By Susanne Mariga, Certified Public Accountant, Certified Profit First Professional – Mastery Level, and Managing Member of Mariga CPA PLLC

When one starts a business there is rarely someone available to guide you through every possible twist and turn.  To give you a head start and to help you avoid some of the pitfalls along the way, I interviewed 5 amazing thought leaders in the Healthcare Staffing Industry.  These are individuals who are truly steering the pack with their excellence in operations, experience, and revolutionary ideas. 

  1. Giving Up Margins For Volume … PK Scheerle, RN and CEO of Gifted Healthcare

Gifted Healthcare is listed as one of the Country’s 2018 Fastest-Growing Staffing Organizations by Staffing Industry Analysts (SIA).  The commitment to their nurses and clients has contributed to a 30% annual growth rate allowing them to gross revenue of $56,543,000 in 2017.  PK Scheerle, CEO of Gifted Healthcare, warns that sometimes, new healthcare staffing firms in an eagerness for growth and customers, against their better judgement trade hours for low margin sales. When this happens a Healthcare Staffing Agency can end up in a place where they find high volume business does not equal profitable business.  When margins are low a Healthcare Staffing Firm is unable to sustain.  They are unable to hire the best internal staff, they are unable to pay payroll taxes, and they are unable to invest in the development of the company. 

PK Scheerle advises that it is just not enough to give up margins.  She advises it is best to hold on to the margins and in exchange for low prices Healthcare Staffing Agencies should provide the best service that it can.  PK advises that Healthcare Staffing Firms should invest time in developing their Best Alternative To A Negotiated Agreement (BATANA) and spend the time understanding what keeps their clients up at night.  For example,  if there is a new emergency room that just opened in the area, it is a wise investment to get to know the owners and ask if they need 3 to 4 available and experienced nurses.  PK says offer your firm up as the firm of quality and convenience letting customers know that you have 4 nurses ready to go.  PK advises that a developing firm should build a strategy of increasing their client prospect pool by calling every reference that was ever received for a nurse. She advises developing relationships and taking a deep dive to understand how your firm can bring something that matters to clients.

PK advises one to learn to convince and negotiate during difficult conversations. For example a healthcare staffing firm may be able to negotiate terms with a client for a nurse who is willing to work 48 hours a week and is willing to stay 20 weeks with a client requesting a tenure of 13 weeks.  By offering your client a nurse willing to work additional hours a week and who is committed to stay longer, this benefits the client who is now able to save 4 days of orientation, increasing efficiency and reducing overall training cost.  In another example, the nurse is unable to work a 12 hour shift, however, the nurse is available to work the busiest and hardest to fill shifts for the client. 

PK tells Healthcare Staffing Firm owners that they are smart and valuable and have something to offer.  Clients want to pay for no non-sense service and by offering solutions that make a client most successful, a health care staffing firm will achieve the title of most valued partner without feeling the pressure of lower margins.

  1. Coasting on Auto Pilot … Linda Murphy, VP Client Sales of AMN Healthcare

AMN Healthcare is a Fortune’s 100 Fastest-Growing Company and is listed as one of the 2018 Largest US Staffing Firms with revenue over $100 Million by Staffing Industry Analysts (SIA).  Linda Murphy advises that one of the biggest mistakes that can occur within a Healthcare Staffing Firm, is that once they reach success and objectives are met the Healthcare Staffing Firm may begin to coast on autopilot.   This coasting of autopilot mentality can result in missed opportunities and a failure to adjust to the changes required within the market. Linda Murphy advises Healthcare Staffing Firms to constantly be mindful of what is happening in the industry.  She challenges that as long as a competitor has market share, there is still work to do. 

Linda Murphy advises Healthcare Staffing Firms to embrace change while they are successful.  This includes continuously investing in research to determine if a new prospect fits the company’s business model, desires, and risk tolerance.  Linda advises Healthcare Staffing Firms to look for opportunities for partnerships with competitors in Master Service Provider contracts and with the Centers for Medicare and Medicaid Services (CMS). 

CMS establishes rulings each year to ensure they are delivering quality care to medicare patients and are meeting the needs of the population.  Linda Murphy believes that the CMS is very prudent and values input from members of the community to implement real world ideas.  The CMS is focused on quality and providing a positive impact to it’s patients and there is an opportunity for Healthcare Staffing Firms to work together with the CMS to help them meet this goal.  Linda Murphy encourages Healthcare Staffing Firms to maintain an agile mentality to maintain innovation.  She believes that this innovation doesn’t need to be an extreme shift but can be as slight as gaining greater share into the current market. For example, if one is already well established in nursing consider entering into physician care or allied health opportunities.  Healthcare staffing firms must be willing to plan and ask themselves “where do I want to be or what do I want to do”, and those that hold out on change will loose opportunities.

  1. Failing to Understand the Complexities in Regulations of a Multi-State Environment … Scot Thompson, President & CEO, C&A Industries, Inc.

C&A Industries, Inc. has received the Best Places to Work In Omaha Award since 2009 and is the recipient of the 2018 Circle of Excellence award.  Scot Thompson, President and CEO of C&A Industries, Inc. is listed as 2018’s 100 Most Influential People in Staffing. 

