Matt Young was supposed to be a lawyer. A pre-law political science and criminology student in western Massachusetts, he had a talented attorney for a brother, an acceptance into the police academy, and a year to kill before it started. Then a friend made him an unusual pitch: come be “a sports agent for doctors.”
Two decades later, Young is co-founder and managing partner of All Star Healthcare Solutions, a Deerfield Beach, Florida firm with roughly 340 internal employees serving all 50 states — and, as president of NALTO (the National Association of Locum Tenens Organizations), one of the industry’s leading voices on Capitol Hill. On this episode of The Protean Pulse Podcast, he sat down with host Rajee Hari to talk about the locum tenens staffing industry from every angle: builder, operator, and advocate.
An Industry Where “Everybody Wins”
Ask Young to explain locum tenens and he starts with the stakes. More than 50,000 physicians — before counting NPs, PAs, and CRNAs — now provide temporary care across the country, accounting for over a million patient interactions a year. And most of that care isn’t happening in Beverly Hills.
“We’re really talking about the rural and underserved areas,” he says, where patients can wait three months to see a primary care physician, and where entire counties operate without a single active OBGYN.
That’s what fuels his passion for the model. Hospitals keep ORs open. Physicians choose their contracts, negotiate their rates, and stay in the workforce longer — including semi-retired doctors who’ll work 20 weeks a year but not 45. Patients get care that otherwise wouldn’t exist. “It’s one of those rare situations where everybody wins,” Young says.
The Myth That Wouldn’t Survive the Data
Early in Young’s career, locum physicians carried a stigma: the belief that doctors choosing temporary work were somehow substandard. That theory, he says, has been debunked. Clinical studies have shown patient outcomes from locum physicians are equal or better — at equal and sometimes lower cost, once you account for the full expense of a permanent employee.
The other great change over 20 years? The free flow of information. Where recruiters once had to explain that the industry even existed, physicians now come looking — a trend Rajee Hari has seen firsthand at Protean Med, with more doctors proactively asking for 1099 locum opportunities since COVID. Young agrees: physicians want to take care of patients, not sit on committees or wrestle with credentialing. “All they need to do is show up, take care of the patients, and go home.”
Building From Zero: Lessons From Two Startups
Young helped build his first locum firm, Onyx M.D. in Denver, at age 26 — “I don’t know who’s more screwed, these people or me,” he remembers telling his mother after day one. The lesson that stuck: “The real key is embracing what you know you don’t know.”
At All Star, which he co-founded with Keith and Craig Shattuck in late 2010, that humility hardened into operating principles:
- Do what you say you’re going to do. With no budget for brand-building, reliability is the brand — on both the provider and client side.
- Reinvest relentlessly. “You can be a lifestyle organization or you can be a growth organization. You can’t be both. So if you want to drive a Ferrari after being in business for two years, your company’s never gonna grow.”
- Fund the hockey stick before it happens. Staffing growth means paying physicians on time, every time. Miss payroll by even a few days and the goodwill is gone — “they’re never coming back.”
The Landmines That Sink New Agencies
For small firms — like Protean Med, as Hari candidly notes — Young offers a field guide to what he calls the $100,000 mistakes:
- Bad contracts. Indemnification language and insurance requirements imported from W-2 nurse staffing don’t belong in locum agreements. Sometimes walking away is the win.
- Letting physicians carry their own malpractice. Your client contract warrants that coverage exists. If a provider lapses — or never buys tail coverage on a claim that can surface 17 years later in OB — the lawsuit names you.
- Outgrowing your funding. Margins have tightened, VMS fees and regulatory costs have grown, and it’s more expensive to book a day than ever.
His broader advice for staying competitive as a small player: use NALTO. Monthly free training seminars, risk management guidance, industry relationships, and national lobbying — “you’ll make 50, 100 times” the dues back, he argues.
