AMN Healthcare Services Q4 Earnings Call Highlights

Key Points

• AMN beat Q4 guidance as revenue rose to $748 million, driven by an outsized $124 million in labor-disruption revenue that was roughly double last year and came in about $24 million above guidance; excluding strike activity, core revenue was weaker and only slightly above midpoint guidance.
• For Q1 2026 management assumes roughly $600 million of labor-disruption revenue, lifting reported revenue to about $1.225–1.24 billion but dragging gross margin to ~23.5–24% and adding ~$40 million of incremental SG&A to support the events; management says underlying revenue excluding disruption would be ~$625–640 million with margins nearer 26.8–27%.
• Full-year 2025 revenue fell ~8% to $2.73 billion and adjusted EBITDA dropped ~31% to $234 million, yet the company reduced debt by $285 million (year-end debt $775 million, net leverage 3.3x) and generated $269 million of operating cash flow, while targeting 4–6% organic revenue growth and 10–15% adjusted EBITDA growth after 2026 excluding labor disruption.

AMN Healthcare Services NYSE: AMN reported fourth quarter and full-year 2025 results while highlighting a sharp increase in labor disruption activity that is expected to continue into the first quarter of 2026. Management said the company saw “outsized” labor disruption revenue in the fourth quarter and anticipates “significantly more” in the first quarter due to two large strike events.

Fourth-quarter results exceeded guidance on labor disruption demand

AMN posted fourth-quarter revenue of $748 million, up 2% year-over-year and 18% sequentially, and $18 million above the high end of its guidance range. CFO and COO Brian Scott said the outperformance was driven by labor disruption revenue that came in $24 million above guidance.

Labor disruption revenue totaled $124 million in the quarter, nearly double the year-ago period, management said. Excluding labor disruption, quarterly revenue was $624 million, which CEO Cary Grace said was slightly above the midpoint of guidance. By segment excluding labor disruption revenue, Nurse and Allied Solutions and Physician and Leadership Solutions came in at the high end of guidance, while Technology and Workforce Solutions was below the midpoint.

• Gross margin: 26.1%, slightly above the high end of guidance, but down 370 basis points year-over-year and 300 basis points sequentially. Scott said labor disruption reduced consolidated gross margin by 130 basis points in the quarter.
• Adjusted EBITDA: $54 million, down 27% year-over-year and 5% sequentially, with an Adjusted EBITDA margin of 7.3%.
• Net results: net loss of $8 million versus a net loss of $188 million a year ago (which included a non-cash goodwill impairment) and net income of $29 million in the prior quarter. GAAP loss per share was $0.20 and adjusted EPS was $0.22.

SG&A expenses were $152 million, compared with $159 million in the prior year and $139 million in the prior quarter. Adjusted SG&A rose sequentially to $143 million, which Scott attributed primarily to a $5 million professional liability actuarial adjustment, a $4 million increase in bad debt expense, and about $5 million in additional costs to support the large labor disruption event.

Segment performance: nurse staffing improved sequentially; tech and workforce declined

Nurse and Allied Solutions revenue was $491 million, up 8% year-over-year and up 36% sequentially, exceeding the high end of guidance due to higher-than-anticipated labor disruption revenue. Excluding labor disruption, Grace said the segment’s revenue decline improved to down 7% year-over-year from down 13% in the third quarter. Travelers on assignment (excluding labor disruption) increased 6% sequentially.

Scott said fourth-quarter segment volume was down 5% year-over-year, average rate was flat, and average hours worked were down 1%. Sequentially, volume rose 6%, average rate increased 1%, and hours worked were down 2%. Travel Nurse revenue declined 9% year-over-year to $209 million but increased 6% sequentially. Allied revenue was $147 million, down 1% year-over-year and up 3% sequentially; within Allied, the schools business grew revenue 10% year-over-year.

Physician and Leadership Solutions revenue totaled $170 million, down 2% year-over-year and down 5% sequentially due to seasonality in locum tenens. Locum tenens revenue was $136 million (flat year-over-year and down 7% sequentially). Interim Leadership revenue was $24 million (down 8% year-over-year and up 4% sequentially), and Search revenue was $9 million (down 8% year-over-year and up 1% sequentially). Grace noted that every business in the segment exceeded assumptions embedded in guidance, with Interim Leadership and Search showing the most upside.

