How to start a healthcare (medical) staffing agency

Staffing Industry Analysts (SIA) reports that the 91 largest US healthcare staffing firms generated $33 billion in 2025 and held 86 percent of the segment. The five largest held 40.7 percent. Aya Healthcare led with 16.3 percent, followed by CHG Healthcare Services at 7.4, Jackson Healthcare at 6.6, AMN Healthcare at 5.6, and Medical Solutions at 4.8. Nine new firms joined the list this year, so new names do get in.

SIA’s forecast expects healthcare staffing to grow 1 percent in 2026 and 2 percent in 2027 after three years of decline. SIA’s senior healthcare analyst says the opportunity is in following demand into the specialties and care settings where shortages are most acute. The analyst also says health systems are building internal float pools and asking staffing partners for forecasting, workforce analytics, and broader solutions. For a new agency, that argues for a narrow start: one role family, one care setting, one region.

Medical staffing agency and healthcare staffing agency mean the same business. The choices that shape it are three. Roles: registered nurses, LPNs and LVNs, nursing assistants, allied health such as respiratory therapy, or physicians. Settings: hospitals, nursing homes, schools, and occupational and community sites. Assignment type: per diem shifts, longer travel assignments, locum tenens for physicians, or permanent placement.

Each combination has its own credential file, state rules, and buyer. A per diem nursing assistant desk for local nursing homes and a travel nurse desk for hospitals are different businesses. Pick the one where you already know twenty facilities and ten clinicians you could place this quarter.

There is no national license for a healthcare staffing agency. States regulate it in different ways and under different names: nurse agency, nurse staffing agency, supplemental nursing services agency, health care services pool, or temporary health care services agency. Some states license, some register, some only require reports. Rules can turn on where the agency is, where the worker lives, and where the facility sits. The table shows six primary-source examples. Check every state where you operate.

The list is still growing. McKnight’s Senior Living reports that Nebraska’s LB 921 creates a Health Care Staffing Agency Registration Act, effective July 2027, with annual registration and a $1,500 fee per physical location. It also reports that the act prohibits noncompete clauses and conversion fees. A Barclay Damon alert says New York’s law similarly bars fees when a facility hires a placed worker permanently. If you plan to charge a conversion fee, check the state first.

Use the regulators’ own lists to see your competition. New York, Minnesota, and Florida each publish registered agencies.

Facilities buy a credentialed worker, not a name. Build each file from the role, the state’s law, and the facility contract. Verify nursing and other professional licenses with the issuing state board. If the nurse works across states, check whether the state is in the Nurse Licensure Compact, which lets a nurse hold one multistate license. The compact’s site lists 43 jurisdictions as of October 6, 2026.

Screen for federal program exclusion. HHS-OIG publishes its exclusion database as a monthly file, last updated September 10, 2026 when we checked. Because the Privacy Act keeps Social Security numbers out of the file, OIG says to use its online search to verify a specific person or entity. Screen at hire and again on a schedule.

Then add what the facility contract lists: background check, health screening and immunizations, certifications such as life support, competency evidence, and references. Contracts differ, so read them before you promise a turnaround time.

Healthcare staffing is employer-side contract staffing. You pay clinicians on schedule, and facilities pay on their invoice terms. That payroll gap is the same one covered in our general guide, and healthcare adds regulator and facility requirements on top.

Louisiana’s application shows what a regulator can ask for: a $25,000 line of credit, professional and general liability coverage, and workers’ compensation coverage of at least $1,000,000. Facility contracts add their own limits. Get quotes from a broker who places healthcare staffing risk before you commit to a first contract.

The Joint Commission’s Health Care Staffing Services certification is a quality credential, not a license. To be eligible, a firm must place temporary clinical staff who work under another organization’s direct supervision, place at least 10 clinical staff by the on-site review, and collect four months of data on each of four standardized performance measures. Permanent placement firms, internal pools, and non-clinical staff are not eligible.

The Joint Commission says certification is recognized by insurers and other third parties and may reduce liability insurance costs. Those are its claims. Check whether your target facilities, payers, or insurers ask for it before you budget for it.

Many hospitals and nursing homes buy staffing from approved vendors. Your task is to become one and then be the first call when a shift opens. The buyer is often a nursing leader, a staffing office, or a workforce manager rather than the person who posts the job, so confirm who it is at each facility before you write.

Use public data to find facilities under pressure. CMS publishes Payroll Based Journal data, a facility-level file of daily paid staffing hours that includes agency and contract staff. It updates quarterly, and the latest quarter available when we checked was Q1 2026. A nursing home that leans on contract hours, or is thin on nurse staffing hours, is a lead with a date.

Pair that with job postings. A facility posting several nursing roles is hiring now. A past client that posted again is hiring again. dreach flags both for staffing firms, names the hiring manager with a current email and phone, and shows the warmest way in, so your team works the order from its own accounts.

Days 1 to 30: choose one role, one setting, and your states. Confirm each state’s license, registration, or reporting rule with the regulator. Start insurance quotes. Days 31 to 60: build the credential file template, set up exclusion screening, and sign up your first ten clinicians. Days 61 to 90: list twenty target facilities, find the nursing leader at each, and work them with specific open shifts, not a capabilities deck.