Travel Nurse Questions, pay, bill rate, VMS and MSP questions - Atlas All Access 108
How does pay work for a travel nurse? How does bill rate impact you? What do you need to know about MSPs, VMSs, vendors, and the partnerships your agency has with them?
We dive into all of these questions and more. Be the most educated and informed traveler you can as you push your career further.
Rich Smith: Part two of frequently asked questions. What questions do our recruiters field on a daily, hourly basis? Here's a lot of them. Last week we talked about contracts and if you're a new traveler, kind of what that all entails and the questions that you might have there. This one's going to be all about pay, benefits, and vendor managers, VMS, MSPs, all of those buzz words that you've probably heard before, and you've wanted some details on. So Adam Colette is back. Atlas All Access starts now.
Rich Smith: All right, you ready for part two?
Adam Collette: Part two, here we come.
Rich Smith: All right, here we go. Okay, same as last time, we're just going to go down. Give me some quick answers on these and yeah, we'll get ... There's a lot of questions here and I think it's legitimate. This isn't just new traveler questions. This is just questions across the board.
Adam Collette: Sure.
Rich Smith: So pay and benefits. How do hours work for travelers? Are they guaranteed and how much overtime can I expect? So I guess two different questions here.
Adam Collette: Yeah, so guaranteed hours, for the most part, is going to be 36 or 40 hours a week depending on your unit on there. A good thing to think about is a week is a week. You can't carry over a week or you can't make up hours a next week or anything like that. A week is broken up into Sunday to Saturday, Friday to Thursday, whatever that week that hospital goes to it's broken up into that week.
Rich Smith: Your 36, your 40, whatever that might be.
Adam Collette: 36 or 40. What comes into play after that is maybe a call off policy on there. And what that means is the hospital can call you off for that shift, or a certain number of hours, and it could be one shift every two weeks, it could be one shift per week, it could be 36 hours per 13 week contract, it could be four shifts per 13 week contract.
Rich Smith: Yep. Oh, we've seen it all.
Adam Collette: We've seen it all. And I tell people, you hear the horror stories of getting called off in and those things, the last thing the hospitals want to do is bring travelers in. It costs them a lot of money, they have to orient them, there's turnover and things like that. So I try to tell people it just doesn't happen as often. You see all the horror stories, obviously, online. It doesn't happen. The horror stories come from people that go in, they cause a lot of problems, they're a cancer to the unit. Of course, if somebody's going to get called off, they're going to be the first person to get called off on there. You go in, you do as good as job as you can, you're super positive, you try to interact with people you're going to have a positive experience and everything.
Adam Collette: Another good thing during an interview ask, how often do travelers get called off?
Rich Smith: How much overtime am I getting?
Adam Collette: How much overtime can you get?
Rich Smith: Sure. Can I get one shift a week, or whatever?
Adam Collette: Once, again ,in the interview or during the process of taking a job ask about overtime, how much that you can get, how often travelers get overtime. Some places don't allow travelers to get overtime, so maybe not a place that you want. So, my record for overtime, or number shifts in a row was Ms. Kim and she did like 17 days in a row. And-
Rich Smith: I would not recommend-
Adam Collette: I would not recommend, and she did it on herself, and yelled at me every day. But I loved it.
Rich Smith: I miss her, by the way.
Adam Collette: Yeah.
Rich Smith: I miss her.
Adam Collette: But in the same sense is, her hospital let her work a ton, and she made a bunch of money, and helped the hospital out, and everything as well. So, you can find those contracts where you can definitely bank and get after it.
Rich Smith: Absolutely. They're not the most glamorous places.
Adam Collette: No.
Rich Smith: You want to go to North Dakota? All right, right?
Adam Collette: Let's work a ton.
Rich Smith: You're not going to Denver, right? You're not going to Phoenix.
Adam Collette: No. Exactly. It's going to be an obscure place.
Rich Smith: I mean, I should cool it, but it's pretty rare. Very rare.
Adam Collette: Sure.
Rich Smith: All right. How often travelers get paid?
