CEO: Susan R. Salka.

Revenue: $760 million in 2009; $1.2 billion in 2008.

Net income/loss: $122.2 million net loss in 2009; $34.4 million in net income in 2008.

No. of local employees: 507.

Headquarters: Carmel Valley.

Year founded: 1985.

Stock symbol and exchange: AHS on the New York Stock Exchange.

Company description: Provides travel nurse, per diem local nurse, allied and temporary physician staffing, and permanent physician placement services.

Health care reform may be a permanent fix to provide every American with basic medical services, but look to temporary staffing firms to do a lot of the heavy and challenging lifting on the patient care recruitment front.

Landmark legislation signed into law by President Obama promises to bring far-reaching change to the nations health care system.

While many of the laws provisions dont take effect until 2014, access to health care provided under this bill will greatly increase the need for clinical professionals. At the same time, a large number are already leaving the nursing and physician ranks, which will make recruitment a challenge, according to a local medical staffing executive.

At AMN Healthcare, a San Diego-based temporary health care staffing company doing business nationwide, leaders are paying close attention to the broader discussions as lawmakers, regulators and possibly the nations courts weigh in on the final details.

Were certainly preparing to move forward (and adapt to the changes), but many of the rules have yet to be written, said Susan R. Salka, chief executive officer of AMN Healthcare.

Competition for available workers may increase clients costs of doing business as they vie for temporary and permanent labor to provide high-quality patient care, said Salka, whose employer ranks 11th on the San Diego Business Journals latest list of Largest Public Companies with fiscal 2009 revenue of $759.8 million.

AMN works with a lot of hospitals, which staff up and down with the ebbs and flows of admissions.

Even with the recession, health care has continued to grow.

Lynn Reaser, an economist with Point Loma Nazarene University, has estimated local health care employment at 100,700 people in 2010, with a 2.8 percent increase to 103,600 in 2011.

Revenues Rising

This year, temporary staffing industry revenues in the U.S. are expected to grow by 4 percent to $7.9 billion, according to estimates by Staffing Industry Analysts, an advisory service that provides data about temporary staffing.

Growth in the health care industry may very well fuel growth in other sectors, and the educational institutions will struggle to keep up, said Salka.

By 2019, an additional 32 million uninsured will be covered, increasing the proportion of the population with insurance to 94 percent. In San Diego County, perhaps a half-million newly insured will be entering the health care delivery system. Thats the conservative estimate of health care industry analyst Nathan Kaufman, managing director of Kaufman Strategic Advisors LLC in San Diego.

Salka said she is concerned that not enough providers will fill the ranks of retiring physicians, nurses and allied health professionals.

Its a very rigorous work environment for someone in their 50s and 60s, said Salka, referring to the physical demands of nursing. Its not that easy to lug patients around (when youre older).

Many are already looking to reduce their hours.

Primary Care Concerns

A big concern is the fact that as health care reform is implemented, the role of primary care physicians will increase.

The focus is on primary and preventive care, but we are projecting a physician shortage of 125,000 (primary care) doctors during the next 15 years, said Salka.

It takes eight to 10 years for an undersupply in physicians to be corrected, she said. At the same time, medical students are moving toward the specialty practices because of the higher level of compensation. Salka foresees more residency slots being filled by foreign-trained physicians.

In the new health care environment, Salka said a lot of routine care will also fall to nurse practitioners and physician assistants.

About 40,000 qualified candidates for nursing (schools) were turned away last year; not because there werent enough slots, but because there werent enough faculty members, she noted.

Outsourcing Billing, Coding Functions

With health care reform looming, another local company is looking at potential opportunities to address temporary labor needs on the clinical and nonclinical sides.

We believe a lot of physician practices will be looking at outsourcing more of the medical billing and coding functions under Obamacare, said Bill Stone, president of TheraStaff LLC and Medical Resources Staffing Services, which are part of the San Diego-based Eastridge Group of Staffing Cos., a privately held business.

With billions of additional dollars coming into the system, Stone said the government is looking for higher levels of accountability. New rules targeting fraud may incentivize doctors to contract more billing work out to third parties.

Stone said the company is also looking at generating more business with another large government health care provider: the U.S. military.

Just back from a three-day seminar on how to become a health care vendor, Stone said his company is looking at bringing its physical, occupational and speech therapists to military hospitals in greater numbers.

Anything related to the government is complicated, but if you are going to do business in todays world, you look for new markets, said Stone, who envisions his temporary staffers assisting in the rehabilitation of wounded soldiers at veterans hospitals.

Rather than look at signing multiple contracts with hundreds of providers, working with Uncle Sam is sort of one-stop shopping.

It helps facilitate a greater volume of access to opportunity at U.S. military hospitals in California and across the country, said Stone.