管理層發言
Good afternoon, ladies and gentlemen, and welcome to the AMN Healthcare Second Quarter 2026 Earnings Conference Call. This call is being recorded on Thursday, August 6, 2026. I would now like to turn the conference over to Randy Reece, Vice President of Investor Relations. Thank you. Please go ahead.
Good afternoon, everyone. Welcome to AMN Healthcare's Second Quarter 2026 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. 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. 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. 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.
Thank you, Randy, and good afternoon, everyone. We appreciate you joining us today. I am pleased to report that our second quarter results came in better than we forecast with five of our solutions growing revenue year-over-year. Second quarter consolidated revenue was $673 million, 6% above the high end of our guidance range and 2% higher year-over-year. Adjusted EBITDA was $73 million or 10.9% of revenue, up 26% year-over-year. Adjusted EPS came in at $0.77 compared with $0.30 in the year-ago quarter. And we ended the quarter with $362 million in cash on our balance sheet, providing us with the ability to invest in our long-term strategy, including acquisition opportunities. We used our strong financial position to make two small yet strategic acquisitions that extend and advance our capabilities. Our performance year-to-date demonstrated our effectiveness in balancing day-to-day execution while simultaneously handling large labor disruption events. While there were some unique items in our results, I am very encouraged to report that our core earnings exceeded guidance with building momentum that lifts our third quarter outlook. With contingent labor rates at a historically low premium to permanent staff, more clients are using flexible labor to meet their increasing patient demand. There is also continued interest in broader workforce optimization and tech-enabled talent solutions to build sustainable workforces. As the leader and innovator in total talent solutions, AMN is well positioned to support these market and client needs. Our second quarter performance was highlighted by revenue strength in our travel nurse, international nurse, allied, schools and search businesses. Our Nurse and Allied Solutions segment drove the favorable surprise in the second quarter in several ways. Segment revenue of $422 million grew 11% year-over-year and was 12% ahead of the consensus estimate. Nurse and Allied revenue benefited from higher volume on increased demand as well as higher-than-expected labor disruption revenue. Segment gross margin was 28.4%, with underlying margins in line with our expectations, along with several beneficial factors specific to the quarter. Travel nurse volume showed 6% year-over-year growth and Allied volume grew 7%, both the highest growth rates these businesses have achieved in four years. Improving demand and strong fulfillment drove our performance. Year-over-year, travel nurse orders turned positive in May and accelerated in June. As of early August, the improvement continued with orders up about 40% year-over-year and 20% higher than August 2024. As expected, international nurse had 23% year-over-year revenue growth in the second quarter. While we continue to benefit from the forward movement in visa application cutoff dates, embassy appointments for visa applicants have not kept pace. Relief from the embassy backlog will influence how much this business grows in 2027. Allied orders showed modest year-over-year growth in the first quarter and accelerated through the second quarter with mid-teens growth rates in June and July. Allied demand strength is broad-based in terms of settings and specialties. Notably, our schools business is on track for another year of double-digit revenue growth for the upcoming school year. Our team is executing very well against this higher demand with high fill rates, which fueled the second quarter outperformance and continued volume momentum. Third quarter guidance includes better than 10% year-over-year volume growth for both travel nurse and allied. As demand increases, we are benefiting from our multiyear focus on process automation, 24/7 business operations and AI enablement of recruiting, resulting in higher fill rates across our MSP, VMS and third-party platforms. For the third quarter, we expect Nurse and Allied segment revenue to grow 9% to 11% year-over-year. Physician and Leadership Solutions segment revenue in the second quarter was $165 million, lower by 6% year-over-year and in line with guidance. Segment gross margin was 26.5%, down year-over-year, though modestly up from the first quarter. We saw a positive inflection in the second quarter from our search business, which produced 27% year-over-year revenue growth. New demand showed strong growth across physician and executive search. While the higher demand is being driven by