AMN Healthcare Services Inc (AMN) 2023 Q4 法說會逐字稿

Good day and thank you for standing by. Welcome to AMN Healthcare's fourth-quarter and full-year 2023 earnings conference call. (Operator Instructions) 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 的第四季和 2023 年全年財報電話會議。（操作員指示）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, Randle Reece, Senior Director of Investor Relations. Please go ahead.

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德爾·里斯 (Randle Reece)。請繼續。

Good afternoon, everyone. Welcome to AMN Healthcare's fourth quarter and full year 2023 earnings call. A replay of this webcast will be available at ir.amnhealthcare.com at the conclusion of this call.

大家下午好。歡迎參加 AMN Healthcare 的第四季和 2023 年全年財報電話會議。本次電話會議結束後，將在 ir.amnhealthcare.com 上重播該網路廣播。

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.

我們在本次電話會議中發表的各種有關未來預期、預測、趨勢、計劃、事件或情況的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資訊的當前信念。

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 release, 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.

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、我們的收益發布以及隨後向SEC 提交的文件中確定的因素，我們的實際結果可能與這些前瞻性聲明所顯示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資訊。有關這些非 GAAP 衡量標準與最直接可比較的 GAAP 衡量標準的調整資訊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, President and Chief Executive Officer; and Jeff Knudson, Chief Financial Officer. I will now turn the call over to Cary.

今天參加電話會議的是總裁兼執行長 Cary Grace；和財務長傑夫·克努森 (Jeff Knudson)。我現在將把電話轉給卡里。

Thank you, Randy. AMN Healthcare finished 2023 with a solid fourth quarter and a stabilizing outlook for the first quarter of the new year. Last year, we successfully balanced two objectives.

謝謝你，蘭迪。AMN Healthcare 2023 年第四季表現強勁，新年第一季前景穩定。去年，我們成功平衡了兩個目標。

We worked through the largest cyclical reset in industry history, partnering with clients to help them optimize their workforce mix to meet their strategic and financial objectives. At the same time, we positioned AMN for stronger growth in technology-centric total talent solutions for healthcare.

我們經歷了該行業歷史上最大規模的周期性重置，與客戶合作，幫助他們優化勞動力結構，以實現他們的策略和財務目標。同時，我們將 AMN 定位為以技術為中心的醫療保健整體人才解決方案的更強勁成長。

Throughout the history of our company, AMN has excelled at innovating to support healthcare professionals and clients during changing times. And 2023 saw our team members pull together to transform AMN as clients need shifted during the pandemic. While we navigated a declining staffing market, AMN initiated a wide-ranging series of initiatives to accelerate our agility and align our value proposition with the increasing need for innovative solutions to solve significant healthcare workforce challenges.

縱觀我們公司的歷史，AMN 一直擅長創新，在不斷變化的時代為醫療保健專業人員和客戶提供支援。2023 年，隨著客戶需求在疫情期間發生變化，我們的團隊成員齊心協力改造 AMN。在我們應對不斷下滑的人力資源市場的同時，AMN 發起了一系列廣泛的舉措，以加快我們的敏捷性，並使我們的價值主張與對創新解決方案日益增長的需求相一致，以解決重大的醫療保健勞動力挑戰。

From the beginning, our strategy has been guided by four pillars: be the preferred partner to help healthcare organizations optimize their workforce strategy; be the preferred employer for healthcare professionals and team members; build on and digitize our unmatched portfolio of total talent solutions for healthcare; and be good stewards of capital, investing prudently for the short and long term.

從一開始，我們的策略就以四大支柱為指導：成為幫助醫療保健組織優化其勞動力策略的首選合作夥伴；成為醫療保健專業人員和團隊成員的首選雇主；建立並數位化我們無與倫比的醫療保健整體人才解決方案組合；做好資本管家，謹慎投資短期和長期。

Where at the middle of last year, we were just getting started adapting to market changes and developing our operational plan for growth, I am now pleased to report that AMN has made progress on all these objectives.

去年年中，我們剛開始適應市場變化並製定成長營運計劃，現在我很高興地向大家報告，AMN 在所有這些目標上都取得了進展。

We made ourselves a better partner and elevated our total talent solutions by moving to integrate our solutions, our systems, and our brands going to market truly as One AMN. In addition, we restarted our sales organization to pursue growth opportunities in all segments of our market.

我們透過整合我們的解決方案、我們的系統和我們的品牌，真正以 One AMN 的身份推向市場，使自己成為更好的合作夥伴，並提升了我們的整體人才解決方案。此外，我們重新啟動了銷售組織，以在市場的各個領域尋求成長機會。

As healthcare leaders made workforce management a top strategic priority, we developed the flexibility to deliver a comprehensive range of solutions through our technology platform. We took the best new technology and made our services more powerful, easier to use, and faster to deploy.

隨著醫療保健領導者將勞動力管理作為首要策略重點，我們開發了透過我們的技術平台提供全面解決方案的靈活性。我們採用了最好的新技術，使我們的服務更強大、更容易使用、部署更快。

We have the breadth and depth of solutions to serve clients in any model they choose, ranging from direct staffing to vendor-neutral and master vendor MSP to recruiting solutions and workforce management technology or a hybrid of models. Our ability to broadly serve the market is enabling us to grow our sales pipeline across all service lines.

我們擁有廣泛而深入的解決方案，可以以客戶選擇的任何模式為他們提供服務，從直接人員配備到供應商中立和主供應商 MSP，再到招聘解決方案和勞動力管理技術或混合模式。我們廣泛服務市場的能力使我們能夠擴大所有服務線的銷售管道。

Becoming more agile meant speeding up the pace of IT and operational transformation at AMN. And we have completed some of the largest improvement projects in company history. These included moving nine nurse and allied, and three physician and leadership brands under the AMN Healthcare brand and into One AMN front door for healthcare professionals; important milestones for getting the benefit of operating as a total talent solutions organization.

變得更加敏捷意味著加快 AMN 的 IT 和營運轉型步伐。我們已經完成了公司歷史上一些最大的改進項目。其中包括將 AMN 醫療保健品牌下的 9 名護理師和相關人員以及 3 名醫生和領導品牌轉移到醫療保健專業人員的 One AMN 前門；作為獲得全面人才解決方案組織營運優勢的重要里程碑。

Brand recognition for AMN is already testing at an all-time high. And candidate traffic and applicants have outpaced expectations. This quarter, we are on track to move nurse and allied to the new cloud version of our proprietary front-end platform. Last quarter was the debut of ShiftWise Flex, the cloud-enabled version of our industry-leading VMS software, which we also have extended to a mobile app, enabling on-the-go workforce management.

AMN 的品牌認知度已達到歷史最高水準。候選人流量和申請人數超出了預期。本季度，我們預計將護理師和聯盟轉移到我們專有前端平台的新雲端版本。上季首次推出了 ShiftWise Flex，這是我們業界領先的 VMS 軟體的雲端支援版本，我們還將其擴展為行動應用程序，支援行動勞動力管理。

ShiftWise Flex has an embedded market insights and analytics dashboard available as a standard feature. Addressing the critical need for actionable transparent market intelligence, this solution provides our MSP and VMS customers with daily updates on clinical labor trends and market rates, supporting informed decision-making and strategic planning.

ShiftWise Flex 具有嵌入式市場洞察和分析儀表板作為標準功能。該解決方案滿足了對可操作的透明市場情報的迫切需求，為我們的 MSP 和 VMS 客戶提供臨床勞動力趨勢和市場價格的每日更新，以支援明智的決策和策略規劃。

We also are deploying embedded market rate analytics that can project bill rate at the work order level as far as 90 days out. Our investments in ShiftWise Flex are being validated by the broader market reception and competitive renewals with our existing VMS relationships.

我們也部署嵌入式市場費率分析，可以在工單層級預測長達 90 天的帳單費率。我們對 ShiftWise Flex 的投資正在透過更廣泛的市場接受和與我們現有 VMS 關係的競爭性更新而得到驗證。

We are deploying ShiftWise Flex to current clients and new MSP clients as well. And we have completed API integrations with client systems to automate work order entry, clinician onboarding and offboarding, timekeeping, and invoicing. These changes at AMN have strengthened our ability to serve healthcare professionals.

我們正在向現有客戶和新的 MSP 客戶部署 ShiftWise Flex。我們還完成了與客戶端系統的 API 集成，以自動化工作訂單輸入、臨床醫生入職和離職、計時和開立發票。AMN 的這些變化增強了我們為醫療保健專業人員提供服務的能力。

One AMN branding is an important element of how we support an increasing number of workers through our industry-leading AMN Passport mobile app. Passport has expanded from its start in nursing to encompass allied and soon, physicians and advanced practices. AMN Passport now features AI-driven enhancements to our proprietary matching algorithm.

AMN 品牌是我們如何透過業界領先的 AMN Passport 行動應用程式支援越來越多員工的重要因素。Passport 從最初的護理領域擴展到涵蓋相關領域，並很快涵蓋醫生和先進實踐。AMN Passport 現在對我們專有的匹配演算法進行了人工智慧驅動的增強。

Clinicians receive opportunities that best match their skills and preferences. And they can book for themselves, further personalizing and optimizing their Passport experience. AMN Passport has become an important tool for engaging the workforce, enabling self-service, and giving professionals an always-on connection to AMN. Our development work is making it easier for professionals to find the career options they want and manage not just their assignments but their careers.

