Is outsourcing really helps business?

Medical Staff Outsourcing as a Business

• What are the trends, business models, profit projections for clinical staff outsourcing in government and private healthcare organizations?

• Answer:

  Hello pam_steptoe-ga! Thank you for your patience! The medical staffing industry is quite broad and encompasses many spectrums. It took me a bit longer than I expected to gain a foothold and find some parameters to work within. I hope I have managed to condense the following material in a manner that is comprehensive and understandable without being too scattered! If I can clarify any issues for you, let me know and I will try my best to help. ========================================== OVERVIEW OF THE MEDICAL STAFFING INDUSTRY ========================================== "The growing trend toward cost containment in the healthcare industry has placed a greater burden on hospitals and other medical organizations to effectively manage fluctuations in staffing needs. The result has been an emerging demand for temporary nurses and medical staff to allow flexibility, while ensuring staff-to-patient ratios are acceptably maintained." "Temporary medical staffing company opens office in WH." Polk Online http://www.polkonline.com/stories/042199/win_medical.shtml == According to an article by On-Site Medical Staffing, the healthcare industry uses temporary workers for several reasons other than personnel shortages: 1. "Staffing levels can fluctuate greatly depending on the work load. Temporaries can help fill in the gaps." 2. "Many healthcare facilities use temporary staffing companies to do all their hiring. The temporary company does all of the recruiting and places the employee on its payroll. After a period of time, usually 520 hours, the healthcare facility can choose to transfer the temporary company’s employees to its payroll." 3. "Many healthcare facilities like the simplicity of paying one hourly fee to a staffing service rather than paying separately for payroll, workers compensation, unemployment, state and federal taxes and other administrative tasks." From "TEMPORARY WORKERS AND HEALTHCARE." On-Site Medical Staffing http://www.onsitemedicalstaffing.com/articles.html == Medical Staffing even includes Veterinary Technicians! Though the shortage of Nurses is well known, temporary medical staffing includes many other personnel positions. The list from Dental Medical Staffing Inc. includes: Dentists, Hygienists, Assistants, Office Managers, Receptionists and Bookkeepers, Medical Technicians, Assistants, Biller, X-Ray Technicians, Veterinary Technicians, Transcriptionists, Office Managers, Receptionists and Bookkeepers. http://www.dentalstaffinginc.com/about.html == TheraTech Staffing even provides Speech-Language Pathologists when they are needed! TheraTech Staffing has assignments for: Radiologic Technologists Occupational Therapists Physical Therapists Speech-Language Pathologists http://www.theratechstaffing.com/gettingstarted.asp === J&C Nationwide, which is the "second largest, and fastest growing, medical staffing company in the industry", reports that its locum tenens (temporary) staffing division is its strongest revenue producer. From "J&C Nationwide," by Calvin Bruce. Physician Recruiter.com. http://www.physicianrecruiter.com/Dept/trenches/trenches72199.htm ============================================================== GROWTH AND PROFIT PROJECTIONS IN THE MEDICAL STAFFING INDUSTRY =============================================================== Estimated to be worth 12.9 Billion in 2003 =========================================== "Despite general declines in the staffing industry as a whole, medical staffing continues to prosper as the shortage of permanent medical personnel worsens. Staffing Industry Analysts estimate that the medical staffing industry will be worth $12.9 billion in 2003, up from $10.6 billion in 2002. *Two companies - AMN Healthcare Services Inc. and Cross Country Inc. -dominate the industry.* Last year, both companies had double and triple-digit percentage revenue increases. Nurse staffing currently make up about 73% of the temporary health care niche; other temporary medical professions such as pharmacy are on the rise. (Source: Staffing Industry Report, V.XIII, No. 23/24, 20 December 2002 From "Staffing Industry Bulletin." UIC Center for Urban Economic Development. (Dec. 2002) http://216.239.53.104/search?q=cache:I1dR5o2IYK0J:www.uic.edu/cuppa/uicued/tempwork/BULLETINS/Staffing/Bulletin%2520PDFs/dec.pdf+medical+staffing+industry&hl=en&ie=UTF-8 * AMN Healthcare http://amnhealthcare.com/aboutamn.asp * Cross Country Inc. http://www.crosscountry.com/ccinc/index.html === ANALYSIS of the Healthcare Staffing Industry -------------------------------------------- The