executive turnover and facility expansion, growth is coming also from stronger positioning of AMN solutions in the market, with particular strength in academic medical centers. We are leveraging our market leadership in health care search to broaden our capabilities into adjacent services. In June, we acquired the ESSENTIAL Brand Leadership Assessment solution to support clients in leadership selection, evaluation and coaching as well as succession planning. Locum tenens revenue in the second quarter was $131 million, lower by 8% year-over-year and in line with guidance. We continue to see more locum demand growth in vendor-neutral third-party channels, which are the most competitive to fill. Our locums business is going through the same process and technology transformation that enabled our nurse and allied business segment to compete successfully across all demand channels. Interim leadership revenue was $22 million, down 3% from the prior year. New searches have been building over the past quarter, which is a reflection of our leading market position, increased investments in our sales team and a growing wave of turnover and project-based needs in health care leadership positions. We are optimistic about the direction of demand and our ability to pursue year-over-year growth in 2027. For the third quarter, we project Physician and Leadership Solutions revenue to be down 5% to 7% year-over-year. Technology and Workforce Solutions segment revenue was $87 million in the second quarter, down 15% year-over-year and in line with guidance. Segment gross margin was 48.6%, lower sequentially and year-over-year. Language services revenue of $70 million was down 8%, with VMS revenue of $15 million, down 20% from a year ago. Language services volume was flat year-over-year, while pricing was down 8%. Pricing will remain a headwind as we work through new client wins and renewals. The rollout of our lower-cost core service tier continues to be well received, helping us compete more broadly in the market and win new clients. We are expanding our workforce globalization for service delivery over the next several quarters to stabilize and improve gross margin. In June, we acquired Jaide Health to extend our medically qualified language interpretation services with AI-enabled support for the patient before and after the clinical interaction. The Jaide platform improves the ability of limited-English-proficiency patients to communicate through the intake and discharge processes, further strengthening our value proposition of enabling high-quality and cost-effective patient care. We also continue to strengthen our WorkWise labor force management optimization and engagement platform. We are seeing increasing interest in data and analytics to help drive workforce optimization. Last quarter, we introduced enhancements to our dashboards, including supplier performance and insights with third-party bill and pay rate intelligence that can be segmented by skill set and geographic markets. We built our strongest solution yet to empower data-driven workforce decision-making. And we continue to enhance the features of our market-leading Passport app, including adding AI-enabled search for clinicians. Passport adoption grew throughout the quarter and recently surpassed 400,000 users, up 33% year-over-year, providing AMN with one of the largest clinician networks in health care staffing. Importantly, monthly active users increased by more than 50% over the prior year. For the third quarter, we estimate Technology and Workforce Solutions revenue to be down 11% to 13% year-over-year. This quarter's financial performance has continued to improve our balance sheet strength. Our capital allocation approach remains focused on creating long-term shareholder value, reflected in this quarter with the two targeted acquisitions that enhance our solutions portfolio while also returning capital through modest share repurchases. As the health care workforce services market continues to normalize, we are seeing increasing indications of industry consolidation, and we believe our financial strength and market leadership position us well to be both an active participant and a beneficiary of these trends. We also welcomed two important additions to our leadership team with the appointment of a new Chief People Officer and Chief Commercial Officer. These proven leaders will help strengthen our talent strategy, enhance our technology-enabled and people-centered solutions and drive a more integrated go-to-market approach aligned with our long-term growth objectives. Their appointments also underscore AMN Healthcare's position as a premier destination for top talent, reflecting the strength of our platform, culture and growth opportunities, as we continue to attract experienced leaders who can help advance our strategic priorities. Now I'll turn the call to Brian for a deeper look at our second quarter results and third quarter outlook.