The Fight to Keep Physicians 1099
Young’s proudest work may be legislative. When policies like California’s AB5 and the proposed PRO Act threatened to reclassify independent contractors as employees, NALTO retained a DC lobbying firm and went to work. The result: 30 of 50 U.S. senators now know what locum tenens is, and H.R. 7881 — a bill NALTO helped write — was introduced with bipartisan support.
The stakes, as Young frames them: force locum physicians into W-2 status and the available workforce could be cut in half or worse, with higher costs for hospitals and fewer providers for the communities that need them most. Physicians themselves are joining NALTO on Capitol Hill to make the case. His ask takes 30 seconds: visit nalto.org/action.
Rolls-Royce Economics and the AI Question
On M&A, Young is blunt: private equity and strategic buyers have a heavy appetite for profitable locum firms, and he doesn’t see it slowing. “This is the Rolls-Royce of staffing,” he says — physicians are both socially critical and revenue-producing, and the physician shortage projected by 2035–2040 only widens the supply-demand gap.
And AI? A reallocation, not a revolution. Pattern-recognition tools may transform fields like radiology and automate staffing busywork, but the relationships — the weddings attended, the decades-long friendships with providers — stay human. “I don’t think anything will ever substitute the human interaction piece.”
The Takeaway
From accidental recruiter to industry president, Matt Young’s story doubles as a thesis: locum tenens staffing works because the incentives align — for physicians, hospitals, agencies, and above all, patients. Protecting that alignment is now the industry’s biggest job.
✊ Protect physician independence: nalto.org/action
Rajee Hari (00:00): Hey everyone, welcome to Protean Pulse, a healthcare podcast from Protean Med. I’m Rajee Hari, President and CEO of Protean Med, a healthcare staffing and recruiting solution provider based out of The Woodlands, Texas. I have a charming, dynamic, high-energy, successful veteran in the locum tenens industry: Mr. Matt Young. He is the co-founder and partner of All Star Healthcare Solutions, located in Deerfield Beach, Florida.
He had plans of pursuing a career in law — and I don’t know what happened and how his life turned around — but he came into the locum tenens industry. We would like to pick his brain and learn more about him, his knowledge, and his viewpoint on the industry. We are excited to welcome you, Matt. Welcome to the podcast.
Matt Young (00:48): Thank you so much. It’s always a pleasure to see you, and thanks for having me on.
Rajee Hari (00:52): Absolutely, Matt. You can say that you have been there and seen that for pretty much everything in the locum industry — from hiring and training, you’ve done operations, sales, marketing, the IT department, and of course now you’re in a leadership position. Can you share a little bit about your background and how your career has shaped you thus far?
Matt Young (01:13): Sure. And I don’t know who the charming person is — that must be the person coming on after me — but thank you for those kind words. I’ve spent almost two decades now in the locum tenens staffing industry. I got my start by accident, a little bit. As you mentioned in the introduction, I was a pre-law political science major in criminology at a small university in western Massachusetts.
I met a couple of great mentors — we all have these forks in our lives where we meet people and they make tremendous impacts. I had a couple of professors that saw something in me I guess I didn’t see in myself, and I’m very grateful for that to this day. I became a little bit of a late-developing student-slash-nerd, I suppose you could say. My brother is a very talented attorney who now works for the GAO in DC, and I thought that was the route I wanted to take — but I didn’t want to take it in the Northeast. So I moved to Florida right after my undergraduate degrees.
I had a really close friend — my now business partner, Keith Shattuck; he is the chairman of our board at All Star Healthcare Solutions. He was one of only two people I knew in the entire state of Florida when I moved. I was looking through my options for grad school, and I had been accepted into the police academy, believe it or not. I would have made an awful police officer — God bless our men and women that are LEOs; I don’t know how well I would have done. What was funny about it was I had about a year to wait before I would enter the academy. And again, a gentleman who I respect and love dearly said, “Hey, why don’t you try this niche? I’m doing this work and I’m like a sports agent for doctors. There are these talented people that are traveling all over the country and saving lives, and I’m making a little bit of money doing it. I think you’d be good at it.” And I said, well — a job with benefits, dealing with highly intelligent people, and I’ve got a year to kill anyway. Okay, great.
