AMN Healthcare Services Inc (AMN) 2023 Q2 法說會逐字稿

Good day, and thank you for standing by. Welcome to AMN Healthcare Second Quarter 2023 Earnings Call. (Operator Instructions) Finally, please be advised that today's conference is being recorded.

美好的一天，感謝您的支持。歡迎參加 AMN Healthcare 2023 年第二季度財報電話會議。 （操作員指示）最後，請注意，今天的會議正在錄製中。

I would now like to hand the conference over to your speaker today, Randy Reece, Senior Director of Investor Relations.

現在我想將會議交給今天的發言人，投資者關係高級總監蘭迪·里斯 (Randy Reece)。

Good afternoon, everyone. Welcome to AMN Healthcare's Second Quarter 2023 Earnings Call. A replay of this webcast will be available at ir.amnhealthcare.com, following the conclusion of this call.

大家下午好。歡迎參加 AMN Healthcare 的 2023 年第二季度財報電話會議。本次電話會議結束後，將在 ir.amnhealthcare.com 上重播該網絡廣播。

Various remarks we make during this call about future expectations, projections, trends, plans, events or circumstances constitute forward-looking statements. These statements reflect the company's current beliefs based upon information currently available to it. Our actual results may differ materially from those indicated by these forward-looking statements because of various factors and cautionary statements, including those identified in our most recently filed forms 10-K and 10-Q, our earnings and subsequent filings with the SEC. The company does not intend to update guidance or any forward-looking statements provided today prior to its next earnings release.

我們在本次電話會議中就未來預期、預測、趨勢、計劃、事件或情況發表的各種言論均構成前瞻性陳述。這些陳述反映了公司基於當前可獲得的信息的當前信念。由於各種因素和警示性聲明，包括我們最近提交的10-K 和10-Q 表格、我們的收益以及隨後向SEC 提交的文件中確定的因素和警示性聲明，我們的實際結果可能與這些前瞻性聲明所表明的結果存在重大差異。該公司不打算在下一次收益發布之前更新今天提供的指導或任何前瞻性聲明。

This call contains certain non-GAAP financial information. Information regarding and reconciliations of these non-GAAP measures to the most directly comparable GAAP measures are included in our earnings release and on our financial reports page at ir.amnhealthcare.com.

本次電話會議包含某些非公認會計準則財務信息。有關這些非 GAAP 衡量標準與最直接可比的 GAAP 衡量標準的調節信息包含在我們的收益發布和 ir.amnhealthcare.com 的財務報告頁面上。

On the call today are Cary Grace, Chief Executive Officer; Jeff Knudson, Chief Financial Officer; Landry Seedig, Group President and COO of Nursing and Allied Solutions; and James Taylor, President and COO of Physician and Leadership Solutions.

今天參加電話會議的是首席執行官 Cary Grace；傑夫·克努森 (Jeff Knudson)，首席財務官； Landry Seedig，護理及聯合解決方案集團總裁兼首席運營官；以及醫生和領導力解決方案總裁兼首席運營官詹姆斯·泰勒。

I will now turn the call over to Cary.

我現在將把電話轉給卡里。

Thank you, Randy, and welcome, everyone. Let me begin by expressing my gratitude for the remarkable efforts of our health care professionals and team members. You empower our mission to improve access and quality of health care throughout the country.

謝謝你，蘭迪，歡迎大家。首先，我對我們的醫療保健專業人員和團隊成員的卓越努力表示感謝。您賦予我們改善全國醫療保健的可及性和質量的使命。

As we have successfully done in the past, AMN is balancing the demands of short-term business conditions against the pursuit of long-term value for our stakeholders. Health care organizations need more powerful strategies and tools to deal with complex labor needs that are growing faster than the supply of workers. We believe strongly in these market dynamics and are investing to address the current and future health care environment.

正如我們過去成功所做的那樣，AMN 正在平衡短期業務條件的需求與利益相關者對長期價值的追求。醫療保健組織需要更強大的戰略和工具來應對複雜的勞動力需求，這些需求的增長速度快於勞動力供應的增長速度。我們堅信這些市場動態，並正在投資解決當前和未來的醫療保健環境。

To meet these needs, we have ramped internal investments in technology and bringing all of our solutions together. Our industry-leading mobile app, AMN Passport, has surpassed 200,000 users and now engages most of our health care professionals on assignment. Our language services platform now has API integration, with leading electronic medical record systems enabling faster and easier connections with our medically qualified interpreters. And the early reception to ShiftWise 2.0, our market-leading VMS platform, has been very favorable.

為了滿足這些需求，我們加大了內部技術投資並將所有解決方案整合在一起。我們行業領先的移動應用程序 AMN Passport 已超過 200,000 名用戶，現在吸引了我們大多數醫療保健專業人員的參與。我們的語言服務平台現已集成 API，並與領先的電子病歷系統相結合，可以更快、更輕鬆地與我們的具有醫學資質的口譯員建立聯繫。我們市場領先的 VMS 平台 ShiftWise 2.0 的早期反響非常好。

In the near term, we are managing through a demand environment that in our Nurse and Allied Solutions segment has remained slow as the health care sector has moved toward a new normal for total labor costs. Overall demand for Travel Nurse staffing is low as clients try to regain a sustainable balance of permanent and contingent staff. This year has been harder to predict as clients have focused on accelerating short-term cost management as well as looking at long-term ways to rebuild their workforce. Our outlook for third quarter revenue in Nurse and Allied is approximately $65 million lower than consensus.

短期內，我們正在應對需求環境，隨著醫療保健行業總勞動力成本走向新常態，我們的護士和聯合解決方案部門的需求環境仍然緩慢。由於客戶試圖重新獲得長期和臨時員工的可持續平衡，對旅行護士人員配置的總體需求較低。今年更加難以預測，因為客戶專注於加速短期成本管理以及尋找重建勞動力的長期方法。我們對 Nurse and Allied 第三季度收入的預期比預期低約 6500 萬美元。

As we progressed through the second quarter, demand for contingent labor from our large MSP clients was lower than we had assumed. They increased the pace of permanent hiring, and we proactively partnered with them on temp-to-perm conversions and overall cost management goals. We are continuing to position our organization to serve our clients in the way they want, whether it is supporting a self-managed operation, vendor-neutral MSP, staffing-led MSP or the many other solutions we have to offer clients. We have improved our internal fill rates on MSPs throughout this year.

隨著第二季度的進展，我們的大型 MSP 客戶對臨時勞動力的需求低於我們的預期。他們加快了長期招聘的步伐，我們積極與他們合作，實現臨時工到永久工的轉換以及總體成本管理目標。我們將繼續讓我們的組織以客戶想要的方式為他們提供服務，無論是支持自我管理運營、供應商中立的 MSP、人員主導的 MSP 還是我們為客戶提供的許多其他解決方案。今年我們提高了 MSP 的內部填充率。

In addition, we have invested in our VMS technology to make them more adaptable to individual client needs if they choose to exercise more internal control over their programs. Current and prospective clients continue to be open to new solutions that will help them rebuild and manage their workforce. We have ramped sales and marketing efforts to take advantage of this opportunity not just for staffing-led MSP but also in pursuit of direct and vendor-neutral MSP. We feel good about the sales pipeline we have developed as we finished the year and how it will impact 2024 and thereafter.

此外，我們還投資了我們的 VMS 技術，如果客戶選擇對其項目實施更多內部控制，則可以使它們更能適應個人客戶的需求。當前和潛在的客戶繼續對新的解決方案持開放態度，這將有助於他們重建和管理員工隊伍。我們加大了銷售和營銷力度，以利用這一機會，不僅針對人員主導的 MSP，而且還追求直接且供應商中立的 MSP。我們對今年結束時開發的銷售渠道以及它將如何影響 2024 年及以後的情況感到滿意。

For our Physician Solutions, locum tenens and permanent placement, client needs remain strong, and we are working to bolster the sustainability of our growth trajectory. Locum tenens had record high revenue in the second quarter, growing 15% year-over-year while also producing strong profitability. Demand in our interim leadership and permanent placement businesses has been affected by client cost control efforts, though perm demand seems to have stabilized. We are pleased that the PLS segment was able to make impressive year-over-year progress on gross and operating margins despite flat revenue and a mix headwind.

對於我們的醫師解決方案、代理和永久安置，客戶需求仍然強勁，我們正在努力增強我們增長軌蹟的可持續性。 Locum tenens 第二季度收入創歷史新高，同比增長 15%，同時也產生了強勁的盈利能力。儘管燙髮需求似乎已經穩定，但我們臨時領導和永久安置業務的需求受到客戶成本控制努力的影響。我們很高興看到，儘管收入持平且面臨各種不利因素，但 PLS 部門在毛利率和營業利潤率方面仍能取得令人印象深刻的同比進步。

Our Technology and Workforce Solutions segment saw revenue decline from Q1 to Q2 as VMS tracks a softer staffing market. As expected, profit margins in that segment are lower with a revenue mix shift toward language solutions. That business grew revenue 19% year-over-year, and the segment as a whole continued to have a favorable impact on our consolidated profit margin.

