2015 Largest Healthcare Staffing Firms in the US

Confidential Report – NOT for Distribution | ©2015 by Crain Communications Inc. All rights reserved.

2015 Largest Healthcare Staffing Firms in theUnited StatesAugust 3, 2015Timothy Landhuis, Research [email protected]

North America

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PROPRIETARY DATA, DO NOT DISTRIBUTE OUTSIDE YOUR ORGANIZATION. Your company’s use of this report precludes distribution of its contents, in whole or in part, to other companies or individuals outside your organization in any form –electronic, written or verbal – without the express written permission of Staffing Industry Analysts. It is your organization’s responsibility to maintain and protect the confidentiality of this report.

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Key Findings:

• We estimate that 34 firms generated at least $50 million in U.S. healthcare temporary staffing revenue in 2014. Added together, these firms generated $6.5 billion in such revenue in 2014, accounting for 61% of the market, by our estimates. The complete list of 34 firms can be found starting on page four of this report.

• This report also contains rankings of the largest staffing firms by revenue in four sub-segments. We estimate that 21 firms generated at least $25 million in travel nurse revenue, totaling $2.1 billion (86% of the market); 12 firms generated at least $25 million in per diem nurse staffing revenue, adding to $1.0 billion (37% of the market); ten firms generated at least $25 million in locum tenens revenue, accounting for $1.9 billion (77% of the market); and 21 firms generated at least $25 million in allied healthcare staffing, representing $1.5 billion (49% of the market).

• We have ranked companies by revenue, according to custom, but this ranking should not be taken to imply that a firm with a higher rank provides better service or more value to its owners.

• The market share percentages shown in this report are calculated based on our 2014 U.S. market size estimates: Travel nurse ($2.4 billion), Per diem nurse ($2.8 billion), Locum tenens ($2.5 billion), Allied healthcare ($3.0 billion), and total Healthcare temporary staffing ($10.7 billion).

• Staffing firms varied in degree of financial transparency, and even when forthcoming with information, in some cases data provided was adjusted for the sake of consistency. Therefore, for all firms on this list, the revenue reported is estimated by Staffing Industry Analysts.

• Overall, we believe that this list is accurate and can be used appropriately to get a “big picture” reading of the U.S. healthcare temporary staffing industry landscape. However, as we are constantly improving our methodology, this year’s estimate may not be strictly comparable to those of previous years. For that reason, we did not report prior year revenue in this list.

All of the companies listed were invited to provide their revenue numbers via online survey in February and March 2015. For firms that did not participate in the survey, revenue estimates were based on company reports, company websites and other sources. Our lists are of strong interest to staffing buyers and we hope those listed will benefit from the increased buyer awareness. Firms not on this list that feel they should have been included are encouraged to contact Staffing Industry Analysts, as we will be releasing a follow‐up briefing for any late additions. Many thanks to the staffing firms who offered their encouragement and assistance in this year's list process.

2015 Largest Healthcare Staffing Firms in the United States | August 3, 2015

2015 Largest Healthcare Staffing Firms in the United States

3Confidential Report – NOT for Distribution | ©2015 by Crain Communications Inc. All rights reserved.

Notes and observations regarding the largest U.S. healthcare staffing firms


• AMN Healthcare retained its place as the largest healthcare staffing firm in the United States, with 9% market share in 2014 by our estimates. AMN Healthcare ranks as the largest travel nurse firm, the largest allied healthcare staffing firm, the third-largest locum tenens firm, and the fourth-largest per diem nurse staffing firm.

• CHG Healthcare ranks as a very close second-largest healthcare staffing firm by revenue, also with 9% market share. CHG Healthcare is by far the largest locum tenens firm in the U.S., holding 31% market share in locum tenens revenue by our estimates. We note that CHG Healthcare has achieved significant organic growth over the past decade with revenue growth not aided by acquisitions.

• Cross Country Healthcare moved up from fourth-largest on last year’s report to third-largest in major part due to its acquisition of Medical Staffing Network in 2014. Cross Country Healthcare is now the second-largest travel nurse firm, the second-largest per diem nurse staffing firm, the fifth largest locum tenens firm, and the fifth largest allied healthcare firm.

