AMN Healthcare Services Inc (AMN) 2025 Q1 法說會逐字稿

Good day and thank you for standing by. Welcome to the AMN Healthcare first-quarter 2025 earnings call. (Operator Instructions) Please be advised that today's conference is being recorded. I would now like to hand the conference over to your first speaker today, Randle Reece, Vice President of Investor Relations.

您好，感謝您的支持。歡迎參加 AMN Healthcare 2025 年第一季財報電話會議。（操作員指示）請注意，今天的會議正在錄音。現在，我想將會議交給今天的第一位發言人，投資者關係副總裁 Randle Reece。

Good afternoon, everyone. Welcome to AMN Healthcare's first-quarter 2025 earnings call. A replay of this webcast will be available at ir.amnhealthcare.com at the conclusion of this call. 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.

大家下午好。歡迎參加 AMN Healthcare 2025 年第一季財報電話會議。本次電話會議結束後，您可以在 ir.amnhealthcare.com 上重播該網路廣播。我們在本次電話會議中對未來預期、預測、趨勢、計畫、事件或情況所作的評論構成前瞻性陳述。這些聲明反映了公司根據目前掌握的資訊所形成的當前信念。

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.

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、我們的收益報告以及隨後向美國證券交易委員會提交的文件中確定的因素和聲明，我們的實際結果可能與這些前瞻性聲明所示的結果存在重大差異。

Company does not intend to update guidance or any forward-looking statements provided today prior to its next earnings release. 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.

本公司不打算在下次發布收益報告之前更新今天提供的指導或任何前瞻性聲明。本次電話會議包含某些非 GAAP 財務資訊。有關這些非 GAAP 指標與最直接可比較的 GAAP 指標的資訊及其對帳包含在我們的收益報告和 ir.amnhealthcare.com 的財務報告頁面中。

On the call with me today are Cary Grace, President and Chief Executive Officer; and Brian Scott, Chief Financial and Operating Officer. I will now turn the call over to Cary.

今天與我一起通話的有總裁兼執行長 Cary Grace 和財務兼營運長 Brian Scott。現在我將把電話轉給卡里。

Thank you, Randy, and welcome to our first quarter conference call. The AMN team showed off its energy and resource units in the first quarter and the results for revenue and profit margins that exceeded the high end of guidance. Revenue of $690 million topped the high end of guidance by $10 million due to strength in our labor disruption, locum tenens and Allied businesses.

謝謝你，蘭迪，歡迎參加我們的第一季電話會議。AMN 團隊在第一季展示了其能源和資源部門，其收入和利潤率的業績超出了預期的高端。由於我們的勞工中斷、臨時醫生和相關業務的強勁表現，6.9 億美元的收入比預期上限高出 1000 萬美元。

Our other businesses on balance were in line with our revenue forecast. The company reported $64 million in adjusted EBITDA and another quarter of robust cash flow and debt reduction. Thank you to our health care professionals and the entire AMN team for delivering a solid start to the year.

整體而言，我們的其他業務符合我們的收入預測。該公司報告稱，調整後的 EBITDA 為 6,400 萬美元，本季現金流和債務均保持強勁減少。感謝我們的醫療保健專業人員和整個 AMN 團隊為今年帶來了良好的開端。

For the second quarter, our outlook for revenue and earnings compares well against consensus estimates with continued upside from labor disruption locum tenens and Allied staffing revenue. We received $39 million in revenue from 2 labor disruption events in the first quarter with continued activity in the second quarter. Increasingly, labor disruption has become a differentiated solution that supports an important client needs.

對於第二季度，我們對收入和收益的預期與普遍預期相比表現良好，勞工中斷臨時工和聯合人員配備收入將繼續上漲。我們在第一季因兩次勞工糾紛事件獲得了 3,900 萬美元的收入，而第二季這些事件仍在繼續。勞動力中斷日益成為支持重要客戶需求的差異化解決方案。

We have built the leading event management technology and strengthened our ability to manage labor disruption activities without interrupting the strong service quality in our core business. These differentiating capabilities have been greeted by a series of client wins and a large pipeline of opportunities, which could offer upside potential this year and next.

我們建立了領先的事件管理技術，並加強了管理勞工中斷活動的能力，同時又不影響我們核心業務的強大服務品質。這些差異化能力已贏得一系列客戶並帶來大量機遇，可能在今年和明年帶來上行潛力。

Bookings for locum tenens picked up significantly in the first four months of the year. We expect locum tenens to have sequential revenue growth this quarter, with good momentum going into the rest of the year. Demand for our Allied business has grown mid-teens year-over-year. We continue to see healthy allied demand into this quarter and strong execution from our team.

今年前四個月，臨時醫生的預訂量大幅增加。我們預計本季臨時醫生的收入將持續成長，並且在今年剩餘時間內將保持良好勢頭。我們的聯合業務的需求年增了百分之十五左右。我們繼續看到本季健康的盟軍需求和我們團隊的強勁執行力。

In our schools business, bookings for the next full year are trending towards year-over-year growth driven by strength in orders and candidate submission. For our travel nurse business, revenue volume and bill rates were in line with our projections for the first quarter.

在我們的學校業務中，受訂單量和考生提交量的強勁推動，下一全年的預訂量呈現同比增長趨勢。對於我們的旅行護理師業務，收入量和收費率符合我們對第一季的預測。

Our second quarter revenue outlook for Travel Nurse calls for relatively normal seasonality, and we continue to see both intense competition to fill orders and some orders priced at levels that no one is filling. We made strides year-to-date in stabilizing gross margin, which came down across our industry last year.

我們對 Travel Nurse 第二季營收的預期是季節性相對正常，我們繼續看到訂單完成的激烈競爭以及一些訂單定價無人填補的水平。今年迄今為止，我們在穩定毛利率方面取得了長足進步，去年整個產業的毛利率均有所下降。

Consolidated gross margin was 28.7% in the first quarter slightly better than the high end of guidance. Nurse and Allied Solutions gross margin of 22.7% was 90 basis points better than consensus. Our gross margin performance benefited from some process changes that have enabled improved internal execution, and we just rolled out new technology that enhances recruiter productivity and faster speed to submission.

第一季綜合毛利率為28.7%，略高於預期上限。Nurse and Allied Solutions 的毛利率為 22.7%，比普遍預期高出 90 個基點。我們的毛利率表現受益於一些流程變化，這些變化改善了內部執行，而且我們剛剛推出了新技術，提高了招募人員的工作效率並加快了提交速度。

We continue to invest in technology that improves our speed and fill rate including AI tools that reduce costs and improve how we deliver our services. Our market-leading app for health care professionals, AMN Passport has now been rolled out to locum tenens. The app has potential for valuable improvements to our physician engagement and support. Passport gives Locum's physicians the ability to submit their shift work in the app which we expect to greatly speed the submission process, reduce errors and improve physician satisfaction.

我們將繼續投資於提高速度和填充率的技術，包括降低成本和改善我們提供服務方式的人工智慧工具。我們針對醫療保健專業人士推出的市場領先應用程式 AMN Passport 現已向臨時醫生推出。該應用程式有可能極大地改善我們對醫生的參與和支持。Passport 使 Locum 的醫生能夠在應用程式中提交他們的輪班工作，我們希望這將大大加快提交過程、減少錯誤並提高醫生的滿意度。

We will continue to make enhancements to Passport to expand its capabilities and extend into other AMN service lines. AMN also is gaining momentum in enterprise sales. The company signed five new MSP and vendor-neutral wins last quarter reflecting improvement in our win rates, and we are seeing strong client retention rates. While the selling environment remains highly competitive, we are seeing interest in solutions that combine technology and services to help clients build and sustain a high-quality and cost-effective workforce.

我們將繼續增強 Passport 的功能，以擴展其功能並擴展到其他 AMN 服務線。AMN 在企業銷售方面也表現出色。上個季度，公司簽署了五份新的 MSP 和供應商中立合同，這反映了我們中標率的提高，而且我們看到了強勁的客戶保留率。儘管銷售環境競爭仍然激烈，但我們看到，客戶對結合技術和服務的解決方案越來越感興趣，以幫助客戶建立和維持高品質、高成本效益的員工團隊。

We will complete the rollout of ShiftWise Flex to our client base next month. This powerful and versatile technology is a cornerstone of our new worldwide staffing management, engagement and optimization platform. Workwise has drawn a positive reception from new and existing clients.

我們將於下個月向我們的客戶群全面推出 ShiftWise Flex。這項強大且多功能的技術是我們新的全球人員管理、參與和優化平台的基石。Workwise 得到了新舊客戶的正面評價。

Workwise is another example of how our diverse set of solutions is positioned to serve clients and health care professionals across the spectrum of care. This diversification also has allowed AMN to maintain operating leverage that is superior to our competitors and generate cash flow to invest in the business while also reducing debt.

