		40,398		34,077
Income before income taxes	$	284,289	$	606,703	$	443,921

Schedule of Revenue Disaggregated by Service Type

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


		Year Ended December 31, 2023
		Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
	Travel nurse staffing	$	1,806,653	$	—	$	—	$	1,806,653
	Labor disruption services	13,303		—		—		13,303
	Local staffing	76,553		—		—		76,553
	Allied staffing	709,632		—		—		709,632
	Locum tenens staffing	—		464,797		—		464,797
	Interim leadership staffing	—		136,953		—		136,953
Temporary staffing		2,606,141		601,750		—		3,207,891
Permanent placement		18,368		67,951		—		86,319
	Language services	—		—		260,121		260,121
	Vendor management systems	—		—		169,370		169,370
	Other technologies	—		—		24,222		24,222
Technology-enabled services		—		—		453,713		453,713
Talent planning and acquisition		—		—		41,331		41,331
Total revenue		$	2,624,509	$	669,701	$	495,044	$	3,789,254


		Year Ended December 31, 2022
		Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
	Travel nurse staffing	$	2,912,677	$	—	$	—	$	2,912,677
	Labor disruption services	112,160		—		—		112,160
	Local staffing	142,724		—		—		142,724
	Allied staffing	806,491		—		—		806,491
	Locum tenens staffing	—		428,133		—		428,133
	Interim leadership staffing	—		184,819		—		184,819
Temporary staffing		3,974,052		612,952		—		4,587,004
Permanent placement		8,401		84,994		—		93,395
	Language services	—		—		216,120		216,120
	Vendor management systems	—		—		265,525		265,525
	Other technologies	—		—		29,553		29,553
Technology-enabled services		—		—		511,198		511,198
Talent planning and acquisition		—		—		51,645		51,645
Total revenue		$	3,982,453	$	697,946	$	562,843	$	5,243,242


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

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 (Loss)
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)
Statement of Stockholders' Equity [Roll Forward]
Repurchase of common stock (in shares)	(25)			(25)
Repurchase of common stock	$ (2,688)			$ (2,688)
Equity awards vested, net of shares withheld for taxes (in shares)		235
Equity awards vested, net of shares withheld for taxes	(7,232)	$ 2	(7,234)
Share-based compensation	25,217		25,217
Comprehensive income (loss)	327,053				327,388	(335)
Ending balance (in shares) at Dec. 31, 2021		49,849
Ending balance at Dec. 31, 2021	$ 1,162,027	$ 498	486,709	$ (121,831)	796,946	(295)
Ending balance (in shares) at Dec. 31, 2021				(2,586)
Statement of Stockholders' Equity [Roll Forward]
Repurchase of common stock (in shares)	(5,644)			(5,644)
Repurchase of common stock	$ (576,767)			$ (576,767)
Equity awards vested, net of shares withheld for taxes (in shares)		260
Equity awards vested, net of shares withheld for taxes	(15,098)	$ 3	(15,101)
Share-based compensation	30,066		30,066
Comprehensive income (loss)	$ 443,406				444,050	(644)
Ending balance (in shares) at Dec. 31, 2022	41,879	50,109
Ending balance at Dec. 31, 2022	$ 1,043,634	$ 501	501,674	$ (698,598)	1,240,996	(939)
Ending balance (in shares) at Dec. 31, 2022	(8,230)			(8,230)
Statement of Stockholders' Equity [Roll Forward]
Repurchase of common stock (in shares)	(4,383)			(4,383)
Repurchase of common stock	$ (428,445)			$ (428,445)
Equity awards vested, net of shares withheld for taxes (in shares)		314
Equity awards vested, net of shares withheld for taxes	(13,148)	$ 3	(13,151)
Share-based compensation	18,020		18,020
Comprehensive income (loss)	$ 211,195				210,679	516
Ending balance (in shares) at Dec. 31, 2023	37,810	50,423
Ending balance at Dec. 31, 2023	$ 831,256	$ 504	$ 506,543	$ (1,127,043)	$ 1,451,675	$ (423)
Ending balance (in shares) at Dec. 31, 2023	(12,613)			(12,613)

Notes Payable and Credit Agreement - Letters of Credit (Details) - Standby Letters of Credit - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Line of Credit Facility [Line Items]
Letters of credit, amount outstanding	$ 21,312	$ 21,962
Debt collateral	$ 554

CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Current assets:
Cash and cash equivalents	$ 32,935	$ 64,524
Accounts receivable, net of allowances of $32,233 and $31,910 at December 31, 2023 and 2022, respectively	623,488	675,650
Accounts receivable, subcontractor	117,703	268,726
Prepaid expenses	21,889	18,708
Other current assets	45,670	66,037
Total current assets	841,685	1,093,645
Restricted cash, cash equivalents and investments	68,845	61,218
Fixed assets, net of accumulated depreciation of $285,081 and $227,617 at December 31, 2023 and 2022, respectively	191,385	149,276
Other assets	236,796	172,016
Goodwill	1,111,549	935,364
Intangible assets, net of accumulated amortization of $442,052 and $361,327 at December 31, 2023 and 2022, respectively	474,134	476,832
Total assets	2,924,394	2,888,351
Current liabilities:
Accounts payable and accrued expenses	343,847	476,452
Accrued compensation and benefits	278,536	333,244
Other current liabilities	33,738	48,237
Total current liabilities	656,121	857,933
Revolving credit facility	460,000	0
Notes payable, net of unamortized fees and premium	844,688	843,505
Deferred income taxes, net	23,350	22,713
Other long-term liabilities	108,979	120,566
Total liabilities	2,093,138	1,844,717
Commitments and contingencies
Stockholders’ equity:
Preferred stock, $0.01 par value; 10,000 shares authorized; none issued and outstanding at December 31, 2023 and 2022	0	0
Common stock, $0.01 par value; 200,000 shares authorized; 50,423 issued and 37,810 outstanding at December 31, 2023 and 50,109 issued and 41,879 outstanding at December 31, 2022	504	501
Additional paid-in capital	506,543	501,674
Treasury stock, at cost; 12,613 and 8,230 shares at December 31, 2023 and 2022, respectively	(1,127,043)	(698,598)
Retained earnings	1,451,675	1,240,996
Accumulated other comprehensive loss	(423)	(939)
Total stockholders’ equity	831,256	1,043,634
Total liabilities and stockholders’ equity	$ 2,924,394	$ 2,888,351

Share-Based Compensation

12 Months Ended

Dec. 31, 2023

Share-Based Payment Arrangement [Abstract]

Share-Based Compensation

(a) Equity Award Plans

Equity Plan

The Company established the AMN Healthcare Equity Plan (as amended or amended and restated from time to time, the “Equity Plan”), which has been approved by the Company’s stockholders. Any shares to be issued under the Equity Plan will be issued by the Company from authorized but unissued common stock or shares of common stock reacquired by the Company. As of December 31, 2023 and 2022, 2,264 and 2,414 shares of common stock were reserved for future grants under the Equity Plan, respectively.