following is from "THE STATE OF THE HEALTHCARE STAFFING INDUSTRY - 4TH QTR 2002." expressFactor.com http://www.expressfactor.com/CompanyInfo/hcs4q02.asp "The healthcare staffing industry has experienced solid and steady growth during the last decade. The industry should continue to grow at a strong pace during the short and long term due to its attractive value proposition and increased demand resulting from both political developments and demographic changes." The healthcare staffing industry provides three key benefits to its stakeholders: * "Cost savings to healthcare facilities through the use of temporary and project-based personnel, both of which help minimize labor costs in response to swings in occupancy rates." * "Greater access to highly skilled professionals on a short-term basis, which may help fulfill temporary and specialized needs." * "Opportunities for medical professionals and highly skilled technicians to work on a contract or consulting basis, with lucrative monetary incentives and opportunities to travel." MARKET OVERVIEW ---------------- Market Attributes: "The temporary healthcare staffing industry is highly competitive and has low barriers to entry. The industry is also highly fragmented, with the 10 largest companies accounting for less than one-third of the total U.S. market." Market Size and Growth: "Healthcare stafffing is a $9.1 billion industry. The industry is experiencing rapid growth. Over a five year period, the industry's rate of growth increased from 10% in 1996 to over 25% in 2001. The following chart indicates market size in billions of dollars and annual percentage growth since 1991." Year '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 Mkt Size 3.3 3.2 3.3 3.5 3.8 4.2 4.9 5.4 6.2 7.2 9.1 Growth % NA -3% 3% 6% 9% 11% 17% 10% 15% 16% 26% "The industry has benefited from a lack of employees to meet the demand of healthcare facilities. For example, over 80% of hospitals are unable to meet their current nursing needs and more than 125,000 budgeted nursing positions were left unfilled across the U.S. in 2001." "The population of registered nurses under the age of 30 dropped from 25.1% of the total nurse population to only 9.1% in 2000. Most likely, this will lead to an environment in which the nursing shortage becomes more severe over the next ten years." "The shortage of medical personnel extends beyond nurses and includes physicians, radiologists, and allied healthcare professionals. Based on the current supply gap, it is not surprising that the current pricing environment remains robust, with recent price increases in th 13-15% range." Market Segments -------------- Nurse Staffing: "Nurse staffing is the largest sector within the temporary healthcare staffing industry. It accounted for approximately 74% of industry revenue in 2000." "There are two categories of temporary nurse staffing - per diem and traveling nurses. Per diem nurse staffing is the largest sector of the temporary healthcare staffing industry representing $4.1 billion in revenue, or 57% of industry revenue in 2000. The traveling nurse market represents approximately 17%, or $1.2 billion, of total industry revenues in 2000. Traveling nurses are sourced on a fixed-term contract basis ranging from 8 to 26 weeks, but are typically 13 weeks long and are usually booked four to five weeks ahead of time." Other Medical Staffing: "The remaining 26% of healthcare staffing industry revenue - $1.9 billion - was generated from allied healthcare staffing (radiology and diagnostic imaging specialists, clinical laboratory technicians and pharmacists), physicians, and med-financial professionals (medical accounting, billing, and collections)." LEGISLATIVE DEVELOPMENTS "Recently, legislation has been enacted on both the federal and state levels that will have a significant impact on the healthcare industry, especially the nursing segment. Most significantly, the Nurse Reinvestment Act was passed to attract more people into the nursing profession through increased educational funding. However, this legislation will not have an immediate impact as it may take between two and four years before newly enrolled students enter the workforce." "At the state level, California recently passed legislation that will require minimum nurse-patient ratios. This legislation has paved the way for similar legislation in other states and may strengthen demand for outsourced nurse staffing services. Already, similar legislation has been introduced in several states including Massachusetts, Florida, Ohio, Rhode Island, and Illinois." INDUSTRY OUTLOOK ------------------ Market Size and Growth "An aging population and technological advances in healthcare treatment will create substantial demand throughout the