• There were seven companies that qualified for this year’s largest healthcare staffing firms ranking (firms with at least $50 million in revenue) that did not appear on last year’s list. The companies are (in alphabetical order) AyaHealthcare, All Medical Personnel, Emerald Health Services, Healthcare Support Staffing, Interim HealthCare, Loyal Source, and Medix.

• As evidence of the strong growth in demand for travel nurse staffing in 2014, this year’s ranking of the largest travel nurse firms includes seven firms that generated at least $100 million in travel nurse revenue. In order of revenue size, the firms are AMN Healthcare, Cross Country Healthcare, Healthcare Staffing Services (Fastaff and U.S. Nursing Corporation), Medical Solutions, Aya Healthcare, Trustaff, and Aureus Medical Group (C&A Industries).

• We have raised our estimate of the size of the U.S. travel nurse staffing industry in 2014 to $2.4 billion (up from $2.0 billion in our U.S. Staffing Industry Forecast – April 2015 Update report) based on data collected as part of the production of this report. Accordingly, our estimate of the U.S. healthcare temporary staffing industry was also increased to $10.7 billion (up from $10.3 billion in our April forecast report).

• The locum tenens sub-segment remains the segment with the most market share concentration. The ten largest locum tenens firms hold 77% of the market, and the three largest firms hold more than half of the market (56%).




1. Does not include revenue from Locum Leaders and Onward Healthcare, acquired in 1Q152. Includes revenue from acquisition of Medical Staffing Network (2Q14)3. Includes revenue from physician staffing unit (Vista Staffing Solutions) sold to Envision Healthcare in 1Q154. Includes revenue from multiple acquisitions completed in 20145. Owner of Fastaff Travel Nursing and U.S. Nursing Corporation

Ranked by estimated 2014 U.S. healthcare temporary staffing revenue

Rank Company2014 U.S. Healthcare

Temporary Staffing

Revenue ($million)

Market

Share

1 AMN Healthcare Services1991 9%

2 CHG Healthcare Services 912 9%

3 Cross Country Healthcare2702 7%

4 Jackson Healthcare 530 5%

5 Maxim Healthcare Services 328 3%

6 Parallon Workforce Management Solutions (HCA) 256 2%

7 Supplemental Health Care 218 2%

8 Aureus Medical Group (C&A Industries) 212 2%

9 Soliant Health (Adecco) 180 2%

10 On Assignment3148 1%

11 Accountable Healthcare Staffing4137 1%

11 Healthcare Staffing Services5137 1%

13 Medical Solutions 133 1%

14 Trustaff 128 1%

15 Aya Healthcare 125 1%

16 InGenesis 118 1%

17 Favorite Healthcare Staffing 101 1%

18 TekPartners/MedPartners 96 1%




6. Represents revenue from health information management unit sold to RCM Acquisition Inc. in 3Q14

Ranked by estimated 2014 U.S. healthcare temporary staffing revenue

Rank Company2014 U.S. Healthcare

Temporary Staffing

Revenue ($million)

Market

Share

19 CareerStaff Unlimited (Genesis HealthCare) 94 1%

20 Loyal Source 84 1%

21 D&Y (Team Health) 82 1%

22 Act-1 Group 80 1%

22 Medicus Healthcare Solutions 80 1%

24 Medix 73 1%

25 ATC Healthcare 69 1%

26 The Delta Companies 66 1%

27 Advantage RN 64 1%

28 Kforce657 1%

29 Healthcare Support Staffing 55 1%

30 CoreMedical Group 54 1%

31 Kelly Services 52 <1%

32 All Medical Personnel 50 <1%

32 Emerald Health Services 50 <1%

32 Interim HealthCare 50 <1%

6,512 61%Total


2015 Largest Travel Nurse Staffing Firms in the United States


1. Does not include revenue from Onward Healthcare, acquired in 1Q152. Includes revenue from acquisition of Medical Staffing Network (2Q14)3. Owner of Fastaff Travel Nursing and U.S. Nursing Corporation4. Includes revenue from multiple acquisitions completed in 2014

Ranked by estimated 2014 U.S. travel nurse temporary staffing revenue

Rank Company2014 U.S. Travel

Nurse Staffing

Revenue ($million)