Employee Stock Purchase Plan

During 2023, the Company established the AMN Healthcare Services, Inc. Employee Stock Purchase Plan (the “ESPP”) which authorizes the issuance of up to 1,000 shares of the Company’s common stock. The ESPP provides eligible employees with the opportunity to purchase shares of the Company’s common stock at a discount through payroll deductions during a six-month purchase period. Shares will be purchased at 85% of the fair market value of the Company’s common stock on the offering date or the purchase date of the applicable purchase period, whichever is lower. No purchases were made and no shares were issued under the ESPP during the year ended December 31, 2023, and all of the authorized shares remained available for future issuance.

Other Plans

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

Additionally, the Company established the 2014 Employment Inducement Plan, which reserves for issuance 200 shares of common stock for prospective employees of the Company. As of December 31, 2023, 181 shares of common stock remained available for future grants under the 2014 Employment Inducement Plan.

(b) Share-Based Compensation

Restricted Stock Units

RSUs and PRSUs (subject to performance conditions being achieved) granted under the Equity Plan generally entitle the holder to receive, at the end of a vesting period, a specified number of shares of the Company’s common stock. The following table summarizes RSU and PRSU activity for the years ended December 31, 2023, 2022 and 2021:


	Number of Shares	Weighted Average Grant Date Fair Value per Share
Unvested at January 1, 2020	717	$	58.88
Granted—RSUs	290	$	85.30
Granted—PRSUs (1)	186	$	97.46
Vested	(280)	$	56.05
Canceled/forfeited	(158)	$	65.69
Unvested at December 31, 2021	755	$	78.13
Granted—RSUs	200	$	109.66
Granted—PRSUs (1)	190	$	92.65
Vested	(405)	$	72.43
Canceled/forfeited	(75)	$	82.13
Unvested at December 31, 2022	665	$	94.79
Granted—RSUs	196	$	95.67
Granted—PRSUs (1)	176	$	109.74
Vested	(349)	$	89.76
Canceled/forfeited	(87)	$	104.14
Unvested at December 31, 2023	601	$	101.01

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

As of December 31, 2023, there was $26,499 unrecognized compensation cost related to unvested RSUs and PRSUs. The Company expects to recognize such cost over a period of 1.8 years. As of December 31, 2023 and 2022, the aggregate intrinsic value of the RSUs and PRSUs outstanding was $44,979 and $68,348, respectively.

Share-Based Compensation

Total share-based compensation expense for the years ended December 31, 2023, 2022 and 2021 was as follows:


	Years Ended December 31,
	2023		2022		2021
Share-based employee compensation, before tax	$	18,020	$	30,066	$	25,217
Related income tax benefits	(4,685)		(7,817)		(6,556)
Share-based employee compensation, net of tax	$	13,335	$	22,249	$	18,661

Income Taxes

12 Months Ended

Dec. 31, 2023

Income Tax Disclosure [Abstract]

Income Taxes

The provision for income taxes from operations for the years ended December 31, 2023, 2022 and 2021 consists of the following:


	Years Ended December 31,
	2023		2022		2021
Current income taxes:
Federal	$	65,877	$	145,217	$	98,795
State	20,666		42,051		34,025
Total	86,543		187,268		132,820
Deferred income taxes:
Federal	(10,203)		(20,173)		(12,992)
State	(2,730)		(4,442)		(3,295)
Total	(12,933)		(24,615)		(16,287)
Provision for income taxes from operations	$	73,610	$	162,653	$	116,533

Certain reclassifications have been made to the prior years’ presentation of income tax expense in the table below in order to conform to the current year presentation. There is no change to the prior years’ income tax expense from operations. The Company’s income tax expense differs from the amount that would have resulted from applying the federal statutory rate of 21% for 2023, 2022 and 2021 to pretax income from operations because of the effect of the following items during the years ended December 31, 2023, 2022 and 2021:


	Years Ended December 31,
	2023		2022		2021
Tax expense at federal statutory rate	$	59,701	$	127,390	$	93,223
State taxes, net of federal benefit	14,170		29,711		23,990
Non-deductible expenses	3,010		—		—
Share-based compensation	(944)		(2,383)		(1,460)

Unrecognized tax benefit	1,957		3,245		(680)
Company-owned life insurance policies	(4,428)		4,094		(1,968)
Tax credits	(3,172)		(2,741)		(551)
Other, net	3,316		3,337		3,979
Income tax expense from operations	$	73,610	$	162,653	$	116,533

Certain reclassifications have been made to the prior year’s presentation of deferred tax assets in the table below in order to conform to the current year presentation. There is no change to the prior year total deferred tax assets. The tax effects of temporary differences that give rise to significant portions of deferred tax assets and liabilities are presented below as of December 31, 2023 and 2022:


	December 31,
	2023		2022
Deferred tax assets:
Share-based compensation	$	5,461	$	7,556
Deferred compensation	41,976		32,962
Accrued bonus	2,585		22,437

Accrued expenses	11,426		14,452

Operating lease liabilities	11,296		4,532
Net operating losses	4,809		5,803
Loss contingencies	813		10,857
Workers compensation insurance	5,997		6,661
Professional services expenses	16,242		419
Provision for expected credit losses	9,161		9,074
Sales credits	6,896		6,233
Other	1,516		3,749
Total deferred tax assets	$	118,178	$	124,735
Deferred tax liabilities:
Intangible assets	$	(111,590)	$	(114,967)
Fixed assets	(14,947)		(21,739)
Operating lease right-of-use assets	(8,539)		(4,228)
Other	(6,452)		(6,514)
Total deferred tax liabilities	$	(141,528)	$	(147,448)

Net deferred tax liabilities	$	(23,350)	$	(22,713)

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

The amount of federal net operating losses (“NOL”) carryforward that is available for use in years subsequent to December 31, 2023 is $22,310, which begins to expire by 2030. The amount of state NOL carryforward that is available for use in years subsequent to December 31, 2023 is $1,616, which begins to expire by 2036.