Thank you, Cary. I'd like to call out some details to expand on our second quarter financial results published this afternoon. Consolidated second quarter revenue of $673 million grew 2% year-over-year and was 6% above the upper end of our guidance range. The revenue upside came from labor disruption and strong performance in travel nurse, allied and search. Our Q2 guidance had assumed $10 million in labor disruption revenue, while the actual reported revenue came in at $25 million. Reported gross margin was 30.6%, 210 basis points above the top end of guidance. Second quarter net income was $21 million compared with a net loss of $116 million in the prior year period and net income of $62 million in the prior quarter. Adjusted EBITDA was $73 million or 10.9% of revenue. Adjusted EPS was $0.77. Our consolidated results benefited from several items that are not expected to recur in the third quarter, including a true-up of billing accruals from the large Q1 labor disruption event, a reserve reversal from a prior year event and other favorable reserve adjustments. These Q2 items added about $27 million to revenue, 290 basis points to our consolidated gross margin and 370 basis points to our adjusted EBITDA margin. Excluding these items, our Q2 revenue would still be almost 2% above the high end of our guidance range, and our EBITDA margin would be at the top end of our 6.7% to 7.2% guidance. Consolidated SG&A expenses in the quarter were $147 million. Adjusted SG&A, excluding certain items, was $135 million, down 4% compared to the prior year. SG&A included a $5 million unfavorable professional liability actuarial adjustment, partly offset by a $3 million favorable adjustment to the allowance for credit losses. The Nurse and Allied segment reported revenue of $422 million with a 28.4% gross margin and 13.8% segment operating margin. The previously noted labor disruption billing and reserve adjustments contributed 490 basis points to the gross margin and 600 basis points to segment operating margin during the quarter. Turning to our traditional staffing operations, performance was led by our travel nurse and allied business lines. Travel nurse volume grew 6% year-over-year and was 3% better than the high end of guidance. Allied volume was up 7% year-over-year and exceeded our guidance by 1%. International nurse revenue also grew 23% year-over-year. Nurse and allied average bill rate was nearly flat year-over-year, a bit better than we had expected, and average work were up 1% year-over-year. Higher demand and strong capture of that demand drove revenue above expectations. Bookings momentum is a key driver of our third quarter revenue outlook, which calls for double-digit year-over-year growth at the midpoint for the Nurse and Allied segment. The highlight of our Physician and Leadership Solutions segment this quarter was search. Physician search grew new searches by 37% sequentially and 40% year-over-year. Executive search saw new searches increase 30% year-over-year and leadership search volume rose by 60%. Our locum tenens revenue was flat sequentially due in part to a negative sales adjustment that reduced revenue and gross profit by $2 million. Volume increased by just under 1%, which is below our typical seasonal uplift, which we called out on last quarter's call. As Cary noted, we are actively engaged in several initiatives to get this business back to growth. In our Technology and Workforce Solutions segment, while revenue was down 15% year-over-year, it was down 11% excluding the divestiture of SmartSquare. Language services continues to navigate through the transition to our shared service strategy, which is enabling us to retain more clients. Minutes were up 3% sequentially and flat year-over-year despite the pressures on the limited-English-proficiency population and nominal contribution from new clients. Price per minute was down 3% sequentially and 8% year-over-year. Revenue in our VMS business was $15 million in the second quarter, and we expect this revenue to stabilize at this level over the second half of the year with prospects for sequential growth in 2027. Days sales outstanding for the quarter was 52 days. Excluding working capital effects from the large labor disruption events in the first quarter, DSO was 54 days, flat sequentially and 2 days lower year-over-year. While our earnings release provides additional balance sheet and cash flow details, I want to highlight that we ended the quarter with $362 million in cash and equivalents. This was above our expectation of $175 million, primarily due to favorable working capital impacts, including a remaining outstanding balance of strike-related client deposits of $117 million at quarter end. Even with Q3 cash flow, including a $20 million interest payment and higher cash tax payments and assuming the remainder of the deposits are repaid this quarter, we would anticipate at least $225 million of cash at quarter end. We ended the second quarter with total debt of $750 million, and our leverage ratio as calculated per our credit agreement was 1.5x. During the second quarter, we repurchased 85,000 shares at an average price of $26.33. Going forward, and assuming no other material capital allocation needs, we anticipate modest share repurchases primarily to offset dilution from equity awards. Moving to the third quarter outlook. We expect consolidated revenue in the range of $640 million to $655 million. Gross margin is expected to be 27% to 27.5%. Reported SG&A is projected to be 22% to 22.5% of revenue. Operating margin is expected to be 0.2% to 0.8% and adjusted EBITDA margin is expected to be 6.5% to 7%. Additional guidance details are provided in the earnings release. Now operator, let's open up the call for questions.
分析師問答
And your first question comes from the line of Jeff Silber from BMO Capital Markets.