Adam Collette: Once, again, that's based off of your company that you're working with. We do every week here at Atlas. You get paid on Friday for the hours that you worked the week prior, so your first week when you show up on orientation you don't get paid on that Friday, but you get paid the next Friday on there. Once again, your assignment ends, you get paid the week after would be your last paycheck for that assignment.
Rich Smith: Yep. How does the bill rate work for me, so how much of the bill rate does the agency take, and how much can I expect to recruit or to share with me about the bill rate?
Adam Collette: Yeah absolutely. Once again, it's going to go back to your company. Every company is going to have some specific standards on there. I think industry standard wise, let's say the bill rate is $100, most companies are keeping anywhere from 20 to 30% of that. Some are higher, some are lower on there. And I think with most companies are probably a grace period or some these are our standards.
Rich Smith: There's wiggle room.
Adam Collette: These are our standards on there. Once, again, how truthful your recruiter, your company's going to be with you on that. But I would say industry standards for us to run a business, for a bank to loan money for us to be able to pay people we have to be somewhere in between that 20 and 30% of that take home. And that, obviously, pays for lights, buildings, payroll people, HR people, recruiters, salaries. What it goes into it all comes out of that on there.
Rich Smith: Of that. And I can tell you just from a business stand point, having seen a balance sheet and profit and loss statements, something I deal with every week here at Atlas or whatever. During very high growth periods, we've averaged like an 18% margin on those deals. At other times, you push that 10 to 24% right? Go look at, there are publicly traded travel healthcare companies out there. You can see they report this every quarter. You can go look, they have to report margin to their shareholders, right? So you can go and see that and you can see it broke down between here's the nursing section, here's the allied section, here's the locum section. I mean, you can see each one of those broken down.
Rich Smith: I like to read it. It's something that kind of keeps me within the industry. It's kind of one of those trailing indicators for us. Whatever they report generally happens to us three months later, kind of weirdness. I mean, it's always kind of been like that even through our growth phases. So, I mean I can tell you Atlas, right now, 18 to 24% is right where we need to be. And that's perfectly acceptable within ... there's a lot of other companies that are our size that are right in that same sort of boat.
Adam Collette: Yeah, absolutely.
Rich Smith: So why is company X offering me more or less money for the same job?
Adam Collette: Yeah. Once, again, kind of a multilevel question on there. One, typically, you'll see smaller companies with less overhead, obviously, be able to pay a little bit more of their margins. There's less on their books that they have to pay for on there. That could be a reason. On part one, we talked about changing bill rates. There could be a change in bill rate at some point in time of $5, $10, I've seen $30 higher bill rates for people that I've had placed and now I'm trying to place somebody else and they're getting $30 more. And that's just being honest with your other travelers that, "Hey, this is going to happen. There's nothing I can do about it," and those things as well.
Adam Collette: And then, yeah, you absolutely could be getting taken by a company, if they're taking a really high GPH on somebody as well. And without digging into getting that information, it's really hard to see where that fell into, but asking the right questions, not assuming that you're getting screwed over, or getting taken advantage of try to narrow that down to where that's at.
Rich Smith: You are your best advocate in those cases, right?
Adam Collette: Yeah.
Rich Smith: The more questions you ask the better, and you should never feel like you can't ask those questions.
Adam Collette: You should always ask those questions. And, once again, if you get a, "Well, it's none of your business," or, "It is what it is, deal with it," you got to question is that somebody that you feel that you want to partner up and have teamwork in this industry?
Rich Smith: Right. Okay, next one, why do some jobs have stipends and some don't? Well, that's an interesting question that I think maybe was ... I saw this one come through, in particular. I almost wonder if this is like a local job versus a travel job, right? Because they exist, right?