A summary of the changes in the amount of unrecognized tax benefits (excluding interest and penalties) for 2023, 2022 and 2021 is as follows:


	2023		2022		2021
Beginning balance of unrecognized tax benefits	$	6,980	$	4,067	$	4,916
Additions based on tax positions related to the current year	1,873		1,464		504
Additions based on tax positions of prior years	491		1,966		—
Reductions for tax positions of prior years	—		—		(301)
Reductions due to lapse of applicable statute of limitation	(655)		(517)		(1,052)

Ending balance of unrecognized tax benefits	$	8,689	$	6,980	$	4,067

At December 31, 2023, if recognized, approximately $9,138 net of $1,495 of temporary differences would affect the effective tax rate (including interest and penalties).

The Company recognizes interest related to unrecognized tax benefits in income tax expense. The Company had approximately $1,942, $1,390 and $564 of accrued interest related to unrecognized tax benefits at December 31, 2023, 2022

and 2021, respectively. The amount of interest expense recognized in 2023, 2022 and 2021 was $552, $826 and $34, respectively.

The Company is subject to taxation in the U.S. and various states and foreign jurisdictions. With few exceptions, as of December 31, 2023, 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 2020.

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

Pursuant to the business tax provisions in the Coronavirus Aid, Relief, and Economic Security Act (the “CARES Act”), the Company deferred payment of the employer’s share of payroll taxes of $48,452. Approximately half of such taxes was paid during the fourth quarter of 2021 and the remaining balance was paid during the fourth quarter of 2022.

- 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
-Topic 946
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 13
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480990/946-20-50-13

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 235
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(h)(2))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480678/235-10-S99-1

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-Name Accounting Standards Codification
-Publisher FASB
-URI https://asc.fasb.org//740/tableOfContent

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 14
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482685/740-10-50-14

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 21
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482685/740-10-50-21

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 270
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482526/740-270-50-1

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 17
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482685/740-10-50-17

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SAB TOPIC 6.I.5.Q1)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479360/740-10-S99-1

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 2
-Subparagraph (SAB Topic 11.C)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479360/740-10-S99-2

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 30
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482603/740-30-50-2

+ Details

Audit Information	12 Months Ended
Audit Information	Dec. 31, 2023
Audit Information [Abstract]
Auditor Name	KPMG LLP
Auditor Location	San Diego, California
Auditor Firm ID	185

Retirement Plans - Deferred Compensation Plan (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Deferred Compensation Arrangement with Individual, Postretirement Benefits [Line Items]
Life insurance cash surrender value	$ 162,780	$ 117,139
Key Executives and Key Employees
Deferred Compensation Arrangement with Individual, Postretirement Benefits [Line Items]
Service vesting period	5 years
Maximum percent of base salary deferrable	80.00%
Maximum percent of bonus deferrable	90.00%
Maximum percent of vested RSUs and PRSUs deferrable	100.00%
Employer contributions	$ 10,822	$ 18,023	$ 8,951

Goodwill and Identifiable Intangible Assets - Acquired Intangible Assets (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	$ 916,186	$ 838,159
Accumulated Amortization	(442,052)	(361,327)
Net Carrying Amount	474,134	476,832
Staffing databases
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	52,336	41,036
Accumulated Amortization	(33,398)	(24,784)
Net Carrying Amount	18,938	16,252
Customer relationships
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	532,048	478,122
Accumulated Amortization	(210,606)	(179,795)
Net Carrying Amount	321,442	298,327
Tradenames and trademarks
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	284,488	260,140
Accumulated Amortization	(161,656)	(121,576)
Net Carrying Amount	122,832	138,564
Non-compete agreements
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	9,399	7,555
Accumulated Amortization	(6,727)	(6,035)
Net Carrying Amount	2,672	1,520
Acquired technology
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	37,915	51,306
Accumulated Amortization	(29,665)	(29,137)
Net Carrying Amount	$ 8,250	$ 22,169

Leases - Maturity of Lease Liabilities (Details) $ in Thousands	Dec. 31, 2023 USD ($)
Lessee, Operating Lease, Liability, to be Paid [Abstract]
2024	$ 10,584
2025	8,150
2026	6,437
2027	6,494
2028	6,665
Thereafter	16,765
Total lease payments	55,095
Less imputed interest	(9,499)
Present value of lease liabilities	$ 45,596

Commitments and Contingencies (Details) $ in Thousands	Dec. 31, 2023 USD ($)
Pending Litigation \| Wage and Hour Claims
Loss Contingencies [Line Items]
Litigation matters accrual	$ 62,000

Fair Value Measurement - Schedule of Available-for-sale Securities (Details) $ in Thousands	Dec. 31, 2023 USD ($)
Debt Securities, Available-for-sale, Maturity, Allocated and Single Maturity Date, Fair Value [Abstract]
Due in one year or less	$ 5,635
Due after one year through five years	9,928
Total	$ 15,563

Goodwill and Identifiable Intangible Assets

12 Months Ended

Dec. 31, 2023

Goodwill and Intangible Assets Disclosure [Abstract]

Goodwill and Identifiable Intangible Assets

As of December 31, 2023 and 2022, the Company had the following acquired intangible assets:


	As of December 31, 2023						As of December 31, 2022
	Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount		Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount
Intangible assets subject to amortization:
Staffing databases	$	52,336	$	(33,398)	$	18,938	$	41,036	$	(24,784)	$	16,252
Customer relationships	532,048		(210,606)		321,442		478,122		(179,795)		298,327
Tradenames and trademarks	284,488		(161,656)		122,832		260,140		(121,576)		138,564
Non-compete agreements	9,399		(6,727)		2,672		7,555		(6,035)		1,520
Acquired technology	37,915		(29,665)		8,250		51,306		(29,137)		22,169
	$	916,186	$	(442,052)	$	474,134	$	838,159	$	(361,327)	$	476,832

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

Aggregate amortization expense for intangible assets was $89,756 and $83,078 for the years ended December 31, 2023 and 2022, respectively. Based on the net carrying amount of intangible assets subject to amortization, the estimated future amortization expense as of December 31, 2023 is as follows:


	Amount
Year ending December 31, 2024	$	92,766
Year ending December 31, 2025	75,637
Year ending December 31, 2026	67,111
Year ending December 31, 2027	56,070
Year ending December 31, 2028	35,891
Thereafter	146,659
	$	474,134