由於 VMS 跟踪人力資源市場疲軟，我們的技術和勞動力解決方案部門的收入從第一季度到第二季度有所下降。正如預期的那樣，隨著收入結構轉向語言解決方案，該領域的利潤率較低。該業務的收入同比增長 19%，整個部門繼續對我們的綜合利潤率產生有利影響。

As we have noted, clients have reacted to the post-pandemic environment by stepping up permanent hiring and seeking change in how they manage labor flexibility. Overall, we see an environment in which labor supplies will still be challenged to deal with growth in health care utilization as well as improving the overall well-being and engagement of health care professionals.

正如我們所指出的，客戶對大流行後環境的反應是增加永久性招聘並尋求改變管理勞動力靈活性的方式。總體而言，我們認為勞動力供應仍將面臨挑戰，以應對醫療保健利用率的增長以及改善醫療保健專業人員的整體福祉和參與度。

We think our broad and deep set of solutions and technology platforms position us well to serve the needs of clients and clinicians now and for the long term. AMN is managing through this environment, realigning talent and adjusting costs appropriately to protect margins while also sustaining important strategic investment initiatives.

我們認為，我們廣泛而深入的解決方案和技術平台使我們能夠很好地滿足客戶和臨床醫生現在和長期的需求。 AMN 正在這種環境下進行管理，重新調整人才並適當調整成本，以保護利潤，同時維持重要的戰略投資計劃。

In recent weeks, our Nurse and Allied Solutions segment successfully completed a major upgrade of its back-office technology platform to better serve our internal growth objectives and our health care professionals. The success and scale of this technology transition set new standards for how we manage change at AMN. In many aspects, we accelerated our pace of technology enablement, and this process will continue into 2024 with lasting benefits for our solutions, clients, health care professionals and team members.

最近幾週，我們的護士和聯合解決方案部門成功完成了後台技術平台的重大升級，以更好地服務於我們的內部增長目標和醫療保健專業人員。此次技術轉型的成功和規模為我們管理 AMN 變革的方式設立了新標準。在許多方面，我們加快了技術支持的步伐，這一進程將持續到 2024 年，為我們的解決方案、客戶、醫療保健專業人員和團隊成員帶來持久的利益。

Our long track record in technology-enabled solutions such as VMS, Workforce Analytics and broad-based staffing strengthens our positioning with clients through what more comprehensive solutions.

我們在 VMS、勞動力分析和廣泛的人員配置等技術支持解決方案方面的長期記錄通過更全面的解決方案加強了我們在客戶中的地位。

Now I'll turn over the call to Jeff for the details about our results and outlook, after which I will return with some final comments.

現在我將把電話轉給傑夫，了解有關我們結果和前景的詳細信息，之後我將返回一些最終評論。

Thank you, Cary, and good afternoon, everyone.

謝謝你，卡里，大家下午好。

Second quarter revenue of $991 million was near the high end of our guidance range driven by outperformance in locum tenens. Consolidated revenue was down 31% from the second quarter of 2022. Sequentially, as anticipated, revenue was down 12% as clients' expense management continued to drive demand levels lower and the expected step-down of bill rates within Nurse and Allied and VMS.

由於代理業績出色，第二季度收入達到 9.91 億美元，接近我們指導範圍的上限。合併收入較 2022 年第二季度下降 31%。隨後，正如預期的那樣，由於客戶的費用管理繼續降低需求水平以及 Nurse and Allied 和 VMS 內賬單費率的預期下降，收入下降了 12%。

Gross margin for the quarter was 33.3%, just below our guidance range. Compared with the prior year period, gross margin was up 100 basis points, primarily due to a favorable revenue mix shift and margin improvements within the Nurse and Allied segment, partially offset by margin contraction within Technology and Workforce Solutions. Sequentially, gross margin increased 50 basis points.

本季度毛利率為 33.3%，略低於我們的指導範圍。與去年同期相比，毛利率上升了100 個基點，主要是由於護士和相關部門的收入結構發生了有利的變化以及利潤率的提高，但部分被技術和勞動力解決方案部門的利潤率下降所抵消。隨後，毛利率增加了 50 個基點。

Consolidated SG&A expenses were $202 million, including a nonrecurring legal settlement, or 20.4% of revenue compared with $244 million or 17.1% of revenue in the prior year period and $206 million or 18.3% of revenue in the previous quarter. The decrease in SG&A expenses year-over-year was primarily driven by lower employee expenses, consistent with the current demand environment. Sequentially, lower business volumes led to lower employee expenses, along with lower bad debt reserve and professional liability insurance expenses.

綜合銷售、管理及行政費用為2.02 億美元，包括非經常性法律和解費用，佔收入的20.4%，而上年同期為2.44 億美元，佔收入的17.1%，上一季度為2.06 億美元，佔收入的18.3%。 SG&A 費用同比減少主要是由於員工費用減少，這與當前的需求環境一致。因此，業務量下降導致員工費用減少，壞賬準備金和職業責任保險費用也減少。

Adjusted SG&A, which excludes certain nonrecurring expenses and stock-based compensation expense, was $170 million in the second quarter or 17.1% of revenue compared with $229 million or 16% of revenue in the prior year period. The increase in adjusted SG&A margin as a percentage of revenue year-over-year was mainly driven by lower revenue.

第二季度調整後的銷售及管理費用（不包括某些非經常性費用和股票補償費用）為 1.7 億美元，佔收入的 17.1%，而上年同期為 2.29 億美元，佔收入的 16%。調整後的銷售及行政管理利潤率佔收入的百分比同比增加主要是由於收入下降。

In the second quarter, Nurse and Allied revenue was $689 million, down 37% from the near-record revenue in the prior year period. Sequentially, segment revenue was down 16% driven by lower volume and bill rates. Average bill rate was down 19% year-over-year and down 6% sequentially. Year-over-year, volume was down 17% and average hours worked were down 3%. Sequentially, volume was down 10% and average hours were down 2%.

第二季度，《Nurse and Allied》收入為 6.89 億美元，比去年同期接近創紀錄的收入下降了 37%。隨後，由於銷量和賬單費率下降，該部門收入下降了 16%。平均賬單費率同比下降 19%，環比下降 6%。與去年同期相比，工作量下降了 17%，平均工作時間下降了 3%。隨後，交易量下降了 10%，平均工時下降了 2%。

Travel Nurse revenue during the second quarter was $477 million, a decrease of 39% from the prior year period and 19% from the prior quarter. Allied revenue during the quarter was $182 million, down 12% year-over-year and 7% sequentially.

Travel Nurse 第二季度收入為 4.77 億美元，同比下降 39%，環比下降 19%。該季度 Allied 收入為 1.82 億美元，同比下降 12%，環比下降 7%。

Nurse and Allied gross margin during the second quarter was 26.7%, which increased 100 basis points from the prior year period and grew 80 basis points sequentially. The year-over-year increase in gross margin was primarily due to normalization of the bill pay spread. Segment operating margin of 14.9% increased 30 basis points year-over-year due to higher gross margin, partially offset by lower SG&A leverage. Sequentially, operating margin increased 110 basis points, driven by lower bad debt reserve and professional liability expense.

Nurse and Allied 第二季度毛利率為 26.7%，比去年同期增長 100 個基點，比上一季度增長 80 個基點。毛利率同比增長主要是由於賬單支付利差正常化。由於毛利率上升，該部門營業利潤率為 14.9%，同比增長 30 個基點，但 SG&A 槓桿率下降部分抵消了這一影響。隨後，在壞賬準備金和專業責任費用下降的推動下，營業利潤率增加了 110 個基點。

Continuing with the Physician and Leadership Solutions segment. Second quarter revenue of $176 million was flat year-over-year and up 6% sequentially. Locum tenens revenue in the quarter was $122 million, a 15% increase from the prior year and up 14% sequentially.

繼續醫生和領導力解決方案部分。第二季度收入為 1.76 億美元，與去年同期持平，環比增長 6%。 Locum Tenens 本季度收入為 1.22 億美元，比上年增長 15%，比上一季度增長 14%。

Interim leadership revenue of $36 million decreased 24% from the prior year period and was down 10% from the prior quarter. Search revenue of $18 million dropped 19% from the prior year and was down 5% sequentially. Interim and search revenue were down year-over-year primarily due to lower demand as health care systems continue to focus on cost containment measures.

中期領導收入為 3600 萬美元，比去年同期下降 24%，比上一季度下降 10%。搜索收入為 1800 萬美元，比上年下降 19%，比上一季度下降 5%。中期和搜索收入同比下降，主要是由於醫療保健系統繼續關注成本控制措施而導致需求下降。

Gross margin for the Physician and Leadership Solutions segment was 35.1%, up 90 basis points year-over-year and down 10 basis points sequentially. The margin increase year-over-year was primarily due to improved gross margin for Locum tenens, partially offset by the revenue mix within the segment.

醫生和領導力解決方案部門的毛利率為 35.1%，同比增長 90 個基點，環比下降 10 個基點。利潤率同比增長主要是由於 Locum tenens 毛利率的提高，部分被該部門的收入組合所抵消。

Segment operating margin was 15%, which increased an impressive 360 basis points year-over-year due to lower SG&A expenses and gross margin improvement. Sequentially, operating margin decreased 10 basis points.