current decade for healthcare services and medical personnel. This is particularly true with regard to the registered nursing profession which represents the single largest occupation in the healthcare industry." "The percentage of the U.S. population over the age of 55 is expected to climb from 12.5% in 2000 to almost 15.8% in 2010 and continue to rise further through 2020, according to the Social Security Administration. The implications of an aging population are apparent to agencies such as Medicare and Medicaid, as indicated by a steady growth in projected Medicaid expenditures from about $200 billion to almost $445 billion in 2010." Supply "Historically low enrollment rates in nursing schools suggest that new entrants will not keep up with the large percentage of the current nursing workforce expected to enter retirement during the next ten years. As a result, nursing is one of the top ten occupations projected by the Bureau of Labor Statistics to create the largest number of new jobs." "The U.S. Labor Department predicts a shortage of 450,000 nurses by 2080.[12] This shortage is expected to create an environment where employers will be willing to pay top dollar to find quality labor to replace skilled nurses leaving the workforce." Market Growth "We expect the market will sustain growth rates in excess of 20% over the next three to five years, driven by an aging population that requires more health care, a wealthier population that can afford better health care, and advances in medical technology that permit aggressive treatment of an increased number of health problems. The healthcare staffing market should exceed $10 billion in 2002." Year '02E '03E Market Size 10.6 12.9 Growth % 16.5% 21.7% Pricing "Long-term secular trends support sustainable annual bill rate growth in excess of the historical average of 5-7%." CONCLUSION Allied healthcare, med-financial, and contract nurse staffing represent substantial growth opportunities for traditional staffing agencies. ==================================== HOW SERIOUS IS THE NURSING SHORTAGE? ==================================== The shortage of nurses has forced Washington hospitals to commit even more money to temporary staffing: "....hospitals spent $40 million on contract and agency nurses in 1999, almost quadrupling spending in 1995, said Troy Hutson, WSHA's director of clinical and legal policy. And he believes spending has risen even more steeply since. "The average large hospital in Washington probably spends $100,000 a month on temporary staffing," he said. "Area hospitals are recruiting nurses from as far away as India and New Zealand. But at local and national staffing agencies, business is booming." "A nurse may go through 15 years on the job to get to where they can take a month off. Those who have the qualifications and skills are finding out there are many ways to look at money," said Abel Borromeo III, business development manager for Pro Med staffing agency is Shoreline. "Rising demand for agency nurses in the Puget Sound convinced Kelly Services to open a health-care division in Seattle last month. It joins 10 other Kelly health-care offices nationwide. "Opportunity for nurses is huge, said Jayme MacKenzie, state recruiter for Kelly." On average, Pace Staffing Network pays its RNs about $36 an hour. "Nurses with the right experience and background can pretty much name their price," said Patty Steen, area manager for Pace's health-care division in Seattle. "It's a nurses' market right now." ... "Nurses who opt to work through local or national staffing agencies can choose their shifts, earn higher hourly rates and sign "traveling contracts" that pay rent for months at a time - even, in many cases, if a nurse lives within a short commute of the workplace. "It's way more flexible," nurse Kathy Kennard said of temping. Kennard left her full-time job at St. Joseph's Hospital in Tacoma last year for agency opportunities with StarMed Staffing Group in Seattle. She now works about 32 hours a week and has weekends off. This past winter, StarMed placed her on a local traveling contract that covered her rent for 13 weeks." From "Nurses find silver lining in staffing shortage," by Ari B. Kramer. Puget Sound Business Journal. (May 2002) http://www.bizjournals.com/seattle/stories/2002/05/13/focus9.html?page=1 FEELING THE IMPACT DURING WARTIME ================================== The State of Texas already feels the nursing shortage but the War in Iraq is threatening to cut into the temporary staffing industry as well. "The state already needs an estimated 40,000 more nurses alone," said Paulette Standefer, vice president of Dallas-Fort Worth Hospital Council. "The health care staffing issues have gotten so much more severe than during the time of