臨床醫生可以獲得最適合他們的技能和偏好的機會。他們可以自行預訂，進一步個人化和優化他們的 Passport 體驗。AMN Passport 已成為吸引員工、實現自助服務以及為專業人士提供與 AMN 始終在線的聯繫的重要工具。我們的開發工作使專業人士能夠更輕鬆地找到他們想要的職業選擇，並不僅管理他們的任務，還管理他們的職業生涯。

AMN Passport and ShiftWise Flex are also central to our powerful solutions that enables clients to manage internal resource pools, internal agencies, and direct sourcing. Passport's acclaimed clinician experience is essential for clients to attract the best people at the best cost in less time.

AMN Passport 和 ShiftWise Flex 也是我們強大解決方案的核心，讓客戶能夠管理內部資源池、內部機構和直接採購。Passport 廣受好評的臨床醫生經驗對於客戶在更短的時間內以最優惠的成本吸引最優秀的人才至關重要。

Our change initiatives also have provided exciting opportunities for our corporate team members. We have automated labor-intensive tasks and enabled around-the-clock credentialing, bringing our team members to be more productive and focus on higher-impact activities, such as time with clients and clinicians.

我們的變革舉措也為我們的企業團隊成員提供了令人興奮的機會。我們實現了勞動密集型任務的自動化，並實現了全天候認證，使我們的團隊成員提高了工作效率，並專注於影響力更大的活動，例如與客戶和臨床醫生相處的時間。

Our team received the valuable experience of working with the latest technology. And our entire go-to-market has been reshaped to be more customer-friendly and efficient, which will empower our team members to make even a bigger difference in the continuum of care.

我們的團隊獲得了使用最新技術的寶貴經驗。我們的整個市場進入流程都經過了重新設計，變得更加方便客戶、更有效率，這將使我們的團隊成員在持續照護方面發揮更大的作用。

As proof points, our team member engagement scores last year ranked at the top of our industry and above the Gallup benchmark for best practice organization. We improved team member retention. Becker's named AMN one of the best healthcare places to work. And we are recognized by numerous organizations for our strong culture of inclusion and diversity.

作為證據，我們的團隊成員去年的敬業度得分在業界名列前茅，並且高於蓋洛普最佳實踐組織基準。我們提高了團隊成員的保留率。Becker 將 AMN 評為最佳醫療保健工作場所之一。我們因強大的包容性和多元化文化而受到許多組織的認可。

Along with what I have noted, we have reinforced our total talent solutions in other ways. Our One AMN brand consolidation is only part of the heavy lifting that we have done to integrate the sales and delivery of our solutions, simplifying and speeding service to new and existing clients.

除了我所指出的之外，我們還透過其他方式強化了我們的整體人才解決方案。我們的 One AMN 品牌整合只是我們為整合解決方案的銷售和交付、簡化和加快為新舊客戶提供服務而所做的繁重工作的一部分。

On the front end, we have built on our 39 years of experience to provide advisory services under the leadership of Chief Business Officer, Meredith Lapointe; and Chief Growth Officer, Pat McCall. In the last quarter, we acquired MSDR to expand our scale and diversification in locum tenens. This acquisition was our first major deal since 2020 and a large part of the investments we made last year.

在前端，我們憑藉 39 年的經驗，在首席商務官 Meredith Lapointe 的領導下提供諮詢服務；和首席成長長帕特·麥考爾。上個季度，我們收購了 MSDR，以擴大我們在代理商領域的規模和多元化。這項收購是我們自 2020 年以來的第一筆重大交易，也是我們去年投資的很大一部分。

AMN generated $372 million of operating cash flow in 2023, enabling us to invest a record-high $104 million in capital expenditures. We also used our strong balance sheet to repurchase $425 million of our stock, which we continue to view as an attractive investment opportunity.

AMN 在 2023 年產生了 3.72 億美元的營運現金流，使我們能夠投資創紀錄的 1.04 億美元的資本支出。我們也利用強大的資產負債表回購了價值 4.25 億美元的股票，我們仍然認為這是一個有吸引力的投資機會。

Early in 2024, we see a mixed picture in our market. Our allied staffing business expects sequential revenue growth in the first quarter. Interim leadership and search show signs of stabilization and a sense of reaching the bottom.

2024 年初，我們看到市場的狀況好壞參半。我們的聯合人力資源業務預計第一季營收將持續成長。臨時領導和搜索顯示出穩定的跡象和觸底的感覺。

Our sales pipeline continues to both grow and progress. And recent new client wins in staffing include the largest win we have seen since 2019. In the direct and third-party staffing market, we have early signs that our technology and process changes are making us more competitive across the entirety of the market.

我們的銷售管道持續成長和進步。最近在人員配置方面贏得的新客戶包括我們自 2019 年以來最大的勝利。在直接和第三方人力資源市場中，我們的早期跡象表明，我們的技術和流程變革正在使我們在整個市場上更具競爭力。

We continue to expect organic growth in a solid market for locum tenens. And with our recent acquisition of MSDR, our annualized revenue run rate in locum is now more than $600 million. Language services continues to be one of our strongest-growing businesses with its strongest pipeline of prospects.

我們繼續預期代理市場將實現有機成長。隨著我們最近收購 MSDR，我們的實際年收入運行率現已超過 6 億美元。語言服務仍然是我們成長最強勁的業務之一，擁有最強勁的前景。

Offsetting these positives, our Q1 guidance assumes slightly lower nurse and allied segment revenue than fourth-quarter level. First-quarter guidance assumes zero labor disruption revenue. And the typical cancellations of some winter needs orders happened earlier in the quarter than usual.

抵消這些積極因素，我們第一季的指導假設護理師和相關部門的收入略低於第四季度的水平。第一季指引假設勞動力中斷收入為零。一些冬季需求訂單的典型取消發生在本季度比平常更早。

The overall labor backdrop is favorable. And this year's 30% increase in ACA marketplace enrollment indicates that the insured population is growing, which we expect will fuel demand utilization. We are encouraged by the green shoots we see from our total market growth strategy and are pleased with our accelerated progress.

整體勞動力環境有利。今年 ACA 市場註冊人數增加了 30%，顯示受保人口正在成長，我們預計這將推動需求利用率。我們對整體市場成長策略中看到的萌芽感到鼓舞，並對我們的加速進展感到高興。

Our strategy will unfold over multiple years. And we expect our initiatives to have an increasingly positive impact on our business later in 2024 and beyond.

我們的策略將在多年內展開。我們預計我們的舉措將在 2024 年稍後及以後對我們的業務產生越來越積極的影響。

Now, I'll turn the call over to Jeff who will review our latest financial results and outlook.

現在，我將把電話轉給傑夫，他將審查我們最新的財務表現和前景。

Thank you, Cary, and good afternoon, everyone. Fourth-quarter revenue was $818 million, which included a $13 million contribution from the November-end acquisition of MSDR. Organic revenue was towards the upper end of our guidance range.

謝謝你，卡里，大家下午好。第四季營收為 8.18 億美元，其中包括 11 月底收購 MSDR 帶來的 1,300 萬美元貢獻。有機收入接近我們指導範圍的上限。

Consolidated revenue was down 27% from the fourth quarter of 2022. Sequentially, revenue was lower by 4%, and organic revenue was down 6%. The sequential decrease was driven mainly by the expected lower bill rates, volume, and hours worked in the nurse and allied segment and VMS business.

合併收入較 2022 年第四季下降 27%。隨後，收入下降了 4%，有機收入下降了 6%。環比下降的主要原因是護理人員及相關部門和 VMS 業務的帳單費率、數量和工作時間預期下降。

Gross margin for the quarter was 31.9%, slightly below our guidance range, primarily due to lower bill pay spread in the nurse and allied business and less VMS revenue. Compared with the prior-year period, gross margin was down 140 basis points. Sequentially, gross margin decreased 200 basis points, primarily due to lower nurse and allied margin and an unfavorable revenue mix shift in technology and workforce Solutions.

本季毛利率為 31.9%，略低於我們的指導範圍，主要是由於護理人員及相關業務的帳單支付差額較低以及 VMS 收入減少。與去年同期相比，毛利率下降140個基點。隨後，毛利率下降了 200 個基點，主要是由於護理人員和相關利潤率下降以及技術和勞動力解決方案的不利收入組合變化。

Consolidated SG&A expenses were $185 million or 22.7% of revenue, compared with $219 million or 19.5% of revenue in the prior-year period and $163 million or 19.1% of revenue in the previous quarter. The decrease in SG&A expenses year over year was primarily due to lower employee expenses, driven by lower business volumes, along with lower bad debt reserve.

綜合銷售、管理及行政費用為 1.85 億美元，佔營收的 22.7%，而上年同期為 2.19 億美元，佔營收的 19.5%，上一季為 1.63 億美元，佔營收的 19.1%。SG&A 費用年減主要是因為業務量減少以及壞帳準備金減少導致員工費用減少。

Sequentially, increased acquisition, integration, and other costs and SG&A for MSDR led to the increase in SG&A expenses. Adjusted SG&A, which excludes acquisition, integration, and other costs and stock-based compensation expense, was $159 million in the fourth quarter or 19.4% of revenue, compared with $202 million or 17.9% of revenue in the prior-year period and $157 million or 18.4% of revenue in the previous quarter.

隨後，MSDR 的收購、整合和其他成本以及 SG&A 費用的增加導致了 SG&A 費用的增加。第四季調整後的銷售及管理費用（不包括收購、整合和其他成本以及股票補償費用）為1.59 億美元，佔收入的19.4%，而去年同期為2.02 億美元，佔營收的17.9%，去年同期為1.57 億美元。佔上一季營收的 18.4%。

In the fourth quarter, nurse and allied revenue was $538 million, down 35% from a year ago. Sequentially, segment revenue was down 6%, driven by lower bill rates, volume, and hours worked. Average bill rate was down 12% year over year and down 3% sequentially, in line with our expectations and an improvement from the 7% sequential decline we experienced in both Q2 and Q3.

