When Susan Salka came to AMN Healthcare in 1990, it was still known as American Mobile Nurses and employed 18 people. She was hired as the “head of finance,” which meant she did everything—literally.
“It ranged from, ‘Can you wash the dishes’ to ‘Can you keep the books?’ I joined them thinking, ‘Well, you know, I’ll do this for a year or two.’ Because who makes a career out of healthcare staffing?” Salka says to Chief Executive.
Twenty-eight years later and she’s still there. AMN is no longer just a small little healthcare staffing company. Today, it employs 3,000 people, has revenue of more than $2 billion, and is publicly-traded on the New-York Stock Exchange. It’s diversified beyond staffing into workforce solutions, such as managed service programs, vendor management and recruitment process outsourcing.
Salka, CEO, President and Director of AMN Healthcare, says she never had any intention of becoming the company’s chief, but as AMN grew, she took different roles and responsibilities. “It really gave me an appreciation and a love for the work we’re doing. And it became much more of a mission and a journey than a job,” she says.
Diversifying the company
Salka grew up in rural Nebraska with a Midwestern sensibility around “salt-of-the-earth people” like her parents, and graduated in a high school class of 12. She moved out to San Diego after college, crashing on the couch of her parents’ friend’s house. She got a job at a company named Hypertech for a year, making such an impression on the CEO and CFO that they asked her to join them at their venture capital firm.
“This was another really good lesson for me because I had people that believed in me, probably even more than I knew that I was capable of. They gave me opportunities to stretch myself and do interesting things, and gave me experiences that I really had no business trying,” she says.
Eventually she made her way to AMN, and rose the ranks of the company as it made acquisitions to solidify itself as the biggest staffing firm in healthcare, both in nursing and overall. Salka was named CEO in 2005 and by 2010, she was guiding the company as it transitioned from strictly being a staffing firm to offering workforce solutions.
“It was not a popular move with our shareholders because we were just coming out of the recession, just gaining some ground and traction. And then, we took on a bunch of debt and made this seemingly risky move. But we felt very passionate about the benefits that we could deliver for our clients and our shareholders,” she says.
The move has paid off, not just because workforce solutions represents more than half of AMN’s revenues from 2017. But also, Salka says, because many companies have begun to offer early-stage workforce solutions within healthcare, which shows AMN was ahead of the curve.
The shortage of talent in healthcare is the biggest challenge AMN faces, Salka says. “We hear this anecdotally from our clients that as fast as they hire people, people are going out the back door. And for every two jobs that are open, only one gets filled.”
In nursing, this shortage has especially heightened of the last few years, as the older generation of nurses has started to retire. Moreover, the good economy is actually bad for the nursing shortage, Salka says, because either nurses go part time or retire. Another factor is younger nurses tend to work shorter hours than the people retiring.
All together, it’s led to a brutal shortage. AMN did a survey in 2017 of more than 3,000 nurses, 48 percent said it was worse than it was five years ago, compared to 37 percent in the same survey from two years prior. Salka estimated there was a shortage 200,000-300,000 nurses and about 100,000 physicians. Future projections tend to vary, but most are fairly grim – in 2015, the Bureau of Labor Statistics projected a need of more than one million nurses by 2024.
Salka sees a few solutions to the problem. For one, she notes that more than 50,000 qualified candidates gets turned away from nursing school each year. Quite simply, there’s not enough faculty to teach them. “So one thing that can be done is to try to create more nurses with PhDs and master’s degrees,” and pay them accordingly, she notes. Another solution is to keep the older nurses working.
“We have to keep them in the workforce longer without overburdening them. So how can you create flexible work schedules and give them work that’s not as physically demanding? To be lugging patients around can be very taxing on you physically,” she says.
Another avenue, especially in regards to the physician shortage, is technology. Telemedicine, Salka notes, is picking up steam, becoming reimbursed by health insurers and more doctors are getting on board with it. “It will give us greater access to care at a lower cost. And we just will have to do it in order to make do with the shortages that we’re going to be encountering,” she notes.
Diversity and approachability
Diversity is one of the core values AMN is hoping to embody under Salka’s leadership. As the company has grown in size, it’s implemented structure and programs to ensure it’s continuing to focus on diversity inclusion, she says. As an example, the company has run data analysis to ensure it’s being as equitable as it says it’s being.
“The first piece of advice I would have for people is to really put a lens of metrics on what you say you want to do. And I think that’s a mistake that people make is they have programs and nice mission statements and charters, but they forget to actually measure those statements. Start with the baseline to say, ‘Where are we today?’”
“And I think that’s a mistake that people make is they have programs and nice mission statements and charters, but they forget to actually measure those statements.”
Salka says two-thirds of the entire workforce at AMN are women and about 62 percent of its supervisors and managers. At its C-Suite and corporate director level, half of the executives are woman. On the ethnicity front, Salka says the organization has a “ways to go” and about one-third of the team is non-white.
Along with measuring diversity with metrics, Salka makes sure to interact with employees at all levels and make herself approachable. “You might have this nice little mission statement, but if you aren’t actually seeing and hearing inclusion happen on a daily basis throughout the organization, then that mission statement doesn’t mean much. And so one of the things that I do is I walk the floors a lot,” she says.
Salka credits her dad with the approachability she brings to her job at AMN. “I’m my dad’s daughter for sure, because my dad would stop and talk to any stranger on the street and strike up a conversation. And I’m the same way in and out of the office.”