Selling a Medical Staffing Business in 2026: Multiples, Named Buyers, and the Operator Playbook
Quick Answer
A US medical staffing business in 2026 typically sells for roughly 3x to 9x EBITDA. Multiples have compressed from the 2021-2022 COVID-era peak (when travel-nurse bill rates and EBITDA were transient peaks) and have rationalized. By profile: a small single-state staffing firm at $300-700k SDE goes 2.5x-4x SDE; a profitable regional firm ($500k-1.5M SDE) goes 3.5x-5x SDE; a small multi-state firm ($1.5-4M EBITDA) goes 4x-6x EBITDA; a mid-size staffing platform ($4-15M EBITDA, multi-state, diversified specialty mix) goes 5x-7x EBITDA; a premium scale platform ($15M+ EBITDA, multi-state, named MSP/VMS contracts, technology-enabled) reaches 6x-9x+ EBITDA. Note: post-COVID travel-nurse bill rates compressed materially in 2023-2024; buyers normalize to post-COVID run-rate. Active buyers include AMN Healthcare (NYSE: AMN, ~$4B+ revenue, largest US public medical staffing), Cross Country Healthcare (NASDAQ: CCRN, ~$2B+ revenue), Aya Healthcare (private, ~$3B+ revenue, the largest US private medical staffing), Maxim Healthcare Group (private), Medical Solutions (TPG Capital), Trustaff (PE-backed), Fusion Medical Staffing (Aldrich Capital), Onward Healthcare, Triage Staffing (PE), CompHealth (CHG Healthcare Services, private), Locum Leaders, plus PE sponsors (TPG Capital, Apollo Global Management, Aldrich Capital, KKR, Blackstone, and multiple healthcare-services PE funds). The biggest multiple drivers are specialty mix (travel nurse vs. locum tenens vs. allied health vs. per-diem; allied health and specialty locums premium), MSP/VMS client contracts (managed services provider, vendor management system relationships with health systems), technology platform (TempWorks, Bullhorn, Avionté Bold, ClearStaff, Erecruit), and clinician retention. Buyer-paid M&A advisory (CT Strategic Partners) costs the seller nothing.
If you own a medical staffing business in 2026, the M&A market has rationalized from the 2021-2022 COVID peak (when travel-nurse bill rates briefly hit $200-300/hr and EBITDA inflated). Bill rates and margins normalized in 2023-2024. AMN Healthcare (NYSE: AMN), Cross Country Healthcare (NASDAQ: CCRN), and Aya Healthcare (private, the largest US private medical staffing) are the three dominant national platforms. PE-backed platforms (Medical Solutions / TPG Capital, Trustaff, Fusion Medical Staffing) continue rolling up regional firms.
What the asset is worth depends on three things: (1) specialty mix (allied health, specialty locum tenens, and per-diem premium to commodity travel nurse), (2) MSP/VMS client contract footprint with named health systems, and (3) technology platform sophistication and clinician retention. This guide covers real multiples by profile, the named buyers transacting, and the operator-level diligence buyers will run.
What this guide covers
- Medical staffing multiples 2026: 2.5x-4x SDE for small single-state, 3.5x-5x SDE for profitable regional, 4x-6x EBITDA for small multi-state, 5x-7x for mid-size platforms, 6x-9x+ for premium scale with MSP/VMS contracts and tech-enabled operations. Multiples compressed from 2021-2022 COVID peak.
- Active buyers: AMN Healthcare (NYSE: AMN, ~$4B+), Cross Country Healthcare (NASDAQ: CCRN, ~$2B+), Aya Healthcare (private, ~$3B+ largest US private), Maxim Healthcare Group, Medical Solutions (TPG Capital), Trustaff (PE), Fusion Medical Staffing (Aldrich Capital), CompHealth (CHG Healthcare), Triage Staffing.
- PE sponsor activity: TPG Capital (Medical Solutions), Aldrich Capital (Fusion), Apollo Global Management, KKR, Blackstone, plus multiple healthcare-services PE funds.
- Multiple drivers: specialty mix (allied health, specialty locum tenens, per-diem premium to commodity travel nurse), MSP/VMS client contracts with named health systems, technology platform (TempWorks, Bullhorn, Avionté Bold, ClearStaff, Erecruit), clinician retention.
- Things that compress the multiple: commodity travel-nurse-only mix, MSP/VMS-contract loss, weak clinician retention (high turnover signals quality issues), legacy operating systems, owner-recruiter dependence, 2021-2022 COVID-peak revenue normalization gap, classification issues on 1099 vs. W-2 clinicians.
- Sellers pay nothing on CT Strategic Partners’ buyer-paid advisory.