第四季度，護理師及相關收入為 5.38 億美元，比去年同期下降 35%。隨後，由於帳單費率、數量和工作時間下降，該部門收入下降了 6%。平均帳單費率年減 12%，季減 3%，符合我們的預期，比第二季和第三季季減 7% 有所改善。

Year over year, volume was down 22%. And average hours worked were 4% lower. Sequentially, both volume and average hours worked ticked down 1%. Travel nurse revenue in the fourth quarter was $353 million, a decrease of 40% from the prior-year period and 8% from the prior quarter. Allied revenue in the quarter was $164 million, down 16% year over year and 2% sequentially.

與去年同期相比，成交量下降了 22%。平均工作時間減少了 4%。隨後，工作量和平均工作時間均下降了 1%。第四季旅行護士收入為3.53億美元，年減40%，季減8%。Allied 本季營收為 1.64 億美元，年減 16%，季減 2%。

Nurse and allied gross margin during the fourth quarter was 25.5%, which decreased 110 basis points from the prior-year period and 200 basis points sequentially. The decrease in gross margin was primarily due to lower bill pay spread and lower hours worked.

第四季護理師及相關業務毛利率為 25.5%，較去年同期下降 110 個基點，較上一季下降 200 個基點。毛利率下降的主要原因是帳單支付差額減少和工作時間減少。

Third-quarter gross margin had been unusually high due to some benefits that did not recur, which mainly included a release of a workers compensation reserve. Segment operating margin of 11.7% decreased 100 basis points year over year due to less revenue and lower gross margin. Sequentially, operating margin decreased 280 basis points.

第三季的毛利率異常高，因為一些福利沒有重複發生，其中主要包括釋放工人賠償儲備金。由於收入減少和毛利率下降，該部門營業利潤率為 11.7%，年減 100 個基點。隨後，營業利益率下降了 280 個基點。

Moving to the physician and leadership solutions segment, fourth-quarter revenue of $168 million was flat year over year, as organic growth in locum tenens and the addition of MSDR were offset by decreases in interim leadership and search. Sequentially, revenue was up 5% due to MSDR, partially offset by lower revenue from organic locum tenens, interim, and search.

轉向醫生和領導力解決方案領域，第四季度收入為 1.68 億美元，與去年同期持平，因為代理職位的有機增長和 MSDR 的增加被臨時領導力和搜索的減少所抵消。隨後，由於 MSDR，收入增長了 5%，但部分被有機代理、臨時和搜尋收入的下降所抵消。

Locum tenens revenue in the quarter was $123 million, including $13 million from MSDR. Excluding MSDR, revenue increased 7% year over year. Slightly lower volume in the organic business was more than offset by an increase in bill rates. Sequentially, organic revenue was down 2%, mainly due to lower volume driven by seasonality.

本季 Locum Tenens 營收為 1.23 億美元，其中包括來自 MSDR 的 1,300 萬美元。不計MSDR，營收年增7%。有機業務的銷售量略有下降被帳單費率的增加所抵銷。隨後，有機收入下降了 2%，主要是由於季節性導致銷量下降。

Interim leadership revenue of $29 million decreased 35% from the prior year and 5% from the prior quarter. Search revenue of $15 million was down 20% year over year and down 6% sequentially. Interim and search revenue were down year over year, primarily driven by lower demand.

中期領導收入為 2,900 萬美元，比上年下降 35%，比上一季下降 5%。搜尋收入為 1500 萬美元，年減 20%，季減 6%。中期和搜尋收入年減，主要是由於需求下降。

Gross margin for the physician and leadership solutions segment was 33.3%, down 170 basis points year over year and in line with the 33.4% gross margin generated in the third quarter. The year-over-year decline was mainly due to the revenue mix shift within the segment and a specialty mix change in locum tenens.

醫生和領導解決方​​案部門的毛利率為 33.3%，年減 170 個基點，與第三季 33.4% 的毛利率持平。年比下降主要是由於該部門內的收入組合變化以及代理業務的專業組合變化。

Segment operating margin was 13%, which decreased 370 basis points year over year comparing against an unusually high profit margin in the fourth quarter of 2022 of 16.7%, compared with 13.2% for the full year 2022. Sequentially, operating margin decreased 50 basis points due to the revenue mix shift towards locum tenens.

分部營業利益率為 13%，年減 370 個基點，而 2022 年第四季利潤率為 16.7%，異常高，而 2022 年全年利潤率為 13.2%。隨後，由於收入結構轉向臨時業務，營業利潤率下降了 50 個基點。

Technology and workforce solutions revenue for the fourth quarter was $113 million, down 16% year over year and 7% sequentially. Language services revenue of $68 million increased 18% year over year and 3% sequentially. VMS revenue for the quarter was $31 million, a decrease of 45% year over year and 20% sequentially.

第四季技術和勞動力解決方案收入為 1.13 億美元，年減 16%，季減 7%。語言服務收入為 6,800 萬美元，較去年同期成長 18%，較上季成長 3%。該季度 VMS 營收為 3,100 萬美元，年減 45%，季減 20%。

Segment gross margin was 60.5%, down from 73.3% in the prior-year period, primarily attributable to lower VMS and RPO revenue and lower gross margin in language services. Sequentially, gross margin fell 450 basis points, mainly driven by a revenue mix shift within the business segment. Segment operating margin in the fourth quarter was 36.8% compared with 50.2% in the prior year and 42.1% in the prior quarter, as the business mix shifted toward language services.

分部毛利率為 60.5%，低於去年同期的 73.3%，主要是由於 VMS 和 RPO 收入下降以及語言服務毛利率下降。隨後，毛利率下降了 450 個基點，主要是由於業務部門內的收入組合轉變所致。隨著業務組合轉向語言服務，第四季的部門營業利潤率為 36.8%，去年同期為 50.2%，上一季為 42.1%。

Fourth-quarter consolidated adjusted EBITDA was $104 million, a decrease of 40% year over year and 22% sequentially. Adjusted EBITDA margin for the quarter of 12.7% was at the midpoint of the guidance range. Year over year, adjusted EBITDA margin was down 280 basis points and sequentially, was down 300 basis points. The decrease in EBITDA margin year over year was primarily due to lower gross margin and less operating leverage.

第四季綜合調整後 EBITDA 為 1.04 億美元，年減 40%，季減 22%。本季調整後 EBITDA 利潤率為 12.7%，處於指導範圍的中點。與去年同期相比，調整後 EBITDA 利潤率下降了 280 個基點，較上季下降了 300 個基點。EBITDA 利潤率年減主要是由於毛利率下降和營運槓桿減少。

Fourth-quarter net income was $12.5 million, down 85% year over year and 77% sequentially. Fourth-quarter GAAP diluted earnings per share was $0.33 in the quarter. Adjusted earnings per share for the quarter was $1.32 compared with $2.48 in the prior-year period and $1.97 in the prior quarter.

第四季淨利為 1,250 萬美元，年減 85%，季減 77%。第四季 GAAP 稀釋後每股收益為 0.33 美元。本季調整後每股收益為 1.32 美元，去年同期為 2.48 美元，上一季為 1.97 美元。

Days sales outstanding, excluding MSDR, was 66, five days higher than the prior quarter and 11 days higher than the prior year, primarily due to billing delays related to a back-office system conversion. We expect DSO to return to historical levels as we progress through to 2024.

不包括 MSDR 在內的應收帳款天數為 66 天，比上一季高 5 天，比上年同期高 11 天，這主要是由於與後台系統轉換相關的計費延遲。我們預計，隨著 2024 年的進展，DSO 將恢復到歷史水準。

Operating cash flow for the fourth quarter was a use of $41 million, driven by the timing of cash collections and $67 million of deferred income tax payments. Capital expenditures for the quarter were $30 million. As of December 31, we had cash and equivalents of $33 million, long-term debt of $1.3 billion, including a $460 million draw on our revolving line of credit, and a net leverage ratio of 2.2 times to 1.

由於現金收款時間和 6,700 萬美元的遞延所得稅支付，第四季度的營運現金流量使用了 4,100 萬美元。該季度的資本支出為 3000 萬美元。截至 12 月 31 日，我們擁有 3,300 萬美元的現金和等價物，13 億美元的長期債務，其中包括循環信貸額度中提取的 4.6 億美元，淨槓桿率為 2.2 比 1。

Recapping financial highlights for the full-year 2023, we reported revenue of $3.8 billion, a year-over-year decrease of 28%. Gross margin for the year was 33%, an increase of 30 basis points. Adjusted EBITDA was $579 million, a decrease of 32% from the prior year. Full-year adjusted EBITDA margin of 15.3% was 80 basis points lower year over year.

回顧 2023 年全年的財務亮點，我們報告收入為 38 億美元，年減 28%。全年毛利率為33%，增加30個基點。調整後 EBITDA 為 5.79 億美元，較前一年下降 32%。全年調整後 EBITDA 利潤率為 15.3%，較去年同期下降 80 個基點。

Net income of $211 million decreased 53% compared with 2022. For 2023, GAAP EPS was $5.36, and adjusted EPS was $8.21 compared with GAAP EPS of $9.90 and adjusted EPS of $11.90 in 2022. Full-year cash flow from operations was $372 million, and capital expenditures totaled $104 million.