Adam Collette: Yeah. I mean, it really goes back to duplicating expenses. There's this really gray unwritten written rule of if you're 50 miles from home, and you're not duplicating expenses, you should take an hourly rate with no stipends versus a non-taxed stipend and those kinds of things. Once again, we're not the tax people and not going to debate those rules or anything, but that might be the difference that you see on there. There's also other people that say, "Hey, I'm going to go buy a house next year. I don't want to have any stipends on my paycheck. I want to take a taxed rate on there." So, that could be a different reason you see those as well. But I would say it's more local travel versus a true travel job.
Rich Smith: Again, your best friend is Google here, right? Duplicating expenses, what is duplicating expenses. And then you understand, okay, I'm not doing that so I'm taking a fully taxed hourly rate here to work at this job. Or I am doing that, I qualify for stipends. That is a super simplified explanation. Again, we're not tax advisors. I don't pretend to be one on TV. Talk to the person that does your taxes, talk to your CPA.
Adam Collette: Correct.
Rich Smith: All right. Benefits. Do I get benefits from my agency and are those benefits any good or travelers get the plan B for benefits?
Adam Collette: Sure. I've done this for five years and I've seen across the board benefit packages from companies. And it's one of those things, get educated on benefits and health insurance coverage and those things. At the end of the day it's you, the traveler, that needs to know what you need. There are companies out there that have $10 a week plans and if you're not taking any medications, you go to the doctor once a year when you got a cold, you just can't get rid of that $10 plan may be great for you and there's nothing wrong with that on there. There's other companies that they have the best health plans out there and you know what? It costs a little bit more money.
Rich Smith: Good health plans are expensive.
Adam Collette: Good health plans are expensive on there. So, when I talk to new travelers or current travelers I, usually, tell them, go to the open market that the US government has an open market for healthcare. Go get a quote from somebody, go get two quotes. And then let's compare that versus what Atlas has, or what your company has. What are the benefits? And I always tell people, let's pick a worst case scenario. You're hiking in the hills, you twist your ankle, you break it. Now, you're out of a job and you have $10 healthcare, and $50,000 worth of medical bills. Where does that leave you at?
Rich Smith: Right. Break it down to the most basic. What's your copay? What do you pay for, right? When you're comparing those, and you're looking at that scenario break it down to that. What are you paying when you go in? What's your co-insurance look like? What's the total deductible? What's the deductible for the year? Break it all down. And I think, again, you will find good insurance is expensive, but not everybody needs that.
Adam Collette: Correct. And so there is nothing wrong with looking at other options on there. So, every company is going to have some sort of insurance, what level that is for what you need is going to be dependent on what people need out there.
Rich Smith: What matches your needs.
Adam Collette: Yeah.
Rich Smith: Right. I can tell you, at Atlas, we've always taken the same standpoint where I don't want to skimp on any of that stuff, right? So, I have the same insurance that travelers have, that you have, right?
Adam Collette: That's correct.
Rich Smith: You have the same insurance that I have, that your travelers have.
Adam Collette: Yeah.
Rich Smith: I have the same 401k that you have. Once you're eligible for our 401k, which is six months, and that's you, and me, and ER traveler in Bozeman, Montana all have the same 401k. You're eligible after six months, you're eligible for the same match. It's all the same.
Adam Collette: Correct.
Rich Smith: My short-term disability is your short-term disability. It's the same exact stuff. One, logistically, it's hard to separate them right? And insurance companies, there are many, many rules out there that I wasn't even aware of when you categorize different workers, right? Okay, so these are just contract workers, just contract workers, right? These are just recruiters, right? These are just whatever. It is easier for us to mash everyone altogether.
Adam Collette: Correct.
Rich Smith: And it's more fair. Ask that question, is your recruiters insurance the same as your insurance? That's a legit question.
Adam Collette: That is.
Rich Smith: Last question for paying benefits, what are the differences between taxable and tax free money? I think that's, we're just going right back around to duplicating expenses again, right?
Adam Collette: Yeah, absolutely. I mean, obviously, you should have an hourly wage that is taxable by the federal government. If you are duplicating expenses you qualify for some tax free housing money, some tax free per diem food, incidental money, travel money, and certification, get reimbursements for some stuff would be tax free as well.