Named medical staffing M&A transactions (2022-2025)
| Target | Buyer | Year | What it tells us |
|---|---|---|---|
| Post-COVID rate normalization | Industry-wide | 2023-2024 | Travel-nurse bill rates compressed materially from 2021-2022 peaks. Buyer-side EBITDA normalization is required. |
| AMN regional tuck-ins | AMN Healthcare (NYSE: AMN) | 2022-2025 | Largest US public medical staffing continues selective tuck-in M&A across specialty staffing. |
| Cross Country regional tuck-ins | Cross Country Healthcare (NASDAQ: CCRN) | 2022-2025 | Public consolidator continues selective tuck-in M&A. |
| Aya Healthcare expansion | Aya Healthcare (private) | 2022-2025 | Largest US private medical staffing continues organic + selective M&A growth. |
| Medical Solutions continued M&A | TPG Capital | 2022-2025 | PE-backed staffing platform continues regional rollups. |
| Fusion Medical Staffing growth | Aldrich Capital | 2022-2025 | PE-backed allied-health-focused staffing platform continues regional rollups. |
The named buyer landscape
National public/strategic platforms
- AMN Healthcare (NYSE: AMN, ~$4B+ revenue) — the largest US public medical staffing company.
- Cross Country Healthcare (NASDAQ: CCRN, ~$2B+ revenue) — second-largest public.
National private platforms
- Aya Healthcare (private, ~$3B+ revenue) — the largest US private medical staffing company.
- CompHealth (CHG Healthcare Services, private) — large private locum tenens leader.
- Maxim Healthcare Group (private) — diversified healthcare services + staffing.
PE-backed national platforms
- Medical Solutions (TPG Capital) — multi-state staffing platform.
- Trustaff (PE-backed) — travel nursing + allied health.
- Fusion Medical Staffing (Aldrich Capital) — allied-health-focused.
- Triage Staffing (PE-backed) — travel + per-diem.
- Onward Healthcare, NurseFly, Vivian Health — tech-enabled platforms.
PE sponsors active in this space
- TPG Capital (Medical Solutions), Aldrich Capital (Fusion Medical Staffing), Apollo Global Management, KKR, Blackstone, plus multiple healthcare-services PE funds.
What each buyer will pay for vs. what they reject
- Will pay premium for: specialty mix premium to commodity travel nurse (allied health, specialty locum tenens, per-diem, advanced practice providers), MSP/VMS client contracts with named health systems (HCA, Tenet, AdventHealth, Ascension, etc.), technology platform sophistication (TempWorks, Bullhorn, Avionté Bold, ClearStaff, Erecruit), clinician retention, multi-state licensure footprint, documented post-COVID normalized run-rate revenue and margin.
- Will compress or reject: commodity travel-nurse-only revenue mix, MSP/VMS contract loss risk, weak clinician retention, legacy operating systems, owner-recruiter dependence, 2021-2022 COVID-peak revenue with unclear normalization, classification exposure on 1099 vs. W-2, weak technology platform.
The operator-level KPI playbook buyers will diligence
Specialty mix and revenue composition
- Specialty mix: Travel nurse %, locum tenens (physician) %, allied health (PT/OT/Speech/Lab/Imaging) %, per-diem %, advanced practice provider (APP, NP/PA) %.
- Specialty depth: ICU, OR, ED, oncology, mother-baby, NICU, cath lab, surg-tech.
- Average bill rate by specialty.
- Average margin per assignment.
Client base
- MSP (managed services provider) contracts: Document client by client.
- VMS (vendor management system) participation.
- Named health system contracts: HCA, Tenet, AdventHealth, Ascension, Trinity, etc.
- Client concentration: No single client above 20% of revenue.
- Contract terms and exit clauses.
Clinician workforce
- Active clinician count by specialty.
- Clinician retention rate.
- 1099 vs. W-2 classification: Most large platforms now W-2; 1099 has classification exposure.
- Background check, license verification, OIG exclusion check.
- Compact-state nursing license tracking (NLC).
Technology platform
- ATS/CRM: Bullhorn (the recruiting standard), TempWorks, Avionté Bold, ClearStaff, Erecruit, Salesforce + custom.
- Self-serve clinician app: Vivian, NurseFly, custom.
- VMS integration: Cross-Country VMS, Shiftwise/AMN, others.
- Credentialing automation.
RCM and financial controls
- Days in AR: <45 days is healthy.
- Bill-pay spread (gross margin per assignment).
- Bad-debt write-off.
- Credit-line and factoring usage.
Post-COVID normalization
- 2021-2022 peak revenue vs. 2023-2026 normalized run-rate.
- Bill-rate trends by specialty.
- Margin trend documentation.
Dangers and traps in medical staffing M&A
1. 2021-2022 COVID-peak revenue normalization
Travel-nurse bill rates briefly hit $200-300/hr in 2021-2022 with corresponding EBITDA inflation. Buyer-side diligence will normalize to 2023-2026 run-rate. Don’t market off peak EBITDA.
2. Commodity travel-nurse-only revenue mix
Commodity travel nurse is the lowest-margin segment. Specialty mix (allied health, specialty locum, per-diem, APP) is the multiple-builder.
3. MSP/VMS contract loss risk
If named MSP/VMS contracts are up for renewal during sale process, that creates uncertainty.
4. 1099 vs. W-2 clinician classification
Worker classification exposure has been an ongoing IRS/DOL focus. Most large platforms operate W-2.
5. Clinician retention and quality
Low clinician retention signals operational and recruiting issues.