Desert Storm. The vacancy rate for critical care nurses is 16% here (in the Metroplex)." .... "The $10 billion temporary staffing industry has served as a safety net for hospitals and medical practices for several years, but many of those temporaries - estimates are more 30,000 - also are reservists. "We've had 18 candidates in just the last week or so tell us they are on ready notice to be called up," said Colin McCall, director of marketing for Irving-based Med Travelers Inc., which does temporary allied health staffing. "Half of them are working in hospitals nationwide now." .... "Rural areas also are expected to be hit hard. "In some rural areas, the loss of even one physician from a health care network could cut physician staff by half, while the loss of a single individual with a specialty skill - such as orthopedics - could result in the loss of that medical service in an entire community creating a substantial surgical deficit," said Van Allen, president of TimeLine Recruiting, a retainer search firm with offices in Frisco and Columbia, Mo." "Harris Brooks, assistant administrator at Palo Pinto General Hospital in Mineral Wells, said the expected loss of the one certified registered nurse anesthetist who also is a reservist will constitute a third of the department. To avoid being forced to cancel elective surgeries, the hospital plans to use temporary help." From "Nurses to be more scarce with war in Iraq, " by Stephanie Patrick. Dallas Business Journal (January 2003) http://dallas.bizjournals.com/dallas/stories/2003/01/06/story1.html?page=1 =================================== GROWING FIELDS FOR MEDICAL STAFFING ==================================== Home Health Care and Senior Care -------------------------------- "Home health is forecasted to grow by over 42% in the next five years, as key demographic drivers remain in place in this new decade. At the same time, the number of certified home health agencies operating in the U.S. has decreased from over 14,000 to less than 8,000; thus significantly decreasing local market competition. This presents enormous opportunity to forge new client relationships where entrenched competition was previously present. In addition, the nation's population continues to age. In 1994, approximately one in eight Americans was age 65 and older. By 2030, one in five Americans will be a senior citizen. From 1960 to 1994, the "oldest" population (persons aged 85 and over) increased by 274% compared with 100% for those 65 and over. One quarter (8 million) of the nation's elderly population have some form of disability for which they require assistance, such as help with bathing, dressing, eating, preparing meals, or taking medication; by 2020 it is estimated that 15 million will be disabled in some form. And, according to an AARP survey in 2000, 82% of mid-life and older Americans prefer not to move from home if they need help caring for themselves. From "Industry Trends." Interim Healthcare. (2003) http://www.interimhealthcare.com/franchise/industry_trends.asp == "Among other problems, costs continue to rise, doctors and other medical professionals are in short supply, and healthcare providers are closing down or restricting services. Since most of the elderly are on a fixed income, and since they have the biggest need for medical care, changes in the medical system hit them the hardest. "If I were going to pinpoint one issue that is affecting the elderly, I would say access to care," says Shirlee Zane, executive director of the Council on Aging. "Seniors also lack long-term care, a term that used to mean nursing care but now covers a variety of services, including in-home, mental health, physical therapy, and even food and shopping." From "Same Old Problems," by Joy Lanzendorfer. North Bay Bohemian. http://www.metroactive.com/papers/sonoma/06.26.03/healthcare-0326.html Pharmacists ----------- "The shortage of pharmacists has become acute, according to the American Association of Colleges of Pharmacy (AACP). A report last fall, produced by the Pharmacy Manpower Project Inc., predicted a shortfall of as many as 157,000 pharmacists by 2020 due to the aging of baby boomers and other demographic factors." "Increasingly fueled by the continuing shortage of pharmacy professionals, * the demand for temporary pharmacists is outstripping the supply, say executives for locum tenens firms. The current shortage is estimated at 15% to 20%, and the number of retail pharmacies is increasing as the population ages and as more pharmaceuticals are used. The temporary staffing industry is growing at an estimated 15%." "What’s driving the need for pharmacists is the demand for pharmacy services, and the aging population is serving as the main contributor," says Jeffrey Jacobsen, executive