Travel Nursing Companies – Does size matter for the Travel Nurse?

In our previous post, we discussed how to differentiate travel nursing companies by their size. In this post, we’re going to discuss how the size of a travel nursing company can potentially affect the service travel nurses receive from them.

The Travel Nursing Company’s Available Travel Nursing Jobs

The size of the agency will most certainly have an impact on the volume and selection of available jobs that the agency has to offer. Simply put, large agencies have the largest selection of available jobs. This is because they have contracts with more health care providers than smaller agencies. That’s part of what makes them large.

You see, in order for an agency to grow, it has to do a very good job at retaining its current travel nurses. And retaining them requires that the agency has job options when a current job ends without an extension offer. The agency must be able to offer options for the traveler’s next job.

Meanwhile, maintaining a contract with a hospital often requires that agencies continue to provide the hospital with candidates for the hospital’s job openings. Agencies can lose a contract with a hospital if the agency has been unable to fill open jobs for the hospital in a long period of time. The hospital will view the agency as dead weight, and cut them off at some point, or the relationship will go stale. This can also be true for Sub-Vendor relationships when a Vendor Management Service is involved.

Large agencies do an excellent job at managing their contracts, landing new contracts, and retaining their employees. This translates into a larger selection of available jobs. And I’m not just talking about more jobs in a given region. Large agencies have more options nation wide.

They also have more options in terms of facility types. Large agencies are more apt to work with surgery centers, chemotherapy centers, home health providers, dialysis providers and other niche providers. Large agencies are also more likely to work with the most prestigious hospitals in the country, and university hospitals. These hospitals typically sign exclusive contracts with one of the larger agencies. For example, as of the writing of this blog post Stanford Medical Center and Lucille Packard Children’s Hospital go through American Mobile, while Cedars Sinai goes through Cross Country. Remember, there are sub-vendors (other agencies) who can staff these hospitals through exclusive contract holder.

You can expect medium agencies to have fewer contracts and small agencies to have even fewer still. This is not to say that all is lost for these agencies when it comes to providing you with the options you need. Some medium and small agencies do an excellent job of focusing on a specific niche, or region. For example, there are agencies that specialize in working with Operating Room Registered Nurses, or Ultrasound Technicians.

Other agencies may focus on a specific region, or market. For example, some agencies provide services only for California, or only for Florida, or only for some large metropolitan area like Chicago. Niche agencies may have available jobs for their specific area of focus which can be comparable to the offerings of even the largest agencies.

Travel Nursing Company Customer Service

The size of the company may have an impact on the type of service travel  nurses receive. On the message boards and blogs dedicated to travel nursing, it seems to be fairly well established that small and mid-sized agencies tend to offer a personalized and personable approach.

As the story goes, at small and mid-sized agencies, you’ll often have only one point of contact, your travel nurse recruiter. You’ll contact your recruiter for anything and everything, and your recruiter will know everything there is to know about all aspects of your contract and your personal circumstances. In addition, you’ll work with only one recruiter no matter where you take a job, or what specialty the job is for. All of this tends to ensure continuity of service.

When it comes to large agencies, the conventional wisdom contends that you’re just a number. As the story goes, large agencies deal in volume at the sacrifice of service. You’ll have to talk to the benefits department for any problems with your medical benefits, and to the housing department for any problems with your housing, and to the payroll department for any problems with your pay. You’ll find that these departments may be unaware of the conversations you’ve had with your recruiter regarding these issues, so you’ll have to explain again. As a result, coming to a conclusion can be a far more tedious task.

In addition, the recruiters at large agencies may be assigned to geographic territories or have particular specialties that they work with. As a result, if you move from the east coast to the west coast, or accept a job for a different specialty than before, you may have to work with a different recruiter. All of this combines to reduce service levels.

These narratives exist because there’s some truth to them and when evaluating travel nursing agencies you’ll definitely want to ask questions that are geared toward determining how they operate from a service standpoint. However, I have a different take on the issue of service. I believe that you’ll receive different levels of service depending on the particular agency, recruiter, and issue in question.

For example, I agree that you stand a better chance of receiving more personalized service from a smaller agency. You may indeed have one point of contact that is responsible for every aspect of the service you receive. However, that recruiter is also responsible for every aspect of service for every other travel nurse that he or she works with. At some point, providing that level of service can become overwhelming.

During these periods, you may not recognize that your recruiter is failing you in other ways. For example, the recruiter may be failing you on finding your next  job. This is one of the reasons that larger agencies tend to have higher retention rates. You may be just a number, but you’re a number that they really want to keep. The recruiters and Account Managers at large agencies tend to be laser focused on making sure that you’ll have your next job lined up in advance because that’s the primary focus of their job.