由於 SG&A 費用降低和毛利率改善，該部門的營業利潤率為 15%，同比增長了 360 個基點，令人印象深刻。隨後，營業利潤率下降了 10 個基點。

Technology and Workforce Solutions revenue during the second quarter was $126 million, down 16% year-over-year and 7% sequentially. Language Services generated revenue of $64 million, an increase of 19% year-over-year and 3% quarter-over-quarter. VMS revenue for the quarter was $47 million, a decrease of 38% year-over-year and 14% sequentially.

第二季度技術和勞動力解決方案收入為 1.26 億美元，同比下降 16%，環比下降 7%。語言服務收入為 6400 萬美元，同比增長 19%，環比增長 3%。本季度 VMS 收入為 4700 萬美元，同比下降 38%，環比下降 14%。

Segment gross margin was 66.7% and down from 78.3% and 71.4% in the prior year and prior quarter, respectively. The sharp decrease in gross margin year-over-year and sequentially was primarily due to a revenue mix shift away from high-margin VMS and a lower gross margin in language services.

部門毛利率為 66.7%，低於去年同期的 78.3% 和上一季度的 71.4%。毛利率同比和環比大幅下降，主要是由於收入組合從高利潤的 VMS 轉移以及語言服務毛利率較低。

Segment operating margin in the second quarter was 44.1% compared with 55.2% in the prior year driven by lower gross margin. Sequentially, segment operating margin decreased 520 basis points.

由於毛利率下降，第二季度的分部營業利潤率為 44.1%，而上年同期為 55.2%。隨後，分部營業利潤率下降了 520 個基點。

Second quarter consolidated adjusted EBITDA was $162 million, a decrease of 30% year-over-year and 10% sequentially. Adjusted EBITDA margin of 16.3% was flat year-over-year and up 40 basis points sequentially.

第二季度綜合調整後 EBITDA 為 1.62 億美元，同比下降 30%，環比下降 10%。調整後 EBITDA 利潤率為 16.3%，與去年同期持平，比上一季度增長 40 個基點。

Second quarter net income was $61 million, down 51% year-over-year and down 28% sequentially.

第二季度淨利潤為 6100 萬美元，同比下降 51%，環比下降 28%。

Second quarter GAAP diluted earnings per share was $1.55 in the quarter. Adjusted earnings per share for the quarter was $2.38 compared to $3.31 in the prior year period and $2.49 in the prior quarter.

第二季度 GAAP 稀釋後每股收益為 1.55 美元。本季度調整後每股收益為 2.38 美元，去年同期為 3.31 美元，上一季度為 2.49 美元。

Days sales outstanding was 53 days, 2 days lower than the prior quarter and 3 days higher than the prior year when collections were very strong.

應收賬款天數為 53 天，比上一季度減少 2 天，比去年回款非常強勁的情況下增加 3 天。

Operating cash flow for the second quarter was $198 million, and capital expenditures were $26 million.

第二季度運營現金流為1.98億美元，資本支出為2600萬美元。

As of June 30, we had cash and equivalents of $7 million; long-term debt of $1.04 billion, including a $190 million draw on our revolving line of credit; and a net leverage ratio of 1.5x to 1.

截至 6 月 30 日，我們擁有現金及等價物 700 萬美元； 10.4 億美元的長期債務，其中包括從我們的循環信貸額度中提取的 1.9 億美元；淨槓桿率為1.5倍：1。

As you may recall, we announced a $200 million accelerated share repurchase program on our previous earnings call, which began in the second quarter. During the quarter, we repurchased 2.4 million shares of stock for a total of $250 million. In total, year-to-date as of June 30, we have bought back 4.1 million shares of stock for a total of $425 million. As of today, $227 million was outstanding on the repurchase program authorized by our Board of Directors.

您可能還記得，我們在第二季度開始的上一次財報電話會議上宣布了一項 2 億美元的加速股票回購計劃。本季度，我們回購了 240 萬股股票，總金額為 2.5 億美元。截至今年 6 月 30 日，我們總共回購了 410 萬股股票，總價值為 4.25 億美元。截至今天，董事會授權的回購計劃中尚未支付 2.27 億美元。

Moving to the third quarter 2023 guidance. We project consolidated revenue to be in a range of $840 million to $860 million, down 24% to 26% from the prior year period. Gross margin is projected to be between 33.3% and 33.8%. Reported SG&A expenses are projected to be 19.8% to 20.3% of revenue. Operating margin is expected to be 8.8% to 9.4%, and adjusted EBITDA margin is expected to be 14.3% to 14.8%. Average diluted shares outstanding are projected to be approximately 38.6 million. Additional third quarter guidance details can be found in today's earnings release.

轉向 2023 年第三季度指導。我們預計綜合收入將在 8.4 億至 8.6 億美元之間，比去年同期下降 24% 至 26%。毛利率預計在33.3%至33.8%之間。報告的 SG&A 費用預計佔收入的 19.8% 至 20.3%。營業利潤率預計為 8.8% 至 9.4%，調整後 EBITDA 利潤率預計為 14.3% 至 14.8%。攤薄後平均流通股預計約為 3860 萬股。其他第三季度指導細節可以在今天的收益發布中找到。

As Cary mentioned, utilization from our top clients is lower than we anticipated, which is reflected in our third quarter guidance. Order trends have been stable for 3 months and clients have indicated they will place winter needs orders within the next few weeks. As such, we expect Nurse and Allied revenue in the fourth quarter to grow modestly over the third quarter level. The Physician and Leadership Solutions and Technology and Workforce Solutions segments should see seasonal revenue declines in the mid-single digits.

正如卡里提到的，我們的頂級客戶的利用率低於我們的預期，這反映在我們的第三季度指導中。訂單趨勢已經穩定了三個月，客戶表示他們將在未來幾週內下冬季需求訂單。因此，我們預計護士和聯盟第四季度的收入將比第三季度的水平小幅增長。醫生和領導力解決方案以及技術和勞動力解決方案部門的季節性收入應會出現中個位數的下降。

As we have noted, clients have reacted to the post-pandemic environment by stepping up permanent hiring and seeking change in how they manage labor flexibility. The result has been a surge of new opportunities along with greater client turnover within the industry. The near-term impact is visible in continued soft demand from our MSP clients and a lesser impact from turnover. These client transitions went largely as expected in recent months and were not the drivers of change in our 2023 expectations.

正如我們所指出的，客戶對大流行後環境的反應是增加永久性招聘並尋求改變管理勞動力靈活性的方式。其結果是新機會的激增以及行業內客戶流失率的增加。短期影響顯而易見，我們的 MSP 客戶需求持續疲軟，營業額影響較小。近幾個月來，這些客戶轉變基本上符合預期，並不是我們 2023 年預期發生變化的驅動因素。

And now I'd like to hand the call back to Cary.

現在我想把電話轉給卡里。

Thank you, Jeff. This quarter, we say farewell to 2 of the people who helped to build AMN and the concept of total talent solutions in health care.

謝謝你，傑夫。本季度，我們將告別兩位幫助建立 AMN 和醫療保健領域整體人才解決方案概念的人。

Denise Jackson, our Corporate Secretary and Chief Legal Officer, is retiring after 23 years of making a profound impact on the AMN family. Denise was instrumental in bringing AMN from its IPO to becoming an industry leader in corporate governance. Her fierce conviction, determination and relentless dedication ensured that our culture embodies diversity, equity, equality and inclusion. Denise provided well for her succession. She has mentored Whitney Laughlin, her successor, for 17 years, and we are excited to see how Whitney builds on Denise's legacy. Thank you, Denise, and congratulations to Whitney.

我們的公司秘書兼首席法務官丹尼斯·傑克遜 (Denise Jackson) 在對 AMN 家族產生深遠影響 23 年後即將退休。 Denise 在 AMN 從首次公開募股到成為公司治理行業領導者的過程中發揮了重要作用。她堅定的信念、決心和不懈的奉獻精神確保我們的文化體現多樣性、公平、平等和包容。丹妮絲為她的繼任提供了良好的條件。她指導了她的繼任者惠特尼·勞克林 (Whitney Laughlin) 17 年，我們很高興看到惠特尼如何繼承丹尼斯的遺產。謝謝你，丹尼斯，祝賀惠特尼。

Landry Seedig joined AMN in 2008 as part of an acquisition. We always want acquisitions to bring in leadership talent, and Landry is a brilliant example of how that should work. He was instrumental in growth of our Travel Nurse and Allied businesses. He became the leader of our Nurse and Allied Solutions segment in March 2020, right at the beginning of the pandemic. Landry kept his team together during the pandemic with his unique blend of business acumen, insightful leadership and a personal charm that no one who met him will forget. Landry is leaving the staffing industry for another opportunity that is very special to him. We are grateful for his efforts to prepare his successor. Robin Johnson is superbly prepared to take over leadership of Nurse and Allied at this critical time in our evolution.