vice president of allied staffing for Medical Staffing Network in Boca Raton, Fla. "And as new drugs come online, we will need more well-trained pharmacists because so many people are on multiple therapies." Read "Temps Fill a Growing Need." Quality Indicator.com (Feb 2003) http://www.qualityindicator.com/cgi-bin/article.cgi?article_id=1359 Staffing Military Treatment Facilities -------------------------------------- During wartime, military medical facilities "at home" are hard hit. Interim Healthcare is one company that has stepped into fulfilling the needs in that arena. "Interim HealthCare Inc., the nation's largest combined provider of home health care and supplemental staffing services, will be playing a significant role in helping the U.S. Army fulfill civilian medical staffing needs at Army medical treatment facilities through a new contractual relationship with Washington, D.C.-based Aliron International, Inc." "The company has selected Interim to be the exclusive medical staffing contractor which means that during these times of world conflict and heavy Army deployment activity, Aliron's and Interim's contributions could be critical to the successful accomplishment of the Army's health care mission, both at home and abroad." "Interim has been actively working to develop large inventories of available medical personnel who are eager, ready and willing to serve in a non-military health care capacity that will not only benefit and help preserve the health of our American soldiers, but also their families," commented Michael Schundler, Interim HealthCare President and CEO." From "Interim HealthCare to Play Important Role in Meeting U.S. Army Staffing Needs." Interim Healthcare News. (Feb. 2003) http://www.interimhealthcare.com/news/HtmlNews/USArmyStaffing.asp Providing Bilingual Interpreters --------------------------------- "Recruiting for bilingual positions can be problematic, even for widely spoken languages such as Spanish. However, there are creative ways to overcome this gap. For example, foreign-trained health care workers can be retrained and utilized in professional or paraprofessional roles. Special programs can assist them to become certified or licensed in their original profession, or can train them for other health care roles, such as physician assistant or community health worker." "When bilingual providers are not available to care for monolingual patients, well-trained interpreters can do much to bridge the language and culture gaps. A variety of hiring approaches are currently used to obtain professional interpreter services: * Interpreters are hired as full-time or part-time regular employees - most common where need for a particular language is high. * Interpreters are hired as hourly, on-call employees or as independent contractors - most useful where demand for a particular language is intermittent * In-person interpreter services are obtained through an outside agency. This agency may specialize in medical interpreting or provide a spectrum of interpretation specialties. * Telephone interpretation - also known as remote consecutive interpretation - can be obtained through outside agencies that specialize in this service From "Overview of Models and Strategies for Overcoming Linguistic and Cultural Barriers to Health Care," by Sherry Riddick. Diversity RX http://www.diversityrx.org/HTML/MOVERA.htm == "The California Health and Safety Code (HSC) section 1259 states that "access to basic health care services is the right of every resident of the state, and that access to information regarding basic health care services is an essential element of that right." The code stipulates that when a hospital serves a geographic area or patient population in which at least 5 percent of the population or patients speak the same primary language, the hospital must make, to the extent possible (as reasonably determined by the hospital) interpreters available on the premises or by telephone 24 hours a day. SHS has met this criterion for Spanish-speaking patients, and we are approaching this level in other non-English speaking populations." Physicians and other healthcare providers can be encouraged to sharpen their language skills. "One caveat here, however, is that we can't ask physicians or nurses to drop their regular duties in order to serve as interpreters." Read "Don't Shoot the Interpreter," by Lawrence M. Shuer. Chief of Staff. Medical Staff Update. http://www-med.stanford.edu/shs/update/archives/april97/shuer.html == "It's not the patients' responsibility to bring along an interpreter. In fact, according to the state health and safety code, we're required to provide services unless the patient explicitly refuses and requests that a family member or friend provide this