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	42,990		—		—		42,990
Balance, December 31, 2022	382,005		152,800		400,559		935,364
Goodwill adjustment for Connetics acquisition	415		—		—		415
Goodwill from MSDR acquisition	—		175,770		—		175,770
Balance, December 31, 2023	$	382,420	$	328,570	$	400,559	$	1,111,549
Accumulated impairment loss as of December 31, 2022 and 2023	$	154,444	$	60,495	$	—	$	214,939

Summary of Significant Accounting Policies

12 Months Ended

Dec. 31, 2023

Accounting Policies [Abstract]

Summary of Significant Accounting Policies

(a) General

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

(b) Principles of Consolidation

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

The preparation of financial statements in conformity with accounting principles generally accepted in the United States of America requires management to make a number of estimates and assumptions relating to the reporting of assets and liabilities and the disclosure of contingent assets and liabilities at the dates of the financial statements and the reported amounts of revenue and expenses during the reporting periods. On an ongoing basis, the Company evaluates its estimates, including those related to goodwill and indefinite-lived intangible assets, professional liability reserve, contingent liabilities such as legal accruals, and income taxes. The Company bases these estimates on the information that is currently available and on various other assumptions that it believes are reasonable under the circumstances. Actual results could differ from those estimates under different assumptions or conditions.

(d) Cash and Cash Equivalents

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

(e) Restricted Cash, Cash Equivalents and Investments

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


	December 31, 2023		December 31, 2022
Cash and cash equivalents	$	32,935	$	64,524
Restricted cash and cash equivalents (included in other current assets)	22,056		37,225
Restricted cash, cash equivalents and investments	68,845		61,218
Total cash, cash equivalents and restricted cash and investments	123,836		162,967
Less restricted investments	(15,563)		(25,095)
Total cash, cash equivalents and restricted cash	$	108,273	$	137,872

(f) Fixed Assets

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

method based on the estimated useful lives of the related assets (typically three to ten years). The Company depreciates leasehold improvements and equipment obtained under finance leases over the shorter of the term of the lease or their estimated useful lives. The Company includes depreciation of equipment obtained under finance leases with depreciation expense in the accompanying consolidated financial statements.

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

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

(g) Leases

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

Operating lease right-of-use assets are included in other assets, and operating lease liabilities are included in other current liabilities and other long-term liabilities in the consolidated balance sheets.

(h) Goodwill

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

(i) Intangible Assets

Intangible assets consist of identifiable intangible assets acquired through acquisitions, which include tradenames and trademarks, customer relationships, staffing databases, developed technology and non-compete agreements. The Company amortizes intangible assets, other than those with an indefinite life, using the straight-line method over their useful lives. The Company amortizes non-compete agreements using the straight-line method over the lives of the related agreements. The Company reviews for impairment intangible assets with estimable useful lives whenever events or changes in circumstances indicate that the carrying amount may not be recoverable.

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

fair value with its carrying amount. If the carrying amount exceeds the fair value, the Company records the excess as an impairment loss.

(j) Insurance Reserves

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

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

(k) Revenue Recognition

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

The Company’s customers are primarily billed as services are rendered. Any fees billed in advance of being earned are recorded as deferred revenue. While payment terms vary by the type of customer and the services rendered, the term between invoicing and when payment is due is not significant.

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

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

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

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

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

(l) Accounts Receivable

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

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


	2023		2022
Balance as of January 1,	$	31,910	$	6,838

Provision for expected credit losses	5,544		27,622
Amounts written off charged against the allowance	(5,221)		(2,550)

Balance as of December 31,	$	32,233	$	31,910

The increase in the provision for expected credit losses for the year ended December 31, 2022 was primarily the result of developments that raised concern with a specific customer’s ability to meet its financial obligations, and uncertainty regarding the collectability of cash flows from other customers due primarily to the macroeconomic outlook.

(m) Concentration of Credit Risk

The majority of the Company’s business activity is with hospitals located throughout the United States. Credit is extended based on the evaluation of each entity’s financial condition. One customer primarily within the Company’s nurse and allied solutions segment comprised approximately 17%, 18% and 17% of the consolidated revenue of the Company for the years ended December 31, 2023, 2022 and 2021, respectively.

The Company’s cash and cash equivalents and restricted cash, cash equivalents and investments accounts are financial instruments that are exposed to concentration of credit risk. The Company maintains most of its cash, cash equivalents and investment balances with high-credit quality and federally insured institutions. However, cash equivalents and restricted cash equivalents and investment balances may be invested in non-federally insured money market funds, commercial paper and corporate bonds. As of December 31, 2023 and 2022, there were $123,836 and $162,967, respectively, of cash, cash equivalents and restricted cash, cash equivalents and investments, a portion of which was invested in non-federally insured money market funds, commercial paper and corporate bonds. See Note (3), “Fair Value Measurement,” for additional information.

(n) Income Taxes

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

the period in which the change in judgment occurs. The Company records interest and penalties related to unrecognized tax benefits in income tax expense.

(o) Fair Value of Financial Instruments

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

(p) Share-Based Compensation

The Company accounts for its share-based employee compensation plans by expensing the estimated fair value of share-based awards on a straight-line basis over the requisite employee service period, which typically is the vesting period, except for awards granted to retirement-eligible employees, which are expensed on an accelerated basis. Restricted stock units (“RSUs”) typically vest over a three-year period. Share-based compensation cost of RSUs is measured by the market value of the Company’s common stock on the date of grant, and the Company records share-based compensation expense only for those awards that are expected to vest. Performance restricted stock units (“PRSUs”) primarily consist of PRSUs that contain performance conditions dependent on defined targets of the Company’s adjusted EBITDA, with a range of 0% to 200% of the target amount granted to be issued under the award. Share-based compensation cost for these PRSUs is measured by the market value of the Company’s common stock on the date of grant, and the amount recognized is adjusted for estimated achievement of the performance conditions. A limited amount of PRSUs contain a market condition dependent upon the Company’s relative and absolute total stockholder return over a three-year period, with a range of 0% to 175% of the target amount granted to be issued under the award. Share-based compensation cost for these PRSUs is measured using the Monte-Carlo simulation valuation model and is not adjusted for the achievement, or lack thereof, of the market conditions. Share-based compensation cost for purchase rights granted under the Company’s employee stock purchase plan is measured using the Black-Scholes model and the related employee contributions are included in accrued compensation and benefits in the consolidated balance sheets. See Note (11), “Share-Based Compensation,” for additional information.