Landry Seedig 於 2008 年通過收購加入 AMN。我們總是希望通過收購來引進領導人才，蘭德里就是一個很好的例子，說明了這一點應該如何運作。他對我們的旅行護士和相關業務的發展發揮了重要作用。 2020 年 3 月，也就是大流行剛開始時，他成為了我們護士和聯合解決方案部門的領導者。蘭德里憑藉他獨特的商業頭腦、富有洞察力的領導力和見過他的人都不會忘記的個人魅力，在大流行期間讓他的團隊團結在一起。蘭德里將離開人力資源行業，尋找另一個對他來說非常特別的機會。我們感謝他為準備繼任者所做的努力。羅賓·約翰遜已做好充分準備，在我們發展的這個關鍵時刻接手護士和盟軍的領導權。

I am excited about the depth of leadership talent we have built and will continue to build AMN to bring the best to our clients and health care professionals in the changing industry ecosystem.

我對我們培養的領導人才深度感到興奮，並將繼續建設 AMN，在不斷變化的行業生態系統中為我們的客戶和醫療保健專業人員帶來最好的服務。

Now operator, please open the call for questions.

現在接線員，請打開電話提問。

(Operator Instructions) Our first question comes from A.J. Rice of Credit Suisse Financial Services.

（操作員說明）我們的第一個問題來自 A.J.瑞信金融服務公司的賴斯。

Just technical, to make sure I understand Q3, it sounds like you're looking for Nurse and Allied revenues to be down about 20%, if I've got that right, from Q2 to Q3. I know in Q2, the volumes were down about 10%, and the bill rates were down about 8% in the same category. Can you give us a sense of where you think that split falls out in Q3 between what you're seeing in volume decline versus what you're seeing in bill rate decline?

只是技術性的，為了確保我理解第三季度，聽起來你正在尋找護士和盟友的收入從第二季度到第三季度下降約 20%（如果我沒記錯的話）。我知道第二季度，同一類別的銷量下降了約 10%，賬單費率下降了約 8%。您能否告訴我們您認為第三季度銷量下降與賬單利率下降之間的差異在哪裡？

Yes, A.J., the volume decline in Nurse and Allied in Q3 would be down low double digits sequentially. And then the bill rate, we had originally expected bill rates to be down mid-single digits in Q3 over Q2. And it's slightly stronger than that, maybe down 7% to 8%, Q3 over Q2 on the bill rate side.

是的，A.J.，護士和聯盟在第三季度的銷量下降將連續下降兩位數。然後是賬單利率，我們最初預計第三季度的賬單利率將比第二季度下降中個位數。在賬單利率方面，第三季度比第二季度略強，可能下降 7% 至 8%。

Okay. And then just stepping back with a broader question, I think your principal public peer at least, yesterday described what they were seeing in the market heading into the third quarter as an inability at the current bill rates to find staff to fill positions. It sounds like you're putting more of the emphasis on the demand side than maybe at least I interpreted that they were. I don't know if there's any way to comment on that. You're saying, though, that your order trend has been steady for 3 months, I guess. It would somewhat suggest that the orders are there, I guess. But anyway, do you have any takeaway? That's an open-ended question, but to sort of characterize it from a demand versus supply challenge to market.

好的。然後退一步提出一個更廣泛的問題，我認為至少您的主要公眾同行昨天描述了他們在進入第三季度的市場中所看到的情況，即按照當前的賬單利率無法找到員工來填補職位空缺。聽起來您對需求方的重視程度可能比至少我的理解要高。不知道有沒有什麼辦法可以評論一下。不過，我猜您是說您的訂單趨勢已經穩定了 3 個月。我想，這在某種程度上表明訂單已經存在。但無論如何，你有什麼外賣嗎？這是一個開放式問題，但可以從市場的需求與供給挑戰來描述它。

A.J., let me give a general comment, and then I'll turn it over to Landry to fill in some details. I think overall, we're seeing the same thing across the market, and there's probably a nuance just in terms of our businesses and the mix of some of our businesses. But what we talked about last quarter in Nurse and Allied is that we had started to see some modest growth off an early April trough. We continue to see that growth into June, and we expected it to continue into Q3. What we saw is that after the increases that we saw going into June, it really flattened out. And so the change for us was a change in utilization with our largest clients. So it wasn't a supply challenge, it really was a utilization, lower than expected from some of our largest clients.

A.J.，讓我給出一般性評論，然後我會將其交給蘭德里填寫一些細節。我認為總體而言，我們在整個市場上看到了同樣的情況，而且我們的業務和某些業務的組合可能存在細微差別。但我們上個季度在《護士與聯盟》中談到的是，我們已經開始看到四月初低谷後出現了一些溫和的增長。我們在 6 月份繼續看到這種增長，並預計這種增長將持續到第三季度。我們看到的是，在進入六月份的增長之後，它真的趨於平緩。因此，對我們來說，變化就是我們最大客戶的利用率發生變化。因此，這不是供應方面的挑戰，而是利用率方面的挑戰，低於我們一些最大客戶的預期。

And if we go forward into what we have seen and some of the patterning that Jeff mentioned in his opening comments, we have gotten some early indications from clients about winter needs. And based on those indications, we would expect that we would see a little bit back to some normal seasonal patterning of some growth from Q3 to Q4.

如果我們繼續研究我們所看到的以及傑夫在他的開場評論中提到的一些模式，我們已經從客戶那裡得到了一些關於冬季需求的早期跡象。根據這些跡象，我們預計從第三季度到第四季度，我們將看到一些正常的季節性增長模式。

Landry, I don't know if you want to...

蘭德里，我不知道你是否願意...

Yes. A.J., it's Landry. So on that pay front, so pay, of course, is just one factor that these clinicians are considering whenever they're looking at our jobs and accepting our jobs. I think we might have said in the past, really, location is the #1 preference. That's the most important. There's other things, work-life balance, flexibility of the job, the facility's reputation, working conditions. So there's a lot of different factors. And we do see certain customers right now that are posting orders that we would consider below market rates. And we do see that those go unfilled, for the most part. But that dynamic, that's not new. I mean we've seen that over many years where you have a portion of the needs that go unfilled.

是的。 A.J.，我是蘭德里。因此，在薪酬方面，薪酬當然只是這些臨床醫生在考慮我們的工作並接受我們的工作時考慮的因素之一。我想我們過去可能說過，確實，位置是第一優先。這是最重要的。還有其他一些事情，工作與生活的平衡、工作的靈活性、設施的聲譽、工作條件。所以有很多不同的因素。我們現在確實看到某些客戶正在發布我們認為低於市場價格的訂單。我們確實看到這些大部分都沒有得到滿足。但這種動態並不新鮮。我的意思是，多年來我們已經看到，有一部分需求沒有得到滿足。

A lot of our kind of more strategic and larger clients, they're posting orders at what we would consider market rate. Those customers are experiencing high fill rates. They're getting their jobs filled. So really, the reason for some of the softer volumes that we're seeing going into Q3, it's more of a demand story for us. It's just not being quite as robust as what we'd like to see. And then I guess the last thing that I'd mention is just applications. Our new application stats are still really, really strong. So there's still a lot of interest in Travel. They still remain much higher than what we ever saw pre-pandemic.

我們的許多更具戰略性和規模更大的客戶，他們都按照我們認為的市場價格發布訂單。這些客戶的填充率很高。他們的工作崗位正在被填補。事實上，我們在第三季度看到的一些銷量疲軟的原因，對我們來說更多是一個需求故事。它只是沒有我們希望看到的那麼強大。然後我想我要提到的最後一件事就是應用程序。我們的新申請統計數據仍然非常非常強勁。所以大家對旅遊還是很感興趣的。它們仍然比我們在大流行前看到的要高得多。

Our next question is from Jeff Silber of BMO Capital Markets.

我們的下一個問題來自 BMO 資本市場的 Jeff Silber。

Given the environment, I'm just curious what your company has been doing with internal head count. Has there been any changes? And should we expect future changes?

鑑於目前的環境，我只是好奇你們公司在內部員工人數方面做了什麼。有什麼變化嗎？我們應該期待未來的變化嗎？

Yes. Thanks for the question. As you know, one thing that AMN has done extremely well over its history is be able to flex up and flex down in different environments. And so as we saw lower demand really as you entered last year and entered this year, we have managed our internal resources and head count accordingly. So if you look from the beginning of the year until what we would expect in the third quarter, we will be down around 9% from a head count standpoint. And we do that. We have programs that we put in place around managing that through normal attrition, performance management. One thing I would note is, from a producer standpoint, we have intentionally kept our producers because we expect demand to increase as we get into the fourth quarter and into next year, and we want to be ready for that.

是的。謝謝你的提問。如您所知，AMN 在其歷史上做得非常出色的一件事是能夠在不同的環境中向上和向下彎曲。因此，隨著去年進入和今年進入，我們看到需求確實有所下降，因此我們相應地管理了我們的內部資源和人員數量。因此，如果從今年年初到我們對第三季度的預期，從員工數量的角度來看，我們將減少約 9%。我們就是這麼做的。我們制定了一些計劃，通過正常的人員流失和績效管理來管理這一點。我要指出的一件事是，從生產商的角度來看，我們有意保留我們的生產商，因為我們預計隨著進入第四季度和明年需求將會增加，我們希望為此做好準備。

And Jeff, I would just add, at the midpoint of the Q3 guide, although with revenue coming down as we've moved through the year, adjusted SG&A as a percent of sales has increased, but the absolute dollars have come down sequentially every quarter since the first quarter, and we would expect that trend to continue into the fourth quarter.