Workwise 是另一個例子，它展示了我們的多樣化解決方案如何為整個護理領域的客戶和醫療保健專業人員提供服務。這種多樣化也使 AMN 能夠保持優於競爭對手的經營槓桿，並產生現金流來投資業務，同時減少債務。

We are pleased to receive industry recognition for innovation that measurably improves the quality and efficiency of care. Modern Healthcare recognized work-wise in AMN Taskport in its 2025 Innovators award. AMN is the only talent solutions company to make this year's list of 15 innovative health care organizations. Congratulations to the AMN team from those who develop and deploy our technology to everyone who has integrated these market-leading tools into our solutions to the benefit of health care professionals and clients.

我們很高興獲得業界的認可，因為我們的創新顯著提高了護理的品質和效率。現代醫療保健在 AMN Taskport 的 2025 年創新者獎中因其工作出色而獲得認可。AMN 是今年 15 家創新醫療保健組織名單中唯一一家人才解決方案公司。向 AMN 團隊表示祝賀，從開發和部署我們技術的人員到將這些市場領先的工具整合到我們的解決方案中以造福醫療保健專業人士和客戶的所有人。

In the first quarter, the company generated $93 million in operating cash flow, enabling us to reduce our revolving credit balance by $60 million and add $45 million of cash to our balance sheet. We do not control all the factors that will determine the trajectory of our businesses after our solid start to the year.

第一季度，公司產生了 9,300 萬美元的營運現金流，使我們能夠減少 6,000 萬美元的循環信貸餘額，並在資產負債表上增加 4,500 萬美元的現金。我們無法控制所有決定我們今年業務開局之後走勢的因素。

Demand has not recovered to pre-pandemic levels in several of our businesses such as travel nurse, interim leadership and search and the ongoing low demand in nurse staffing also affects our VMS revenue. Cost consciousness among hospitals and health systems is not a new condition. We continue to be focused on winning new clients, expanding our relationships with current clients and improving our fill rates in direct and vendor-neutral channels.

我們的多項業務（例如旅行護理師、臨時領導和搜尋）的需求尚未恢復到疫情前的水平，而且護理人員配置需求持續低迷也影響了我們的 VMS 收入。醫院和衛生系統的成本意識並不是什麼新鮮事。我們將繼續致力於贏得新客戶、擴大與現有客戶的關係以及提高直接和供應商中立管道的填充率。

Across our businesses, competitors continue to grasp the proposition while serving a universe of cost-conscious clients and GPOs. We are seeing heightened competition in language services where industry consolidation has resulted in some large arrivals and price competition has intensified.

在我們的業務中，競爭對手在服務大量注重成本的客戶和 GPO 的同時，也不斷掌握這項主張。我們看到語言服務領域的競爭日益激烈，產業整合導致了一些大型企業的湧入，價格競爭也愈演愈烈。

On the other hand, we have already seen some clients who chose other vendors but due to quality issues returned to AMN. We hold a distinct advantage in our high-quality cost-competitive solutions. After two years of extraordinary growth, slower growth in Spanish language volume may indicate some impact from the current political and regulatory environment.

另一方面，我們已經看到一些客戶選擇了其他供應商，但由於品質問題而返回 AMN。我們在高品質、具成本競爭力的解決方案方面擁有獨特的優勢。經過兩年的非凡增長後，西班牙語數量增長放緩可能表明當前政治和監管環境產生了一些影響。

Our sales activity in Language Services is healthy and revenue growth could improve later in 2025 as new wins come. Across the spectrum of care from preventative to urgent acute and post-acute, we seek clients with varying degrees of exposure to changes in tariffs and federal health care policies.

我們在語言服務領域的銷售活動表現良好，隨著新訂單的到來，2025 年下半年的收入成長可能會有所改善。從預防性到緊急急性和急性後的各種護理，我們尋求對關稅和聯邦醫療保健政策變化有不同程度接觸的客戶。

Health care providers continue to be laser focused on cost containment and the sustainability of their workforce, continued growth in patient volumes. We have improved the ability of AMN to help clients find and implement the best solutions for optimizing labor versus quality, supply and cost.

醫療保健提供者繼續高度重視成本控制和員工隊伍的可持續性，以及患者數量的持續增長。我們提高了 AMN 幫助客戶找到並實施優化勞動力與品質、供應和成本的最佳解決方案的能力。

I am confident that our focused expertise, diversified solutions and high-quality service delivery will be increasingly valuable in the future as health care demand grows faster than supply. Now I'll turn the call over to Brian for the details of our latest results and outlook.

我相信，隨著醫療保健需求的成長速度超過供應，我們專注的專業知識、多樣化的解決方案和高品質的服務在未來將變得越來越有價值。現在我將把電話轉給布萊恩，以了解我們的最新結果和展望的詳細資訊。

Thank you, Cary, and good afternoon, everyone. First quarter consolidated revenue was $690 million, above the high end of guidance driven primarily from better-than-expected performance in labor disruption, locos and Allied. Revenue was down 16% from the prior year and down 6% sequentially.

謝謝你，卡里，大家下午好。第一季綜合營收為 6.9 億美元，高於預期上限，主要得益於勞工中斷、機車和聯合業務表現優於預期。營收較前一年下降 16%，較上一季下降 6%。

Consolidated gross margin for the first quarter was 28.7%, 10 basis points above the high end of our guidance range. Year-over-year gross margin decreased 270 basis points while sequentially, gross margin was down 110 basis points.

第一季綜合毛利率為28.7%，比我們預期範圍的高階高出10個基點。毛利率年減 270 個基點，季減 110 個基點。

Consolidated SG&A expenses were $148 million compared with $175 million in the prior year and $159 million in the previous quarter. Adjusted SG&A, which excludes certain expenses, was $136 million in the first quarter or 19.7% of revenue compared with $162 million or 19.7% of revenue in the prior year and $145 million or 19.8% of revenue in the previous quarter.

合併銷售、一般及行政費用為 1.48 億美元，去年同期為 1.75 億美元，上一季為 1.59 億美元。第一季調整後的銷售、一般及行政費用（不包括某些費用）為 1.36 億美元，佔營收的 19.7%，而去年同期為 1.62 億美元，佔營收的 19.7%，上一季為 1.45 億美元，佔營收的 19.8%。

The year-over-year SG&A decline was primarily due to lower employee headcount and variable compensation along with reduced consulting and bad debt expenses. The sequential decrease was mainly a result of lower compensation expense and favorable bonus and related accrual adjustments.

銷售、一般及行政費用較去年同期下降主要是因為員工人數減少、薪資變動以及諮詢及壞帳費用減少。環比下降主要由於薪酬費用降低以及獎金和相關應計調整有利。

First quarter Nurse and Allied revenue was $413 million, down 20% from the prior year primarily from lower volume and rates, partially offset by increased labor disruption revenue. Sequentially, segment revenue was down 9%, mainly driven by lower labor disruption revenue, a modest volume decline in 2 fewer days.

第一季護理師及相關服務收入為 4.13 億美元，較前一年下降 20%，主要原因是數量和費率下降，但被勞工中斷收入的增加部分抵銷。該部門營收季減 9%，主要原因是勞工中斷收入下降，以及兩天內銷售量略有下降。

Year-over-year, segment volume decreased 22%. Average rate was down 5% and average hours worked was down 1%. Sequentially, volume was down 2%, and the average rate and hours worked were both 1% higher. Travelers revenue in the first quarter was $215 million, a decrease of 36% from the prior year period and 6% from the prior quarter.

與去年同期相比，該部門銷量下降了 22%。平均薪資下降了 5%，平均工作時間下降了 1%。環比而言，工作量下降了 2%，平均薪資和工作時間都增加了 1%。第一季旅客營收為 2.15 億美元，較去年同期下降 36%，較上一季下降 6%。

Allied revenue in the quarter was $147 million, down 13% year-over-year and 1% sequentially. Nurse and Allied gross margin in the first quarter was 22.7%, a decrease of 240 basis points year-over-year, mainly driven by higher housing and redeem reimbursements.

本季聯合航空的營收為 1.47 億美元，年減 13%，季減 1%。第一季 Nurse and Allied 的毛利率為 22.7%，年減 240 個基點，主要原因是房屋和贖回銷金額增加。

Sequentially, gross margin was down 110 basis points due mainly to favorable sales adjustments recorded in the prior quarter. Segment operating margin of 7.8% decreased 250 basis points year-over-year and 80 basis points sequentially driven in large part from the lower gross margin.

環比毛利率下降 110 個基點，主要原因是上一季的銷售調整有利。分部營業利益率為 7.8%，較去年同期下降 250 個基點，較上季下降 80 個基點，主要原因是毛利率下降。

Moving to Physician and Leadership Solutions segment. First quarter revenue was $174 million, decreasing 8% year-over-year, driven by lower volume across all businesses, partially offset by bill rate growth in Locum. Sequentially, revenue increased 1% on growth in locum. Locum Tenens revenue in the quarter was $141 million, down 3% year-over-year and up 3% sequentially.

