’We’re Not All the Same’: A Former Staffing Firm Leader Offers a Peek Behind the VMS/MSP Curtain

I recently had the pleasure of sitting down and speaking with my friend Mindy Milligan, senior program manager at healthcare workforce solutions provider Qualivis.

Mindy and I met several years ago during her time as director of nursing services for a staffing firm in South Carolina. We bonded quickly over our passion for the healthcare staffing industry and our shared desire to create a better experience for travelers, for agencies, and for hospitals alike.

Speaking with Mindy was incredibly insightful. Because Mindy spent time in the trenches as a recruiter before joining the managed services provider (MSP) side, her perspective on the relationships between vendor management systems (VMSs)/MSPs, facilities, and agencies is refreshing and unbiased.

In my opinion, the biggest takeaway from this conversation should be that MSPs don’t reserve all-access backstage passes for their favorite agencies. Despite what you may have heard, MSPs are there to serve us all and want to see us all be successful. Next time you’re frustrated with an MSP, pick up the phone and have a conversation. Ask for feedback and find ways to be a better partner in the employment market.

Don’t take my word for it. Check out our conversation for your own sneak peek behind the VMS/MSP curtain:

Shari Dalton: How has the healthcare staffing market evolved since you began working in it 12 years ago?

Mindy Milligan: VMSs and MSPs didn’t really exist 12 years ago. The best you could hope for was an exclusive agreement with a few hospitals. Facilities are now given access to large pools of agencies they wouldn’t have previously had the opportunity to work with because they weren’t going to sign 100 agency contracts. With the amount of need we see and the rate at which hospitals are merging and buying up other hospitals, there is no way that 4-5 agencies can keep up. An MSP can help with that and give facilities access to many, many more agencies.

We’ve seen other MSPs implement a tiered status for agencies, but we’ve also seen them have to shrink their lag times when opening needs to lower-tiered groups because of the amount of needs to fill. For example, a Tier 1 agency may typically get needs 48-72 hours before a Tier 2 agency. Now, several MSPs that operate this way have to shrink that 48-72 hour lag time in order to fill the open jobs more quickly.

We don’t currently have tiered status, but it’s certainly a consideration, especially if we were to hit another recession. We want to work with companies that are “coloring inside the lines,” following the rules of our MSP, and that are the best partners and give us the best chances of filling needs with quality travelers.

The people who are running an MSP have to become your valued partners, people you build relationships with. Until I was in this role, I had this idea that an MSP was a barrier to making placements, but in actuality the only difference is whom you’re talking to. You can still have that relationship. A lot of agencies fail with this because they are only looking at the MSP as a barrier, and they go over, under, or through it instead of working with us. No matter how much technology is forward-facing, there are still people paying attention. That’s easy to forget if you’re not looking at the VMS/MSP as a partner.

I work to give constant feedback, because I know how frustrating it can be. I think it makes me a better contact, and I try to help as best I can.

SD: How has your perspective on VMSs and MSPs changed since you began working on the “dark side”?

MM: Ha — I am like a kid backstage at a magic show! All the things I wanted to know, I suddenly had access to. I was so surprised about what goes on behind the scenes. It is really not much like what most people think.

Previously, I thought MSPs were a machine put there to be in the way, and that there wasn’t really a way to navigate that machine. In actuality, the information is there, and there are plenty of people willing to help if you go about it the right way.

One failed contract, or one failed placement, was devastating as a recruiter/agency, but from where I stand now, the hospital doesn’t view every problem as an agency problem. There is consideration for why things happen, but as with any good relationship, when the communication is better, it works out better. If a traveler goes MIA, the agency sometimes goes MIA. Instead of wasting a week, be up front. Communicate what has happened. Stop holding on for dear life. It’s just as important to have good communication with us as it is to expect good communication from us. The better the communication, the smoother the process will be both ways.

SD: What are some of the biggest benefits of using a VMS/MSP for agencies and hospitals?

MM: For hospitals, it saves them money, regulates pricing, and gives them more control over process. It also provides a layer of protection from the aggressive behaviors of some agencies.

For small and medium agencies, it gives access to larger system needs that they may not otherwise have been able to reach. It also makes these agencies more attractive to recruits because of the variety of locations and opportunities they can now offer.

For larger agencies, it gives them further reach and the opportunity to place more travelers. Some of them also use it as a platform to try and find facilities that may not be happy with their current MSP models and use this as an opportunity through proven staffing.