Rich Smith: Yep. All right, now we're going to cover vendors, MSPs, VMSs that type of thing because I know those are buzzwords that people have heard. And there's always, always questions about them. And we've talked about them multiple times. But there are some details here that I think we can get into that are important not only for new travelers but for experienced travelers too. Okay so on the very basic level, how do VMSs and MSPs work?
Adam Collette: Yeah, so the basics of VMS or an MSP vendor management system, or a manage serviced provider, basically, I think back in the Wild, Wild West of travel nursing there were probably 5, 10 agencies, and they would all call the hospital and say, "Hey, we can provide you a service of getting travel nurses." As the years have gone on and other companies have grown to 4 or 500 companies out there hospitals were getting tired of having 4 or 500 people call in to the hospital. And so people started vendor management services or MSPs, so there's one single point of contact where their profiles are going to the VMS or the MSP. They are then filtering through those, and sending the qualified candidates to the hospital. It alleviates, probably, jobs at the hospital level of fielding and bringing those in. So that is the meaning or why that those have come up?
Rich Smith: Yep. Generally, the vendor, the VMS is not associated with an agency. The MSP, the managed service provider generally is an agency. When you get right down to the nuts and bolts, they kind of operate the same.
Adam Collette: It's the same thing.
Rich Smith: Yeah. And at least from a traveler standpoint, the two could be interchangeable to you. It's fine. I mean we kind of deal with that here is as well.
Adam Collette: Yeah, I mean in all reality for the traveler a VMS is probably better because it's vendor neutral. It's not owned by a company who is going to take only their candidates first on there, but that doesn't necessarily mean ...
Rich Smith: That doesn't, right.
Adam Collette: The vendor management system or the MSP has a quota that they've got to fill for the hospital. So it, typically, doesn't happen that way.
Rich Smith: Right. What is the difference ... Well, we just answered that. What is the difference between an MSP and a VMS company versus vendor? Vendor neutral is important. I mean, that's important that you brought that up. There are good ones out there, RightSourcing comes to mind, that is vendor neutral. But then there are also VMSs that are owned by agencies.
Adam Collette: Correct.
Rich Smith: ShiftWise, for example, I'm sure you've heard of that one. ShiftWise is owned by American Mobile. That's not a secret, they report that in their earnings, right? That absolutely happened a couple years ago.
Rich Smith: This is an interesting question and I think better in the context of this question is relative. Are certain MSPs or VMSs better than others? Again ...
Adam Collette: Yes and no. I mean, it really just depends. And I think it depends on your relationship that your specific agency has with said vendor, said MSP. I think one of the great things about Atlas is we've always kind of taken the stance of Switzerland of, "Hey, we want to work with everybody. We want everybody to be our partner and work well on there." And I don't know if this is a later question, but as we move through this and as there's a ton of companies out there, all these MSPs and VMSs have gone to, basically, tiering systems. And a tiering system could mean better rates for some versus others. It goes back to pay. We didn't really kind of talk about that. But tier one companies might get a better bill rate than that. How quick you get jobs, how fast you get jobs.
Rich Smith: The agency gets the jobs.
Adam Collette: The agency gets the job. So like an MSP ran by a company, they're going to give their own internal recruiters three, five days to fill the jobs. And then after that said time, then they're going to open it up to maybe tier one companies for the first 10 days. And then, after that tier two, three, four companies will get a shot a month down the line. And so, you might take a job that you see online to your company and they say, "Well, I don't have that right now." And then two days later you all of a sudden have the job.
Rich Smith: All of a sudden that job pops up.
Adam Collette: It's on there. And it's just the nature of the business. Something that we, as recruiters, have to deal with on there. But a lot of times, even if you aren't tier one, tier two, tier three, if you see that job and you go ask for that job and you're a qualified candidate we typically can still get that job for you.
Rich Smith: If you go back and ask them, yeah. So, like I said, I think better is a relative question there. From, my standpoint, maybe from an agency ownership standpoint, there are some out there that I would consider maybe better because they pay us quicker, right? So it all depends. They pay us, the agency better, right? When we send the invoice they send us quicker. So it's all relative there. Like Adam said though, it's the relationship that your company has, your agency has with that vendor, or with that managed service provider.