傑夫，我想補充一點，在第三季度指南的中點，儘管收入隨著這一年的推移而下降，調整後的銷售及管理費用佔銷售額的百分比有所增加，但絕對美元每個季度都在連續下降自第一季度以來，我們預計這種趨勢將持續到第四季度。

Okay. That is very helpful. My next question may be long, I apologize about it, but I want to talk about labor disruption. So first, I don't know if it had any impact on the second quarter, if you're expecting any impact in the third quarter. But more importantly, and this may be more anecdotal than anything else. I live in Central New Jersey, one of our large hospitals, Robert Wood Johnson, I hadn't seen the news today, but the nurses were expected to go on strike tomorrow. And one of the issues was that they wanted hospitals to reduce their contract labor spend. Obviously, it's self-serving. But I don't remember seeing that kind of pressure from the nurses themselves. Is this something that's happening elsewhere? And does that produce another headwind for your business?

好的。這非常有幫助。我的下一個問題可能很長，我對此表示歉意，但我想談談勞動力中斷問題。首先，我不知道它是否對第二季度有任何影響，如果您預計第三季度會產生任何影響。但更重要的是，這可能比其他任何事情都更具軼事性。我住在新澤西州中部，我們的一家大型醫院羅伯特·伍德·約翰遜，我今天沒有看到新聞，但預計護士明天會罷工。問題之一是他們希望醫院減少合同工支出。顯然，這是自私的。但我不記得看到過護士自己施加過這種壓力。這是其他地方發生的事情嗎？這是否會給您的業務帶來另一個阻力？

Yes. I would say, Jeff, I mean, for us, we had about $5 million in labor disruption revenue in the second quarter. And there's nothing that we're servicing our clients on from a labor disruption front in the third quarter, so there's 0 in revenue embedded in the Q3 guide. .

是的。我想說，傑夫，我的意思是，對我們來說，第二季度我們的勞動力中斷收入約為 500 萬美元。第三季度我們沒有從勞動力中斷方面為客戶提供任何服務，因此第三季度指南中的收入為 0。 。

And Jeff, I would say, overall, we haven't heard that as a theme from clients.

傑夫，我想說，總的來說，我們還沒有從客戶那裡聽說過這個主題。

Okay. Maybe one-off here.

好的。也許這裡是一次性的。

Our next question is from Trevor Romeo of William Blair.

我們的下一個問題來自威廉·布萊爾的特雷弗·羅密歐。

One, I appreciate the commentary on winter order indications kind of giving you confidence in Q4, growing sequentially for Nurse and Allied solutions. I guess as you look kind of forward, based on what you're seeing and hearing now, does it feel like there's potential for further softness in either bill rates or volumes next year after the winter? Or does it kind of feel like Q3 of this year will truly be the trough for the Travel business in this demand kind of cycle and hospitals are comfortable with where they stand in terms of contract labor?

第一，我很欣賞對冬季訂單指示的評論，這給了您對第四季度的信心，護士和聯合解決方案的連續增長。我想，當你展望未來時，根據你現在所看到和聽到的情況，是否感覺明年冬季過後，賬單利率或交易量有可能進一步疲軟？還是感覺今年第三季度將真正成為旅遊業務在這種需求週期中的低谷，並且醫院對合同工方面的狀況感到滿意？

Yes. Let me give you some macro comments, and then I'll let Landry and Jeff chime in a little bit on what we could expect to see from a bill rate, and I think we've talked a bit about what we expect to see from a demand standpoint. If you look at the macro thesis that we've talked about for some time, that remains intact. And so on the one side, we expect to continue to see an increase in overall health care demand, utilization, agent demographics, a number of factors going into that, and we'll continue to have supply constraints against that. And so we expect for there to continue to be demand across the board for the services we provide, everything from workforce planning into how we operationalize their workforce strategies, of which contingent staffing is a piece of that.

是的。讓我給你們一些宏觀評論，然後我會讓蘭德里和傑夫插話一下我們對賬單利率的預期，我想我們已經討論了我們對賬單利率的預期。需求的立場。如果你看看我們已經討論了一段時間的宏觀論點，你會發現它仍然完好無損。因此，一方面，我們預計整體醫療保健需求、利用率、代理人人口統計等一系列因素將繼續增加，而我們將繼續受到供應限制。因此，我們預計，我們提供的服務將繼續存在全面需求，從勞動力規劃到我們如何實施其勞動力戰略，其中臨時人員配置就是其中的一部分。

If you look at, on average, what you have seen, and I think this has been reinforced in the commentary from some of the public company hospital systems, they, on average, are getting back into a range of normal on contingent labor. The caveat that I put to that is clients are at different paces of change in getting there. So while we have clients that have gotten down into what they would consider some of their target rates, we have other clients that still are at high levels for a variety of reasons. And so when we think about what that looks like, this year really has been one of how do we get back into more of a normal sustainable workforce framework. But we expect that we will continue to see the supply-demand imbalance creating a need for our broad-based services as we go forward.

如果你看看你所看到的平均情況，我認為一些上市公司醫院系統的評論強化了這一點，平均而言，他們正在恢復到正常的意外分娩範圍。我要警告的是，客戶在實現這一目標的過程中處於不同的變化速度。因此，雖然我們的一些客戶已經降到了他們認為的一些目標利率，但我們還有其他客戶由於各種原因仍然處於高水平。因此，當我們思考這是什麼樣子時，今年確實是我們如何回到更正常的可持續勞動力框架的一年。但我們預計，隨著我們的發展，供需失衡將繼續導致對我們基礎廣泛的服務的需求。

Yes. And Trevor, on the bill rate side, our expectations for the fourth quarter is that bill rates would be down low single digits off of Q3 levels. That would put the 2023 exit rate, call it somewhere in the 32%, 33% above pre-pandemic levels or a 7% CAGR from 2019. And that's very much in line with, from a CAGR standpoint, where annualized nurse wage inflation is running since 2019. So that gives us confidence that that's the starting point for bill rates as we think about '24.

是的。 Trevor，在賬單利率方面，我們對第四季度的預期是賬單利率將比第三季度的水平下降低個位數。這將使2023 年的退出率比大流行前的水平高出32%、33%，或者自2019 年起的複合年增長率為7%。從復合年增長率的角度來看，這與年化護士工資通脹率非常一致。自 2019 年以來一直在運行。因此，這讓我們相信這是我們考慮“24”時賬單利率的起點。

Yes. Understood. And then I just kind of wanted to touch on the locums business, which I think you highlighted as a record revenue quarter in the second quarter. Just wondering, are you seeing broad-based increases in demand across the locums book or any particular specialties driving the strength? And then given the strength in Q2 for locums, I guess how do you reconcile that with the Q3 guide of PLS segment kind of being down 3% to 5%?

是的。明白了。然後我只是想談談 Locum 業務，我認為您強調了第二季度創紀錄的收入季度。只是想知道，您是否看到整個代理書或任何特定專業的需求出現廣泛增長？然後考慮到第二季度的代理實力，我想您如何將這一點與第三季度 PLS 細分市場指南下降 3% 到 5% 相協調？

As I turn that over to James to give some color, I want to just underscore and congratulate our entire locums team for the quarter. It was extraordinary. .

當我將其交給詹姆斯提供一些顏色時，我想強調並祝賀我們整個季度的 Locums 團隊。這是非凡的。 。

James, do you want to talk a little bit about what you're seeing?

詹姆斯，你想談談你所看到的嗎？

Sure. Thank you, Cary. And like Cary, I would like to thank the locums team as well and specifically under Jeff Decker's leadership, the team has leaned in and really lived the values of who we are as an organization. They do outstanding work. If you think about the locums business, our locums market is very strong from a demand perspective, but we're still at 1.5x the pre-COVID levels. And that demand is really driven -- it's up quarter-over-quarter and year-over-year from the specific specialties of CRNA, advanced practice, primary care and surgery. And the surgery continues to move forward.

當然。謝謝你，卡里。和 Cary 一樣，我也要感謝 Locums 團隊，特別是在 Jeff Decker 的領導下，該團隊已經融入並真正踐行了我們作為一個組織的價值觀。他們的工作非常出色。如果您考慮一下果蔬業務，從需求角度來看，我們的果蔬市場非常強勁，但仍處於新冠疫情前水平的 1.5 倍。這種需求確實受到驅動——它來自 CRNA、高級實踐、初級保健和外科等特定專業的逐季和逐年增長。而手術還在繼續推進。

I think what I will state is that when you think about our results, the results for Q2, we have record high in revenue of 14.3%, sequentially up, 15% over year-over-year up on revenue and other favorable metrics that we have from a demand, from fill rates, from book spreads, POA and revenues they fill, all of those metrics were up both quarter-over-quarter and year-over-year. Team's focusing upon our clients and helping our clients to meet their demand because when we meet their demand and put physicians in place, those are revenue-generating positions that help our clients to be able to meet their financial numbers. And we do that through leveraging our MSP and thinking about total talent solution. So the locums team keeps leveraging our MSP and leveraging our total talent solutions. I think that we're well positioned. Market is very high in demand, and the team is delivering against that demand.