轉向醫生和領導力解決方案部門。第一季營收為 1.74 億美元，年減 8%，原因是所有業務的銷量下降，但 Locum 的帳單費率上漲部分抵消了這一影響。由於臨時醫生人數增加，收入連續增長 1%。Locum Tenens 本季營收為 1.41 億美元，年減 3%，季增 3%。

Interim leadership revenue of $24 million decreased 21% from the prior year period and 9% sequentially. Search revenue of $9 million was down 29% year-over-year and 8% sequentially. Gross margin for the Physician and Leadership Solutions segment was 27.3% down 430 basis points year-over-year, attributable to a lower bill base spread in locum tenens and an unfavorable revenue mix shift.

臨時領導層營收為 2,400 萬美元，較去年同期下降 21%，較上一季下降 9%。搜尋收入為 900 萬美元，年減 29%，季減 8%。醫生和領導解決方​​案部門的毛利率為 27.3%，年減 430 個基點，原因是臨時醫生的帳單基數較低以及收入結構轉變不利。

Sequentially, gross margin decreased 120 basis points, mainly due to an unfavorable revenue mix and lower margin in the Interim business. Segment operating margin was 8.3%, which decreased 350 basis points year-over-year, primarily due to lower gross margin and deleveraging of SG&A expenses partially offset by lower bad debt expense.

環比毛利率下降 120 個基點，主要原因是中間業務的收入結構不利以及利潤率較低。分部營業利益率為 8.3%，年減 350 個基點，主要原因是毛利率下降和銷售、一般及行政費用去槓桿，但壞帳費用下降部分抵銷了這一影響。

Sequentially, operating margin decreased 150 basis points, driven by the lower gross margin. Technology and Workforce Solutions revenue for the first quarter was $102 million down 9% year-over-year as growth in Language Services was more than offset by decreases in BMS and outsourced solutions.

由於毛利率下降，營業利潤率較上月下降 150 個基點。第一季技術和勞動力解決方案收入為 1.02 億美元，年減 9%，因為語言服務的成長被 BMS 和外包解決方案的下降所抵消。

Sequentially, revenue was down 4%. Language Services revenue for the quarter was $75 million, an increase of 5% year-over-year and down 2% sequentially. VMS revenue in the quarter was $19 million, a decrease of 33% year-over-year and 14% sequentially. Segment gross margin was 55.5%, down 440 basis points from the prior year period, primarily due to lower revenue mix from BMS and outsourced solutions.

收入環比下降 4%。本季語言服務收入為 7,500 萬美元，年增 5%，季減 2%。本季 VMS 營收為 1,900 萬美元，年減 33%，季減 14%。分部毛利率為 55.5%，較去年同期下降 440 個基點，主要原因是 BMS 和外包解決方案的收入組合下降。

Sequentially, gross margin declined 180 basis points, mainly driven by a decline in Language Services and an unfavorable revenue mix shift. Segment operating margin in the first quarter was 34.5% a decrease of 480 basis points in the prior year period, driven primarily by lower gross margin. Sequentially, the operating margin declined by 320 basis points on a lower gross margin and a higher quarter consolidated adjusted EBITDA was $64 million, down 34% year-over-year and 15% sequentially.

環比毛利率下降 180 個基點，主要原因是語言服務業務的下滑以及收入結構不利的變化。第一季分部營業利益率為 34.5%，較去年同期下降 480 個基點，主要原因是毛利率下降。由於毛利率較低，營業利潤率較上季下降 320 個基點，而本季合併調整後 EBITDA 為 6,400 萬美元，較去年同期下降 34%，季減 15%。

Adjusted EBITDA margin for the quarter was 9.3%, down 260 basis points for the prior year period and 90 basis points sequentially, driven by the lower gross margin. First quarter net loss was $1 million. This compared with net income of $17 million in the prior year period and a net loss of $188 million in the prior quarter, which included a $222 million goodwill impairment charge.

本季調整後 EBITDA 利潤率為 9.3%，比去年同期下降 260 個基點，比上一季下降 90 個基點，原因是毛利率下降。第一季淨虧損100萬美元。相較之下，去年同期的淨收入為 1,700 萬美元，上一季的淨虧損為 1.88 億美元，其中包括 2.22 億美元的商譽減損費用。

First quarter GAAP diluted loss per share was $0.03. Adjusted earnings per share for the quarter was $0.45 compared with $0.97 in the prior year period and $0.75 in the prior quarter. Day sales outstanding for the quarter was 55 days, which was 9 days lower than a year ago and flat sequentially.

第一季GAAP攤薄每股虧損為0.03美元。本季調整後每股收益為0.45美元，去年同期為0.97美元，上季為0.75美元。本季未償還債務天數為 55 天，比去年同期減少 9 天，與上一季持平。

Operating cash flow in the first quarter was $93 million, and capital expenditures were $10 million. As of March 31, we had cash and equivalents of $56 million and debt of $1 billion, including $150 million on our revolver. During the quarter, we reduced our revolver balance by $60 million, and we will continue to use free cash flow to reduce the balance.

第一季經營現金流為9,300萬美元，資本支出為1,000萬美元。截至 3 月 31 日，我們擁有現金和等價物 5,600 萬美元，債務 10 億美元，其中包括 1.5 億美元的循環信貸。本季度，我們的循環信貸餘額減少了 6,000 萬美元，我們將繼續利用自由現金流來減少該餘額。

We ended the quarter with a net leverage ratio of 3.1x to 1. Moving to second quarter guidance. We project consolidated revenue to be in the range of $645 million to $660 million, down 11% to 13% from the prior year period. This guidance includes an assumption of $16 million of labor disruption revenue.

本季末我們的淨槓桿率為 3.1 倍比 1。轉向第二季度指引。我們預計合併收入將在 6.45 億美元至 6.6 億美元之間，比去年同期下降 11% 至 13%。該指引包括 1,600 萬美元的勞工中斷收入假設。

Gross margin is projected to be between 28.5% and 29%. Reported SG&A expenses are projected to be 23.2% to 23.7% of revenue. Operating margin is expected to be minus 0.7% to 0%, and adjusted EBITDA margin is expected to be 7.8% to 8.3%. Additional second quarter guidance details can be found in today's earnings release. And now let's go back to Cary for some closing remarks.

預計毛利率在28.5%至29%之間。預計銷售、一般及行政費用將佔收入的 23.2% 至 23.7%。預計營業利益率為-0.7%至0%，調整後EBITDA利潤率預計為7.8%至8.3%。更多第二季指導細節可在今天的收益報告中找到。現在讓我們回到卡里，做一些結束語。

Thank you, Brian. This week is National Nurses Week and May is National Nurses Month. The theme of nurses week this year is the Power of Nurses, and we are extremely grateful for the profound difference that nurses make in the health of all Americans. I encourage everyone to share our appreciation for nurses everywhere, including the thousands of nurses who are part of the AMN family.

謝謝你，布萊恩。本周是全國護士週，五月是全國護士月。今年護士週的主題是“護士的力量”，我們非常感謝護士為所有美國人的健康做出的巨大貢獻。我鼓勵每個人都分享我們對世界各地護理人員的感激之情，包括 AMN 大家庭中的數千名護理師。

Our 2025 RN survey showed that 8 in 10 nurses want to see improvement at their workplace in three areas: patients to nurse ratio, flexible scheduling and administrative burdens. We at AMN are continually working on innovative and flexible talent solutions to support nurses physical and mental well-being and improvement of work life balance to combat burnout.

我們的 2025 年 RN 調查顯示，十分之八的護理人員希望看到其工作場所在三個方面得到改善：病人與護理人員的比例、靈活的時間安排和行政負擔。AMN 持續致力於創新且靈活的人才解決方案，以支持護理人員的身心健康並改善工作與生活的平衡，以對抗倦怠。

Our business depends on the quality of people we bring to serve the steadily growing demand of providing health care. So far in 2025, we have been thrilled to welcome top talent from across the industry on to the AMN team. These superb professionals have joined us in client-facing and key leadership positions.

我們的業務取決於我們招募的人才的素質，以滿足不斷增長的醫療保健需求。到 2025 年為止，我們很高興歡迎來自整個行業的頂尖人才加入 AMN 團隊。這些優秀的專業人士已加入我們，擔任面向客戶和關鍵領導的職位。

Our dedication to quality and innovation is making AMN a prime destination for the best people in the business. In further demonstration of our dedication to the highest quality, AMN again has received certification from the Joint Commission on the Accreditation of Health Care Organizations. AMN was the first health care staffing company to receive this certification, and we have continuously maintained it since 2005.

我們對品質和創新的執著使 AMN 成為業內最優秀人才的首選。為了進一步證明我們對最高品質的追求，AMN 再次獲得了醫療組織聯合委員會的認證。AMN 是第一家獲得此項認證的醫療保健人員配備公司，並且自 2005 年以來我們一直保持此項認證。

Before we move to questions, I want to take a moment to acknowledge the recent passing of Healthcare's founder and long-time CEO, Alan Brenan. On behalf of AMN Healthcare, we extend our deepest condolences to Allan's family, friends and the entire IA team during this difficult time. Alan dedicated himself to growing the health care staffing industry and he leaves a lasting legacy. Operator, please open the call for questions.