Travel Nursing Pay and Travel Nursing Company Size

I often times read or hear it stated that smaller agencies can provide better pay because they have lower overhead costs. I’ve discussed this with many of the travel nurses that I’ve worked with and I’ve read it in travel nursing chat rooms and on blogs. The logic seems sound. Larger companies have larger offices, more internal staff, larger advertising budgets, and so on. As a result, they have to keep a higher percentage of the bill rate to cover the costs, which results in less pay for the nurse. While this may be true to some degree, my experience has proven that there is much more going on than this simple logic accounts for.

I would argue that there is a curve of sorts. For the smallest of companies, this conventional logic may be true. These companies are so small, and their overhead is so low, that they do indeed have a competitive advantage. However, once a company begins to realize any sort of growth they can begin to lose this advantage.

You see, large companies realize economies of scale that small to mid-sized companies are unable to realize. For example, if a small company wants to offer medical benefits, they are going to be burdened with much higher costs than a large company. Like almost every industry in the world, the health insurance industry gives price breaks for buying in bulk. Additionally, large agencies may realize advantages in their worker compensation, disability, and unemployment insurance costs.

Large agencies may be able to negotiate discounts with organizations that provide some of the standard amenities that comprise a travel nursing pay package. For example, larger agencies can get a better deal on rental cars because they use them more.

Larger agencies can also get great deals on apartments and hotels. Large agencies may work out a deal with a large national property management company that manages apartment complexes throughout the nation. Large agencies will sometimes sign long-term leases on apartments in major markets where they know that they will regularly have travelers to occupy the space. Meanwhile, smaller and mid-sized agencies are stuck paying premium prices for short-term leases. These short-term leases can often times costs 10%-15% more than a standard lease.

Large agencies also realize economies of scale when it comes to recruitment costs. For starters, large agencies have much higher employee retention rates. This is because they have contracts with more hospitals than smaller agencies, which results in a larger selection of jobs at a higher number of locations throughout the country. So, when a travel nurse is finished with one contract, the larger agencies will have many more options available for the next job. This is a huge cost reduction because bringing on new travelers is much more expensive than retaining current travelers.

Large agencies also do an excellent job of attracting talent with advertising campaigns and, better yet, with referral campaigns. While advertising may seem like an overhead cost, the simple truth is that advertising exists because it works. It works to generate enough revenue that the costs are more than made up for. And large agencies are able to advertise nationally, because they are able to staff nationally, because they have more contracts. Additionally, because they have more travelers working for them, large agencies receive more referrals.

This all translates in to lower recruitment costs. The recruiters at a large agency are spending less time finding interested candidates because the company, and the company’s success, is driving candidates to them. As a result, they have more time to work with candidates. Meanwhile, recruiters at small and mid-sized agencies are spending much more time finding candidates, which results in higher recruitment costs.

Finally, large agencies may be generating revenue in other ways that they can then divert to their travel nursing operations should they so choose. For example, American Mobile has a continuing education site called RN.com. In fact, American Mobile operates over 20 websites. Other companies have highly successful blogs or job posting sites that also generate revenue. I can’t be certain about this, but I suspect that all of this revenue makes its way to the bottom line, and could possibly afford these large agencies the leeway to offer better pay rates.

Smaller agencies may have one advantage over their larger counterparts when it comes to pay. They often offer much more flexible pay packages. Larger agencies have a tendency to maintain boiler plate type travel nursing packages. They’ll often offer the same stipends no matter where you go.

For example, I’ve heard that Cross Country offers $250 per week for Meals and Incidental Expenditures (M&IE) whether you’re in San Francisco, or Bakersfield. In contrast, a smaller company might offer the maximum stipends for any given location. For example, a smaller company might give you $500 per week for San Francisco and $300 per week in Bakersfield. This is not to say that the smaller agency is giving you more money overall, but they are willing to divvy the money up in a way that may result in higher net pay for you.

Smaller agencies may also exhibit greater flexibility with housing options. Large agencies often have specific housing locations in any given area. Also, with larger agencies you may have no say at all in the housing choice. They will often put you where they have availability. In contrast, smaller agencies may be willing to provide you with several housing options, each with different prices. You can then select the option that best suits your needs. This can come in handy when traveling with pets. A smaller agency may be better able to accommodate pets because they’re willing to search for a housing option that accepts pets.

Now, I’m not guaranteeing that large agencies will pay you more. All I’m saying is that you can’t assume that they will pay you less. There are many advantages to being large. Many of these advantages involve significant cost savings. As a result, a large agency may be able to pay you the same as, or more, than a smaller competitor. In order to know for sure, you’ll need to conduct an apples-to-apples comparison between agencies.

With all of this in mind, it’s important to note that these are generalizations. As we all know, generalizations don’t always hold true. And as many travelers will tell you, whether or not you have a good experience with a travel nursing company will most likely boil down to your recruiter.