Cary, in your prepared remarks, you mentioned how your clients are seeing contingent premium at historic lows. Can you quantify roughly where it is now, and I know there's no such thing as normal, but what should we expect that to normalize at over time?
Yes. Thank you, Jeff. If you look at the cadence over the past cycle, pre-COVID you would have seen the premium of contingent to permanent labor be in the mid- to high-teens. During COVID, it rose to about a 100% premium because of the significant spike in demand. We're now back down into the mid- to high single digits. Some markets would put that even lower. The effect is that coming out of COVID, getting back to permanent and reducing contingent spend was part of workforce cost containment. Given where we are today, particularly with the relatively limited premium and the flexibility it provides, contingent labor is an important part of how clients solve for their workforce strategy.
All right. That's helpful. I guess I was thinking about the penetration rate, the percentage of contract labor. Any comments on how that's tracking in your clients versus what was maybe pre-COVID?
We have clients in different places, and even within clients you can have urban locations with much higher utilization. As a general comment, we've seen overall utilization with clients that is at or slightly below where they were pre-COVID.
And your next question comes from the line of A.J. Rice from UBS.
First, just to ask about your margin assumption. Obviously, this quarter there's a lot of puts and takes, but it sounds like you were 10.9% in aggregate. You're going for a 6.5% to 7% EBITDA margin in the third quarter. It doesn't sound like you're assuming the margin for the core business was about the same in the third quarter that you saw in the second, or is there any place where you're assuming much of a change sequentially quarter-to-quarter?
Thanks, A.J. I would say there's not any significant changes when you work through the items that impacted the higher margin in the second quarter. When you look from Q2 to Q3, there aren't any significant changes in the gross margins across the three segments, and our SG&A is running pretty consistently as well. When you bring that over, that's where you end up in the range for both the gross margin guidance as well as adjusted EBITDA. The Technology and Workforce Solutions segment is more of a mix effect, with that business down a bit and it has a higher margin profile. That's why the guide on the gross margin at the midpoint would be a bit below where our second quarter was. On a normalized basis, it's more mix between segments than material changes within a segment.
And maybe in there somewhere I missed it, but is the guidance on the strike revenue to go back to about $10 million for the third quarter?
Yes. We've embedded in the guidance around $7 million to $8 million of strike-related revenue in the third quarter.
Okay. And then maybe a bigger picture question on the step-up in demand that you're seeing in Nurse and Allied. Is that focused in any particular area — large systems, academic medical centers, community hospitals, MSP, non-MSP? Is it across the board, or can you characterize where you're seeing pickup in strength?
We're seeing it broad-based across regions, sizes of providers, and across service models. We saw increases in our MSP book and increases in vendor-neutral and third-party programs. The demand acceleration we've seen in Allied has been present for most of 2025 and 2026, and the acceleration in nurse demand that began in May was broad-based.
You referenced some market disruption. Do you think what you're seeing is mostly underlying market strength, or are you picking up share given disruption at some competitors?
I think we're benefiting from two things. One is underlying demand acceleration across the market. The second is that we are executing very well against that demand. We've spent years building a more automated, tech-enabled, scaled chassis. We're faster, we're playing across the entirety of the market, and we're executing well on filling that demand.
Yes. In fact, we grew the market overall in the second quarter, which is indicative of our increased fill rates on vendor-neutral programs that typically imply we're taking some share. The team has delivered high fill rates on our direct and MSP programs. Overall demand and patient utilization remain up; the rate of growth has slowed, but there have been several years of increasing patient volumes. Permanent hiring has slowed, and total cost of permanent labor has increased significantly over the last three to four years. As hiring has slowed and attrition continues, it's not unsurprising that demand for contingent labor picks up.
And your next question comes from the line of Tobey Sommer from Truist Securities.
I'd love to get your perspective, both historically and prospectively: when demand increases or orders increase to this degree, historically rates follow if the demand persists for long enough, not a month or two but maybe six months. Are you seeing any difference in bill rates in your order book versus your TOA, and do you expect to?