在我們開始提問之前，我想花點時間回顧一下 Healthcare 創始人兼長期首席執行官艾倫·布雷南 (Alan Brenan) 最近去世的消息。我謹代表 AMN 醫療保健公司，向艾倫的家人、朋友和整個 IA 團隊致以最深切的哀悼。艾倫致力於發展醫療保健人員配備行業，並留下了持久的遺產。接線員，請打開電話詢問。

(Operator Instructions) Mark Marcon, Baird.

（操作員指示）馬克·馬孔，貝爾德。

So good afternoon, Cary that was a nice thing for you to say, obviously. I don't know the family or friends, but obviously, condolences tragic and puts things in perspective. Can you talk a little bit about the VMS wins that you had and the MSP wins that you had, it sounds like you've got 5. How big are they? Are they new to using an MSP or VMS? Or were they competitive wins? Any sort of color there would be appreciated.

下午好，卡里，顯然你說的這是一件好事。我不認識死者的家人或朋友，但顯然，我對悲劇表示哀悼，並客觀地看待事情。您能否稍微談談您獲得的 VMS 勝利和 MSP 勝利，聽起來您已經獲得了 5 個。它們有多大？他們是第一次使用 MSP 或 VMS 嗎？或者說，這是競爭性的勝利？任何顏色都可以。

Yes. A couple of things. One is, I think as you think about just the wins overall, they're reflective of a very intentional strategy we've had to accelerate our go-to-market particularly to broaden our positioning across the entirety of the market where we had been MSP-centric for some period of time. And so Mark, a lot of the wins that we are seeing now are manifestations of strategies we put into place over a year ago, just given some of the lead times.

是的。有幾件事。一方面，我認為，當你考慮整體勝利時，它們反映了我們必須採取的一種非常有目的性的策略，即加快我們的市場進入速度，特別是為了拓寬我們在整個市場的定位，在一段時間內，我們一直以 MSP 為中心。所以馬克，我們現在看到的許多勝利都是我們一年前實施的策略的體現，只是考慮到了一些準備時間。

For those wins, I'd characterize them as small to medium win. But the names underneath them are -- have -- carry even more weight in a couple of cases and what their spend under management would indicate, and they were competitive wins.

對於那些勝利，我將其描述為小勝利到中等勝利。但是，在某些情況下，他們下面的名字更有分量，他們的管理支出也表明了這一點，他們是競爭的勝利。

A broader comment that I'll say about what we're seeing, we've seen pipeline -- healthy pipeline growth in our sales pipeline from Q4 to Q1. We had been seeing for, I'd say, probably two years coming out of the pandemic, a bias in the pipeline towards vendor neutral. We are just starting to see some swing back, so we're still seeing strong interest in vendor neutral, but we're seeing some swing back in growth in our pipeline in MSP.

我要就我們所看到的情況發表更廣泛的評論，我們已經看到管道——從第四季度到第一季度，我們的銷售管道呈現健康的管道成長。我想說，在疫情爆發後的大概兩年裡，我們已經看到通路對供應商中立的偏見。我們剛開始看到一些回升，因此我們仍然看到人們對供應商中立的濃厚興趣，但我們看到 MSP 管道的增長有所回升。

That's great. Do you have a size in terms -- I mean you said they were small to medium, but when we consolidate them all, like what sort of revenue contribution could they ultimately end up generating at once the --

那太棒了。你們的規模是多少？我的意思是，你說它們是小型到中型的，但是當我們把它們全部合併起來時，它們最終能產生什麼樣的收入貢獻？--

If you look at year-to-date, we're in a net client win position. And so think of it as that would help us from a net revenue standpoint as we go later into the year.

如果看一下年初至今的情況，我們處於淨客戶贏利狀態。因此，請認為這將從淨收入的角度幫助我們度過今年稍後的時期。

Okay. Great. And then can you talk a little bit more about language services and some of the dynamics there. We haven't -- historically has been a growing space with really healthy margins. And just wondering about like what you're seeing from a competitive perspective and how you would expect that to unfold over the quarter and the year ahead?

好的。偉大的。然後您能否再多談談語言服務及其一些動態。從歷史上看，我們一直是一個不斷成長的領域，利潤率也非常可觀。我只是想知道從競爭角度您看到了什麼，以及您預計未來一個季度和一年內這種情況將如何發展？

Yes. So in Language Services overall, we continue to see healthy growth, you will see that in the second quarter, and we expect that to continue as we go through the year. From a competitive standpoint, we have seen particularly over the past 12 plus months some consolidation in the space. And so you have seen that consolidation, particularly among kind of two or three players, happen over 2024 and a bit in 2023.

是的。因此，在語言服務領域，我們總體上繼續看到健康的成長，您將在第二季度看到這一點，我們預計這種增長將持續到今年年底。從競爭的角度來看，我們在過去 12 個多月中看到該領域的一些整合。因此，您已經看到這種整合，特別是兩三家公司之間的整合，將在 2024 年和 2023 年發生。

That's putting a bit of pressure on margins. We still see this business as a high-growth, high-margin business and it is very attractive. We are very well positioned with our solution set of video and audio, and so we can offer both a high-quality solution, but given the efficiency of how we deliver our services, it also is a cost-effective solution for clients. So we think we are very well positioned even in a competitive environment.

這給利潤率帶來了一些壓力。我們仍然認為這項業務是高成長、高利潤的業務，而且非常有吸引力。我們的視訊和音訊解決方案非常出色，因此我們不僅可以提供高品質的解決方案，而且考慮到我們提供服務的效率，這對客戶來說也是一種經濟高效的解決方案。因此我們認為，即使在競爭環境中，我們也處於非常有利的地位。

So would you expect the margins, the gross margins on that part of the business to basically stabilize at these levels? Or how are you thinking about that?

那麼您是否預期該部分業務的利潤率和毛利率基本上會穩定在這些水準？或者您對此有何看法？

Yes. Mark, this is Brian. I think that's a fair characterization. We've seen a little bit of a decline as we called out. But we also are working internally on always improving the quality of the service, but also how we think about utilization of interpreters, in the mix between permanent and use of contracts, onshore, offshore as well.

是的。馬克，這是布萊恩。我認為這是一個公正的描述。當我們發出呼籲時，我們看到了一點點的下降。但我們內部也不斷努力提升服務品質，同時也在思考如何利用口譯員，包括長期使用和合約使用，在岸和離岸使用。

So we're already making some adjustments that we'll bring down some of our costs with in no way impacting the quality of our service, which we know is a differentiator. So at this point, we feel like we've got some good actions that are going to help stabilize even if there's a little more pressure on the price side with some of the competitors. So we're feeling good that this is a good stable point.

因此，我們已經做出了一些調整，以降低部分成本，但不會影響我們服務的質量，我們知道這是一個差異化因素。因此，目前，我們覺得我們已經採取了一些良好的行動，即使一些競爭對手在價格方面面臨更大的壓力，這些行動也將有助於穩定局勢。因此，我們感覺這是一個很好的穩定點。

Mark, one thing I'll note, just picking up on one of Brian's comments is, it is a differentiator both the kind of our video capabilities, but also our onshore/offshore, so for some clients having the ability to have onshore interpreters is very important to them, not every competitor offers that option. So that is also a differentiation that is important to a number of clients and/or prospects that we talk to.

馬克，有一件事我要指出，我剛才談到布萊恩的一條評論，那就是我們的視頻功能和在岸/離岸服務都有區別，所以對於一些客戶來說，擁有在岸口譯員的能力對他們來說非常重要，但並不是每個競爭對手都提供這種選擇。因此，對於我們交談過的許多客戶和/或潛在客戶來說，這也是一個重要的區別。

Great. And can I squeeze one more in? Just on travel nurse bill rates. It sounds like they were only down a little bit year-over-year. Do you feel like that's pacing out?

偉大的。我可以再擠一個嗎？僅關於旅行護士的收費標準。聽起來與去年同期相比只是略有下降。您覺得這像是在放慢節奏嗎？

I know that there's still some orders out there that aren't competitive. But do you feel like we're starting to see some real basing and a point where we can start building again?

我知道仍有一些訂單沒有競爭力。但是您是否覺得我們開始看到一些真正的基礎以及我們可以重新開始建造的點？

Yes. If you look at the bill rates, we've really seen stabilization from the back half of 2024. So even though we're down 6% year-over-year, it was -- you saw stabilization that we talked about in the past quarter as well. Currently, we are at a premium spread of contingent cost to permanent labor of about 11%.

是的。如果你看一下票據利率，我們確實看到從 2024 年下半年開始利率趨於穩定。因此，儘管我們的銷售額比去年同期下降了 6%，但正如我們在上個季度所討論的那樣，我們也看到了穩定的跡象。目前，我們的臨時成本與永久勞動力的溢價率約為 11%。

Pre pandemic, you would have seen that range more in the mid- to high teens, and so I think as we have talked about over the past couple of quarters, as we've seen some of the stabilization in bill rates, you're continuing to see signs that you have seen some stabilization, unfilled orders are relatively where they were last quarter, maybe a slight uptick.