6. Legacy operating systems
Bullhorn is the recruiting standard. Legacy or home-grown systems trigger integration discount.
7. Owner-recruiter dependence
If the owner is the lead recruiter for top clients, build the BD/account-management bench.
8. Credit-line / factoring exposure
Many staffing firms rely heavily on credit lines or factoring; document leverage and working-capital structure.
Our POV on medical staffing M&A in 2026
Medical staffing M&A has rationalized from the 2021-2022 COVID-era peak. AMN (NYSE: AMN), Cross Country (NASDAQ: CCRN), and Aya Healthcare (private) are the three dominant national platforms. PE-backed platforms (Medical Solutions/TPG Capital, Trustaff, Fusion Medical Staffing/Aldrich) continue rolling up regional firms. Premium multiples require specialty mix beyond commodity travel nurse, named MSP/VMS contracts, and modern tech platforms.
Preparing your medical staffing business for sale: 12-18 months out
- Get multi-year audited or reviewed financials. Document post-COVID normalization.
- Diversify specialty mix. Build allied health, specialty locum tenens, per-diem, APP exposure.
- Lock in MSP/VMS contracts. Multi-year terms.
- Resolve 1099 vs. W-2 classification issues.
- Document clinician retention metrics.
- Modernize the tech platform. Bullhorn, TempWorks, Avionté Bold.
- Build the BD/account-management bench.
- Document credit-line and working-capital structure.
- Run a competitive process. AMN, Cross Country, Aya, CompHealth (CHG), Maxim, Medical Solutions (TPG), Trustaff, Fusion (Aldrich), plus PE sponsors directly.
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Start a Confidential Conversation →Frequently asked questions
What is the typical multiple for a medical staffing business in 2026?
Small single-state firms ($300-700k SDE) typically sell at 2.5x-4x SDE. Profitable regional firms ($500k-1.5M SDE) go 3.5x-5x SDE. Small multi-state firms ($1.5-4M EBITDA) go 4x-6x. Mid-size platforms ($4-15M EBITDA) go 5x-7x. Premium scale platforms ($15M+ EBITDA, MSP/VMS contracts, tech-enabled) reach 6x-9x+. Multiples are materially compressed from the 2021-2022 COVID peak.
Who are the active buyers of medical staffing businesses right now?
National public: AMN Healthcare (NYSE: AMN, ~$4B+ revenue), Cross Country Healthcare (NASDAQ: CCRN, ~$2B+). National private: Aya Healthcare (~$3B+, largest US private), CompHealth (CHG Healthcare Services, locum tenens leader), Maxim Healthcare Group. PE-backed: Medical Solutions (TPG Capital), Trustaff, Fusion Medical Staffing (Aldrich Capital), Triage Staffing. PE sponsors: TPG Capital, Aldrich Capital, Apollo Global Management, KKR, Blackstone.
What hurts a medical staffing business’s valuation most?
2021-2022 COVID-peak revenue without clear post-COVID normalization documentation, commodity travel-nurse-only revenue mix without specialty diversification, MSP/VMS contract loss risk, 1099 vs. W-2 classification exposure, weak clinician retention, legacy operating systems, owner-recruiter dependence, and weak credit-line/working-capital structure.
What happened to medical staffing after the 2021-2022 COVID peak?
Travel-nurse bill rates briefly hit $200-300/hour during COVID with corresponding EBITDA inflation. Rates and margins normalized in 2023-2024. Buyer-side diligence now normalizes to post-COVID run-rate revenue and margin, which is materially lower than the 2021-2022 peaks. Marketing off peak EBITDA leads to deal failure or material price-down at term sheet.
Why is specialty mix so important for valuation?
Commodity travel nurse is the lowest-margin segment and most commoditized. Specialty mix (allied health like PT/OT/Speech/Lab/Imaging, specialty locum tenens physicians, per-diem nursing, advanced practice providers like NPs and PAs) commands higher margins, has less rate compression, and demonstrates platform sophistication. Diversified specialty platforms achieve 1-2 turns of EBITDA premium.
Do I have to pay a broker fee?
No. CT Strategic Partners runs a buyer-paid M&A advisory model. The seller pays nothing. The buyer pays the success fee at closing.
How long does it take to sell a medical staffing business?
Once you go to market with a buyer-paid advisor, a typical process runs 4-7 months from initial outreach to closing. Add 12-18 months of preparation work before going to market.
When should I start preparing if I plan to sell in 2027 or 2028?
12-18 months before going to market is the right window. Highest-leverage pre-sale work: diversify specialty mix beyond commodity travel nurse, lock in MSP/VMS contracts, resolve worker classification, modernize the tech platform (Bullhorn), and document post-COVID normalized run-rate.
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About the Author
Christoph Totter is the founder of CT Acquisitions, a buy-side partner headquartered in Sheridan, Wyoming. We work directly with 76+ buyers, search funders, family offices, lower middle-market PE, and strategic consolidators, including direct mandates with the largest home services consolidators that other intermediaries can’t access. The buyers pay us when a deal closes, not the seller. No retainer, no exclusivity, no contract until close. Connect on LinkedIn · Get in touch