service," Shuer said." "But except in unavoidable emergencies, it's not a good idea to use a family member to interpret medical information," he added. Shuer noted that physicians can be legally liable for an untoward clinical outcome if communications difficulties result from nonexistent or inadequate interpreter services." "And there are civil rights issues that emerge when a patient whose English skills are limited is not provided with adequate interpreter services and health care is therefore compromised," said Linda Haffner, director of the inter- preter services at Stanford Hospital and Clinics. From "Call Interpreters Often and Wisely, Shuer Says." Medical Staff Update. http://www-med.stanford.edu/shs/update/archives/june98/intrpret.html The Growing Demand for Pediatric Sub-Specialists ------------------------------------------------- "Almost overnight, pediatric sub-specialists including anesthesiologists, surgeons, cardiologists, and neurologists, have become some of the most sought-after and best compensated physicians," said Ron Fasnacht, senior vice president and managing principal of Cejka & Company in St. Louis." "..the demand for pediatric sub-specialists far exceeds the supply. "This is partly due to managed care’s emphasis on capitation and primary care physicians as gatekeepers throughout most of the 1990’s," Fasnacht said. "Now that capitation and the gatekeeper concept are on the wane and open access to specialists is the order of the day, the market for specialists is in the process of rightsizing itself. But until it does, pediatric sub-specialists will remain in short supply." "Fasnacht pointed out over 70 positions for pediatric sub-specialists are currently posted on Cejkasearch.com, yet in some cases, only 25 physicians will complete their fellowships in a pediatric subspecialty and enter the job market this year. The competition for those physicians is such that hospitals will not only hire a firm like Cejka Search to recruit pediatric sub-specialists from elsewhere, but also to woo their own graduating fellows, some of whom they may hope to retain." Read "Pediatric Sub-Specialties: Once Modestly Paid, Now Command Top Dollar." In the News. Cejka Search. (Nove 2002) http://www.cejkasearch.com/content.asp?intPageID=515 Providers of "Staffing Plans" ------------------------------ "Today, more than ever, healthcare providers are depending on physician staffing plans to help them define the optimum physician specialty mix they need to support their patient population. However, physician staffing plans do more than provide a list of needs to healthcare providers - they also make sure providers are in compliance with government rules and regulations, identify services which are critical to the continued success of the organization, identify geographic areas of strength and areas for development, and provide prospective candidates with proof that their specialty is in demand in the given organization and location. Furthermore, healthcare providers who utilize physician staffing plans demonstrate a commitment to the community - a desire to fully understand and fulfill the healthcare needs of the population they serve." Read "Why Do Healthcare Providers Need a Physician Staffing Plan?" by By Michael P. Broxterman, CEO, Pinnacle Health Group and Terry Lane, Editor. (2002) http://www.phg.com/article_a028.htm ============================ WHAT ARE COMPANIES OFFERING? ============================= "United Emergency Services Inc." (Founded in 1966) ================================================== Business description: "United Emergency Services is a health-care staffing company focused on providing emergency department physicians and operating room nurses to hospitals throughout the United States. The company currently has a total of 372 active traveling nurses, surgical technicians, independent physician contractors, and physician assistants providing services under 472 hospital contracts in 42 states. UES is comprised of two business units: emergency department physician staffing and traveling nurse staffing. * Management believes UES represents the only provider of both ED physicians and operating room nurse staffing services in its markets. "UES targets suburban and rural hospitals with 5,000 to 40,000 ED patient visits per year. Historically, these hospitals have had difficulty recruiting and retaining qualified ED physicians due to the difficulty of matching physicians to the demographic characteristics of the local market, traditionally high turnover of ED physicians, and the economic challenges unique to ED medicine. Management estimates that there are 650 hospitals in its target market that use ED staffing services. TVL is now aggressively growing by entering larger markets." "In the