Market

Share



3 Healthcare Staffing Services3137 6%

4 Medical Solutions 133 6%

5 Aya Healthcare 125 5%

6 Trustaff 104 4%







13 Advantage RN 51 2%

14 Emerald Health Services 50 2%


16 Nightingale Nurses 42 2%

17 Trinity Healthcare Staffing Group 38 2%


19 CoreMedical Group 31 1%


21 Travel Nurse across America 30 1%

2,073 86%Total


2015 Largest Per Diem Nurse Staffing Firms in the United States


1. Includes revenue from acquisition of Medical Staffing Network (2Q14)2. Does not include revenue from Onward Healthcare, acquired in 1Q153. Includes revenue from multiple acquisitions completed in 2014

Ranked by estimated 2014 U.S. per diem nurse temporary staffing revenue

Rank Company2014 U.S. Per Diem Nurse

Temporary Staffing

Revenue ($million)

Market

Share

1 Maxim Healthcare Services 266 10%






7 ATC Healthcare 50 2%

8 Interim HealthCare 47 2%

9 InGenesis 45 2%


11 ACCESS Healthcare Services 35 1%


1,035 37%Total


2015 Largest Locum Tenens Firms in the United States


1. Does not include revenue from Locum Leaders, acquired in 1Q152. Includes revenue from physician staffing unit (Vista Staffing Solutions) sold to Envision Healthcare in 1Q15

Ranked by estimated 2014 U.S. locum tenens revenue

Rank Company2014 U.S. Locum

Tenens Revenue

($million)

Market

Share




4 On Assignment2126 5%

5 Cross Country Healthcare 124 5%

6 D&Y (Team Health) 80 3%

6 Medicus Healthcare Solutions 80 3%

8 The Delta Companies 44 2%

9 InGenesis 41 2%


1,921 77%Total


2015 Largest Allied Healthcare Staffing Firms in the United States


1. Does not include revenue from Onward Healthcare, acquired in 1Q152. Includes revenue from acquisition of Medical Staffing Network (2Q14)3. Represents revenue from health information management unit sold to RCM Acquisition Inc. in 3Q14

Ranked by estimated 2014 U.S. allied healthcare temporary staffing revenue

Rank Company2014 U.S. Allied Healthcare

Temporary Staffing

Revenue ($million)

Market

Share






6 TekPartners/MedPartners 92 3%

7 Act-1 Group 80 3%


9 Medix 73 2%

10 Kforce357 2%


11 Healthcare Support Staffing 55 2%

13 Kelly Services 52 2%


15 ACS Group (American CyberSystems) 45 2%

16 All Medical Personnel 41 1%

17 Ardor Health Solutions 35 1%

18 Advanced Medical Personnel Services 34 1%

19 InGenesis 31 1%


21 Yoh 27 1%

1,461 49%Total


Market share held by largest healthcare staffing firms increasing


• The chart at right shows the combined market share of the five largest and ten largest healthcare staffing firms from 2007 to 2014.

• The market share captured by the five largest and ten largest healthcare staffing firms remained roughly the same from 2007 to 2012. However, the market share increased in 2013 and 2014. We note that this trend of consolidation was aided in 2014 by Cross Country Healthcare’s acquisition of Medical Staffing Network (the fourth-largest firm acquiring the sixth-largest firm, by 2013 healthcare staffing revenue).

Combined market share of 5 largest and 10 largest healthcare staffing firms, 2007 to 2014

27% 27% 27%28% 28% 28% 29%

32%

39% 40% 40% 40% 39% 39% 40%42%

2007 2008 2009 2010 2011 2012 2013 2014

5 Largest 10 Largest


About Staffing Industry AnalystsStaffing Industry Analysts is the global advisor on contingent work. Known for its independent and

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buy temporary staffing. In addition to temporary staffing, Staffing Industry Analysts also covers related

staffing sectors. The company provides accreditation with its Certified Contingent Workforce Professional

(CCWP) program. Founded in 1989 and acquired by Crain Communications Inc. in 2008, the company is

headquartered in Mountain View, California, with offices in London, England.

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2015 Largest Healthcare Staffing Firms in the US

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