在大流行之前，你會看到這個範圍更多地在十幾到十幾個百分點之間，所以我認為，正如我們在過去幾個季度中談到的那樣，我們看到票據利率有所穩定，你會繼續看到一些跡象表明你已經看到了一些穩定的跡象，未完成的訂單相對上一季度的水平，可能略有上升。

So I think from here on in, really, if there's an immediacy of the need of some of these clinicians you would expect for some of those bill rates to go up to ensure that they are able to fill that need.

因此我認為從現在開始，如果這些臨床醫生確實有迫切的需求，那麼你會預期部分收費標準會上升，以確保他們能夠滿足這一需求。

Trevor Romeo, William Blair.

特雷弗羅密歐、威廉布萊爾。

I want to thank you also for providing the slide deck this quarter. That's extremely helpful for us. So I appreciate that. Maybe I'll just pick up on the unbillable order topic. I had a question on that.

我還要感謝您本季提供的幻燈片。這對我們非常有幫助。我很感激。也許我只會談論無法計費的訂單主題。我對此有一個疑問。

I mean it definitely appears that order volumes are picking up across the industry still. I think Cary, you talked about continuing to see orders priced at levels no one's filling, but the margins -- gross margins seem a bit more stable this quarter. So two questions on that. One is, are you starting to see competitors taking less of those low-margin orders? And then two, what do you think it will take for clients to move those bill rates higher so that they can be filled?

我的意思是，整個行業的訂單量似乎仍在回升。我認為，卡里，您談到繼續看到訂單價格處於無人填寫的水平，但利潤率 - 本季的毛利率似乎更加穩定。關於這一點有兩個問題。一是，您是否開始發現競爭對手承接的低利潤訂單減少了？其次，您認為客戶需要採取什麼措施才能提高這些帳單利率，以便能夠滿足需求？

Yes. So on the first one, I think the unfilled orders is probably reflective of rationality of competitors of not filling orders that don't make economic sense. What we have seen in terms of those unfilled orders getting filled, is it typically is a client going back, and there's a more immediate need of getting that filled and increasing the bill rate to a price that will be reflective of current market conditions, whether that's geographic or by specialty.

是的。因此，就第一個問題而言，我認為未完成的訂單可能反映了競爭對手不履行沒有經濟意義的訂單的合理性。就那些未完成的訂單而言，我們看到的通常是客戶回來了，並且更迫切地需要完成這些訂單並將賬單費率提高到能夠反映當前市場狀況的價格，無論是按地理位置還是按專業。

And so a part of the challenge that you've had, particularly over the past three or four quarters, is that while you got in 2024, we really started to see the bill rates stabilize. But the underlying labor market, you're still seeing increases in wages. And so there is a market matching condition that you have to have around the bill rate to reflect where clinicians are willing to go to take the assignment. And so it's pretty client specific. And as we see more of those needs become more immediate, we would expect some of those bill rates to change.

因此，您面臨的挑戰之一，特別是在過去的三到四個季度，當進入 2024 年時，我們才真正開始看到票據利率趨於穩定。但在基礎勞動市場中，你仍然會看到薪資上漲。因此，你必須在收費標準方面有一個市場匹配條件，以反映臨床醫生願意去哪裡接受任務。所以它是針對特定客戶的。隨著我們看到越來越多的此類需求變得更加迫切，我們預計部分帳單利率將會改變。

Yes. In terms of competitive behavior, it seems it's been pretty much the same, right? We're seeing that on field percentage that may be the same or maybe ticking up a bit, which is I think an indication that clients with low rates have kind of tested the bottom and maybe gone too far. And so it's competitors may be filling some orders, but they're not filling these ones that have rates that just don't make economic sense and that really hasn't changed.

是的。從競爭行為來看，似乎情況大致相同，對嗎？我們看到，實際百分比可能保持不變或略有上升，我認為這表明低利率的客戶已經觸底，並且可能走得太遠了。因此，它的競爭對手可能會完成一些訂單，但他們不會完成那些費率不經濟的訂單，而且這種情況實際上並沒有改變。

I think as we go through this year, if there's a greater need or competitors just realize is it's not going to change, you'll probably see some of them move away from the industry, which should be healthy, longer term. But ideally, clients, if they have pushed it for a while and realized that, that rate is not going to actually attract clinicians in that they'll start to move. And again, it's on a client-by-client basis, we're definitely seeing that happen, you see it more broadly across the industry.

我認為，隨著今年的到來，如果有更大的需求或競爭對手意識到這種情況不會改變，你可能會看到其中一些公司退出該行業，從長遠來看，這應該是健康的。但理想情況下，如果客戶堅持了一段時間並意識到這個速度實際上並不會吸引臨床醫生，他們就會開始改變。再說一次，這是基於每個客戶的情況的，我們確實看到這種情況發生，你可以在整個行業中更廣泛地看到這種情況。

And Trevor, one other add I would have to Brian's comments is when you look at some of the things that have improved for the health care system, you've seen a return to pre-pandemic retention rates. You saw a reestablishment of their permanent base through accelerated hiring, and so those two things were significant improvements in terms of the stability of their workforce.

特雷弗，我想對布萊恩的評論補充一點，當你看到醫療保健系統的一些改進時，你會發現保留率已經恢復到疫情前的水平。你可以看到他們透過加速招募重建了永久基地，因此這兩件事對於他們的勞動力穩定性而言是重大的改善。

You now have from a completion strategy, very cost-effective contingent labor cost, and so I do think as you look forward how systems think about the completion of that strategy, it probably will look different than it maybe did 18 months ago when that premium spread was at much higher levels.

現在，從完成策略來看，您擁有非常具有成本效益的或有勞動力成本，因此我確實認為，當您展望系統如何考慮該策略的完成時，它可能會與 18 個月前溢價差處於更高水平時的情況有所不同。

Got it. That makes a lot of sense. And then I guess for my follow-up, I wanted to ask on the labor disruption piece. I mean it seems like it's coming ahead of your expectations the last couple of quarters. Cary, you talked about the pipeline. I think some of the recent capabilities have improved in that area.

知道了。這很有道理。然後我想作為我的後續問題，我想問有關勞工中斷的問題。我的意思是，過去幾個季度它的表現似乎超出了你的預期。卡里，你談到了管道。我認為最近該領域的一些能力已經提高。

So I guess would you say that the underlying amount of labor disruption is growing? Or is it more about that internal kind of focus and execution and either way, is this an area where you could see kind of a more consistent revenue cadence going forward?

那麼，我想您是否認為潛在的勞工中斷數量正在增加？或者更多的是關於內部的關注和執行，無論如何，這是一個你可以看到未來更一致的收入節奏的領域嗎？

It's more the internal focus and how we operate. So as we went back and looked at the total CBAs in the market last year versus this year, last year was higher. Our pipeline and the clients and the events we're supporting are higher because we've been focused on it. And I'd say it's been on really two very important fronts. One is, it is very clear to us that for clients who have this need, it is a very important need. And our focus is on how we support our clients.

這更多的是內部關注點以及我們的運作方式。因此，當我們回顧去年和今年市場上的 CBA 總量時，我們發現去年的 CBA 總量更高。因為我們一直專注於此，所以我們支援的管道、客戶和活動都更高。我想說的是，這確實涉及兩個非常重要的方面。一是，我們非常清楚，對於有這種需求的客戶來說，這是一個非常重要的需求。我們的重點是如何支持我們的客戶。

The second part really speaks to some of the commentary that I had in the beginning, which is, we now have technology, we have more automation in our business. We have an ability to support important parts of our process 24/7, around the clock globally. And so there are a number of things that we have worked on over the past 12 to 18 months that have positioned us to be able to support our clients very effectively here while also not affecting the high service quality in our core businesses.

第二部分實際上談到了我一開始的一些評論，那就是，我們現在有了技術，我們的業務更加自動化。我們有能力在全球範圍內全天候支援我們流程的重要部分。因此，在過去的 12 到 18 個月中，我們開展了許多工作，使我們能夠非常有效地為客戶提供支持，同時又不影響我們核心業務的高品質服務。

And so we wanted to have confidence that we could do that and make sure that we were not affecting the quality of service that we had in our core. From a modeling standpoint, it's a great question. We still model $5 million of revenue a quarter. It's just not as predictable. But we do have a stronger pipeline. We have more upside than we have had, especially more recently in some of these events.

因此，我們希望有信心做到這一點，並確保我們不會影響我們核心的服務品質。從建模的角度來看，這是一個很好的問題。我們仍預計每季的營收為 500 萬美元。它只是不那麼可預測。但我們確實擁有更強大的管道。我們的優勢比以往更大，特別是在最近的一些事件中。

But it can still be lumpy because even when there's a an expiring organic agreement, that doesn't necessarily mean that the next day, they go on strike. And so there may be an agreement in place. We're planning for it, but the timing is somewhat unknown and the duration. So we do believe that there will be -- we will continue to have the service and there will be strikes that will happen.