Technology and Workforce Solutions revenue was $88 million, down 18% year-over-year and 7% sequentially. Grace said the year-over-year decline was 14% excluding the divested Smart Square business. Language Services revenue declined 9% year-over-year to $70 million, while VMS revenue was $16 million, down 28% year-over-year and 4% sequentially.

Full-year 2025: revenue down, debt reduction and cash flow highlighted

For full-year 2025, AMN reported revenue of $2.73 billion (Scott cited $2.7 billion), down 8% year-over-year. Adjusted EBITDA was $234 million, down 31%, with an Adjusted EBITDA margin of 8.6% (down 280 basis points). Gross margin for the year was 28.3%, down 250 basis points.

Management emphasized balance sheet progress, noting the company reduced debt by $285 million during 2025. At year-end, AMN had $34 million in cash and equivalents and total debt of $775 million, with a net leverage ratio of 3.3x. Days sales outstanding were 47 days in the quarter; excluding the impact of large labor disruption events, year-end DSO was 56 days. Fourth-quarter operating cash flow was $76 million, and full-year cash flow from operations was $269 million.

First-quarter 2026 outlook: $600 million labor disruption assumption drives step-up

AMN’s first-quarter outlook includes an assumption of approximately $600 million in labor disruption revenue from multiple strike events. Scott said consolidated revenue is expected to be $1.225 billion to $1.24 billion, with gross margin projected at 23.5% to 24%. Management estimated labor disruption would reduce gross margin by about 300 basis points in the quarter.

Reported SG&A is expected to be about 14.5% to 15% of revenue and includes about $40 million of additional costs to support labor disruption activity. Operating margin is expected to be 5.9% to 6.5%, and Adjusted EBITDA margin is expected to be 9.7% to 10.2%.

In Q&A, Scott provided a framework for thinking about results excluding labor disruption. He said stripping out the $600 million implies revenue of roughly $625 million to $640 million. Excluding the labor disruption drag, he indicated gross margin would be closer to the 26.8% to 27% range and underlying adjusted SG&A would be about $130 million to $135 million, describing the underlying run-rate as similar to the fourth quarter excluding strike activity.

Operational approach to strike support and AI themes

Grace said AMN has built a dedicated strike team and an event management system over the past two years, along with a playbook for scaling resources across the company and externally. She said supporting the current large events required moving “many, many corporate resources” but characterized impacts on the core business as marginal relative to the size of the events.

Management also discussed the labor supply supporting disruption events, saying the company uses a mix of clinicians known to AMN, new clinicians, and suppliers. Grace said AMN views the events as an opportunity to build longer-term relationships with clinicians after the strikes end, whether for future labor disruption support or for travel and per diem roles.

On language services, Grace said AI is not driving the pricing pressure the business has faced. She told analysts that the clinical setting requires a human interpreter under federal regulations, and the competitive pressure AMN has seen is from an “aggressive competitor consolidator,” along with industry impacts from tougher immigration policies in 2025. AMN said it is piloting a tiered service strategy to address price competition and expects gross margin benefits in the second half of the year. The company also said it is investing in AI to support administrative and other non-clinical patient interactions where human interpretation is not required.

Looking beyond labor disruption, Grace described 2026 as “a year of transition” aimed at returning the company’s businesses to growth. Management said it expects Allied, International, and Search to return to year-over-year growth in the first quarter, with other businesses returning to growth in subsequent quarters. Executives also reiterated longer-term targets, stating that after 2026 and excluding labor disruption, they see a path to sustainable organic revenue growth of 4% to 6% per year and 10% to 15% growth in Adjusted EBITDA, driven in part by operating leverage and ongoing technology and AI enablement investments.

About AMN Healthcare Services NYSE: AMN

AMN Healthcare Services, Inc NYSE: AMN is a leading provider of healthcare workforce solutions in the United States. The company specializes in staffing and recruitment services for a broad range of clinical and allied health professionals, including travel nurses, permanent placement of nursing staff, locum tenens physicians, and allied health personnel. In addition to direct staffing, AMN Healthcare offers comprehensive workforce management solutions such as vendor management systems (VMS), recruitment process outsourcing (RPO), and compliance and credentialing services through its technology platforms.

Founded in 1985 as American Mobile Nurses, the company rebranded to AMN Healthcare in 2010 to reflect its expanding portfolio of services.

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