(q) Net Income per Common Share

Share-based awards to purchase 88, 19 and 33 shares of common stock for the years ended December 31, 2023, 2022 and 2021, respectively, were not included in the calculation of diluted net income per common share because the effect of these instruments was anti-dilutive.

The following table sets forth the computation of basic and diluted net income per common share for the years ended December 31, 2023, 2022 and 2021, respectively:


	Years Ended December 31,
	2023		2022		2021
Net income	$	210,679	$	444,050	$	327,388

Net income per common share - basic	$	5.38	$	9.96	$	6.87
Net income per common share - diluted	$	5.36	$	9.90	$	6.81

Weighted average common shares outstanding - basic	39,173		44,591		47,685
Plus dilutive effect of potential common shares	168		279		360
Weighted average common shares outstanding - diluted	39,341		44,870		48,045

(r) Segment Information

The Company’s operating segments are identified in the same manner as they are reported internally and used by the Company’s chief operating decision maker for the purpose of evaluating performance and allocating resources. 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, and allied staffing (including 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 (“VMS”), workforce optimization, 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.


	Years Ended December 31,
	2023		2022		2021
Revenue
Nurse and allied solutions	$	2,624,509	$	3,982,453	$	2,990,103
Physician and leadership solutions	669,701		697,946		594,243
Technology and workforce solutions	495,044		562,843		399,889
	$	3,789,254	$	5,243,242	$	3,984,235
Segment operating income
Nurse and allied solutions	$	362,158	$	576,226	$	461,311
Physician and leadership solutions	94,966		92,331		81,439
Technology and workforce solutions	214,736		299,390		187,578
	671,860		967,947		730,328
Unallocated corporate overhead	154,484		153,669		123,416
Depreciation and amortization	154,914		133,007		101,152
Depreciation (included in cost of revenue)	6,013		4,104		2,545
Share-based compensation	18,020		30,066		25,217
Interest expense, net, and other	54,140		40,398		34,077
Income before income taxes	$	284,289	$	606,703	$	443,921

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


		Year Ended December 31, 2023
		Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
	Travel nurse staffing	$	1,806,653	$	—	$	—	$	1,806,653
	Labor disruption services	13,303		—		—		13,303
	Local staffing	76,553		—		—		76,553
	Allied staffing	709,632		—		—		709,632
	Locum tenens staffing	—		464,797		—		464,797
	Interim leadership staffing	—		136,953		—		136,953
Temporary staffing		2,606,141		601,750		—		3,207,891
Permanent placement		18,368		67,951		—		86,319
	Language services	—		—		260,121		260,121
	Vendor management systems	—		—		169,370		169,370
	Other technologies	—		—		24,222		24,222
Technology-enabled services		—		—		453,713		453,713
Talent planning and acquisition		—		—		41,331		41,331
Total revenue		$	2,624,509	$	669,701	$	495,044	$	3,789,254


		Year Ended December 31, 2022
		Nurse and Allied Solutions		Physician and Leadership Solutions		Technology and Workforce Solutions		Total
	Travel nurse staffing	$	2,912,677	$	—	$	—	$	2,912,677
	Labor disruption services	112,160		—		—		112,160
	Local staffing	142,724		—		—		142,724
	Allied staffing	806,491		—		—		806,491
	Locum tenens staffing	—		428,133		—		428,133
	Interim leadership staffing	—		184,819		—		184,819
Temporary staffing		3,974,052		612,952		—		4,587,004
Permanent placement		8,401		84,994		—		93,395
	Language services	—		—		216,120		216,120
	Vendor management systems	—		—		265,525		265,525
	Other technologies	—		—		29,553		29,553
Technology-enabled services		—		—		511,198		511,198
Talent planning and acquisition		—		—		51,645		51,645
Total revenue		$	3,982,453	$	697,946	$	562,843	$	5,243,242


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

(s) Reclassifications

To conform to the current year presentation, certain reclassifications have been made to prior year balances in the consolidated balance sheets and accompanying Note (6 ), “Balance Sheet Details.”

(t) Recently Adopted Accounting Pronouncements

In October 2021, the Financial Accounting Standards Board issued Accounting Standards Update (“ASU”) 2021-08, “Business Combinations (Topic 805): Accounting for Contract Assets and Contract Liabilities from Contracts with Customers.” The new guidance requires companies to apply the definition of a performance obligation under Accounting Standards Codification (“ASC”) Topic 606, Revenue from Contracts with Customers, to recognize and measure contract assets and contract liabilities, such as deferred revenue, relating to contracts with customers that are acquired in a business combination. Under prior guidance, an acquirer generally recognized assets acquired and liabilities assumed in a business combination, including contract assets and contract liabilities arising from revenue contracts with customers, at their acquisition-date fair values in accordance with ASC Subtopic 820-10, Fair Value Measurements—Overall. Generally, this new guidance will result in the acquirer recognizing acquired contract assets and liabilities on the same basis that would have been recorded by the acquiree prior to the acquisition under ASC Topic 606. The Company adopted this standard effective January 1, 2023 on a prospective basis, and the adoption did not have a material effect on the Company’s consolidated financial statements.

Share-Based Compensation - Share Based Compensation Expense (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Share-Based Payment Arrangement [Abstract]
Share-based employee compensation, before tax	$ 18,020	$ 30,066	$ 25,217
Related income tax benefits	(4,685)	(7,817)	(6,556)
Share-based employee compensation, net of tax	$ 13,335	$ 22,249	$ 18,661

Pay vs Performance Disclosure - USD ($) $ in Thousands	12 Months Ended
Pay vs Performance Disclosure - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Pay vs Performance Disclosure
Net Income (Loss) Attributable to Parent	$ 210,679	$ 444,050	$ 327,388

- Definition

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

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

Acquisitions - Synzi and SnapMD Acquisition (Details) - USD ($) $ in Thousands		3 Months Ended
	Apr. 07, 2021	Jun. 30, 2022	Jun. 30, 2021	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Business Acquisition [Line Items]
Goodwill				$ 1,111,549	$ 935,364	$ 892,341
Synzi
Business Acquisition [Line Items]
Purchase price	$ 42,240	$ 42,148
Cash returned to the Company for final working capital settlement			$ 92
Fair value of tangible assets acquired		2,757
Cash received		884
Liabilities assumed		275
Identified intangible assets		12,440
Goodwill		27,226
Goodwill expected to be tax deductible		$ 6,044
Weighted average useful life of intangible assets		7 years
Synzi \| Developed Technology Rights
Business Acquisition [Line Items]
Identified intangible assets		$ 10,890
Synzi \| Trademarks
Business Acquisition [Line Items]
Identified intangible assets		$ 1,220