但它仍然可能很不平穩，因為即使有機協議即將到期，也不一定意味著第二天他們就會罷工。因此可能會達成協議。我們正在為此做計劃，但具體時間和持續時間還不清楚。因此，我們確實相信，我們將繼續提供服務，並且會發生罷工。

But in terms of the magnitude and the exact timing, it's still very difficult to predict. The good thing is, as Cary pointed out, we have a team that can support that really well. We now have industry-leading technology behind it. So we feel like we're really well positioned to be able to win those opportunities that come up and provide really critical service, but it is still hard to predict the exact timing and magnitude.

但其規模和具體時間仍很難預測。正如 Cary 指出的那樣，好消息是，我們擁有一支能夠很好地支持這一點的團隊。我們現在擁有業界領先的技術。因此，我們覺得自己已經做好了充分的準備，能夠贏得出現的這些機會並提供真正關鍵的服務，但仍然很難預測確切的時間和規模。

Yes. And if I could maybe just sneak in one quick follow-up on that, Brian, on the incremental margins on that business, can you just maybe remind us what you typically see there relative to your other businesses in that segment?

是的。布萊恩，如果我可以偷偷快速跟進這個問題，關於該業務的增量利潤率，您能否提醒我們一下，相對於該領域的其他業務，您通常看到的情況是什麼？

Yes. It's a fair question. And again, there's lots of variables in that because, again, there's -- sometimes if there's work leading up to an event and it doesn't happen, you might get more fees on kind of preparing and that could be a higher margin. But if you -- we found over the last couple of years for events that occur.

是的。這是一個公平的問題。再說一次，這其中有很多變數，因為，再說一次，有時候，如果在某個活動前做了一些準備工作，但活動沒有舉行，你可能會得到更多的準備費用，這可能會帶來更高的利潤。但是如果你——我們發現過去幾年發生的事件。

As we've mentioned in the last couple of quarters, where we've had revenue, the gross margins are not materially different than the segment margin. We obviously get more flow through though, the G&A side of it, we definitely have incremental cost.

正如我們在過去幾季中提到的那樣，我們的收入、毛利率與分部利潤率並沒有實質的差異。不過，我們顯然獲得了更多的流量，從 G&A 方面來看，我們肯定有增量成本。

That team is already in place, but travel costs and other logistics support that occurs. So we get a nice flow-through on the EBITDA margin, but the gross margin impact for nurse and allied is pretty consistent with what you're seeing in our core business.

團隊已經到位，但需要支付差旅費和其他後勤支援費用。因此，我們在 EBITDA 利潤率上獲得了良好的流通，但護理人員和相關人員的毛利率影響與您在我們的核心業務中看到的情況非常一致。

AJ Rice, UBS.

瑞銀的 AJ Rice。

Maybe a couple here, some of which clarification on previous comments. Just to make sure I understand Nurse and Allied bill, especially the nursing, the bill rates are stabilizing. You've said that in the last two quarters, but you've also had an uptick in labor disruption. Revenues is on an apples-to-apples basis, putting the labor disruption aside, are you seeing stabilization? Or is that having any influence on sort of helping stabilize the rates?

這裡可能有幾個，其中一些是對先前評論的澄清。只是為了確保我了解護士和相關人員的帳單，特別是護理費用，帳單費率正在穩定下來。您在過去兩個季度中已經說過這​​一點，但勞工糾紛也出現了增加的趨勢。收入是按同類比較計算的，撇開勞工中斷不談，您是否看到了穩定性？或者這對穩定利率有什麼影響嗎？

Yes, thanks for the question. So just to be clear, the labor disruption revenue, those rates are not included in the bill rates that you see us talk about here and that stability there. So we're really talking about the bill rates for our kind of core travel nurse and travel allied businesses. And that's where we've seen stability for the last several quarters, so the rates on labor disruptions vary quite a bit. They can be higher just because you're trying to pull in for short duration, but that's not influencing the metrics we're talking about here.

是的，謝謝你的提問。因此，需要明確的是，勞動中斷收入，這些費率不包括在我們在這裡討論的帳單費率和那裡的穩定性中。所以我們實際上談論的是我們的核心旅行護理師和旅行相關業務的收費標準。過去幾個季度，我們看到了穩定的局面，因此勞工中斷的發生率差異很大。它們可能會更高，只是因為你試圖在短時間內拉動，但這不會影響我們在這裡討論的指標。

Okay. That's helpful. And then going back to the language services, I understand the comments about the competitive landscape, but you also mentioned in the prepared remarks, a little bit of weakening in demand for Spanish translation services that may be potentially impacted by some of the dynamics out of Washington, begs the question about how much of an impact is that? How big is Spanish translation services in your business? And I guess, if I think about it from what's going on with immigration at all, do you have a lot of that in the emergency room?

好的。這很有幫助。然後回到語言服務，我理解關於競爭格局的評論，但您在準備好的評論中也提到，西班牙語翻譯服務的需求略有減弱，這可能會受到華盛頓一些動態的影響，這引出了一個問題，即這種影響有多大？西班牙文翻譯服務在您的業務中佔多大比例？我想，如果我從移民問題的角度來考慮這個問題，急診室裡是不是有很多這樣的病人？

Or is that more people that are actually admitted to the hospital, et cetera?

或者實際上有更多的人入院等等？

We haven't -- the language is the number one language for interpretation and that's not a surprise. What we have seen so far is a modest downturn in Spanish as a percentage of our total language mix. And so it's something that we're monitoring as we have typically seen that as very strong growth. It's not something that is at this point that we would see impacting. We're actually seeing growth into second quarter, and we would expect that to continue throughout the year.

我們沒有——該語言是第一大口譯語言，這並不奇怪。到目前為止，我們看到西班牙語在我們整個語言組合中所佔的比例略有下降。因此，這是我們正在監控的事情，因為我們通常看到它非常強勁的成長。目前看來，這還不會對我們造成影響。我們實際上看到了第二季度的成長，並且我們預計這種成長將持續全年。

But it's something that we're monitoring. We haven't seen any slowdown in interest or demand from clients. And so the only place where we have seen any type of impact is a modest downtick in the percentage of Spanish as total minutes offered.

但這是我們正在監控的事情。我們並未看到客戶的興趣或需求有任何放緩。因此，我們看到的唯一影響是西班牙語課程佔總授課時間的比例略有下降。

Okay. And then just one last one. I think in the prepared remarks, you mentioned that you had a little pressure in bill pay spread and locum tenens. I know you can have volatility based on the specialists that are in demand at any given time. But I don't think I've heard you say that there was some pressure on the bill pay spread before. Maybe I'm wrong on that, but what are you seeing there?

好的。最後再說一句。我想在準備好的發言中，您提到您在帳單支付差額和臨時醫生方面面臨一些壓力。我知道，根據任何特定時間對專家的需求，可能會出現波動。但我認為我以前沒有聽過您說過帳單支付利差存在一些壓力。也許我錯了，但是你看到了什麼？

Yes. I mean, I think we've probably called it out at times. I mean, there's competition there. And so there's been some pressure on just the spreads overall as we're really trying to drive days bill. And then there has been a component of mix with like our CRNA business, which has been a nice strong growth in days, but it does carry a lower margin impacting the spreads overall for that business.

是的。我的意思是，我想我們可能有時會這樣稱呼它。我的意思是，那裡存在競爭。因此，由於我們確實在努力提高帳單天數，因此整體利差面臨一些壓力。然後出現了像我們的 CRNA 業務這樣的混合成分，該業務在幾天內一直保持強勁增長，但它的利潤率較低，影響了該業務的整體利差。

I think we've -- and so you see more of an impact on a year-over-year basis. It's much smaller sequentially. And as we look into the second quarter and the remainder of the year, feel like we're in a good place and spreads are starting to stabilize.

我認為我們已經——因此你會看到同比影響更大。它按順序小得多。當我們展望第二季和今年剩餘時間時，我們感覺我們處於一個良好的狀態，利差也開始穩定下來。

I think the other important point, I think we mentioned in the last call is that we're seeing good momentum in some of our other specialties now. A lot of -- we built up the teams there and some of the internal medicine, psych, surgery, there's other areas that have a better rate and margin profile.

我認為另一個重要點，我想我們在上次電話會議中提到過，我們現在看到我們的一些其他專業領域發展勢頭良好。我們在那裡建立了許多團隊，包括一些內科、精神科、外科等，其他領域的費率和利潤率都比較好。

The team is very confident that we're going to be able to grow those specialties, which should have a positive influence on our margins longer term.

團隊非常有信心，我們將能夠發展這些專業，這將對我們的長期利潤產生積極的影響。

Brian Tanquilut, Jefferies.

傑富瑞的布萊恩‧坦奎魯特 (Brian Tanquilut)。

This is Megan Holtz on for Jack Slevin, so just a little bit deeper and beyond the Spanish commentary. Are you guys seeing any apprehension from clients in taking on full-time hires given the background right now on the macro side and the policy uncertainty? Or is it soon to tell?