淨利為 2.11 億美元，較 2022 年下降 53%。2023 年，GAAP 每股收益為 5.36 美元，調整後每股收益為 8.21 美元，而 2022 年 GAAP 每股收益為 9.90 美元，調整後每股收益為 11.90 美元。全年營運現金流為 3.72 億美元，資本支出總計 1.04 億美元。

Moving to first-quarter 2024 guidance, we project consolidated revenue to be in the range of $810 million to $830 million, down 26% to 28% from the prior-year period. Gross margin is projected to be between 31% and 31.5%. Reported SG&A expenses are projected to be 21% to 21.5% of revenue.

展望 2024 年第一季指導，我們預計綜合營收將在 8.1 億美元至 8.3 億美元之間，比去年同期下降 26% 至 28%。毛利率預計在31%至31.5%之間。報告的 SG&A 費用預計佔收入的 21% 至 21.5%。

Operating margin is expected to be 4.2% to 4.9%, and adjusted EBITDA margin is expected to be 11.2% to 11.7%. Average diluted shares outstanding are projected to be approximately 38.2 million. Additional first-quarter guidance details can be found in today's earnings release.

營業利潤率預計為 4.2% 至 4.9%，調整後 EBITDA 利潤率預計為 11.2% 至 11.7%。攤薄後平均流通股預計約 3,820 萬股。更多第一季指導細節可以在今天的財報中找到。

And now, operator, please open the call for questions.

現在，接線員，請打開電話提問。

(Operator Instructions) Trevor Romeo, William Blair.

（操作員說明）特雷弗·羅密歐、威廉·布萊爾。

Hi, good afternoon. Thanks for taking the questions.

嗨，下午好。感謝您提出問題。

One I had just on the supply of nurse and allied professionals and kind of the overall population there. I think last quarter, you might have mentioned AMN's applications for nurse and allied roles are somewhere around 30% to 50% above pre-pandemic levels or something like that. So I had a two-part question related to that.

我剛剛了解了護士和相關專業人員的供應情況以及那裡的整體人口情況。我想上個季度，您可能已經提到 AMN 對護理師和相關職位的申請比大流行前的水平高出大約 30% 到 50% 或類似的水平。所以我有一個與此相關的由兩部分組成的問題。

One, I guess, are you still seeing that interest and willingness to take travel assignments well above pre-pandemic levels? And then two, are your clients receptive to a structurally larger contingent contract population as a percentage of their overall workforce? Or would they like that percentage to come kind of all the way back down to where it was pre-pandemic?

第一，我想，您是否仍然看到遠高於大流行前水平的出差任務的興趣和意願？第二個問題，您的客戶是否願意接受結構上較大的臨時合約人口占其勞動力總數的百分比？或者他們希望這個百分比能夠一路回到疫情前的水平嗎？

Hey, Trevor, thanks for the question. Let me give a little bit of context where clients are and a bit about how they're thinking about their workforce. And then I'll touch a bit on what we're seeing in supply in our different businesses.

嘿，特雷弗，謝謝你的提問。讓我介紹一下客戶的背景以及他們如何看待自己的員工團隊。然後我會談談我們在不同業務中看到的供應情況。

First off -- and I think this has been widely documented particularly over the past quarter -- workforce issues remain, if not the top priority for CEOs and C-suite of healthcare organizations. It's among the top priorities. And so we're seeing the focus on workforce manifest itself in kind of two ways.

首先——我認為這已經被廣泛記錄，特別是在過去的一個季度——勞動力問題仍然存在，即使不是醫療保健組織執行長和最高管理層的首要任務。這是首要任務之一。因此，我們看到對勞動力的關注以兩種方式體現。

One is, how do I continue to focus on expense management? That's an overall comment, and workforce is a part of it. And then the second part of that is, how do I ensure I have the right workforce to be able to serve what they see as increased demand utilization in the coming years? Once you get past those macro conditions, what we see from clients, it really varies client to client with what their mix looks like overall.

一是，我如何繼續專注於費用管理？這是一個總體評論，勞動力是其中的一部分。第二部分是，我如何確保擁有合適的勞動力來滿足他們認為未來幾年需求利用率增加的需求？一旦你克服了這些宏觀條件，我們從客戶那裡看到的，它確實會因客戶的整體組合而有所不同。

I'd say as a broad comment, you saw a tremendous reset in 2023, coming off of all-time highs of using contingent labor. And so a lot of the progress of stabilizing, you really saw it play through in 2023.

我想說的是，作為一個廣泛的評論，你會看到 2023 年發生了巨大的重置，從使用臨時勞動力的歷史最高點回落。因此，在穩定方面取得了很多進展，你確實在 2023 年看到了它的表現。

There are a number of organizations over the past couple of weeks who have talked about being at or close to their target from a contingent standpoint. We also have some systems and some clients who still have some work to go. So I think that where clients are are very client-specific.

在過去幾週，許多組織都從偶然的角度談論了達到或接近目標的情況。我們還有一些系統和一些客戶仍有一些工作要做。所以我認為客戶所在的地方是非常針對客戶的。

In terms of overall supply, if we look at, I'd say, nurse and allied -- and there might be some allied specialties where we do see more demand than you have supply. But generally speaking, the focus is more on, how do you think about increasing demand?

就整體供應而言，如果我們看看護理師和相關專業，可能會有一些相關專業，我們確實看到需求多於供應。但整體來說，焦點更多的是，您如何看待需求的成長？

If you get into our locums business, you have a lot of demand out there. And we continue to think that will be the case in 2024. And so we're very focused on how we continue to increase our supply, which the MSDR acquisition was a big part of that.

如果您進入我們的locum業務，您將有很多需求。我們仍然認為 2024 年情況仍將如此。因此，我們非常關注如何繼續增加供應，收購 MSDR 是其中的一個重要部分。

And then if you go into our TWS segment, you typically see VMS follows suit with our nurse and allied segment. And if you look at language services, we continue to see demand, very healthy demand, in that space. And so again, our focus is, how do we continue to have the supply to meet that healthy demand?

然後，如果您進入我們的 TWS 細分市場，您通常會看到 VMS 緊跟著我們的護理人員和相關細分市場。如果你看看語言服務，我們會繼續看到該領域的需求，非常健康的需求。因此，我們的重點是，我們如何繼續擁有供應來滿足健康的需求？

Okay. Thanks, Cary. That was really helpful. And then maybe one for Jeff, I guess. It'd be great to get a sense for your bill rate and TOA volume assumptions for the nurse and allied segment, I guess, in Q1 and then anything preliminary you have for the rest of 2024.

好的。謝謝，卡里。這真的很有幫助。我猜，也許還有傑夫的一份。我想，如果能了解第一季度護士和相關部門的賬單費率和 TOA 數量假設，以及 2024 年剩餘時間的任何初步信息，那就太好了。

And then as we kind of think about seasonality for the rest of the year, does it feel like the typical seasonality should be coming back to the business in the coming quarters? Or should we still be building an additional room for normalization? Thanks.

然後，當我們考慮今年剩餘時間的季節性時，是否感覺典型的季節性應該在未來幾季回歸業務？或者我們還應該為正常化建立額外的空間嗎？謝謝。

Yeah. So Trevor, in the first quarter, bill rates will be flat over Q4 levels. And so any change in the nurse and allied revenue will be driven by volume. So the implied guidance for nurse and allied is that it will be down 1% to 4% sequentially. And that will entirely be driven by TOA.

是的。因此，特雷弗（Trevor）表示，第一季的帳單利率將與第四季的水平持平。因此，護士和相關收入的任何變化都將由數量驅動。因此，對護理人員和相關人員的隱含指導是，它將連續下降 1% 至 4%。這將完全由 TOA 驅動。

As we look forward, the demand trends that we're seeing currently, demand is down in the low 20% range from Q4 levels within travel nurse. Allied demand remains healthy. It's still above 2 time from 2019 levels. And on the seasonality point, historically, nurse and allied revenue, excluding any impact from labor disruption or acquisitions, would be down mid- to high single digits sequentially, Q2 over Q1, with an average of right around 6%.

展望未來，我們目前看到的需求趨勢是，旅行護理師的需求較第四季的水準下降了 20%。盟軍需求依然健康。仍是 2019 年水準的 2 倍以上。從季節性角度來看，從歷史上看，排除勞動力中斷或收購的影響，護理人員和相關收入將連續下降中高個位數，第二季比第一季下降，平均下降約 6%。

Just given with where demand trends sit right now, we would expect that nurse and allied revenue would be down high single digits in the second quarter off of the midpoint of our Q1 guide, which would be at the high end of that range. And that would be driven more by volume than bill rate, about two-thirds, one-third split there.

考慮到目前的需求趨勢，我們預計第二季度護理師和相關收入將比我們第一季指南的中點下降高個位數，該指南將處於該範圍的高端。這將更多地受到數量而非賬單利率的推動，大約三分之二、三分之一在那裡分裂。

Okay. Thanks, Jeff. That's really helpful.

好的。謝謝，傑夫。這真的很有幫助。

A.J. Rice, UBS.

A.J.賴斯，瑞銀。

Thanks. Hi, everybody. First off, generally speaking, when you give your guidance for the quarter ahead, you've got pretty good visibility on it. And I know this time, gross margin dropped even normalizing for the unusual item in the third quarter, about 170 basis points.

謝謝。大家好。首先，一般來說，當您給出未來季度的指導時，您對此有很好的了解。我知道，這一次，即使第三季不尋常項目正常化，毛利率也下降了約 170 個基點。

And you guys had guided for 100, I think, decline -- 100 basis points in the fourth quarter. I think you singled out pressure in VMS as well as the bill pay spread tightening. I wondered -- I assume some of that was already forecast. Where was the surprise that ended up it being worse than you thought as it played out in the quarter?