Capital Stock - Additional Information (Details) - USD ($)				3 Months Ended	7 Months Ended	12 Months Ended
	Aug. 10, 2023	May 08, 2023	Feb. 16, 2023	Aug. 10, 2023	Jun. 15, 2022	Dec. 31, 2023	Dec. 31, 2022	Nov. 01, 2016
Preferred Stock, Number of Shares, Par Value and Other Disclosures [Abstract]
Preferred stock, shares authorized (in shares)						10,000,000	10,000,000
Preferred stock, par value (in dollars per share)						$ 0.01	$ 0.01
Preferred stock, shares outstanding (in shares)						0	0
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Stock repurchase program, authorized amount (up to)						$ 1,350,000,000		$ 150,000,000
Stock repurchase program, authorized cumulative amount			$ 500,000,000		$ 700,000,000
Stock repurchase program, remaining authorized repurchase amount						$ 226,658,000
Treasury stock, shares, acquired excluding accelerated share repurchases (in shares)						2,362,000
Treasury stock, shares acquired, average cost per share excluding accelerated share repurchases (in dollars per share)						$ 95.13
Aggregate purchase price excluding accelerated share repurchases						$ 224,744,000
Accelerated Share Repurchase Agreement
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Accelerated share repurchases, prepaid amount		$ 200,000,000
Accelerated share repurchases, initial delivery, shares (in shares)		1,760,000
Accelerated share repurchases, shares repurchased, percentage	20.00%	80.00%
Accelerated share repurchases, initial price paid per share (in dollars per share)		$ 90.89
Accelerated share repurchases, final delivery, shares (in shares)	261,000
Accelerated share repurchases, final price paid per share (in dollars per share)				$ 98.97

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands

12 Months Ended

Dec. 31, 2023

Dec. 31, 2022

Dec. 31, 2021

Cash flows from operating activities:

Net income

$ 210,679

$ 444,050

$ 327,388

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

Depreciation and amortization (inclusive of depreciation included in cost of revenue)

160,927

137,111

103,697

Non-cash interest expense and other

8,821

5,330

(4,067)

Write-off of fees on credit facilities and senior notes

158

Change in fair value of contingent consideration liabilities

2,430

(2,930)

Increase in allowance for credit losses and sales credits

23,913

57,999

6,263

Provision for deferred income taxes

(12,933)

(24,615)

(16,287)

Share-based compensation

18,020

30,066

25,217

Net loss (gain) on deferred compensation balances

465

(526)

Loss on disposal or impairment of long-lived assets

8,053

1,560

2,707

Net loss (gain) on investments in available-for-sale securities

302

749

(52)

Non-cash lease expense

1,619

5,497

3,806

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

Accounts receivable

70,033

57,921

(419,533)

Accounts receivable, subcontractor

151,023

(29,007)

(165,734)

Income taxes receivable

3,793

(8,875)

6,591

Prepaid expenses

(1,542)

53,806

(58,788)

Other current assets

4,197

17,775

(21,999)

Other assets

(3,177)

210

3,262

Accounts payable and accrued expenses

(183,517)

48,782

256,118

Accrued compensation and benefits

(80,135)

(10,506)

129,235

Other liabilities

(10,248)

(126,566)

122,685

Deferred revenue

(558)

(4,098)

4,320

Restricted investments balance

349

Net cash provided by operating activities

372,165

653,733

305,356

Cash flows from investing activities:

Purchase and development of fixed assets

(103,687)

(75,831)

(53,573)

Purchase of investments

(13,152)

(60,719)

Proceeds from sale and maturity of investments

9,894

14,384

57,660

Purchase of equity investment

(500)

Proceeds from sale of equity investment

Payments to fund deferred compensation plan

(24,902)

(21,518)

(7,565)

Cash paid for initial direct costs

(1,429)

Cash paid for acquisitions, net of cash and restricted cash received

(292,175)

(69,570)

(41,264)

Cash paid for other intangibles

(1,700)

(5,091)

(90)

Net cash used in investing activities

(412,493)

(170,710)

(107,402)

Cash flows from financing activities:

Payments on term loans

(21,875)

Payments on revolving credit facility

(355,000)

(70,000)

Proceeds from revolving credit facility

815,000

70,000

Payments on loans payable

(300)

Repurchase of common stock

^[1]

(424,744)

(576,767)

(2,688)

Payment of financing costs

(3,579)

Earn-out payments to settle contingent consideration liabilities for prior acquisitions

(7,500)

(3,100)

Cash paid for shares withheld for taxes

(13,148)

(15,098)

(7,232)

Net cash provided by (used in) financing activities

10,729

(591,865)

(34,895)

Effect of exchange rate changes on cash

(335)

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

(29,599)

(108,842)

162,724

Cash, cash equivalents and restricted cash at beginning of year

137,872

246,714

83,990

Cash, cash equivalents and restricted cash at end of year

108,273

137,872

246,714

Supplemental disclosures of cash flow information:

Cash paid for amounts included in the measurement of operating lease liabilities

9,311

13,337

39,865

Cash paid for interest (net of $1,229, $703 and $349 capitalized in 2023, 2022 and 2021, respectively)

48,101

37,518

38,085

Cash paid for income taxes

78,256

213,807

106,379

Acquisitions:

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

48,941

2,604

1,906

Goodwill

175,770

42,990

27,193

Intangible assets

92,000

40,200

12,440

Liabilities assumed

(24,536)

(8,224)

(275)

Contingent consideration liabilities

(8,000)

Net cash paid for acquisitions

292,175

69,570

41,264

Supplemental disclosures of non-cash investing and financing activities:

Purchase of fixed assets recorded in accounts payable and accrued expenses

8,130

5,643

3,719

Excise tax payable on share repurchases

3,701

Right-of-use assets obtained in exchange for operating lease liabilities

$ 36,560

$ 5,680

$ 2,672

[1]	The difference between the amount reported for the year ended December 31, 2023 and the corresponding amount presented in the consolidated statements of stockholders’ equity is due to accrued excise tax payable on share repurchases which is recorded within treasury stock.