Adam Collette: Yeah, and once again, there's so many factors behind-the-scenes that go into this. It's insane what happens behind-the-scenes to really be able to nail it down on good, better, best, we want to work with them. We want to have the opportunity to work with every hospital we can.
Rich Smith: So their business, like any other, right?
Adam Collette: Yeah.
Rich Smith: Okay, so how much of my money, traveler money, bill rate does the MSP or the VMS take?
Adam Collette: Yeah, I would say typically anywhere from 2 to 5% is probably fair on the average of what a VMS is taking out of a bill rate on there. There's some that take 8, 10 bucks right off the top of a bill rate, and so what does that equate to a percentage on there is probably still in that 2 to 5%.
Rich Smith: Honestly, it depends on the bill rate. There are others out there that maybe take a portion of the bill rate and then charge a percentage too. But I mean, like you said, it's nature of the disease.
Adam Collette: It's, unfortunately, the cost of doing business and we can complain and be mad about it at the agency level. And the recruiter can be mad about it as well. And, at the end of the day, you can work directly with some hospitals as a 1099 employee, and I would be scared to do that.
Rich Smith: That's a tough one. That's a whole other conversation maybe, yeah.
Adam Collette: But it's the cost of doing business and we've kicked back on some VMSs and some MSPs and said this is too high. And there kind of give us the same thing of it's the cost of doing business, if you want to work with this hospital it's what it's going to be.
Rich Smith: And our standpoint has always been, we're not going to lose a traveler to a location that we don't have because I won't pay a 5% fee.
Adam Collette: Correct.
Rich Smith: That seems silly to me that agencies have said that before. "No, I'm not going to work with that VMS because they charge 5%. So I can't have 95%," right? Or whatever and then be able to pay from that so hey, however they want that's their choice.
Adam Collette: But I think the important question or answer on that MSP as well as just because they have the MSP and they have the direct need doesn't mean they're going to pay you more than a company. Because if we're paying 18 to 24% on average, but that MSP holder has it, they have to get 35% of the margin is their company [crosstalk 00:23:05]. I'm probably still going to beat that company on paying the 3 or 5% fee.
Rich Smith: Absolutely.
Adam Collette: So you got, you got to be smart and you got to go out and ask those questions.
Rich Smith: That plays into the next question, do we, you and your recruiter, right? Your recruiter and the traveler have to use the MSP or the VMS for this job?
Adam Collette: Yes and no. There's always ways to work around it. If you know somebody at the hospital and they, they can reach out and will offer us a direct contract to that certain facility, we don't have to go through there. There are rules on the MSP VMS side, if a hospital has an MSP or VMS we can't directly call into that hospital.
Rich Smith: That's correct.
Adam Collette: Typically. Or we have to break our contract with said VMS or MSP before we can go after that hospital on there. We're not necessarily in that kind of game here at Atlas, so we don't usually get into those kind of bidding wars, or anything like that. But, for the most part, if something's ran by a VMS or MSP we're going through that.
Rich Smith: We're going to use that one, and that's the contract that we signed?
Adam Collette: Yep.
Rich Smith: Right, exactly. So I think in the scenario that you gave initially that's a pretty rare scenario.
Adam Collette: Correct.
Rich Smith: It's we're going to to honor the contract that we have and then go from there.
Adam Collette: Yep.
Rich Smith: So that covers pay benefits and vendors and managed service providers. So next week, Adam will be back at his desk recruiting, and Cassie will be here talking all about compliance. And there's a lot of interesting intro questions, and there's a couple doozies in there too. I can't wait to talk to her about it.
Adam Collette: I love Cassie and she's got a wealth of knowledge and I'm sure she'll have some great answers.
Rich Smith: Absolutely. Adam, thank you again.
Adam Collette: You're welcome.
Rich Smith: See you next week.