Scot Thompson warns that Healthcare Staffing Firms operate in a complex everchanging multistate regulated environment and the failure to maintain that compliance can be detrimental.  Not only are there federal and state regulations, but there are compliance requirements on a municipal level, and Healthcare Staffing Firms must be aware and in compliance with these.  These regulations not only encompass tax regulations, but also include employment regulations.  C&A Industries, Inc. has invested in it’s accounting department in order to stay on top of ever changing regulations, however, for blooming Healthcare Staffing Firms Scot Thompson recommends that these firms invest in the use of a tax advisor that has expertise in multi-state compliance requirements. 

  1. Lack of Balance and Diversification … Bill DeVille, CEO & Co-Founder Health Carousel

Health Carousel is one of the 2018 Inc. 5000 Fastest Growing Private Companies in America. It is voted Best Place To Work In Cincinnati, Ohio, and is a Staffing Industry Analysts (SIA) Largest US Healthcare Staffing Firm.  Bill DeVille warns there is a balance between focus and diversification and a Healthcare Staffing Firm must get it right.  Without a diversified customer base, a Healthcare Staffing Firm is vulnerable if one client goes wrong.  If a Healthcare Staffing Firm is trying to be too many things when they are too small, they can end up sacrificing quality and end up nothing to nobody. 

Bill DeVille encourages Healthcare Staffing Firms to consider building enough diversification that alleviates the Healthcare Staffing Firm from becoming overly dependent upon one employee or one specific account.  He urges Healthcare Staffing Firms to consider becoming a strategic player or a dominant player in a niche. 

To discover one’s sweet spot, Bill DeVille encourages Healthcare Staffing Firms to find the unmet need in the market by discovering the client who is not being served well. However, Bill warns, there is usually a reason companies aren’t serving the unmet need.   The Healthcare Staffing Firm should consider “why” other healthcare staffing firms are not solving this problem and how they may be able to solve it.  In entering a new market or becoming a dominant player, Bill DeVille warns that a Healthcare Staffing Firm will face obstacles.  For example, a new Healthcare Staffing Firm will need to build credibility to solve the problem for it’s clients.  The Healthcare Staffing Firm will need to build enough trusted relationships by delivering on it’s promises.  To truly become the “Go To Market Expert” the Healthcare Staffing Firm will need to build credibility and market acceptance with the right balance of diversification.

  1. Following the Leader … Jeff West, Regional Branch Manager, Nursing Division, Aureus Medical

Aureus Medical Group is a nationwide leader in healthcare staffing and an affiliate of C&A Industries which has more than 45 years of staffing experience.  Jeff West warns against Healthcare Staffing Firms becoming stuck in a follow the leader cycle.  Jeff West believes that Healthcare Staffing Firms should focus on continuously self-defining excellence by making themselves better with an inside/out approach.

To focus on being the best at placing Healthcare Staffing professionals, Jeff West recommends that Healthcare Staffing Firms know their people and provide a plan and a vision for the culture that they want to build.  Building the right culture includes hiring the right people and projecting goals for the next 30 to 60 days, as well as, the next 3 to 5 years. 

In developing a Healthcare Staffing Firm from the inside out, Jeff West recommends that Healthcare Staffing Firms build a reputation as a credible expert.  This can be done by being the resource of education and information for your clients, continuously educating them about current market trends.  This education should also be provided to internal team members and to nurses so that these team members can also teach and advise your clients.  Jeff West believes that although a lot of people come into the industry, credibility and solid reputation is built by what you say and how you follow through. Over time doing the “right thing” builds credibility.  

  1. Bonus … Failing to change when things just aren’t working … Susanne Mariga, CPA, Certified Profit First Professional, and Managing Member of Mariga CPA PLLC

It’s easy for Entrepreneurs and leaders to get into the trap of hoping things will change and turn around.  In instances of an underperforming employee many of us get caught up with the long-term coaching of a loyal team member who is just not capable of turning around. We are afraid to raise our prices due to the fear of loss of a long-time client.  We get too busy just getting things done to examine our own processes to discover more efficient ways of achieving the same end. 

When we sanction status quo or allow things to continue in a downward spiral, we loose not only valuable time and money, but we lose opportunities and our reputation.  When we keep an underperforming employee under our wing, we send a clear message to our other team members that we sanction incompetence and expect the other players to pick up the slack (until they choose not to).  When we fail to raise our prices to keep in line with the growing cost of wages and overall inflation, we slash our ankles because we are no longer able to retain the best and the brightest or stay at the forefront of technology. When we are busy stuck in the production and fail to look up, we miss the opportunities in front of us.  We fail to build relationships with our clients and we fail to hear the hints they express when they tell us what they wish they had.

When marketing initiatives just aren’t working and new service lines or great ideas just aren’t panning out, there is gold in quickly evaluating the situation, turning the ship, shutting off the faucet, and discontinuing the bleed. When we allow a bad situation to fester it rarely improves on it’s own.  When things just aren’t working, quickly evaluate, continue to evaluate, and change.

Susanne Mariga is a Certified Public Accountant, a Chartered Global Management Accountant, a Certified Tax Coach, a Certified Profit First Professional – Mastery Level, the Managing Member of Mariga CPA PLLC, and a John Maxwell Team Certified Coach. Please contact Susanne at or
(713) 937-1737.

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