MSPs are a good competition-based atmosphere for quality. We have set rates, so everyone is on a level playing field. It gives the facility the opportunity to choose based on quality, and it gives the agency the opportunity to shine based on quality and best practices. It increases the positive outcome for the patients because of that competitiveness for quality, not price.

SD: Talk to me about price for a minute. There seems to be constant talk about bill rates going down. Any thoughts on this?

MM: Every hospital system has different reasons for doing what they do, but when you look at hospitals that have 200-300 travelers at a time, it’s got to be cost effective. It’s like gas: It’ll never be 99 cents again. It goes up and down, but it will never be that price again. Hospitals have to make sure they aren’t outpricing themselves. I don’t think they are trying to drive down the market, but trying to keep the market fair. Most of the time, hospitals are getting market research somewhere. They have teams of people that study cost, pay rates, etc. Unfortunately for a lot of places in the South, that number has always been a depressed number.

There is more to a budget than the cost of agency nurses. It’s like the old debate about what travelers should be paid versus what agencies make. There is a fine balance between what you pay for travelers and what you’re paying your permanent staff. There is a lot more that goes into it. In the same way that a traveler doesn’t always know what goes into what is in the bill rate, there are other costs associated with running a hospital and covering costs for internal staff — continuing education units, Epic training, benefits, PTO, etc. Hospitals weigh all of this when making decisions about bill rates.

SD: In your opinion, what is the biggest misconception about VMSs/MSPs?

MM: That we are all the same and can’t be trusted. I think with anything in life, trust is earned, and it is a two-way street.

When Aya Healthcare bought Qualivis, there was a big backlash from current contacts, but at the end of the day, the proof is in the pudding. As it has always been with Qualivis, we’re fair. We work hard for our agencies, and the integrity of the person sitting in this seat matters. I want my clients to trust that I’m going to do the right thing. It’s like a larger scale version of what travelers experience with recruiters: We’re not all the same. There are some that are better than others. It’s about trust and the relationship.

SD: Without naming names, tell me about some of your favorite agencies and why they are at the top of your list.

MM: This is a tricky question because Qualivis is still vendor neutral. However, quality will always shine over quantity. The agencies that stand out are not the ones that send the most profiles, but the ones that send the best (skill-matched) profiles.

When a profile is clean, organized, well matched, and properly submitted, the offers are easy to get. Managers want to see what they need to know and not the fluff. Profiles with tacky fonts, huge logos, and extreme colors are not user-friendly for the managers.

Above all, follow the process. Agencies that become known for credentialing issues, omitting requested time off, and trying to circumvent the process will not get placements as easily. The managers talk about their needs with one another in a facility/system. Reputations can’t be bought; they are earned.

It is also helpful when an agency lists the actual times someone is available to interview. This is highly sought after with hiring managers. Unprofessional profiles will always be rejected. Handwritten references or illegible info — gone.

My favorite agencies don’t submit a lot, but when they do, they almost always get the person placed because they are spot-on with submittals. They do the little things that make the process smoother, they have great matches, and their credentialing teams are ahead of the game!

SD: Knowing what you know now, what advice would you give agencies?

MM: Once again, quality will always shine over quantity. Read the details of job postings. Pay attention to the best practices, memos, and info that is being shared. Valuable nuggets are shared all the time if you pay attention.

Don’t treat travelers like spaghetti, throwing them at everything to see what sticks. It does not make sense to submit travelers to so many needs that they lose opportunities because they can’t decide. Set realistic expectations with travelers about what exactly travel nurses do. Facilities don’t spend premium money for you to walk into an easy, no work, pristine environment. They are probably short-staffed. They can be traveler-friendly, but they do not bend to travelers’ needs or demands. Requests for time off should be limited. Expect to float and follow hospital procedures.

Agencies should also know that communication is a two-way street, and you get what you give. You have to communicate in a productive way. Instead of asking, “Have you heard anything?,” try, “Here’s Jane Doe’s schedule of when she is available for interviews. Do you know when the manager plans to call?”

Finally, don’t assume — ever. Always ask. We are real people, and when we have training calls with agencies, they never ask questions, but then there are issues. We are here to help. We want you to be successful, but we can’t help you unless you’re asking questions.

Shari Dalton is CEO and cofounder of Moxie Mentoring, LLC.