這是梅根霍爾茨 (Megan Holtz) 為傑克斯萊文 (Jack Slevin) 所做的評論，因此，評論會更深入一些，超越西班牙語部分。考慮到目前的宏觀背景和政策不確定性，你們是否發現客戶對聘用全職員工感到擔憂？還是很快就會知道？

Yes. I think generally, it's too early to tell. Clients are monitoring the fluid environment around health care policy and doing scenario planning. What we have seen and what a lot of the commentary, particularly over the past two weeks from some of the health care systems is that they are still seeing a healthy increase in patient demand.

是的。我認為總體來說，現在下結論還為時過早。客戶正在監控醫療保健政策周圍的流動環境並進行情境規劃。我們看到的以及很多評論，特別是過去兩週一些醫療保健系統的評論是，患者需求仍在健康增長。

And so for us, we had a strong start to the year. We are very focused on how we continue to increase our demand and fill more of the demand that's out there in the market. The only thing that we have seen from a behavioral standpoint over the past couple of weeks is we've seen some slowdown in client decision-making.

因此，對我們來說，今年有一個好的開始。我們非常注重如何持續增加我們的需求並滿足市場上更多的需求。從過去幾週的行為角度來看，我們唯一看到的是客戶決策速度有所放緩。

We've seen this off and on over the past two years. And so that is not something that is new to us. And we do think that, particularly with my earlier comments about where you see some of the premium spread to permanent positions, right now, in this environment, contingent is actually a very attractive alternative. If there's not -- while they wait and look at where some of these policies land.

過去兩年來，我們斷斷續續看到這種情況。所以這對我們來說並不是什麼新鮮事。我們確實認為，特別是根據我之前關於您看到部分保費擴散到永久職位的評論，目前，在這種環境下，臨時工實際上是一種非常有吸引力的選擇。如果沒有的話——他們會等待並觀察這些政策的實施結果。

Okay. And then just a follow-up. Can you guys walk through any updated thoughts on the progression of the international business throughout the balance of the year?

好的。然後只是後續行動。你們能否談談今年國際業務進展的最新想法？

Yes. As we've talked about in the last call, I'd say there's no major changes there. We did expect to see, and we have seen a decline sequentially from Q4 to Q1, call it a $3 million to $4 million range. We'll see a similar amount in the second quarter. And that's really just a function of with retrogression that we've got more nurses coming off their contracts than we're able to place.

是的。正如我們在上次通話中討論的那樣，我想說那裡沒有重大變化。我們確實預料到了，而且我們也看到從第四季度到第一季出現了連續下降，大概在 300 萬美元到 400 萬美元的範圍內。我們將在第二季度看到類似的數字。這實際上只是倒退的結果，合約到期的護士數量超過了我們能夠安置的護士數量。

But that is stabilizing. We still expect until we get to the third quarter. So Q3 and 4 should look a lot like the second quarter. So no longer a headwind after the second quarter from everything we're seeing right now. And we still expect to see that start to turn positive in 2026.

但情況正在穩定下來。我們仍然期待直到第三季。因此第三季和第四季應該與第二季非常相似。因此，從我們目前看到的情況來看，第二季之後不再是逆風。我們仍然預計這一數字將在 2026 年開始轉正。

As you continue to see those -- the visa dates move forward. That's really -- other than that, clients want to bring in more international nurses. It's just a function of getting that visa date move forward so that we can pull more that are in the pipeline into the US and into these assignments.

正如您所看到的——簽證日期正在向前推進。確實如此——除此之外，客戶還希望引進更多的國際護理師。這只是將簽證日期提前，以便我們可以吸引更多正在申請美國簽證的人參與這些任務。

Yes. What we've seen just to add on to Brian's comment about support is, the need for international clinicians is supported both in a bipartisan kind of environment, and it's also pretty universally supported by health systems. So it fills a very important need for a number of systems. I'd say particularly those that are nonurban settings that have a harder time being able to retain and attract talent.

是的。我們看到，除了 Brian 關於支持的評論之外，對國際臨床醫生的需求不僅得到了兩黨環境的支持，而且也得到了衛生系統的普遍支持。因此它滿足了許多系統非常重要的需求。我想說的是，特別是那些非城市地區，它們更難留住和吸引人才。

Jeffrey Silber, BMO Capital Markets.

傑弗裡·西爾伯（Jeffrey Silber），蒙特利爾銀行資本市場。

This is Ryan on for Jeff. Just wanted to refresh on the capital allocation priorities at this point in time, is taking leverage ratio down first and foremost. And then just any thoughts on repurchases or M&A.

這是瑞恩 (Ryan) 代替傑夫 (Jeff)。只是想刷新此時的資本配置優先事項，首先是降低槓桿率。然後就是關於回購或併購的任何想法。

Sure. It's Brian. As I mentioned in our prepared remarks, our -- definitely our priority right now is to continue to use free cash flow to pay down debt. And so that is not going to change to this year. From a capital deployment on CapEx, we've said that our -- we'll expect to spend somewhere between $40 million and $50 million this year. That is a little -- a little more than half of what we spent in 2024. So we did adjust our capital expenditures so that we could deploy more towards debt reduction.

當然。我是布萊恩。正如我在準備好的演講中提到的那樣，我們現在的首要任務肯定是繼續利用自由現金流來償還債務。所以今年這種情況不會改變。從資本支出的資本部署來看，我們表示——我們預計今年的支出將在 4,000 萬至 5,000 萬美元之間。這比我們 2024 年支出的一半略多一點。因此，我們確實調整了資本支出，以便我們可以將更多資金用於減少債務。

But that's -- I think it's still creating a quite a differentiation for AMN and that we're still investing in innovation, in AI, things that are going to continue to improve our service delivery speed and fulfillment. And so I think that's where maybe some of our other competitors that are having to pull back even more on the CapEx, we're excited about what we're bringing forward here.

但我認為這仍然為 AMN 創造了相當大的差異化，而且我們仍在投資創新、人工智慧等將繼續提高我們的服務交付速度和履行能力的東西。因此，我認為也許我們的其他一些競爭對手不得不在資本支出上進一步縮減，而我們對我們在這裡所做的努力感到興奮。

You hear us talk about it in the investments we're making across the business. And so we're -- we think those are really important to our long-term strategy, but it's a good balance between deploying for those important investments, but also paying down our debt and keeping that leverage within our covenants.

您可以聽到我們談論我們在整個業務中進行的投資。因此，我們認為這些對我們的長期策略確實很重要，但在部署這些重要投資與償還債務並在我們的契約範圍內保持槓桿作用之間需要取得良好的平衡。

Got it. And then just a follow-up on one of the prior questions. was curious how things trended throughout the quarter and exited the quarter. I was wondering if you noticed any incremental hesitancy from clients either post DOGE or tariff announcements or anything to call out there?

知道了。然後只是對之前的一個問題的跟進。很好奇整個季度的情況如何，以及本季結束時的情況如何。我想知道您是否注意到客戶在 DOGE 或關稅公告或任何需要注意的事情發布後表現出任何猶豫？

No. We continue to see strong demand. So if you kind of look at our businesses, we continue to see strong demand in allied, locum, strike, school bookings, language services. In Nurse, we are still year-to-date through April versus the year-over-year comparison were up mid-teens.

不。我們繼續看到強勁的需求。因此，如果你看一下我們的業務，我們會繼續看到對盟軍、臨時醫生、罷工、學校預訂、語言服務的強勁需求。在 Nurse 方面，截至 4 月份，我們今年迄今的銷售額與去年同期相比仍成長了 15% 左右。

In that, we did see some -- a bit of pullback in April, but even with that, we're still up 15% year-over-year. So we continue to see healthy demand in the businesses. The one thing that, as I mentioned earlier, that we have seen is some slowdown in decision-making. So once a candidate has presented the decision-making around that or around an extension.

在這方面，我們確實看到了一些——4 月出現了一些回調，但即便如此，我們仍然比去年同期成長了 15%。因此，我們繼續看到企業的健康需求。正如我之前提到的，我們看到的一件事是決策速度有所放緩。因此，一旦候選人提出了圍繞該問題或延期做出的決策。

Joanna Gajuk, Bank of America Securities.

美國銀行證券的喬安娜‧加朱克 (Joanna Gajuk)。

Maybe a couple of questions on your guidance. I don't think I've heard some of the metrics that you normally discuss. So would you assume for the Nurse Allied volumes in Q2 and also for the build rates in Q2? And the last piece is gross margin for nurse allied in Q2, I guess, you did 22.7% I think in Q1, so that was better than what you had assumed? So kind of maybe if you can give us some of these assumptions, that will be helpful.

也許我有幾個關於您指導的問題。我認為我沒有聽到您通常討論的一些指標。那麼，您是否可以預測第二季度護理師聯合業務量以及第二季的建設率？最後一點是第二季護理師聯合公司的毛利率，我想，第一季的毛利率是 22.7%，比你預想的還要好嗎？因此，如果您能給我們一些這樣的假設，那將會很有幫助。

Yes. I don't -- yes, I don't think we're going to give that specific level of detail. We did mention in the prepared remarks that there is -- we expect to see kind of normal seasonality in nursing, which if you go back it's not uncommon to see our volume come down, from Q1 to Q2 with some of those winter assignments end. So we're expecting to see that sequentially, sit kind of a normalized pattern low single digits.