我想我要說的是，當你考慮我們的結果時，第二季度的結果，我們的收入創歷史新高，環比增長 14.3%，同比增長 15%，收入和我們認為的其他有利指標從需求、填充率、賬面價差、POA 和填充收入來看，所有這些指標均環比和同比增長。團隊專注於我們的客戶並幫助我們的客戶滿足他們的需求，因為當我們滿足他們的需求並將醫生安置到位時，這些都是創收職位，可以幫助我們的客戶能夠滿足他們的財務目標。我們通過利用我們的 MSP 並思考整體人才解決方案來做到這一點。因此，locum 團隊不斷利用我們的 MSP 和我們的整體人才解決方案。我認為我們處於有利位置。市場需求非常高，團隊正在滿足這一需求。

And on the guide, Trevor, I would just add, the expectation for locums in Q3 would be pretty flattish sequentially over Q2, and that should still be up low teens on a year-over-year basis. And then where we are facing some headwinds within interim and search, demand trends remain soft there as hospital systems continue with their cost containment measures, and we would expect both of those businesses to be down approximately 10% quarter-over-quarter in Q3.

在指南中，Trevor，我想補充一點，第三季度的預期將比第二季度相當持平，而且同比仍應保持在十幾歲以下。然後，我們在中期和搜索方面面臨一些阻力，隨著醫院系統繼續採取成本控制措施，需求趨勢仍然疲軟，我們預計這兩項業務在第三季度將環比下降約 10%。

Next question is from Brian Tanquilut of Jefferies.

下一個問題來自 Jefferies 的 Brian Tanquilut。

I guess my first question would just be any color you can share with us about just the competitive environment. I mean there's a lot of chatter about MSPs moving around. And I know, Cary, you talked about vendor-neutral agreements and wins in that area as well. So just maybe any color you can share on what that environment looks like today. .

我想我的第一個問題就是您可以與我們分享有關競爭環境的任何顏色。我的意思是，有很多關於 MSP 流動的討論。我知道，卡里，您也談到了供應商中立協議和該領域的勝利。因此，您可以分享有關當今環境的任何顏色。 。

Yes. Let me start with something I mentioned in the last call that we have seen continue. If you really look at what we're seeing with clients overall, coming out of the pandemic, for 3 years, they were heads down focused on dealing with a surge in demand and challenges in our workforce. And so we have seen them come out of the pandemic with a huge need around how do I find solutions that are going to help me with transparency, cost containment and building a sustainable workforce. And so we've seen that continue as an overall theme and a bigger openness across the board for clients to try solutions that are going to help them achieve that.

是的。讓我從上次通話中提到的我們已經看到的內容開始。如果你認真觀察一下我們在走出疫情后的客戶整體情況，三年來，他們都在埋頭苦幹，專注於應對需求激增和勞動力挑戰。因此，我們看到他們在走出疫情后，迫切需要如何找到解決方案來幫助我提高透明度、控製成本並建立一支可持續的勞動力隊伍。因此，我們看到這將繼續作為一個整體主題，並且全面開放，讓客戶嘗試能夠幫助他們實現這一目標的解決方案。

I know there's been conversations around MSP, VMS. Obviously, we are a major player in both of them. We look at it as what clients need, and we wrap our solutions around them. We haven't seen one model change, one competitor change, about what clients are coming from are going to. I think the overall theme we're seeing is clients are looking for a way that they can sustainably build a workforce to serve their needs. And so if you go back and look at what we're seeing overall from a competitive market, it's a competitive market. So it was competitive during the pandemic. And as you've gone into this period of lower demand, that competition has intensified. We think we are well positioned as clients look for a variety of solutions because of the breadth of what we provide, to be in a very good position to help clients regardless of whether they want an MSP relationship, a vendor-neutral relationship or any of the other solutions that we provide.

我知道有人在討論 MSP、VMS。顯然，我們是這兩個領域的主要參與者。我們將其視為客戶的需求，並圍繞他們制定解決方案。關於客戶的來源和去向，我們還沒有看到一種模式發生變化，一種競爭對手發生變化。我認為我們看到的總體主題是客戶正在尋找一種能夠可持續地培養勞動力來滿足他們的需求的方法。因此，如果你回顧一下我們從競爭市場中看到的整體情況，就會發現這是一個競爭市場。所以疫情期間還是很有競爭力的。當你進入這個需求較低的時期時，競爭就會加劇。我們認為，由於我們提供的服務範圍廣泛，當客戶尋求各種解決方案時，我們處於有利位置，可以很好地幫助客戶，無論他們想要 MSP 關係、供應商中立關係還是任何其他關係我們提供的其他解決方案。

And one other thing I should mention, Brian, is if we look year-over-year at our MSP pipeline, our pipeline is 300% higher than this time last year.

Brian，我應該提到的另一件事是，如果我們逐年查看我們的 MSP 管道，我們的管道比去年同期高出 300%。

Got it. Okay. That's awesome. I guess my follow-up kind of related as well, I mean, as AJ mentioned earlier, I mean, one of your competitors is talking about challenges with recruitment and whatnot. But they called out the tightening of spread between bill rate and take rate. And as I look at your margins and Nurse and Allied for the quarter, obviously, not showing any deterioration. So maybe just curious in what your outlook is for margins going forward, gross margins in Nurse and Allied, given those commentaries.

知道了。好的。棒極了。我想我的後續行動也與之相關，我的意思是，正如 AJ 之前提到的，我的意思是，你的一位競爭對手正在談論招聘等方面的挑戰。但他們呼籲票據利率和接受率之間的利差收緊。當我查看本季度你們的利潤率以及護士和聯合公司時，顯然沒有顯示出任何惡化。因此，考慮到這些評論，也許只是好奇您對護士和聯合公司未來利潤率、毛利率的展望。

We would expect Nurse and Allied gross margins in the fourth quarter, that's typically seasonally low for us, Brian, just because of the hours worked. And the Q3 level should be pretty comparable to where we were in Q2.

我們預計護士和聯合公司第四季度的毛利率，這對我們來說通常是季節性較低的，布萊恩，只是因為工作時間。第三季度的水平應該與第二季度的水平相當。

The next question is from Kevin Fischbeck of Bank of America.

下一個問題來自美國銀行的 Kevin Fischbeck。

I wanted to ask about what you guys believe your visibility is into the Q4 trends because I guess this is now 2 quarters where both you and your public competitors have taken down guidance for the year. And so it seems like the market is in flux, and it's kind of hard to hit what seems to be a moving target. Because I think last quarter, you both sounded confident that things were firming. I guess, is there a reason to believe that the data points you're getting today are better or more informed data points than what you saw at this point last year or whether things are still in flux and visibility is still kind of below average?

我想問你們認為你們對第四季度趨勢的了解程度如何，因為我想你們和你們的公開競爭對手已經在這兩個季度取消了今年的指導。因此，市場似乎在不斷變化，而且很難達到看似不斷變化的目標。因為我認為上個季度，你們倆聽起來都對形勢的穩定充滿信心。我想，是否有理由相信您今天獲得的數據點比您去年此時看到的數據點更好或更明智，或者情況是否仍在不斷變化並且可見性仍然低於平均水平？

Yes, Kevin, I would say, for us, we would really say the behavior among our top clients was very different than what we had seen historically. We've talked many times about how we thought this year would return to some level of normal seasonal patterns. And we did assume a partial recovery. And then we saw utilization decline into the third quarter. As it relates to Q4, we do believe that the stability that we've seen in the demand trends over the past 3 months as well as the indications that we've received from our clients on their winter order needs is what gives us that visibility into Q4 and that Nurse and Allied revenue will increase sequentially over Q3, and that Q3 will be the trough within Nurse and Allied.

是的，凱文，我想說，對我們來說，我們確實會說我們的頂級客戶的行為與我們歷史上看到的非常不同。我們已經多次討論過我們認為今年將恢復到某種程度的正常季節性模式。我們確實假設部分恢復。然後我們看到第三季度的利用率下降。就第四季度而言，我們確實相信過去 3 個月需求趨勢的穩定性以及我們從客戶那裡收到的有關冬季訂單需求的跡象使我們能夠了解進入第四季度，護士和聯盟的收入將比第三季度連續增長，而第三季度將是護士和聯盟的低谷。

Okay. And I guess maybe your commentary is a little bit different than theirs. I guess the competitor was kind of saying that there were a lot of orders that were coming in below kind of market rates and just not being filled. I don't want to call them phantom orders but kind of orders that potentially the hospital never fully expected to be filled. I just want to make sure that I had it right that these orders, in your view, are kind of orders that make sense at or near market rates that you're seeing firming and there's no mix in kind of how those orders are looking and whether you've got real confidence that they're actually fillable orders.