我認為，你們預計第四季將下降 100 個基點。我認為您特別提到了 VMS 的壓力以及帳單支付利差收緊。我想知道——我想其中一些已經被預測到了。本季的情況最終比您想像的更糟糕的驚喜在哪裡？

I would say, A.J., it was predominantly within travel nurse and really on the winter needs orders and the bill pay spread, that we took there to drive a higher internal capture on those winter needs orders.

我想說，A.J.，主要是在旅行護士內部，實際上是在冬季需求訂單和賬單支付範圍內，我們在那裡推動對這些冬季需求訂單進行更高的內部捕獲。

Okay. On the comments around bill pay spread and thinking about that into '24, is it the competitive dynamics that are driving the tightening? Are you trying to cushion the impact of -- for nurses to keep them -- taking additional assignments? Would -- give us a little more about what you're seeing in bill pay spread and how quickly that might start to recover.

好的。關於帳單支付差額的評論以及對 24 年的思考，是競爭動態推動了緊縮嗎？您是否試圖減輕護理人員承擔額外任務的影響，以留住他們？請給我們更多關於您在帳單支付方面所看到的情況以及這種情況可能會多快開始恢復的資訊。

Yeah. I think a quarter ago, A.J., we had talked about that there's typically a two-quarter-or-so lag in between where bill rates settle out and clinician compensation expectations. As we move into the first quarter of this year, the expectation is that nurse and allied gross margins will be flat over Q4 levels.

是的。A.J.，我想一個季度前，我們曾討論過帳單費率結算與臨床醫生薪酬預期之間通常存在兩個季度左右的滯後。當我們進入今年第一季時，預計護理師和相關毛利率將與第四季水準持平。

Underlying that, there is some improvement in the bill pay spread. But that will be masked by the revenue mix issue with our international nurse business trending down sequentially with the impact of visa retrogression.

在此基礎上，帳單支付利差有所改善。但這將被收入組合問題所掩蓋，因為我們的國際護理師業務隨著簽證倒退的影響而呈連續下降趨勢。

And we would expect that to continue throughout the year, where the bill pay spread will modestly improve as we move through the year. But the impact from visa retrogression will increase and neutralize that.

我們預計這種情況將持續一整年，隨著這一年的推移，帳單支付差額將略有改善。但簽證倒退的影響將會增加並抵消這種影響。

Okay. And maybe one last one to ask about the VMS conversion, the ShiftWise upgrade or change. Is that -- sounds like that's affecting the volume of the business that you're doing in VMS as well as the DSOs.

好的。也許是最後一位詢問有關 VMS 轉換、ShiftWise 升級或更改的問題。聽起來這會影響您在 VMS 和 DSO 中所做的業務量。

For example, is the DSO impaired, the receivables impaired? Or is that just a delay in collection that you'll hope to -- hopefully recover quickly once the system integration or upgrade is completely done? And similarly, some of the pressure you're seeing in VMS, is that because of this transition, and you'll see it revert? Or is it other dynamics of what's happening in the business that are putting pressure there?

例如，DSO 是否受損、應收帳款是否受損？或者這只是您希望的收集延遲——希望在系統整合或升級完全完成後能夠快速恢復？同樣，您在 VMS 中看到的一些壓力是由於這種轉變而造成的，您會看到它恢復嗎？或者是業務中正在發生的其他動態給那裡帶來了壓力？

Yeah, A.J., so the ShiftWise Classic to ShiftWise Flex, that has nothing to do with the DSO. That was from an ERP implementation in the third quarter of last year. And we're just working through some back-office delays that have led to billing. And then also unapplied cash spiked up post the implementation, which made it harder, quite honestly, to collect receivables.

是的，A.J.，所以從 ShiftWise Classic 到 ShiftWise Flex，這與 DSO 無關。這是去年第三季實施的 ERP 的結果。我們正在解決一些導致計費的後台延遲問題。實施後，未使用的現金也激增，老實說，這使得收回應收帳款變得更加困難。

So that has nothing to do with ShiftWise Flex. And ShiftWise Flex also isn't impacting any volumes within the VMS business. There's only a handful of clients right now that have transitioned onto Flex.

所以這與 ShiftWise Flex 無關。而且 ShiftWise Flex 也不會影響 VMS 業務的任何數量。目前只有少數客戶已轉向 Flex。

Hey. And A.J., what I would add to that is what we're seeing as we have announced ShiftWise Flex in the market is that it's being very well received. And we've started the implementation with clients. We actually implemented our largest client this week. And so the ShiftWise Flex implementation is going well.

嘿。A.J.，我要補充的是，當我們在市場上宣布 ShiftWise Flex 時，我們看到它受到了非常好的歡迎。我們已經開始與客戶一起實施。本週我們實際上實現了我們最大的客戶。因此 ShiftWise Flex 的實施進展順利。

Okay. All right. Thanks a lot.

好的。好的。多謝。

You're welcome.

不客氣。

Kevin Fischbeck, Bank of America.

凱文‧菲施貝克，美國銀行。

Great, thanks. I wanted to ask about the -- it sounds like you signed a large customer in the quarter. How do we think about the timing of when that contract starts?

萬分感謝。我想問一下——聽起來你在本季簽了一個大客戶。我們如何考慮合約開始的時間？

And as an MSP contract, I guess in the past, you've talked about how, if you were to lose an MSP contract, you would still be servicing most of that business. Because the incumbent would still be relying on you to provide that. I guess, how long should we think about an MSP contract win to ramp as you start to replace the incumbent vendor within that?

作為 MSP 合同，我想您過去曾談到過，如果您失去 MSP 合同，您仍然可以為大部分業務提供服務。因為現任者仍然依賴你來提供這一點。我想，當您開始更換現有供應商時，我們應該考慮贏得 MSP 合約需要多長時間？

Yeah. So typically, you would see that take a couple of quarters to start seeing the impact of it. So you should expect that those wins would affect more the back half of 2024. We have a lot of initiatives going on to continue to do process improvement around speed, but expect that that's more of a back-half phenomena.

是的。因此，通常情況下，您會發現需要幾個季度才能開始看到其影響。因此，您應該預期這些勝利將對 2024 年下半年產生更大的影響。我們正在採取許多舉措來繼續圍繞速度進行流程改進，但預計這更多是後半部分的現象。

Can you give any color, maybe even related to that contract specifically or just broadly, I guess -- somewhat if a large customer decided to change, what were they looking to change? How did you fit in and solve that?

您能否給出任何顏色，甚至可能與該合約具體或只是廣泛相關，我想 - 如果一個大客戶決定改變，他們希望改變什麼？你是如何融入並解決這個問題的？

And then, I guess, maybe just a broader comment on kind of -- it sounds there are a lot of contracts for renewal, which I guess also means things to defend. So like maybe any commentary on win rate, retention rates as well.

然後，我想，也許只是一種更廣泛的評論——聽起來有很多合約需要續簽，我想這也意味著需要捍衛的東西。就像任何關於獲勝率、保留率的評論一樣。

Yeah. Let me give you first where we are on renewals. So if -- going into 2023, we had effectively three years of renewals that were taking place in 2023. So clients that normally would go through an RFP cycle in 2021 and 2022, during COVID, really pushed those into 2023.

是的。讓我先向您介紹我們的續訂情況。因此，如果進入 2023 年，我們實際上將在 2023 年進行三年的續約。因此，在新冠疫情期間，通常會在 2021 年和 2022 年經歷 RFP 週期的客戶實際上將其推遲到了 2023 年。

So if we typically have in any given year -- because clients typically have a three- to five-year RFP cycle -- we would be defending, call it, 20% to about a third of our book. Last year, in 2023, we were beyond the high end of that range because of the three-year build-up.

因此，如果我們通常在任何特定年份——因為客戶通常有三到五年的 RFP 週期——我們將捍衛我們帳簿的 20% 到大約三分之一。去年，即 2023 年，由於三年的積累，我們超出了該範圍的高端。

If you look into 2024, as we start the year on renewals, we are at the lower end of that range, including two RFP processes from last year that came in. So as we start this year, that looked very different than it did last year. So that's comment one on renewals.

如果你展望 2024 年，當我們開始續約時，我們處於該範圍的低端，包括去年引入的兩個 RFP 流程。因此，當我們今年開始時，情況看起來與去年有很大不同。這是關於續訂的評論一。

If we look at from a growth standpoint on our sales pipeline, we have continued to see, as we have restarted sales really in the second quarter of last year, a continuation like-for-like of the build of our overall sales pipeline. And we've also seen that sales pipeline progress. We talked about the wins in my opening comments. So we're seeing progression both in continuing to build our sales pipeline and continuing to convert that down into wins.

如果我們從銷售管道成長的角度來看，我們會繼續看到，因為我們在去年第二季真正重新啟動了銷售，所以我們整體銷售管道的建設仍在繼續。我們也看到了銷售管道的進展。我們在開場白中談到了勝利。因此，我們在繼續建立銷售管道和繼續將其轉化為勝利方面都看到了進展。

Kevin, on your question about what would be typical for a large client in terms of how we service -- and serve them, it really depends on where their starting point is and where they want to go. Our strategy is we want to be their preferred provider no matter what model they want.

凱文，關於你關於大客戶在我們如何服務和服務他們方面的典型問題，這實際上取決於他們的起點和他們想要去的地方。我們的策略是，無論他們想要什麼型號，我們都希望成為他們的首選供應商。

We ideally want our VMS technology in as the baseline. Because once they have our VMS technology in, they can go MSP. They can go do MSP. They can go vendor neutral. They can go direct without having to shift any technology.