ordinary course of business, executive management meets with the CEO or top administrator as well as physicians of each hospital monthly to identify areas of concern. Management believes that larger, national competitors are unable to deliver this level of service. Offering attractive benefits such as major medical, prescription drug card, life insurance, 401k, dental, AAA, and UES' reputation for being responsive to medical professionals' needs drives nurse and OR technician recruitment. TVL pays its nurses weekly and provides private housing, which is highly attractive to the traveling nursing community. These benefits have resulted in a 70 percent employee retention rate from 2000 through 2002 period, which is higher than the market's estimated rate of 50 percent. The average tenure of an ED physician and OR nurse with UES is three years and two years, respectively." Read More.."CED Participants, T through Z." Triangle Business Journal. (April 2003) http://baltimore.bizjournals.com/triangle/stories/2003/04/21/focus5.html?page=3 Interim Healthcare ================== Interim Healthcare is focused on two healthcare staffing franchises - Medical Staffing and Home Health Care. http://www.interimhealthcare.com/franchise/typefranchise.asp The Medical Staffing franchise "provides per diem, temporary temp-to-perm, direct hire and Site Solutions nurses and other health care personnel to hospitals, nursing homes, assisted living centers, federal, state, county and local governments and commercial clients such as insurance companies, manufacturers, HMOs, doctors, etc." The Home Care Franchise Program provides "continuous and intermittent health care personnel to patients in their homes." == The company has also added a Pediatric Credentialing Program to enhance "the skills of nurses within its network of nearly 300 offices in order to provide a higher quality of care to their youngest patients." "Commenting on the Pediatric Credentialing Program, Mr. Schundler states, "Our unique Pediatric Credentialing Program is one more reason why so many health care professionals are choosing Interim HealthCare as their employer. Our pediatric nurses are a very dedicated group of health care professionals and we are proud of their commitment to improving their skills and providing the highest level of care." Interim HealthCare is now introducing the Pediatric Credentialing program to physicians to inform them of the additional level of training by select Interim HealthCare pediatric nurses. Patients and family members will also be informed of the program to help reassure them during their time of need From "Interim HealthCare's New Pediatric Credentialing Program Attracts Potential Nurse Recruits." Interim Healthcare News. (Oct. 2002) http://www.interimhealthcare.com/news/HtmlNews/NewCredProg.asp AJACom ====== http://www.ajacom.com/Services/SvcHealth.asp Providers of Temporary, Temporary-to-hire and Direct Hire employees. See website for the large variety of healthcare positions they fill as well as support services. Medical Doctor Associates, Inc. =============================== www.mdainc.com "Founded in 1987, MDA is one of the largest privately held medical staffing companies in the U.S., and one of only two that provides occurrence malpractice insurance. Headquartered in Atlanta, GA with major offices located in Dallas and Salt Lake City, and satellite offices located throughout the U.S., MDA provides recruiting expertise for all physician specialties, allied health and healthcare professionals. Dental and Medical Staffing Inc =============================== http://www.dentalstaffinginc.com/staffing.html == Also see TheraTech Staffing for an intersting business Model http://www.theratechstaffing.com/gettingstarted.asp == Additional Reading: "Medical Staffing turns black: earns profit in Q4, '02." South Florida Business Journal (Feb. 19, 2003) http://southflorida.bizjournals.com/southflorida/stories/2003/02/17/daily35.html Neuropsychiatric conditions are replacing infectious conditions as the most rapidly evolving cause of disease in the world. Read "Global Disease Burden," by Dr. Sarina J. Grosswald. Business Briefing Global Healthcare (2002) http://www.wmrc.com/businessbriefing/pdf/healthcare2002/reference/23.pdf ========== I truly hope this information is helpful. If you need anything further, please let me know. And once again, I truly appreciate your patience! Sincerely, umiat Search Strategy "clinical staff" temporary staffing Industry outlook AND temporary clinical staffing temporary staffing +medical medical staffing industry temporary "medical staffing" trends new trends in medical staffing future needs AND healthcare staffing need for bilingual medical staff biggest need in healthcare future healthcare need