The more I got into the industry, the better I became at it. I made a lot of close relationships. And right as I was about to enter that world of law, law enforcement, and graduate school, the more I really wanted to stay within this industry. That’s how I got involved.
The next big thing that happened to me was a physician out of California that I had recruited for an anesthesiology position was building a locum tenens firm on his own, starting it from scratch. I think I was 26 — didn’t know a thing about building a company, didn’t know a thing about Denver, Colorado — but I had a really great relationship with them, and I decided to help a company come up from the ground. That was my first experience of building an organization, and I’m very proud of my time there. I spent a little over five years.
They were building up operations in Texas, and I felt like Florida’s always been my home. That led me to going back with my original close friend from the Massachusetts days, and I co-founded the locums organization with Craig and Keith Shattuck, who now sit on our board of directors. They had a very successful perm placement business, and my expertise really came in the operations of the locums end of things. We’ve continued to operate that profitable perm end of the spectrum, but the expertise I was able to lend — and really, the great team around us — was on the locum end. That’s how I ended up with All Star. I think that was late 2010, 2011. It’s been a wonderful ride. I’ve met a lot of great people and worked with a lot of great HCOs and physicians nationwide. I hope that answered your question, but that’s the condensed version of how I ended up here.
Rajee Hari (05:13): This is mind-boggling for me. You decide to take a one-year break, you had a choice between law and law enforcement, and then you enter the locums field and take off in that direction. You help out as an entrepreneur, pretty much with a crisis, and then you start out with All Star and you have taken it to a new level, I should say. I have been reading up a lot about All Star — I’m pretty new to the field as well — and it’s quite inspiring to hear your story, for sure.
So with this 20-plus years of experience in the locum space, what are the key insights or lessons you have learned about the industry that have shaped you, your life, and your approach to providing these staffing solutions? What do you think has been the growth in the industry, and how has your growth been affected by it?
Matt Young (06:13): I could talk for two hours about that one question — it’s a great question. The first time you meet somebody and you say, “Well, I’m in staffing,” they say, “What kind of staffing?” And you say, “Locum tenens.” And they’re like, “Local tennis? What’s that?” So you have to explain what it is. And I know we’ll get to NALTO and the lobbying that we do a little bit later on, but it’s amazing — there are now over 50,000 physicians alone, never mind NPs, PAs, and CRNAs, that provide this temporary care all over the country.
And I know you know this as well as I do, but most of this care is not being given in Beverly Hills or downtown Miami. On occasion it’s done in places like that, but we’re really talking about the rural and underserved areas, where some of these people across our great country are waiting three months to see a primary care physician. Or, God forbid, they need specialty care or some type of surgical procedure — or an OBGYN. How many counties in our country are without an active OBGYN servicing a population?
So whenever I talk about the industry — and obviously I’m very passionate about it — not only has it really given me the ability to earn a living and be surrounded by amazing people, but when I put my head on the pillow at night, there’s something uniquely, intrinsically satisfying about finding somebody a job, number one. Not that they need me — they could find one without me. But the reality is, if I can put them in positions to make the most impact — and yes, earn a living at the same time, and help grow my own organization as well — it’s one of those rare situations where everybody wins.
And what I mean by everybody: if a healthcare organization doesn’t have a physician in a particular place, they have to, God forbid, close down an OR — there are a lot of these scenarios that are completely undesirable, to put it lightly. There are a lot of complexities that come with these placements, but the bottom line is, if we can place these folks where they’re needed, the organization — a company like All Star — we certainly win. The provider wins; the physician wins, because they’re providing care, perhaps earning some extra money while they’re traveling the country, keeping their skills sharp. Let’s say it’s someone coming out of retirement and they don’t want to work 40, 45 weeks a year, but they’ll work 20 — we want to keep that physician in the workforce. No one wins if that physician retires early and then goes and fishes for the next 25, 30 years.