理想情況下，我們希望將我們的 VMS 技術作為基準。因為一旦他們採用了我們的 VMS 技術，他們就可以採用 MSP。他們可以去做 MSP。他們可以保持供應商中立。他們可以直接進行，而無需改變任何技術。

And so if a client starting from MSP and is on our VMS and going to vendor neutral, we still typically would both serve their technology needs, and we would be a supplier. If a client starting from vendor neutral and going to MSP, we would take a more active role in supplying them. So it really depends on what their starting point and their ending point is.

因此，如果客戶從 MSP 開始使用我們的 VMS 並轉向供應商中立，我們通常仍然滿足他們的技術需求，並且我們將成為供應商。如果客戶從供應商中立開始並轉向 MSP，我們將在向他們供貨方面發揮更積極的作用。所以這實際上取決於他們的起點和終點是什麼。

Okay. That's helpful. And I guess, maybe because the market still is normalizing to some degree, it's hard to tell exactly what's going on from the outside looking in.

好的。這很有幫助。我想，也許是因為市場在某種程度上仍在正常化，所以很難從外部觀察到底發生了什麼事。

I guess, as you think about what happened in Q4 and your guidance for Q1, would you say that -- what you can tell -- that you are growing in line with the industry, that you're gaining share within the industry, or that you're losing share within the industry in those expectations?

我想，當您思考第四季度發生的情況以及對第一季的指導時，您會說——您可以說——您正在與行業同步增長，您正在行業內獲得份額，或者您是否正在失去這些期望中的行業份額？

Yeah. What I would say, overall, it's hard to get industry benchmarks, particularly in any given quarter and especially because we have a different business mix because of the breadth of our solutions than others may have. I think what you saw is, given our focus on MSP clients during the COVID years on a relative basis, while we grew overall, we lost some relative positioning in the industry.

是的。我想說的是，總體而言，很難獲得行業基準，特別是在任何特定季度，尤其是因為我們的解決方案比其他公司的解決方案更廣泛，因此我們擁有不同的業務組合。我認為您看到的是，鑑於我們在新冠疫情期間相對關注 MSP 客戶，雖然我們整體成長，但我們在行業中失去了一些相對地位。

And if you look at, particularly as we left 2023 and go into 2024, as we positioned ourselves against the entire market again -- MSPs, vendor-neutral, direct -- we're getting momentum across the entire market that we didn't have for parts of COVID.

如果你看一下，特別是當我們離開 2023 年並進入 2024 年時，當我們再次將自己定位於整個市場時——MSP、供應商中立、直接——我們在整個市場中獲得了以前沒有的動力有部分新冠病毒。

Okay. And then maybe just last question. The commentary about the Q2 seasonality being a little bit higher than normal -- and I think it's a two-thirds volume, one-third bill rate.

好的。也許只是最後一個問題。關於第二季季節性的評論比正常情況要高一點——我認為這是三分之二的銷量，三分之一的帳單利率。

Is that breakout of this Q2 seasonality similar to the normal breakout? Is it normally two-thirds volume, one-third bill rate from Q1 to Q2 or just -- order of magnitude little bit higher for both? Or is one of them more of a really the driver of that, moving from the mid-single-digit to the high-single-digit seasonality?

第二季季節性突破與正常突破相似嗎？從第一季到第二季度，通常是銷售量的三分之二、帳單費率的三分之一，還是兩者的數量級都高一點？或者其中一個因素才是真正的驅動因素，從中個位數季節性轉向高個位數季節性？

Yeah. Q2 over Q1, we would typically see a low single-digit bill rate decline, just as the higher bill rate winter needs orders roll off into the second quarter. So maybe in totality, it's a little more slanted to the volume side this quarter than it has been historically, Kevin.

是的。與第一季相比，第二季我們通常會看到較低的個位數帳單利率下降，就像較高的帳單利率冬季需要訂單滾存到第二季一樣。因此，也許總的來說，本季的銷量比歷史上的情況更傾斜，凱文。

Okay, perfect. Thank you.

好的，完美。謝謝。

Tobey Sommer, Truist Securities.

托比·索默（Tobey Sommer），Truist 證券公司。

Thank you. You called out a heavy CapEx year last year. I was wondering, as a percent of sales, would you expect that to trend lower in the coming years?

謝謝。去年您表示資本支出很高。我想知道，作為銷售額的百分比，您預計未來幾年會呈現下降趨勢嗎？

And maybe could you characterize what aspects of your tech development and new products and solutions that have resulted, you think, are ahead of the market, best in class? You referenced many but kind of wondering what the top of the list is.

也許您能描述一下您認為您的技術開發以及新產品和解決方案的哪些方面領先於市場，是同類中最好的？您引用了很多，但有點想知道清單頂部是什麼。

Yeah. So number one -- and we can give more details around -- let me try philosophically and strategically give you a breakdown of how we're spending the CapEx. One is, you should expect to continue to see us spend as a percentage of revenue on CapEx, maybe not quite as high as this year but directionally in that range.

是的。因此，第一——我們可以提供更多細節——讓我嘗試從哲學和策略上向您詳細介紹我們如何支出資本支出。一是，您應該期望繼續看到我們在資本支出上的支出佔收入的百分比，可能不像今年那麼高，但方向在這個範圍內。

And if you look at where we spent the dollars in 2023, think about it roughly as about half of that was around how we continue to ensure that our solutions, including our client-facing solutions, our clinician-facing solutions, are innovative and supporting our clients in what they need to rebuild their workforces sustainably.

如果你看看我們在2023 年把錢花在哪裡，你可以想像一下，其中大約一半是圍繞我們如何繼續確保我們的解決方案（包括面向客戶的解決方案、面向臨床醫生的解決方案）具有創新性和支持性。我們的客戶需要什麼來可持續地重建他們的勞動力。

You saw big spend last year in ShiftWise Flex, which we talked about. We've also talked quite a bit about Passport. And a lot of our efforts around our solutions, Tobey, were around us getting speed and agility. One of the things that has accelerated over the past five years is not just how you are matching supply and demand, but the speed that you are matching that supply and demand.

去年我們在 ShiftWise Flex 上看到了巨額支出，我們對此進行了討論。我們也討論了很多關於 Passport 的問題。托比，我們圍繞解決方案所做的許多努力都是為了提高速度和敏捷性。過去五年加速發展的事情之一不僅在於如何匹配供需，還在於匹配供需的速度。

And so we have, both on a tech standpoint and from an operational standpoint, have huge milestones around our speed. That's important in all markets. But it's particularly important in serving the direct and VMS market.

因此，無論是從技術角度還是從營運角度來看，我們的速度都取得了巨大的里程碑。這對所有市場都很重要。但它對於服務直接市場和 VMS 市場尤其重要。

The rest of the CapEx spend, think about it, as Jeff mentioned, some of the big projects that we were doing around ERP and how we make our organization more efficient.

其餘的資本支出支出，請考慮一下，正如傑夫所提到的，我們圍繞 ERP 所做的一些大型專案以及我們如何使我們的組織更有效率。

And I would just say, Tobey, in totality, the CapEx should be down about $20 million roughly year over year this year, with just some of those larger projects rolling off and not carrying over into '24.

我只想說，Tobey，今年的資本支出總共應該比去年同期減少約 2000 萬美元，其中只有一些較大的項目會滾動，不會延續到 24 年。

Thanks. I was wondering if you -- with the lens -- looking to the lens of the last few years, talk to us about the fill rates in your MSP business and if they've -- if that has flexed as demand has fallen and sort of been theoretical for a number of years. And maybe, if you could give us some numbers about where that fill rate and direct fill sits currently.

謝謝。我想知道您是否 - 透過鏡頭 - 回顧過去幾年的鏡頭，與我們談談您的 MSP 業務的填充率以及它們是否 - 隨著需求下降和分類而變化多年來一直是理論上的。也許，如果您能給我們一些有關填充率和直接填充目前的數字。

If you go back and look at what you typically see as you get demand kind of going up and going down, is that in lower demand environment, you would typically see internal capture in your MSPs go up. As you get higher demand environments, you would see that internal capture typically go down.

如果您回頭看看需求上升和下降時通常會看到的情況，那就是在需求較低的環境中，您通常會看到 MSP 中的內部捕獲量上升。當您獲得更高需求的環境時，您會發現內部捕獲通常會下降。

And so if you go back into some of our internal capture rates in our MSPs during COVID, you saw that phenomenon where as you just got this big spike in demand, we were obviously filling for our clients. But we also had a number of other suppliers who took accelerated roles in that.

因此，如果你回顧我們在新冠疫情期間 MSP 的一些內部捕獲率，你會看到這樣的現象：當需求激增時，我們顯然正在為我們的客戶提供服務。但我們還有許多其他供應商在這方面發揮了加速作用。

During 2023, if we look at year-over-year Q4, our internal fill rate for MSPs went up 450 basis points. So we have seen -- as demand has gone down, we've seen our internal capture go up. And we would expect that to continue in 2024.

2023 年第四季度，我們的 MSP 內部填充率上升了 450 個基點。因此，我們看到，隨著需求下降，我們的內部捕獲量上升。我們預計這種情況將在 2024 年持續下去。

We're not expecting as we plan for 2024 for -- in the nurse space, for there to be any really significant increase in demand. We do think that all the efforts that we are doing to position ourselves across the broader market -- MSPs, VMS, direct -- we will have more opportunities to fill in a bigger demand environment.

正如我們計劃的 2024 年一樣，在護理人員領域，需求不會出現任何真正顯著的成長。我們確實認為，我們為在更廣泛的市場（MSP、VMS、Direct）中定位自己所做的所有努力，我們將有更多的機會來適應更大的需求環境。

Thank you very much.

非常感謝。

Brian Tanquilut, Jefferies.

布萊恩·坦奎魯特，傑弗里斯。

Hi. This is Nur Robleh, in for Brian. Thanks for taking my questions.

