You can work with three different agencies and find they all have the same job at the same hospital, at slightly different pay. That's usually not a coincidence. It means the hospital uses an MSP, and every one of those agencies is pulling the job from the same system. Knowing how that works helps you pick the right agency and avoid getting knocked out of a job before anyone even looks at you.
What an MSP is
A managed service provider (MSP) is a company a hospital or health system hires to handle all of its contract staffing. Instead of managing contracts with dozens of agencies, the hospital deals with one MSP. The MSP posts the jobs, collects nurses from agencies, sets the rules, and handles billing.
Most MSPs run the jobs through a vendor management system (VMS), a website where approved agencies see open jobs and submit nurses. Many of the biggest MSPs are run by large staffing companies, which also have their own travel nurse agencies.
On our facility pages, the Agencies and MSP section shows whether a hospital is known to use one and which company runs it, when we've confirmed it. Kaiser Permanente's California hospitals, for example, have used AMN as their MSP.
How a job gets from the hospital to you
- The unit manager needs a traveler and puts in an order with the MSP: specialty, shift, start date, length.
- The MSP posts the order in its VMS with a set bill rate, the hourly amount the hospital will pay for a nurse.
- Approved agencies see the order. In some setups, the MSP's own agency sees it first.
- Recruiters submit nurses' profiles through the VMS.
- The MSP sends the best profiles to the manager, who picks who to interview.
- The offer goes back through the MSP to the agency, and then to you.
The manager usually never talks to your recruiter. Everything goes through the MSP.
Two kinds of MSP setup
| Master vendor | Vendor neutral | |
|---|---|---|
| Who runs it | A staffing company that also places its own nurses | A company that doesn't place nurses itself |
| Who sees jobs first | Often the MSP's own agency, for a set window before other agencies | All approved agencies at the same time |
| Other agencies | Work as subcontractors and pay the MSP a fee | Pay the MSP a fee |
Hospitals don't advertise which kind they use. Recruiters usually know.
What it means for your pay
Every agency on an MSP job is working from the same bill rate. Out of that, each agency pays the MSP its fee, keeps its own margin, and pays you the rest. So the differences between agencies' offers for the same job come down to two things: how big a cut the agency takes, and whether it's paying an MSP fee at all.
- The MSP's own agency often pays more on that MSP's jobs, because it isn't paying a subcontractor fee. It may also get the job before anyone else.
- The bill rate is usually fixed. When a recruiter says "the rate is locked," that's often true. What can still move is the agency's margin, which shows up as your rate, a bonus, or travel money.
- Crisis or rush rates are set by the hospital through the MSP, not by the agency.
- Extension rates are often set by the MSP too. Ask whether your rate stays the same if you extend.
One job, one submission
This is the part that costs nurses jobs. If two agencies submit you to the same job in the same VMS, the system flags it as a double submission. Often both get thrown out, and some MSPs will hold it against you for future jobs.
- Before any recruiter submits you, ask them to tell you the exact hospital, unit, and job.
- Keep a simple list of which agency submitted you to which job, and when.
- If an agency asks you to sign a right to represent, that's normal. It means only that agency can submit you to that job. Don't sign one for the same job with a second agency.
- If two agencies have the same job, pick the one paying more and tell the other one not to submit you.
Time off, changes, and cancellations
With an MSP in the middle, your contract terms are mostly set by the MSP's agreement with the hospital, not by your agency.
- Time off must be in the submission. Days you need off go in with your profile. Asking after you've accepted often gets a no.
- Changes go through the MSP. A schedule change, an extension, or a different start date has to go up through your agency to the MSP and back down. It takes longer than you'd think.
- Cancellation rules are the MSP's. How much notice the hospital has to give and what you're paid if shifts are cancelled usually come from the MSP agreement. Ask your recruiter to show you those terms.
- Problems on the unit go to your recruiter, who takes them to the MSP. You can still talk to your manager, but the formal process runs through the MSP.
The question to ask every recruiter
"Is this job through an MSP? Which one? Is your agency the MSP or a subcontractor?"
That one question tells you whether this agency is likely to pay the most for this job, whether it sees jobs first, and whether the rate can move. Good follow-ups:
- How many nurses have already been submitted to this job?
- How long has it been open?
- Are my time-off dates in the submission?
- What are the MSP's cancellation terms?
- Is the extension rate the same as the starting rate?
If a recruiter can't answer, or won't, that tells you something too.