好的。我想也許你的評論與他們的有些不同。我猜競爭對手是在說，有很多訂單的價格低於市場價格，但沒有被滿足。我不想稱其為“幽靈訂單”，而是指醫院可能從未完全預期會得到滿足的訂單。我只是想確保我的說法是正確的，在您看來，這些訂單是在您看到的市場價格或接近市場價格時有意義的訂單，並且這些訂單的外觀和價格沒有混合。您是否真正有信心它們實際上是可以執行的訂單。

Kevin, it's Landry. So I don't disagree with the other public competitor that if some of those orders had higher pay rate, that they would go at a higher fill rate. So I don't disagree with that. The thing is that's always been a component in the marketplace. And what we see on those orders that are going unfilled, it's not disproportionate to what we would have seen before. So that's why we believe the mix of those orders, and based on what the bill rates are and what the market is demanding and what clinicians are demanding, that we need some more demand. And like Cary and Jeff both mentioned, it's leveled out. And we've seen the list of winter needs from our clients, from some of our top clients. It's not official, but those lists show us that the demand that will be coming in for winter needs, which means Q4 and into Q1, is at or above what we saw last year.

凱文，我是蘭德里。因此，我不同意其他公開競爭對手的觀點，即如果其中一些訂單的支付率更高，那麼它們的履行率就會更高。所以我不同意這一點。問題是它一直是市場的一個組成部分。我們在那些未履行的訂單上看到的情況與我們以前看到的情況並不不成比例。因此，這就是為什麼我們相信這些訂單的組合，並且根據賬單費率、市場需求和臨床醫生的需求，我們需要更多的需求。正如卡里和傑夫都提到的那樣，它已經趨於平穩。我們已經從我們的客戶（一些頂級客戶）那裡看到了冬季需求清單。這不是官方的，但這些清單向我們表明，冬季需求（這意味著第四季度和第一季度）的需求將達到或高於我們去年看到的水平。

Okay. And then maybe just last question. I guess, historically, as we thought about how this year was trending and then we thought about 2024, you guys seem to be guiding to like the Q4 numbers, probably take that annualized, and that's a good base to think about for next year. If I see what you're saying about Nurse and Allied being up and the other 2 divisions being down, that Q4 revenue overall might be flattish to maybe slightly up, which would put you more like a 3.5% type base for annualized. Is that the right way to think about the jumping off point into next year? Or is there something wrong with that?

好的。也許只是最後一個問題。我想，從歷史上看，當我們思考今年的趨勢，然後思考 2024 年時，你們似乎會喜歡第四季度的數據，可能會採用年化數據，這是考慮明年的良好基礎。如果我看到你所說的護士和聯合部門上升而其他兩個部門下降，那麼第四季度的整體收入可能持平甚至略有上升，這會讓你更像是年化增長率為3.5% 的基數。這是考慮明年起點的正確方法嗎？或者這有什麼問題嗎？

It's directionally correct, Kevin. I would say you could think about the back half run rate, certainly on the top line, would smooth out some of that seasonality, particularly within PLS and TWS as well as on the margin side.

方向是正確的，凱文。我想說，你可以考慮後半段的運行率，當然是在頂線上，會消除一些季節性，特別是在 PLS 和 TWS 以及保證金方面。

Okay. So the back half of this year guidance annualized, and then from there, you think growth in bill rates and billable hours make sense.

好的。因此，今年下半年的指導方針按年計算，然後從那時起，您認為賬單費率和計費時間的增長是有意義的。

Rates will depend on inflation, but we would probably envision them being pretty flattish next year off of those Q4 levels. I think Cary spoke about the depth of the MSP pipeline. Obviously, we have tailwinds within locums as well as language services as well. And then the marketplace client churn could potentially be a headwind as well.

利率將取決於通貨膨脹，但我們可能預計明年的利率將與第四季度的水平相當持平。我認為 Cary 談到了 MSP 管道的深度。顯然，我們在所在地和語言服務方面也有優勢。然後，市場客戶流失也可能成為不利因素。

Our next question comes from Tobey Sommer of Truist Securities.

我們的下一個問題來自 Truist Securities 的 Tobey Sommer。

With another 3 months that the firm, Cary, could you share a bit more with us about how you may shape the business in the portfolio as the business looks to be stabilizing towards year-end?

距離公司還有 3 個月的時間，Cary，您能否與我們分享更多有關您如何在投資組合中塑造業務的信息，因為該業務看起來在年底趨於穩定？

Yes. Thank you. And I think, hopefully, you have gotten the sense, both in terms of what we've done from a leadership standpoint as well as areas of emphasis that we have underscored over the past couple of quarters. We look at our portfolio as being very well positioned in a period of extraordinary change with our clients and in the overall health care workforce ecosystem. Areas of focus for us, number one, particularly during this period of inflection, will be on our customers.

是的。謝謝。我認為，希望您已經明白了，無論是從領導力的角度來看我們所做的事情，還是我們在過去幾個季度強調的重點領域。我們認為，在客戶和整個醫療保健勞動力生態系統發生巨大變化的時期，我們的投資組合處於非常有利的位置。我們的首要關注領域，特別是在這個拐點時期，將是我們的客戶。

And by customers, it will be both on the client side and on the clinician side. On the client side, we will continue to drive towards a total talent solution set for them, starting with how we help them in overall workforce planning, which is of incredibly high interest, and be able to operationalize that plan through our broad set of solutions. All of that, both in terms of how we interface with them and also what we do on our own platform, will have increasing degrees of integration on the technology side. On the clinician side, and we mentioned this in the opening comments about Passport, we continue to want to support our producers in their relationships with their clinicians, in making it easy 24/7 for our clinicians to have access to a wider range of capabilities through Passport. Obviously, that has gone very well. We have over 200,000 clinicians on that app.

對於客戶來說，它既可以在客戶端，也可以在臨床醫生端。在客戶方面，我們將繼續推動為他們提供全面的人才解決方案，從我們如何幫助他們進行整體勞動力規劃開始，這是非常令人感興趣的，並能夠通過我們廣泛的解決方案來實施該計劃。所有這些，無論是我們如何與他們交互，還是我們在自己的平台上所做的事情，都將在技術方面具有越來越高的集成度。在臨床醫生方面，我們在有關 Passport 的開場評論中提到了這一點，我們繼續希望支持我們的生產商與臨床醫生的關係，使我們的臨床醫生能夠輕鬆地 24/7 獲得更廣泛的功能通過護照。顯然，一切進展順利。該應用程序上有超過 200,000 名臨床醫生。

Second big area of focus is all the efforts around One AMN, how we continue to strongly grow both organically and through M&A but have a platform that's going to benefit from the growth that we have both organic and inorganic. It has brand component, how we operate our company more effectively, client centricity about how we approach the clients and truly wrap our entire set of solutions around them. Third big component is technology, which I think you've heard me talk about over the past 2 quarters, and you should expect that to continue. We are accelerating all things tech and digital.

第二大重點領域是圍繞 One AMN 所做的所有努力，我們如何繼續通過有機和併購實現強勁增長，同時擁有一個能夠從我們有機和無機增長中受益的平台。它具有品牌成分，我們如何更有效地運營公司，以客戶為中心，即我們如何接近客戶並真正圍繞他們提供整套解決方案。第三大組成部分是技術，我想您在過去兩個季度中已經聽到我談論過它，並且您應該期望這種情況會持續下去。我們正在加速所有科技和數字化事物的發展。

And then the last 2 pieces, M&A, we have grown very successfully in the past as part of our overall strategy through M&A. We expect the M&A market opportunities to continue to accelerate as we leave the year and get into next year, and we would expect to participate in that. And then finally, all of that will be underpinned by our foundation and our culture around DEI, inclusion, attracting and retaining the best talent.

最後兩部分，併購，作為我們通過併購的整體戰略的一部分，我們在過去取得了非常成功的發展。我們預計，隨著今年的結束和明年的到來，併購市場機會將繼續加速，我們預計將參與其中。最後，所有這一切都將得到我們圍繞 DEI、包容、吸引和留住最優秀人才的基礎和文化的支持。

I appreciate that. I was wondering, how do you explain the rapid growth in Stratus win? And at a sort of a foundational level, it doesn't look like the non-native English-speaking population growth has been as robust. What are the factors contributing to that rapid growth in recent years as well as so far this year?

我很感激。我想知道，您如何解釋 Stratus win 的快速增長？從某種基礎層面來看，非英語母語人口的增長似乎並不那麼強勁。是什麼因素促成了近年來以及今年迄今為止的快速增長？

Yes, it's a good question. There's a couple of things. If you look at the overall profit pool for that, we are growing faster. And I think there's a couple of factors, one, in terms of how our clients are utilizing that service. There are some clients who are actually doing it in-house beforehand. So I think one is it's not necessarily that we are taking share away and there's a bigger influx of population that their primary language is not English, it's that they've been served in different ways and probably not as efficiently within the health systems in the past. And so I think this is part of the strategy of how you ensure that you are operating your workforce as effectively as possible.

是的，這是一個好問題。有幾件事。如果你看看整體利潤池，我們的增長速度更快。我認為有幾個因素，第一，我們的客戶如何利用該服務。有些客戶實際上事先在內部就這樣做了。因此，我認為，我們不一定要奪走份額，而且有更多的人口湧入，他們的主要語言不是英語，而是他們以不同的方式獲得服務，而且在衛生系統中可能效率不高。過去的。因此，我認為這是確保盡可能有效地運營員工隊伍的戰略的一部分。

Second piece is we've started to introduce that solution set into our MSP. And so a very big part of the AMN's value proposition is how do we put our entire solution set into our MSP relationships. Just during the course of this year, we've made progress from having an average of 8 of our solutions into our top clients to having 9, and our language services are a big part of that. A final piece that I'll mention, Tobey, is we have a video solution. And what we have seen is that, that solution has a value proposition that is attractive to clients. And so we think that has also been a part of our outsized growth relative to the market.