你好。我是努爾·羅布萊 (Nur Robleh)，替補布萊恩 (Brian)。感謝您回答我的問題。

Looking at Q1 guidance, it looks like revenue is expected to be roughly flat, possibly slightly down sequentially. And given the usual impact of payroll tax increases in Q1, should we expect a sequential decline in EBITDA in Q1?

從第一季的指引來看，營收預計將大致持平，甚至可能比上一季略有下降。考慮到第一季工資稅增加的通常影響，我們是否應該預期第一季 EBITDA 會連續下降？

Yeah. There is a sequential decline in EBITDA dollars and in EBITDA margin in the first quarter. That's partially driven by payroll tax.

是的。第一季 EBITDA 美元和 EBITDA 利潤率連續下降。這部分是由工資稅推動的。

But also, gross margin will be down about 60 basis points Q1 over Q4, primarily driven by mix within the PLS and TWS segments. And then we had talked about last quarter that there would be a $5 million to $6 million SG&A dollar headwind per quarter in 2024 compared to the Q4 run rate, as variable compensation plans reset with the calendar year in Q1.

而且，第一季的毛利率將比第四季下降約 60 個基點，這主要是由 PLS 和 TWS 細分市場的混合所推動的。然後我們在上個季度談到，與第四季度的運行率相比，2024 年每個季度將出現500 萬至600 萬美元的SG&A 美元逆風，因為可變薪酬計劃隨第一季的日曆年重置。

Got it. Thank you for that. And also, just given the increased reporting of utilization across the various health systems, can you provide some color on what you're seeing in terms of further volumes, given your current vision into the next couple of quarters?

知道了。謝謝你。此外，考慮到各個衛生系統的使用率報告有所增加，考慮到您目前對未來幾季的願景，您能否提供一些關於您所看到的進一步數量的信息？

And also, could you just shed some more light on the cadence of top-line growth in EBITDA for this year? Should it mimic pre-COVID patterns or not? Thank you.

另外，您能否進一步介紹今年 EBITDA 營收成長的節奏？它是否應該模仿新冠疫情之前的模式？謝謝。

Yeah. So we had talked a little earlier that, currently, the travel nurse orders are down in the low 20% range from where they sat in Q4. I think we touched on the Q2 seasonality that we were expecting. And then typically, Q3 revenue would be flattish over Q2. And then we would see an uptick in the fourth quarter with the winter needs orders.

是的。因此，我們早些時候曾談到，目前，旅行護士訂單較第四季度下降了 20% 左右。我認為我們觸及了我們預期的第二季季節性。通常情況下，第三季的營收將與第二季持平。然後我們會看到第四季度冬季需求訂單增加。

I think there are a number of tailwinds in the back half, predominantly, as it relates to the new client wins, as well as potential to increase our internal capture that Cary just talked about. But then the headwinds that we would face would be where current demand trends go with our clients as well as the renewal activity that we have to work through on the MSP client side.

我認為後半段有很多有利因素，主要是因為它與新客戶的勝利有關，以及卡里剛才談到的增加我們內部捕獲的潛力。但我們將面臨的阻力將是我們客戶當前的需求趨勢以及我們必須在 MSP 客戶端完成的更新活動。

All right. Thank you.

好的。謝謝。

Mark Marcon, Baird.

馬克馬爾孔，貝爾德。

Good afternoon, and thanks for taking my questions. Most of my questions have been asked. But one, I was -- Cary, I was wondering if you could elaborate a little bit.

下午好，感謝您回答我的問題。我的大部分問題都被問到了。但我是——卡里，我想知道你是否可以詳細說明一下。

You've mentioned earlier that some of the clients -- some of the large hospital systems have basically taken down their contract nursing staff down to optimized levels or appropriate levels for the current census that they have. But others are still kind of working down.

您之前提到過，一些客戶——一些大型醫院系統基本上已經將合約護理人員減少到優化水平或適合當前人口普查的水平。但其他人仍在努力工作。

Can you give us an approximate dimension in terms of like -- is it half of the hospital systems that you work with are down to ideal levels or a third? Or how should we think about that? Just trying to understand further pressure points that we might see and when we truly get stabilization in that base level.

您能否給我們一個大概的維度，例如您合作的醫院系統中有一半還是三分之一下降到了理想水平？或者說我們該如何思考這個問題？只是試圖了解我們可能會看到的進一步壓力點以及我們何時真正在該基準水平上實現穩定。

Yeah. I mean, here's how I frame it up. If you look at where we started 2023 versus where we're starting 2024 in aggregate -- and obviously, you can see it in our numbers and others' numbers, particularly on the nursing side -- clients made significant progress.

是的。我的意思是，這就是我的框架。如果你看看我們從2023 年開始的情況與我們從2024 年開始的情況相比，顯然，你可以從我們和其他人的數據中看到這一點，特別是在護理方面，客戶取得了重大進展。

And it was -- again, it was them getting contingent back into more normalized rate. And at the same time, you saw really aggressive permanent hiring. So that was really the story for 2023.

再一次，他們有可能回到更正常化的利率。同時，你看到了非常積極的長期招募。這就是 2023 年的故事。

If you go back, Mark, and look at how you would categorize different clients, what we have typically seen is some of the larger and most complex clients -- is they moved really fast. You see some clients who have been -- were focused on 2023 but didn't move quite as fast. So I can't think of a client that didn't make progress in 2023, at least our clients.

馬克，如果你回頭看看如何對不同的客戶進行分類，我們通常會看到一些規模較大、最複雜的客戶——他們的行動速度是否非常快。你會看到一些客戶一直專注於 2023 年，但行動卻沒有那麼快。所以我想不出有哪個客戶在 2023 年沒有取得進展，至少是我們的客戶。

And again, a number of them are at their target, and we still have work to do. It would be hard to quantify. Because the other dimension is, we focus a lot around the demand piece, but this is a labor market. And there's a supply dimension as well.

再說一次，其中一些已經達到了目標，但我們仍然有工作要做。這將很難量化。因為另一個維度是，我們非常關注需求部分，但這是勞動市場。還有一個供應維度。

And so there is still a significant portion -- a healthy portion of nurses and doctors who want to work in a more flexible environment. And so it's how they balance this management of spend with also ensuring that they are getting access to 100% of the available market.

因此，仍有很大一部分護士和醫生希望在更靈活的環境中工作。這就是他們如何平衡支出管理並確保他們能夠進入 100% 的可用市場。

Okay, great. And then, what are the expectations for MSDR to contribute in Q1 and then over the balance of the year?

好的，太好了。那麼，對 MSDR 在第一季以及今年餘下時間做出貢獻的預期是什麼？

Yeah. Mark, so we had said MSDR did $13 million in the last month of 2023. You can think about the Q1 expectations in line with that run rate. And then we would expect sequential growth in the second to third quarter from MSDR.

是的。馬克，我們說過 MSDR 在 2023 年最後一個月賺了 1,300 萬美元。您可以根據該運行率來考慮第一季的預期。然後我們預計 MSDR 在第二季至第三季將實現環比成長。

Great. Super. And then in terms of the consolidation with regards to the brand names, it sounds like that's gone really well. It sounds like you're basically not seeing any sort of drop-off in terms of the supply channel.

偉大的。極好的。然後就品牌名稱的整合而言，聽起來進展非常順利。聽起來供應管道方面基本上沒有看到任何形式的下降。

Wondering if you've got any other additional comments with regards to it. And at some point, would we end up seeing some incremental savings from that consolidation?

想知道您對此是否還有其他補充意見。在某個時候，我們最終會看到整合帶來的一些增量節省嗎？

Yeah. So it has gone very well, and that took a lot of planning and preparation from our team. The couple of things that I would focus on, Mark, in terms of -- when we talk about the brand consolidation, there are several elements to it.

是的。所以一切進展順利，我們的團隊進行了大量的規劃和準備。馬克，我要關注的幾件事是——當我們談論品牌整合時，有幾個要素。

So one is the obvious, around the logo. That's where we get a lot of the all-time highs around, awareness of our brands, both on an aided and unaided basis. But importantly, it's about -- we now have, between our Internet and other front doors including increasingly our clinicians at Passport, one way for clinicians to come in and find all the opportunities professionally that they are potentially interested in.

因此，標誌周圍的一處是顯而易見的。這就是我們在有幫助和獨立的基礎上獲得許多歷史最高點的地方，我們的品牌知名度。但重要的是，我們現在在網路和其他前門（包括越來越多的 Passport 臨床醫生）之間擁有一種讓臨床醫生進入並找到他們可能感興趣的所有專業機會的方式。

So we see it as an opportunity, frankly, more from a revenue standpoint, for us to be able to engage clinicians much more holistically throughout the entirety of their professional careers, with the range of different options that we have for them, whether some of those are shorter-term assignments or longer-term and permanent assignments.

因此，坦白說，更多地從收入的角度來看，我們認為這是一個機會，使我們能夠在臨床醫生的整個職業生涯中更全面地參與其中，並為他們提供一系列不同的選擇，無論是這些是短期任務或長期和永久任務。

Where you would see some efficiency from a spend standpoint is -- it will be more efficient for us going forward to be able to continue to increase and get brand awareness when we don't have to support two handfuls of brands. But we're supporting in a more meaningful and substantive way the AMN Healthcare brand.

從支出的角度來看，你會看到一些效率——當我們不必支持兩個品牌時，我們能夠繼續提高並獲得品牌知名度，這對我們來說會更有效率。但我們正在以更有意義和實質的方式支持 AMN Healthcare 品牌。

Great. And then, the last question. Locums was a bright spot. It sounds like demand for you has picked up. Are you seeing that across the industry?