是的。我不——是的，我認為我們不會提供那麼具體的細節。我們確實在準備好的發言中提到過——我們預計護理行業會出現正常的季節性，如果回顧一下，隨著一些冬季任務的結束，從第一季到第二季度，我們的工作量下降是很常見的。因此，我們期望看到這種連續的、標準化的模式，即低個位數。

Allied, again underneath Allied, again, good demand in our core Allied business schools. You typically do see a decline from first and second quarter gains you're moving into the summer months. So I'd say in that regard, it's pretty similar on the rate side, again, the stable rate bill rate going from Q1 to Q2. The only influence, again, some of those winter assignment orders might have had a little bit higher rate attached to them. But underneath that, we've seen stability in rates as well.

聯合商學院，同樣位於聯合商學院之下，同樣，我們的核心聯合商學院的需求量很大。通常情況下，進入夏季，第一季和第二季的收益會下降。因此，我想說，從這方面來看，利率方面非常相似，同樣，穩定利率票據利率從第一季到第二季。唯一的影響是，一些冬季任務訂單的費率可能會稍微高一些。但在此之下，我們也看到了利率的穩定性。

And I guess on the gross margin overall in Q1, you mentioned that mentioned -- but we can see that it was better than your guidance. So what actually drove the outperformance there? And I guess then for your Q2 guidance on the overall gross margin, you could assume kind of stable maybe actually up at the midpoint, a little bit 10 basis points or so. So can you walk us through the outperformance in Q1. And then I guess why are you thinking the gross margins could actually be up sequentially?

我想，關於第一季的整體毛利率，您提到過——但我們可以看到，它比您的預期要好。那麼，究竟是什麼推動了其優異的表現呢？那麼，對於您對第二季整體毛利率的預測，您可以假設它比較穩定，實際上可能在中間點上升，大約 10 個基點左右。那麼，您能否向我們介紹第一季度的出色表現呢？那麼我想問一下，您為什麼認為毛利率實際上會連續上升呢？

Sure. I mean there weren't any major drivers of that outperformance in Q1. We did have a -- we had a workers' comp actuarial, a favorable adjustment of about $1.5 million that was -- that has about 20 basis points. We did have a little bit better performance in our VMS revenue, which is high-margin search as well. So it was kind of a sum of several small things that ended up driving outperformance in the gross margin in the first quarter.

當然。我的意思是，第一季的優異表現並沒有什麼主要驅動因素。我們確實有一個——我們有一個工人補償精算，有利的調整約為 150 萬美元——大約有 20 個基點。我們的 VMS 收入確實表現得更好一些，這也是高利潤的搜尋。因此，正是幾件小事的綜合作用最終推動了第一季毛利率的優異表現。

The guide we've given for Q2 would imply down a little bit, part of that being driven by that onetime workers' comp adjustment in the first quarter, not happening again in the second quarter. And then the rest of it is really predominantly just mix. We're seeing pretty stable margins. Nothing I'd call out is highly notable from Q1 to Q2.

我們給出的第二季度指引暗示會略有下降，部分原因是第一季的一次性工人補償調整，而第二季度不會再次發生。其餘部分實際上主要只是混合。我們看到利潤率相當穩定。從第一季到第二季度，我沒有什麼特別值得注意的事情。

Tobey Sommer, Truist.

托比·索默 (Tobey Sommer)，Truist。

This is Tyler Barish for Tobey. You mentioned in the prepared remarks some changes to your gross margins with some process changes with technology. Can you just be a little more detail on what some of those are?

我是泰勒·巴里什 (Tyler Barish)，為托比 (Tobey) 服務。您在準備好的評論中提到了由於技術的一些流程變化而導致的毛利率的一些變化。您能否更詳細地介紹一下其中的一些內容？

Yes. So part of what we have been doing is we just rolled out after development in the back half of the year, a gross margin tool. And so part of what we have been focused on in our technology investments is how do we create both automation but efficiency. And so that has been very well received. It will create about a 4% on average productivity improvement for our recruiters. And so those tools are really helpful in us both attracting but also retaining the top recruiting talent.

是的。因此，我們一直在做的工作之一是在今年下半年開發完成後推出的毛利率工具。因此，我們在技術投資中關注的部分內容是如何實現自動化和效率。因此，這項舉措受到了廣泛好評。這將使我們的招募人員的生產力平均提高約 4%。因此，這些工具對於我們吸引和留住頂尖招募人才確實很有幫助。

The other pieces that you've seen us focus on in our technology that helps our ability to generate revenue are AI matching. So we put in the fourth quarter in our Locums business. We put AI matching capabilities with candidates that help recruiters with their speed. If we look year-over-year in our locum sales, it has gone up considerably and some of that tech enablement is a part of it.

您所看到的，我們在技術上關注的其他有助於我們提高收入的部分是人工智慧匹配。因此，我們將第四季度的重心放在了 Locums 業務上。我們將人工智慧匹配功能應用於候選人，以幫助招募人員提高招募速度。如果我們逐年查看臨時工的銷售額，就會發現它已經大幅成長，其中一些技術支援是其中的一部分。

And there's continued -- I mean it's daily, weekly, we're rolling out new enhancements in our -- the tools that we're providing to our recruiters, some of it we can't share necessarily from a competitive point of view, but just know that, that we're getting really good internal reaction to some of the investments we're making, continuing to build out AMN Passport for the clinicians as well to make it easier for them to onboard, search for jobs, credentials, so that -- and really create a more cohesive integrated platform between ShiftWise Flex, our internal append tracking system, Passport. So everything is very well connected, and things flow more seamlessly, which, in all cases, improve speed and experience both for clients, clinicians and our internal teams.

我們還在持續改進——我的意思是每天、每週，我們都在為招聘人員提供的工具推出新的增強功能，從競爭的角度來看，有些工具我們不一定能分享，但要知道，我們對所做的一些投資得到了非常好的內部反應，我們繼續為臨床醫生構建 AMN Passport，使他們更容易入職、搜索工作和證書，這樣，並在 ShiftWise、我們在 ShiftWise、我們的內部建立系統之間創建更具凝聚力因此，一切都連結得非常好，事情進展得更順暢，在所有情況下，這都提高了客戶、臨床醫生和我們內部團隊的速度和體驗。

Got it. And then can you just discuss some competition in the marketplace. Has competition eased at all in the last couple of months, especially with a peer being acquired potentially?

知道了。然後您能否討論一下市場上的一些競爭？在過去的幾個月裡，競爭是否有所緩和，尤其是在同業可能被收購的情況下？

Yes. The competition is still very intense. The IO Cross Country acquisition is not complete yet. So they are still competitors. And we expect that competitive environment to stay intense.

是的。競爭還是很激烈的。IO Cross Country 的收購尚未完成。所以他們仍然是競爭對手。我們預期競爭環境將持續激烈。

There is over -- there is more competition for the demand that's out there. You start to see a rationalization and consolidation already over the past year. We think that more has to happen, over the coming years. And so we would expect both for it to continue to be a competitive environment and for there to be continued rationalization of the capacity that's in the market.

已經結束了——對於存在的需求，競爭變得更加激烈。在過去的一年裡，你已經開始看到合理化和整合。我們認為，未來幾年還會發生更多的事情。因此，我們預期市場將繼續保持競爭環境，且市場產能將繼續合理化。

Really kind of furthering some of Brian's earlier comments, if we look at our capabilities, which includes our platforms, our broad solutions, our extraordinary team, we think that we are well positioned in that very competitive environment, and we are seeing that increasingly with our client wins, with our improved fill rate with our ability to win against the entirety of the market from MSPs vendor-neutral direct.

這實際上進一步闡述了 Brian 之前的一些評論，如果我們看看我們的能力，包括我們的平台、廣泛的解決方案、出色的團隊，我們認為我們在競爭激烈的環境中處於有利地位，而且我們看到，隨著我們贏得客戶的不斷增加，隨著我們不斷提高的供應填充率，我們有能力從 MSP 供應商中立的直接競爭中贏得整個市場。

Thank you. I'm showing no other questions at this time. So I would now like to turn it back to Cary Grace for closing remarks.

謝謝。我目前沒有其他問題。現在我想請卡里·格雷斯做最後發言。

Thank you all for your interest in AMN and for tuning into our conference call. And I want to do a shout out both to our AMN team members who got us off to a strong start to 2025, as well as to say a special note of gratitude to every nurse out there as we celebrate you through the entirety of this month. Thank you.

感謝大家對 AMN 的關注以及收聽我們的電話會議。我要向我們的 AMN 團隊成員致以誠摯的謝意，是他們讓我們在 2025 年有了一個良好的開端，同時也要向每一位護士表示特別的感謝，我們將在整個月為你們慶祝。謝謝。

This does conclude the program. You may now disconnect. Have a good day.

該計劃確實就此結束。您現在可以斷開連線。祝你有美好的一天。