And then really the most important aspect of it: the patients and the communities win. Because right now — and COVID taught us this, obviously, going through the pandemic — we have a nation of folks that really are in dire need of preventative care, not to mention when things arise that are more urgent. We want to be a part of that solution. So when people ask where I get my passion from — and one of the reasons I got involved with NALTO, as an example, donating time to do that — it’s because I want to see the industry continue to flourish for all those reasons. It’s one of those few industries where everybody wins, if that makes sense.
Rajee Hari (09:33): Yeah. So have you seen a change in the industry? Have you seen a trend over the past 20 years — and what are those changes?
Matt Young (09:40): First and foremost, number one is really the internet, which has changed all business. There’s a free flow of information that wasn’t there prior. I’m going to say it’s 95% good — you’re going to get five percent bad of anything. But the reality is, in the beginning, you used to call some providers and they wouldn’t even know the industry existed. And some clients weren’t really on the up and up. There was this belief that physicians who chose to do this type of work were substandard.
We now know for a fact — and there have been clinical studies that have proven this — that patient outcomes, number one, and number two, cost: the patient outcomes are actually equal or better, and the cost is equal and sometimes less. Now, some people will say, “Well, you’re paying somebody a day rate that’s more than if you had a permanent position there.” Sometimes, sure. But the reality is you have to build in a lot of other costs with an employee. Whereas a 1099 that’s choosing to be a 1099, working in multiple places — they are accepting the contracts that they choose to and not accepting others. It’s been proven over time.
So if you asked me the greatest difference: it’s the free flow of information. And it’s also that the care — maybe 25 years ago, people said it was substandard. I haven’t read a study to prove that, but let’s even accept it as a possibility. That whole theory has been debunked. There have been several case studies proving the two items I just said: equal or lower cost, and equal or greater patient outcomes.
Rajee Hari (11:24): Interesting. I also feel that locums has become very popular, especially after the COVID situation. What I see is many of them don’t want to take up a perm job — they’re okay with doing 1099. I see a lot of doctors coming to me and saying, “Hey, if you have a locum opportunity, let me know, because I’m ready to go 1099 moving forward.” I think that is a huge trend I have seen post-COVID. I’m not sure if you have seen that as well.
Matt Young (11:52): I think that’s an important point, because early in my career, all I did was talk to physicians — I got involved on the contract side, the hospital and HCO side, later on. The conversations I used to have: “Matt, you know what I want to do? I get joy out of taking care of patients. That’s what I like.” Instead — and you would know more about this than I would, perhaps — the reality of working within an HCO is: “I need you on this committee.” And then there’s maintaining your own malpractice, and all these other ancillary things taking place.
The beauty of locum tenens is: I can work as much or as little as I want. I can negotiate my own rate. I know the key things — med mal, travel, all my logistics — are taken care of. Licensing, credentialing, all the things that are annoying. That’s part of what we do as agencies: we want to alleviate that friction and allow these physicians and providers to go to these areas of great need. All they need to do is show up, take care of the patients, and go home. In my experience, for the majority of the physicians, that’s what they really wanted to do. So I agree with you wholeheartedly. I think that’s a big part of it — and a big part of the growth of the industry overall, both pre-COVID and especially post-COVID.
Rajee Hari (13:16): Absolutely. Correct me if I’m wrong — your expertise is building an organization from the ground up, right? When you were 26 and started this ground-up organization with a physician, what were the challenges you faced, and what are the learning points you took home and implemented at All Star that helped the organization become better and more robust compared to the first time around?