偉大的。然後是最後一個問題。洛庫姆斯是一個亮點。聽起來對你的需求增加。您在整個行業中都看到這種情況嗎？

And if so, what would you attribute that to? What's changed over the last year that would lead to that pickup in demand?

如果是這樣，您會將其歸因於什麼？去年發生了什麼變化導致需求回升？

We continue to see and we expect locums to have continued strong demand in 2024. And that's really more of an industry phenomenon than just an AMN phenomenon. What we have seen is, the systems are really looking at how are they going to meet the increases in utilization that they are experiencing.

我們繼續看到並預計 2024 年對木料的需求將持續強勁。這實際上更像是一種行業現象，而不僅僅是 AMN 現象。我們所看到的是，系統實際上正在考慮如何滿足正在經歷的利用率的成長。

And so particularly, as you think about the very well-publicized constraints on physician shortages, it is a drag on revenue and ability to serve patients when you don't have the right physician support. And so that really is driving a lot of the demand that we're seeing in our portfolio.

尤其是，當您想到廣為人知的醫生短缺限制時，如果沒有合適的醫生支持，就會拖累收入和為患者服務的能力。因此，這確實推動了我們在投資組合中看到的大量需求。

That's great. Could we see some bill rate increases there?

那太棒了。我們能看到那裡的帳單利率上漲嗎？

Yeah. Mark, when we look over the course of last year, most of the year-over-year increases within locums were driven by the rate side more so than volumes.

是的。馬克，當我們回顧去年的情況時，大部分同比增長都是由利率方面驅動的，而不是數量方面。

Excellent. Thank you.

出色的。謝謝。

Jeff Silber, BMO Capital Markets.

Jeff Silber，BMO 資本市場。

Thanks so much. I know it's late. I'll just ask one. Cary, you've been in your role a little over a year. And obviously, we all understand this is a really tough year for this business.

非常感謝。我知道已經太晚了。我就問一個吧卡里，你擔任這個職務已經一年多了。顯然，我們都知道今年對這個行業來說是非常艱難的一年。

But if you knew what you know now, what would you have done differently in 2023? And how does that impact your strategy going forward?

但如果您知道現在所知道的，那麼 2023 年您會採取哪些不同的做法？這對您未來的策略有何影響？

Jeff, thanks for the question. And as we were writing the 2023 press release, I did reflect on -- I started AMN, and 2023 also started at the very beginning of the single biggest historical cyclical reset in the industry. And so as I think about what we were doing, we were doing two things simultaneously. We were helping our customers, our team members, our company successfully navigate that unprecedented reset.

傑夫，謝謝你的提問。當我們撰寫 2023 年新聞稿時，我確實反思了——我創辦了 AMN，而 2023 年也是業界最大的歷史週期性重置的開端。因此，當我思考我們正在做的事情時，我們同時在做兩件事。我們正在幫助我們的客戶、我們的團隊成員和我們的公司成功度過這場前所未有的重置。

And we very quickly also started to ensure that we were putting in place a series of transformational initiatives that were going to enable our company to be able to more fully participate against the entirety of our market opportunity, frankly, both as we went through the tail end of the reset but, certainly, as we came out of the reset.

我們很快也開始確保實施一系列轉型舉措，坦率地說，這些舉措將使我們的公司能夠更充分地參與整個市場機會，無論是在我們經歷尾聲的時候重置結束了，但是，當然，當我們走出重置時。

If I go back and look at the things that we focused on -- and I'll underscore the things that I think we did extraordinarily well in a very tough year. We got focused on clients and our go-to-market strategy incredibly quickly. As I came into this role, that was actually the first thing I did.

如果我回頭看看我們關注的事情，我會強調我認為我們在非常艱難的一年中做得非常好的事情。我們以令人難以置信的速度專注於客戶和我們的上市策略。當我擔任這個角色時，這實際上是我做的第一件事。

And we turned back on sales full force. We realigned how we think about our clients. And we have a team now that is completely responsible for selling the breadth of our solutions. We started a series of One AMN transformation initiatives.

我們全力恢復銷售。我們重新調整了對客戶的看法。我們現在有一個團隊完全負責銷售我們解決方案的廣度。我們啟動了一系列 One AMN 轉型措施。

We just talked about the brand, the brand experience -- one. But we also engaged in a series of transformative technology and operational initiatives that, really, we're already starting to see make a very big difference in our business.

我們剛剛談論了品牌、品牌體驗——其一。但我們也參與了一系列變革性技術和營運舉措，實際上，我們已經開始看到這些舉措對我們的業務產生了巨大的影響。

And then, we spent a lot of time ensuring that we had financial discipline that match the reset that we were going through. So we took early actions around expenses to make sure that we were coming down as the market was coming down.

然後，我們花了很多時間確保我們的財務紀律與我們正在經歷的重置相符。因此，我們針對開支採取了早期行動，以確保我們能夠隨著市場的下滑而下滑。

And we also made some very strategic capital investments, both in our systems but also in MSDR and growing parts of the market, and bought back $425 million in shares. So I am very pleased with what we did, both in getting through the reset and positioning ourselves more strongly for 2024 and 2025.

我們也進行了一些非常策略性的資本投資，不僅在我們的系統中，而且在 MSDR 和不斷成長的市場領域，並回購了 4.25 億美元的股票。因此，我對我們所做的事情感到非常滿意，無論是完成重置，還是為 2024 年和 2025 年做好更強有力的定位。

Great. Thank you.

偉大的。謝謝。

William Sutherland, The Benchmark Company.

威廉·薩瑟蘭，基準公司。

Thanks. You can call me Bill. And I have -- just down to two questions. I was wondering on the fill rate trend, as you look at the most recent orders, do you feel like we've got into an equilibrium here, where the fill rates are going to go in the right direction? Or are they at a decent level already?

謝謝。你可以叫我比爾。我有兩個問題。我想知道填充率趨勢，當您查看最近的訂單時，您是否覺得我們已經達到平衡，填充率將朝著正確的方向發展？或者他們已經處於不錯的水平了嗎？

On the bill rates, Bill?

關於帳單費率，比爾？

Fill, the fill rate.

填充，填充率。

So I mean, Cary mentioned earlier that on internal capture, we had moved that 450 basis points throughout the course of 2023. I think we'll continue to make progress on that as we move through this year.

所以我的意思是，Cary 之前提到，在內部捕獲方面，我們在 2023 年期間將利率提高了 450 個基點。我認為今年我們將繼續在這方面取得進展。

But as we onboard and ramp up some of those new client wins in the back half, that will be a drag initially as it will take those time to ramps like book of business, internal capture rates. But we should see some progress in the first half.

但是，當我們在後半段加入並增加一些新客戶的勝利時，這最初將是一個拖累，因為需要這些時間來提高業務量、內部捕獲率等。但我們應該在上半年看到一些進展。

Okay. Yeah, I heard the MSP commentary. I was thinking, actually, about just your regular book of business, how the fill rate is going with just regular orders in nurse and allied.

好的。是的，我聽到了 MSP 的評論。事實上，我在想的是你的常規業務手冊，護士和相關人員的常規訂單的填充率如何。

Yeah. Overall -- so that's internal capture overall in the fill rates. We're generally back in line with pre-COVID trends.

是的。總體而言，這是填充率的總體內部捕獲。我們總體上回到了新冠疫情前的趨勢。

There you are. Okay. So there is -- I mean, I kind of consider that the metric for equilibrium in the market. And then the last one, Jeff, I was actually thinking about capital deployment since you were so active last quarter.

你在這。好的。所以，我的意思是，我認為這是市場均衡的衡量標準。最後一個，傑夫，我實際上在考慮資本部署，因為你上個季度非常活躍。

And beyond just the CapEx plans, how would you sort of prioritize deployment, whether there's any significant M&A being considered? Or you'd rather lean in on the share repurchase side? Thanks.

除了資本支出計劃之外，您將如何確定部署的優先順序，是否正在考慮任何重大的併購？或者您更願意支持股票回購？謝謝。

Yeah. I think in the near term, right now, with the MSDR acquisition, we're certainly focused on that integration. Leverage is at 2.2 times as we end the year. And in the near term, excess free cash flow will probably be deployed towards debt repayment.

是的。我認為，在短期內，現在，隨著 MSDR 的收購，我們肯定會專注於這種整合。截至年底，槓桿率為 2.2 倍。短期內，多餘的自由現金流可能會被用來償還債務。

Got it. Thanks, Jeff.

知道了。謝謝，傑夫。

Thank you. I'm currently showing no further questions at this time. I'd like to turn the call back over to Ms. Cary Grace for closing remarks.

謝謝。我目前沒有提出任何進一步的問題。我想將電話轉回給卡里·格雷斯女士做結束語。

Thank you for listening to our earnings call and your continued interest in the important work our company is doing in the healthcare workforce. I want to say a special thank you to our AMN team members and our healthcare providers.

感謝您收聽我們的財報電話會議，以及您對我們公司在醫療保健人員方面所做的重要工作的持續關注。我想特別感謝我們的 AMN 團隊成員和我們的醫療保健提供者。

2023 required great resilience as we navigated both the biggest industry reset while working to position our organization strongly against our total market opportunity. We look forward to talking to you next quarter.

2023 年，我們需要強大的韌性，因為我們既經歷了最大的產業重組，又努力使我們的組織能夠強有力地應對整個市場機會。我們期待下個季度與您交談。

This concludes today's conference call. Thank you for your participation. You may now disconnect. Everyone, have a wonderful day.

今天的電話會議到此結束。感謝您的參與。您現在可以斷開連線。祝大家有美好的一天。