Let me give a perspective on what we see today, and Brian can add historical context. We have seen broad-based demand, but we haven't yet seen bill rate increases across the board. Bill rates have been stable. We're seeing some places where bill rates increase with clients who need to get orders filled, but it's not yet sustained. If you start seeing higher periods of demand, particularly if winter orders are sustained, there is a lag effect and you would start to see bill rates improve.
Tobey, you've got it right from historical cycles — there is a lag. Exact timing is hard to predict. It remains a very competitive environment and there are more suppliers now than historically, which creates more competition to fill orders and can keep rates from rising immediately. If demand sustains and grows, though, it should create pressure for rate increases, which we welcome because it will also create opportunity to bring more supply into the industry. Our priority is filling positions for clients.
Could you sustain a decent level of growth just based on increasing TOA at these bill rates, or do you need higher bill rates to generate the supply to sustain meaningful volume growth?
It depends on where the demand is coming from. We have large pockets of clients, particularly in attractive locations, where we could continue to supply at these bill rates. As you move into next year, you'd want to start seeing some bill rate increases because there will be natural labor market increases that are the foundation of these rates.
One last question: could you give an update on the status of the Kaiser renewal RFP? I understand you probably can't say who will win, but maybe your view on the prospects and the format — if it's still a unified single vendor?
Our Kaiser contract runs through the end of 2026, and the client is in the expected RFP process. We expect it to be competitive. We have a very strong, long-standing relationship with Kaiser and strong program performance, so we feel well positioned.
And your next question comes from the line of Kevin Fischbeck from Bank of America.
Great. A follow-up on that one: historically, after RFP reprocurement, do they normally seek better terms, or are the terms similar to a new contract?
Generally, procurement will strive for better terms, as we see across the board. Given the breadth and depth of the Kaiser relationship, we've evolved how we support and service them during this contract. We're more market-like than four or five years ago, and we're not seeing anything different in how people negotiate terms in RFP processes.
Is there a way to size the two deals you did in Technology and Workforce Solutions revenue and EBITDA contribution annually?
The two acquisitions were Jaide in the language services segment and ESSENTIAL Leadership, which supports search and advisory. Between the two deals we spent $3 million. Think of them as capability extensions where we're already seeing strong support: we have three verbals with Jaide, and ESSENTIAL is a solution we used previously that we now own and are seeing interest in.
You mentioned consolidation and said you expect to be both a beneficiary and an active participant. Is that a change? Are you looking at deals more aggressively now?
I wouldn't call it a major change in thinking. What has changed is our balance sheet strength and reduced leverage, which widen our capital allocation aperture. Over the last couple years we focused on delevering. With leverage at 1.5x at quarter end and cash on the balance sheet, plus more market stability, we're better positioned to be more active. We're always monitoring opportunities, and we have a strong filter for anything we would consider. If the right accretive opportunity comes along, we can participate more actively than 12 to 24 months ago. We've expected more consolidation; last year was quiet, but now more assets are coming to market, and we're better positioned to act.
I'd add that when we see competitors going through evolutions or changes, it creates opportunities for us. We're much more proactive around pursuing market opportunities when those present themselves.
And your next question comes from the line of Mark Marcon from Baird.
Wondering about the overall environment as it relates to travel nursing — you mentioned demand has picked up, Cary. Is there a way to quantify it in terms of number of hospitals served or systems served? Are you expanding the aperture of hospitals you serve, or getting deeper in existing ones?
It's a bit of both. We're seeing utilization increases with current clients, and some clients are expanding, so we benefit from that expansion. We're also much more competitive in filling third-party channels, which creates a flywheel: when you start filling more, more work comes to you. We're serving more health systems through those channels and supporting a broader set of programs, whether directly or through third parties.
You mentioned perm hiring at hospitals has slowed. What do you think are the top three reasons for that?
Three reasons: one, hospitals got back to a very good base of permanent hires following COVID; two, retention rates normalized post-COVID, so they are not losing as many clinicians; and three, cost normalization and the attractiveness of contingent labor as a flexibility and cost containment strategy. Clients continue to look for cost-effective solutions and more flexibility.
Are you or the field noticing any demographic changes in clinicians placed into travel nurse roles?