Notes Payable and Credit Agreement (Tables)

12 Months Ended

Dec. 31, 2023

Debt Disclosure [Abstract]

Schedule of Outstanding Debt

Outstanding debt balances as of December 31, 2023 and 2022 consisted of the following:


	As of December 31,
	2023		2022

Senior Credit Facility	$	460,000	$	—

2027 Notes	500,000		500,000
2029 Notes	350,000		350,000
Total debt outstanding	1,310,000		850,000
Less unamortized fees and premium	(5,312)		(6,495)

Long-term portion of notes payable	$	1,304,688	$	843,505

Income Taxes - Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Deferred tax assets:
Share-based compensation	$ 5,461	$ 7,556
Deferred compensation	41,976	32,962
Accrued bonus	2,585	22,437
Accrued expenses	11,426	14,452
Operating lease liabilities	11,296	4,532
Net operating losses	4,809	5,803
Loss contingencies	813	10,857
Workers compensation insurance	5,997	6,661
Professional services expenses	16,242	419
Provision for expected credit losses	9,161	9,074
Sales credits	6,896	6,233
Other	1,516	3,749
Total deferred tax assets	118,178	124,735
Deferred tax liabilities:
Intangible assets	(111,590)	(114,967)
Fixed assets	(14,947)	(21,739)
Operating lease right-of-use assets	(8,539)	(4,228)
Other	(6,452)	(6,514)
Total deferred tax liabilities	(141,528)	(147,448)
Net deferred tax liabilities	$ (23,350)	$ (22,713)

Balance Sheet Details (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Other current assets:
Restricted cash and cash equivalents	$ 22,056	$ 37,225
Income taxes receivable	5,350	8,875
Other	18,264	19,937
Other current assets	45,670	66,037
Fixed assets:
Furniture and equipment	71,815	51,408
Software	388,812	323,418
Leasehold improvements	15,839	2,067
Fixed assets, gross	476,466	376,893
Accumulated depreciation	(285,081)	(227,617)
Fixed assets, net	191,385	149,276
Other assets:
Life insurance cash surrender value	162,780	117,139
Operating lease right-of-use assets	$ 34,543	$ 16,266
Operating lease right-of-use asset [Extensible Enumeration]	Other assets	Other assets
Other	$ 39,473	$ 38,611
Other assets	236,796	172,016
Accounts payable and accrued expenses:
Trade accounts payable	54,128	78,057
Subcontractor payable	122,983	295,259
Accrued expenses	82,257	73,885
Loss contingencies	69,837	14,638
Professional liability reserve	7,761	7,756
Other	6,881	6,857
Accounts payable and accrued expenses	343,847	476,452
Accrued compensation and benefits:
Accrued payroll	53,633	63,857
Accrued bonuses and commissions	31,236	96,760
ESPP contributions	950	0
Workers compensation reserve	12,130	12,113
Deferred compensation	165,574	128,465
Other	15,013	32,049
Accrued compensation and benefits	278,536	333,244
Other current liabilities:
Deferred revenue	11,303	11,825
Acquisition related liabilities	0	5,070
Client deposits	8,707	21,466
Operating lease liabilities	$ 7,993	$ 8,090
Operating lease liabilities [Extensible Enumeration]	Other current liabilities	Other current liabilities
Other	$ 5,735	$ 1,786
Other current liabilities	33,738	48,237
Other long-term liabilities:
Workers compensation reserve	21,169	23,841
Professional liability reserve	36,891	36,214
Operating lease liabilities	$ 37,603	$ 9,360
Operating lease liabilities [Extensible Enumeration]	Other long-term liabilities	Other long-term liabilities
Other	$ 13,316	$ 51,151
Other long-term liabilities	$ 108,979	$ 120,566

Commitments and Contingencies	12 Months Ended
Commitments and Contingencies	Dec. 31, 2023
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and Contingencies 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, representative 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 and representative 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. The Company has reached an agreement to settle this matter in its entirety, which was preliminarily approved in the fourth quarter of 2023. The Company expects final approval in the second quarter of 2024. Accordingly, the Company has recorded an accrual for this matter amounting to $62,000. 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 reached an agreement to settle this matter in its entirety and received court approval of the settlement. Payment was made in the second quarter of 2023. The Company is currently unable to estimate the possible loss or range of loss beyond amounts already accrued. Loss contingencies accrued are included in accounts payable and accrued expenses and other long-term liabilities in the consolidated balance sheets.

Leases - Assumptions Used for Operating Leases (Details)	Dec. 31, 2023	Dec. 31, 2022
Leases [Abstract]
Weighted average remaining lease term	7 years	2 years
Weighted average discount rate	5.30%	3.10%

Summary of Significant Accounting Policies - Share-Based Compensation (Details)	12 Months Ended
	Dec. 31, 2023
Restricted Stock Units (RSUs)
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period	3 years
Performance Shares, Shareholder Return-Based
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Period for relative and absolute shareholder return	3 years
Minimum \| Performance Shares, EBITDA-Based
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percent of target amount granted to be issued	0.00%
Minimum \| Performance Shares, Shareholder Return-Based
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percent of target amount granted to be issued	0.00%
Maximum \| Performance Shares, EBITDA-Based
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percent of target amount granted to be issued	200.00%
Maximum \| Performance Shares, Shareholder Return-Based
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percent of target amount granted to be issued	175.00%

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 35
-Paragraph 1D
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480483/718-10-35-1D

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 35
-Paragraph 3
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480483/718-10-35-3

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (a)(1)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (a)(2)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (a)(3)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)(1)(i)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
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-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)(1)(ii)
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-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)(1)(iii)
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-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)(1)(iv)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)(1)(iv)(01)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)(1)(iv)(02)
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-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)(1)(iv)(03)
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-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)(1)(iv)(04)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 14: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)(2)(i)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 15: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)(2)(ii)
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-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 16: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
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-Name Accounting Standards Codification
-Section 50
-Paragraph 2
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-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 17: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)(2)(iii)(01)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 18: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
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-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)(2)(iii)(02)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 19: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
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-Name Accounting Standards Codification
-Section 50
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-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 20: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
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Reference 21: http://www.xbrl.org/2003/role/disclosureRef
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Reference 22: http://www.xbrl.org/2003/role/disclosureRef
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Reference 23: http://www.xbrl.org/2003/role/disclosureRef
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Reference 24: http://www.xbrl.org/2003/role/disclosureRef
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Reference 25: http://www.xbrl.org/2003/role/disclosureRef
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Reference 26: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
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Reference 27: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
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-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 28: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
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-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (f)(2)(v)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

