TTATN 005 : Travel Nursing Company Relationships and Differentiating By Size

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In this episode we talk about travel nursing companies. Specifically, we discuss the relationships that agencies have with hospitals, how the size of agencies can be used to generally differentiate them from one another, and the basics of your relationship with agencies.

The Relationships Travel Nursing Companies Have With Hospitals:

• The first thing to know is that agencies must have contracts to work with hospitals. The contracts include things like the bill rates, the overtime rules, the holidays, billing rules, employee conduct and a host of other rules and policies that determine the rules of doing business between the parties.
• One of the important things for travelers to note is that no one agency has contracts with every hospital. In fact, you’d be hard-pressed to find one agency that has contracts with every hospital in a given metropolitan area.

Direct Relations Between Hospital and Travel Nursing Company

The traditional relationship was the direct relationship.

• This type of relationship still exists but it’s just becoming increasingly less common.
• In this type of relationship, the agency has a contract directly with the hospital.
• Agency has direct line of communication with the hospital
• Sometimes hospitals work with very few agencies, sometimes hundreds
• sometimes hospitals are vendor neutral and sometimes they are not.
• Problems with direct relationships. a) potential for cronyism b) inefficient: there is no system in place. Things are done by email, phone, and fax. Job orders are a mess, tracking things is difficult.

Vendor Management Services and Travel Nursing

That’s where vendor management services come into play. They are becoming increasingly popular. They are a way for hospitals to work with multiple agencies more efficiently. There are two main types: Vendor Management Systems, and Managed Service Providers

Vendor management systems

• Software applications, manage job orders, and communication between agency and hospital, tracks candidates through the process.
• Supposed to be vendor neutral, but some of them are owned by large staffing agencies. Example Medefis
• They charge a percentage of the bill rate, but all agencies are charged the same fee.
• There is typically not a direct line of communication between the hospital and agency. Communication is conducted through the system. Often, the vendor management system has representatives for when physical communication is needed.

Managed Service Providers

• Managed Service Providers are healthcare staffing agencies that manage all the staffing needs of a hospital. When you hear that an agency has an “exclusive contract” this is almost always what’s being referred to.
• The large agency gets an exclusive contract and then uses “sub-vendors” to help staff the positions.
• Obviously, this is not vendor neutral.
• The MSP gets first crack at the job orders and they have an interest in staffing their people first.
• The MSP will only release orders when they are unable to staff them with their own candidates.
• MSPs charge Sub vendors a fee to work with them. Typically 2-3% of the bill rate, so the MSP makes money no matter what.
• They want travelers working with them because it’s not just about this one contract. It’s about retaining travelers for future contracts.
• At the same time, they have an incentive to get the orders filled because they need to keep the hospital happy and because there is often a fill rate requirement included in the contract.
• When times are tough, this has a huge impact.
• When times are tight, not so much.

Should Travel Nurses Work Only With Large Managed Service Providers?

This is where we get into the differences between Large Medium and Small companies.

Large Travel Nursing Companies:

• They have more job orders.
• They cover larger geographical areas
• However, the service aspect tends to get bashed
• People say they pay less, but that’s not always true
• They have more layers of service
• It can take longer to resolve issues
• They tend to be more ridged with contracts and pay packages
• They rarely offer any incentive for working extra time
• HH AMN Gets a rating of 12 on 31 reviews. On TNC they get a 46.8 on 106 reviews.
• That said, medical solutions is the third largest travel nursing company and they get pretty good rankings.

Medium Sized Companies:

• They have a good number of orders
• They tend to be a bit more geographically challenged
• These companies tend to be the ones that rank the highest for the service they provide. FlexCare, Valley Healthcare Systems, Trinity, Travel Nurse Across America, Atlas MedStaff

Small Companies

• These are like boutiques
• Typically focus on one area only, or they have sparse options across the country
• They generate about $1 to $3 million per year in revenue
• Each full time equivalent is 112,000 in revenue. So 10 to 30 travelers per year.

Your Relationship with Travel Nursing Companies:

• How many companies should you work with?
• The simple answer is that you should work with as many agencies as possible.
• Remember you want maximum exposure to the job market
• You also want to generate competition for your services. Would you apply to just one perm job?
• But working with multiple agencies can cause problems.
• First, overlap: Hi! My wife is a travel nurse. She read online that it isn’t good to have your name submitted by two different companies for the same position. In the episode (or maybe the last one), you discussed getting proposals from multiple companies in order to compare rates. Just looking for some clarification.
• Different hospitals handle this in different ways.
• Agencies want to be able to submit you immediately for open jobs.
• They want to stay ahead of the competition.
• This is good for you to.
• So you can do advanced reconnaissance and shop around for the best rate.
• You can let agencies know who can submit you.
• Second, it seems adversarial to have people competing for you.
• Remember, this is a business relationship, not a friendship
• Friendship is Soft Negotiating and is the weakest possible negotiating stance you can have.
• Third, it causes paperwork and communication issues.
• Ways that you can manage paperwork and communication.

Links:

American Mobile Ratings and Reviews on TNC

American Mobile Ratings and Reviews on Highway Hypodermics

Largest Staffing Companies from Staffing Industry Analysts

Getting To Yes a book about Negotiating

How To Negotiate The Best Travel Nursing Pay Packages free eBook from BluePipes

Travel Nursing Companies That Will Accept BluePipes Documents