We haven't seen demographic changes in the nurses we're placing. One notable trend is retirements ticking back up — from around 1.5% to a bit over 2%. That aligns with the aging demographic. Clients are also focused on scaling clinical experience for younger staff because it's not just replacing numbers in retirements but also replacing experience.
Regarding PLD, what would it take for trends to turn around and become more positive?
Locum tenens is consistent with what we discussed last quarter. Year-over-year demand increased earlier this year with some nice client wins, but we're not as fast on filling because much of the demand is in third-party channels. We're applying the same transformation we did in Nurse and Allied to locum, and we expect to see benefits in 2027 and return to year-over-year growth then. For Search, we had a positive second quarter in Search and expect year-over-year double-digit growth for the remainder of this year and into 2027, with some seasonality at year-end. We expect interim leadership to return to growth in 2027.
And your next question comes from the line of Trevor Romeo from William Blair.
A couple from me. On international nursing, you talked about 23% growth in the quarter and noted embassy appointments may not keep pace with visa dates. Can you talk through those dynamics and whether expectations for growth are still the same? I think last quarter it was high teens for 2026 and maybe low double digits for 2027.
Yes. High teens for this year remains our expectation. A lot of placements that impact 2026 have already been made. Looking to 2027, we've seen good progress on visa cutoff dates moving forward, more than we anticipated, but recently we've seen a slowdown in visa interviews, which may affect volume expectations for 2027. We still expect growth in 2027 over 2026, but probably a bit lower than we had earlier expected. There's still ample demand and a large supply of nurses wanting to come. Improvements in appointments or government processing as the next fiscal year starts could open things up further. We'll have better visibility next quarter. Sitting here today, we expect growth but perhaps in the single-digit range for 2027 unless processing improves.
On language services, can you give more update on competitive dynamics? It sounds like you're expecting lower pricing on renewals. How many quarters from being normalized, and confidence that language services can be a volume and revenue growth market beyond normalization?
Competitive dynamics are consistent with recent quarters: a very competitive environment and some limited demand due to immigration policies. In the last quarter we had flat minutes and about 8% pricing compression. We expect that trend to continue for the rest of this year. Looking to 2027, we expect the pricing compression to be more muted. We've worked through many client renewals and have new clients coming on; our tiered service strategy will help offset compression. Also, our workforce globalization for service delivery — part implemented late last year and the remainder by year end — will help gross margin in 2027.
And our next question comes from the line of Jack Slevin from Jefferies.
To expand on language: do you feel the shift you've made and the addition of Jaide position you well over the next couple of years to move past these issues and reach a more stable revenue and margin point? From a product positioning standpoint, how are you thinking about it?
Two important positioning moves: first, our shared service model enables us to serve the entire market — clients optimizing purely on cost per minute and clients optimizing for total clinical cost and quality. We have proven solutions in both. Jaide complements this by enabling a more consistent patient experience before and after clinical interactions. It strengthens our clinical interaction capabilities and helps clients save money by improving intake and discharge processes, with early results showing meaningful time reductions in discharge that contribute to cost savings.
Another question on demand: in 2024 we saw a spike in demand with low rates. Can you double-click on what gives you confidence this is not an air pocket but could sustainably drive volume into the back half of the year?
The acceleration inflection began in May and has continued through the second quarter and into early August. We need to see a couple more quarters of this pattern, but we're approaching winter order season where historically you typically see order increases. Indications from clients suggest a pattern relatively similar to last year, which would be a positive tailwind. We want to see three to four-plus consecutive quarters of sustained demand.
Also notable is order quality — it's not just the number of orders but whether rates are attractive enough to fill them. What we're seeing is more urgent orders with rates that allow us to place clinicians. Even though the overall average rate hasn't increased materially, the number of orders we can fill at those rates has increased, which is why our fill rates and volume are improving.
That ends our question-and-answer session. I will now hand the call back to Cary Grace for final comments.
Thank you for your interest in AMN Healthcare, and a huge thank you to the AMN team members and clinicians who ensure strong quality care every day in our health care system. We look forward to giving you updates next quarter.
This concludes today's call. Thank you for participating. You may all disconnect.