+ Details

Income Taxes - Operating Loss Carryforwards (Details) $ in Thousands	Dec. 31, 2023 USD ($)
Federal
Operating Loss Carryforwards
Operating loss carryforwards	$ 22,310
State
Operating Loss Carryforwards
Operating loss carryforwards	$ 1,616

Notes Payable and Credit Agreement - Schedule of Outstanding Debt (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Debt Instrument [Line Items]
Total debt outstanding	$ 1,310,000	$ 850,000
Less unamortized fees and premium	(5,312)	(6,495)
Long-term portion of notes payable	1,304,688	843,505
Senior Notes \| 2027 Notes
Debt Instrument [Line Items]
Total debt outstanding	500,000	500,000
Senior Notes \| 2029 Notes
Debt Instrument [Line Items]
Total debt outstanding	350,000	350,000
Revolving Credit Facility \| Line of Credit
Debt Instrument [Line Items]
Total debt outstanding	$ 460,000	$ 0

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References

+ Details

- Definition

Amount, after deduction of unamortized premium (discount) and debt issuance cost, of long-term debt. Excludes lease obligation.

+ References + Details

Summary of Significant Accounting Policies - Allowance for Credit Losses (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance	$ 31,910	$ 6,838
Provision for expected credit losses	5,544	27,622
Amounts written off charged against the allowance	(5,221)	(2,550)
Ending balance	$ 32,233	$ 31,910

Retirement Plans - 401(k) Retirement Savings Plan (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Retirement Benefits [Abstract]
Employer contributions, net of forfeitures	$ 5,673	$ 31,409	$ 13,157

Share-Based Compensation - Summary of Restricted Stock Units (Details) - $ / shares shares in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Number of Shares
Unvested, beginning balance (in shares)	665	755	717
Vested (in shares)	(349)	(405)	(280)
Canceled/forfeited (in shares)	(87)	(75)	(158)
Unvested, ending balance (in shares)	601	665	755
Weighted Average Grant Date Fair Value per Share
Unvested, beginning balance (in dollars per share)	$ 94.79	$ 78.13	$ 58.88
Vested (in dollars per share)	89.76	72.43	56.05
Canceled/forfeited (in dollars per share)	104.14	82.13	65.69
Unvested, ending balance (in dollars per share)	$ 101.01	$ 94.79	$ 78.13
Restricted Stock Units (RSUs)
Number of Shares
Granted (in shares)	196	200	290
Weighted Average Grant Date Fair Value per Share
Granted (in dollars per share)	$ 95.67	$ 109.66	$ 85.30
Performance Restricted Stock Units (PRSUs)
Number of Shares
Granted (in shares)	176	190	186
Weighted Average Grant Date Fair Value per Share
Granted (in dollars per share)	$ 109.74	$ 92.65	$ 97.46

Goodwill and Identifiable Intangible Assets - Changes in the Carrying Amount of Goodwill (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Goodwill [Roll Forward]
Beginning balance	$ 935,364	$ 892,341
Ending balance	1,111,549	935,364
Accumulated impairment loss	214,939	214,939
Nurse and Allied Solutions
Goodwill [Roll Forward]
Beginning balance	382,005	339,015
Ending balance	382,420	382,005
Accumulated impairment loss	154,444	154,444
Physician and Leadership Solutions
Goodwill [Roll Forward]
Beginning balance	152,800	152,800
Ending balance	328,570	152,800
Accumulated impairment loss	60,495	60,495
Technology and Workforce Solutions
Goodwill [Roll Forward]
Beginning balance	400,559	400,526
Ending balance	400,559	400,559
Accumulated impairment loss	0	0
Synzi and SnapMD
Goodwill [Roll Forward]
Goodwill adjustment for acquisition		33
Synzi and SnapMD \| Nurse and Allied Solutions
Goodwill [Roll Forward]
Goodwill adjustment for acquisition		0
Synzi and SnapMD \| Physician and Leadership Solutions
Goodwill [Roll Forward]
Goodwill adjustment for acquisition		0
Synzi and SnapMD \| Technology and Workforce Solutions
Goodwill [Roll Forward]
Goodwill adjustment for acquisition		33
Connetics Communications, LLC
Goodwill [Roll Forward]
Goodwill adjustment for acquisition	415
Goodwill from acquisition		42,990
Connetics Communications, LLC \| Nurse and Allied Solutions
Goodwill [Roll Forward]
Goodwill adjustment for acquisition	415
Goodwill from acquisition		42,990
Connetics Communications, LLC \| Physician and Leadership Solutions
Goodwill [Roll Forward]
Goodwill adjustment for acquisition	0
Goodwill from acquisition		0
Connetics Communications, LLC \| Technology and Workforce Solutions
Goodwill [Roll Forward]
Goodwill adjustment for acquisition	0
Goodwill from acquisition		$ 0
MSDR
Goodwill [Roll Forward]
Goodwill from acquisition	175,770
MSDR \| Nurse and Allied Solutions
Goodwill [Roll Forward]
Goodwill from acquisition	0
MSDR \| Physician and Leadership Solutions
Goodwill [Roll Forward]
Goodwill from acquisition	175,770
MSDR \| Technology and Workforce Solutions
Goodwill [Roll Forward]
Goodwill from acquisition	$ 0

Summary of Significant Accounting Policies - Restricted Cash, Cash Equivalents and Investments (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Accounting Policies [Abstract]
Cash and cash equivalents	$ 32,935	$ 64,524
Restricted cash and cash equivalents (included in other current assets)	22,056	37,225
Restricted cash, cash equivalents and investments	68,845	61,218
Total cash, cash equivalents and restricted cash and investments	123,836	162,967
Less restricted investments	(15,563)	(25,095)
Total cash, cash equivalents and restricted cash	$ 108,273	$ 137,872	$ 246,714	$ 83,990

Fair Value Measurement - Schedule of Assets and Liabilities at Fair Value (Details) - Fair Value, Measurements, Recurring - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Level 2 \| Restricted Cash Equivalents
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	$ 48,206	$ 31,536
Level 2 \| Restricted Investments
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	15,563	25,095
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	48,206	31,536
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	48,206	31,536
Commercial paper \| Level 2 \| Restricted Cash Equivalents
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	48,206	31,536
Commercial paper \| Level 2 \| Restricted Investments
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 \| Restricted Cash Equivalents
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 \| Restricted Investments
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets (liabilities) measured at fair value on a recurring basis	$ 15,563	$ 25,095