第二部分是我們已經開始將該解決方案引入我們的 MSP。因此，AMN 價值主張的一個非常重要的部分是我們如何將整個解決方案集融入我們的 MSP 關係中。就在今年，我們的頂級客戶解決方案從平均 8 個增加到了 9 個，而我們的語言服務是其中的重要組成部分。托比，我要提到的最後一點是我們有一個視頻解決方案。我們看到的是，該解決方案具有對客戶有吸引力的價值主張。因此，我們認為這也是我們相對於市場大幅增長的一部分。

Next question is from Bill Sutherland of The Benchmark Company.

下一個問題來自 Benchmark Company 的 Bill Sutherland。

Been thinking about the locum space, which has just been very, very strong for you and others. What do you think would be the limiting factors on growth there? And what's reasonable kind of looking over the horizon a little bit as far as the sustainability of the growth?

一直在思考代理空間，它對你和其他人來說非常非常強大。您認為限制那裡增長的因素是什麼？就增長的可持續性而言，什麼才是合理的展望？

So first of all, I appreciate your question. In the locum marketplace, from a demand standpoint, as you heard me mention earlier, the demand is still at 1.5x of pre-COVID levels. I believe that, that will continue to remain where it is. When you think about the demand coming in from the consumer needing care. You think about the aging population, 6 out of 10 with a chronic disease. And by 2034, you have people that are a bit more over 65 than you're going to have under 17. And then also wait times to actually get into the health care systems, those wait times are actually going up.

首先，我很欣賞你的問題。在臨時市場中，從需求的角度來看，正如您之前聽到我提到的，需求仍處於新冠疫情前水平的 1.5 倍。我相信，這將繼續保持原樣。當您考慮來自需要護理的消費者的需求時。想想人口老齡化，十分之六的人患有慢性病。到 2034 年，65 歲以上的人口將多於 17 歲以下的人口。而且，真正進入醫療保健系統的等待時間實際上正在增加。

So I think the demand will remain pretty constant. And the limiting factor will be the supply, the number of positions that we have within the marketplace to be able to deliver against that, hence, where we come in and, I think, play a significant role in delivering total talent solution and really thinking through how do we help our clients to, one, have revenue-generating events that help them to be able to manage their bottom line but also to provide care for the patients that are meeting that. So at this point, I think we have to think through how do we solve for that could be a very perfect storm, more people needing care with less physicians to be able to deliver against that. And I think we play a very significant role in helping with that.

所以我認為需求將保持相當穩定。限制因素將是供應，以及我們在市場上能夠提供的職位數量，因此，我們進來的地方，我認為，在提供全面的人才解決方案和真正思考方面發揮著重要作用我們如何幫助我們的客戶，第一，舉辦創收活動，幫助他們管理利潤，同時為達到目標的患者提供護理。因此，在這一點上，我認為我們必須思考如何解決這可能是一場非常完美的風暴，更多的人需要護理，而更少的醫生能夠應對這種情況。我認為我們在幫助實現這一目標方面發揮著非常重要的作用。

And Cary, when you think about resuming M&A, are you thinking more about adding to your toolkit solutions? Or are you thinking more about bench increases to, for instance, an area that's strong like locums?

Cary，當您考慮恢復併購時，您是否更多地考慮添加到您的工具包解決方案中？或者你是否更多地考慮將板凳增加到例如像坐椅這樣強壯的區域？

I would say what we look at is both. And so you should expect us to look at solutions that are going to mirror what we're seeing and anticipate to see in terms of future client needs. Tech-enabled solutions, language services, and what we did there, is probably a great example of what we would continue to look for in the future. And then when we look at areas like what James was just talking about and where we think we have an opportunity to accelerate demand, we will always look at those areas as well.

我想說的是，我們所關注的是兩者。因此，您應該期望我們看到的解決方案將反映我們所看到的並預期未來客戶需求的情況。技術支持的解決方案、語言服務以及我們在那裡所做的事情可能是我們未來繼續尋求的一個很好的例子。然後，當我們關注詹姆斯剛才談到的領域以及我們認為有機會加速需求的領域時，我們也會始終關注這些領域。

Jeff, what would you add about M&A overall?

傑夫，您對併購總體有何看法？

I think the pipeline right now, I would say, we're starting to see more tech-enabled assets. That market has been pretty slow the last 18 months. So we're seeing activity pick up there as well as within James' area on the PLS side, not as much in the pipeline on the Travel Nurse or Allied side.

我認為現在的管道，我想說，我們開始看到更多技術支持的資產。過去 18 個月，該市場增長相當緩慢。因此，我們看到 PLS 方面以及 James 區域內的活動有所增加，而旅行護士或盟軍方面的活動則沒有那麼多。

Our final question is from Andre Childress of Baird.

我們的最後一個問題來自貝爾德 (Baird) 的安德烈·奇爾德里斯 (Andre Childress)。

This is Andre on for Mark Marcon. So I'll just have one quick follow-up on the last comment you made with the tech-enabled assets. Can you first talk about some of the multiples or valuations you're seeing on some of those companies that are for sale? And then also additionally, on capital allocation, can you talk about maybe your appetite for further share repurchases and how you view your leverage ratio?

我是安德烈 (Andre) 替馬克·馬爾孔 (Mark Marcon) 發言。因此，我將快速跟進您對技術支持資產所做的最後評論。您能否首先談談您所看到的一些待售公司的市盈率或估值？另外，關於資本配置，您能否談談您對進一步股票回購的興趣以及您如何看待槓桿率？

Andre, let me take the first part of that, and then I'll let Jeff talk about repurchases. What we are hearing is that on some of the tech-enabled solutions, there is an expectation, as we get through the year, that there's a bit of an understanding that some of those assets have been revalued since what we might have seen. So while we haven't seen a number of those assets trade over the past couple of quarters, we would expect that there would be some expectations that those valuations would look more like what you've seen the broader market trade at. So our expectation is we not only see more but we see valuation levels that could make it interesting.

安德烈（Andre），讓我先講第一部分，然後我將讓傑夫（Jeff）談談回購問題。我們聽到的是，在一些技術支持的解決方案上，隨著我們度過這一年，人們預計其中一些資產自我們可能看到的情況以來已經重新估值。因此，雖然我們在過去幾個季度沒有看到其中一些資產進行交易，但我們預計會有一些預期，這些估值看起來更像是您在更廣泛的市場交易中看到的估值。因此，我們的期望是，我們不僅會看到更多，而且會看到估值水平可能會使其變得有趣。

On the repurchase side, Jeff, I'll let you talk to that.

在回購方面，傑夫，我會讓你談談這個問題。

Yes, I'd just say, Andre, obviously, the balance sheet affords us a tremendous amount of flexibility right now, levered at 1.5x. We did enter into the $200 million ASR this quarter. That could, on an outside date, be completed as late as November or as early, at the counterparty's discretion, sometime in the third quarter. So again, that brought our in-year share repurchases to $425 million. We think that's pretty close to the right number for calendar '23. And then moving into '24 and beyond, obviously, M&A would be our first priority for capital deployment. And then absent anything compelling on the M&A front, we will look to return capital to shareholders and repurchase shares.

是的，我只想說，安德烈，顯然，資產負債表現在為我們提供了巨大的靈活性，槓桿率為 1.5 倍。本季度我們確實簽訂了 2 億美元的 ASR。在外部日期，該交易最遲可能在 11 月完成，也可能最早（由交易對手自行決定）在第三季度的某個時間完成。因此，我們的年內股票回購額再次達到 4.25 億美元。我們認為這非常接近日曆 '23 的正確數字。進入 24 年及以後，顯然，併購將是我們資本部署的首要任務。然後，如果併購方面沒有任何引人注目的事情，我們將尋求向股東返還資本並回購股票。

Seeing no further questions at this time, I would now like to turn the conference back to Cary Grace for closing comments.

由於目前沒有其他問題，我現在想將會議轉回由卡里·格雷斯（Cary Grace）徵求結束意見。

I appreciate that. I always thank our amazing AMN team members and clinicians. And I just want to leave by calling out 4: a special thank you to Landry and Denise and what they did to build AMN into the incredible company it is today, and a huge congratulations to Robin and Whitney on their new roles.

我很感激。我始終感謝我們出色的 AMN 團隊成員和臨床醫生。離開之前，我只想說 4：特別感謝 Landry 和 Denise，感謝他們為將 AMN 打造成為今天這家令人難以置信的公司所做的一切，並熱烈祝賀 Robin 和 Whitney 擔任新職務。

As always, we appreciate your interest in AMN. Thank you all.

一如既往，我們感謝您對 AMN 的興趣。謝謝你們。

This concludes today's conference call. Thank you for participating. You may now disconnect.

今天的電話會議到此結束。感謝您的參與。您現在可以斷開連接。