Each year, the SIA Healthcare Staffing Summit offers a snapshot of where the industry is headed, and this year, the message was clear: the turbulence of the last four years is giving way to a new chapter defined by specialization, technology, and disciplined growth.
Barry Asin and Crystal Fullilove's keynote didn’t just anchor the conference—it provided the thesis for the next era of healthcare staffing.
A Market Resetting Into a New Normal
Asin opened with a reminder that’s easy to forget after the pandemic's volatility: when you zoom out, healthcare staffing has added more than 3 million jobs over the past decade. Remove the COVID spike and dip, and the long-term trajectory looks surprisingly steady.
But beneath that stability, meaningful shifts are happening:
- Travel nursing explains most of the recent boom and pullback, and many agencies are now grappling with thinner margins.
- RN pay has surged since 2019, reflecting the competition for talent.
- Consolidation is reshaping the space, with nearly a quarter of travel nurse firms operating at break-even or worse.
It’s not a crisis, it’s a reshuffling. And in a reshuffling, the firms that know who they are (and play to their strengths) tend to win.
The Tech Era Has Officially Arrived
If there was one universal theme across sessions, it was this: Digital transformation in healthcare staffing is no longer aspirational—it’s underway.
76% of firms plan to increase tech spend next year, and not by a little. The average increase is nearly 8%, and the data confirms what many of us already know...healthcare far outpaces other staffing sectors in its adoption of MSP and VMS systems.
The takeaway?
The ecosystem is becoming increasingly automated, connected, and data-driven. Agencies that can’t adapt will fall behind.
This is showing up in real, practical ways: streamlined workflows, VMS-friendly processes, automated reconciliation, voice AI in the recruiting stack, and tighter reporting.
The firms that accelerate here will gain speed, accuracy, and credibility.
Cash Flow Pressures Are the Silent Threat
One of Asin’s most pointed observations resonated through the entire event:
“Cash is king. Until you get paid, it’s all vapor.”
This isn’t a metaphor—it’s math.
DSO across travel nursing has leapt from 53.7 days in 2022 to nearly 80 days in 2024, far outpacing the broader staffing average of ~46 days. Combine tight margins with high interest rates, and cash flow quickly becomes a competitive differentiator—not just a back-office concern.
Asin challenged the leaders in the room to ask themselves: Are we running a staffing firm, or a bank?
The guidance was simple but sharp: track DSO by client (shameless plug, Cartwheel does exactly this for you). Negotiate. Automate what you can. And then decide intentionally which clients you can afford to serve.
Locum Tenens: Quiet Momentum With Staying Power
The Locum Tenens panel painted a picture of a segment quietly but steadily climbing:
- Physician shortages are structural, especially in primary care and rural markets.
- Hospitals are waiting an average of 300 days to hire a full-time physician.
- Locums now play a crucial role in hospital designations that require 24/7 specialty coverage.
The growth isn’t hype, it’s a necessity.
The panelists described physician recruiting as an art form, one built on grit, relationship-building, and a deep understanding of clients. They emphasized the importance of showing up: visit the facility, get to know the community, run the 5K, attend the gala.
Technology matters, but trust and presence remain the foundation of success in Locums.
Leadership Quality Is the Differentiator
Across sessions, there was a shared belief that firms with strong leadership benches will win the next wave of growth.
40% of the fastest-growing staffing companies are in healthcare. That's an indicator that great operators can still find opportunity even in a tight or cooling market.
The best-performing firms are:
- Specialized
- Culture-driven
- Data-literate
- Selective about growth
- And committed to long-term planning over chasing shiny objects
NATHO benchmarks, 10-year specialty projections, and well-built org charts came up repeatedly as tools for building resilient leadership infrastructure.
So What Should Healthcare Staffing Leaders Do Now?
If the conference had a closing message, it was this: the firms that succeed from here will be the ones that make strategic choices, not reactive moves.
The clearest paths forward:
1. Specialize and own your niche. Become unignorable within a specialty, market, or service line.
2. Invest in technology that connects your workflows—not just adds tools. Focus on VMS/MSP compatibility, automation, and systems that reduce friction (especially in back-office operations like billing and payments).
3. Protect and optimize cash flow. DSO discipline is a competitive advantage—and tech-enabled AR operations are becoming standard.
4. Build a leadership team that can navigate complexity. Recruit for grit, curiosity, and adaptability—especially in locums and travel nursing.
5. Choose growth intentionally. Slow and steady over reactionary, especially in specialties and as you consider the impact of credentialing, compliance, and malpractice complexity.
A New Chapter of Healthcare Staffing
The 2025 SIA Healthcare Staffing Summit made one thing clear: this industry isn’t shrinking—it’s evolving. It’s entering a period where:
- The macro climate is stabilizing
- Cash flow discipline matters more than ever
- Technology is reshaping operations
- And leadership strength will separate the good from the great
Firms that blend specialization, digital maturity, and financial discipline will be the ones that shape the next decade of healthcare staffing.
Interested in seeing how Cartwheel can help your firm prepare for a strong future? Book some time with us. Or, check out our helpful Strategic Planning Guide.
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