Matt Young (13:44): I’m not making light of it, but I remember the first day I worked with my colleagues out in Denver — the firm name was Onyx M.D.; I’m very proud of the work we did there, and they’re now a part of Health Carousel down the line. I remember it was a long day, like a 15-hour day, and we were trying to figure out how to get that plane off the runway. And I remember calling my mom — I had never been to Denver; it was the first time I’d ever been there — and I said, “I don’t know who’s more screwed, these people or me. Because I think they think I know more than I do, and I thought they were further along than they are.”
But as with all great companies — even Apple started in the garage, right? You get all these stories of entrepreneurs that, not fake it till they make it, but through brute force say: okay, I have this level of expertise. I think the real key is embracing what you know you don’t know — that’s very Socratic, I believe. I went out there with this talented group of people and said: okay, here’s what we know and here’s what we don’t know. But do we know enough to create a contract, find a physician, put a deal together, send them, and get the proper malpractice and the proper logistics? Well, we can do that. Okay, let’s do that 25 times. And as we’re doing that, we’re going to try the best we can — because the problems of a zero-to-five-employee organization pale in comparison to when it’s a hundred people, or two hundred, or five hundred.
Rajee Hari (15:14): Tell me about it. I’m in that zero to five, right? So I know the pain point.
Matt Young (15:18): So you’re basically breaking rocks out there, trying to make a brand, make a name for yourself. You don’t have a huge budget. And I wish there was a better answer for this, but you have to come through and do what you say you’re going to do. When you do that enough times — both on the provider side and the client side, and I’m using “client” to describe HCOs — that’s what starts momentum.
And then: being able to keep those retained earnings in the company to help fuel the growth. Because you have two choices. You can be a lifestyle organization or you can be a growth organization. You can’t be both. So if you want to drive a Ferrari after being in business for two years, your company’s never going to grow. Luckily, I was around people — obviously at Onyx, but especially at All Star — where we embraced that early on.
And luckily for me — I want to make sure to give him his due, too — Keith, my business partner, had a long history in locum tenens as well. He was one of the top billers for years. So when we got that enterprise moving, that was like pouring gasoline on a fire. To be honest — and obviously I’m biased — I would pick myself, Keith, and Craig up against anybody building a company from the ground up. It was the perfect team for me. I couldn’t have done it on my own by any stretch, and our executive team then grew from there.
So in the beginning, it’s just brute force: creating a brand, getting some momentum, getting profitable, and then being willing to reinvest that into not only more placements, but also knowing what you don’t know. There are textbooks written on companies that outgrow themselves. They all want to do this hockey stick, but they don’t realize — in staffing in particular — as soon as you hit that increase, that’s the hockey stick, you better have the funding in place to be able to pay the doctors. Because I’ll tell you what: the first time you miss a couple of those payments, all that goodwill you built up with these providers — they don’t want to work for an organization that delays their pay a day or two days or three days. They’re never coming back. So you have to be prepared to meet those challenges head-on.
Rajee Hari (17:31): Interesting. So tell me a little about All Star. Is it only focused on locums, or does it do perm as well? Are you across the country? What’s your employee strength? Tell me a little bit about All Star.
Matt Young (17:45): Of course. As I mentioned a little earlier, All Star was a perm firm prior to my arrival — they were very, very successful. They didn’t do retained, but they did contingency perm work. And then we developed locum tenens, in part due to my arrival, though obviously there was expertise there outside of my own. We now service all 50 states. The last number I saw was about 340 internal employees — that’s everybody from the people that call the providers, to the people that handle the logistics, to the financial end, to the travel end.
What the average person doesn’t necessarily understand when they hear about the industry for the first time is the amount of complexity in one single placement. Whether it’s: “Hey, I need somebody in North Dakota.” “Well, I don’t have a license in North Dakota.” Well, we have a licensing team. Now they need to get credentialed — they get credentialed. “I’m only going to go there if my travel is under X amount of hours.” Well, we have a travel department. The number of people that have to contribute to make one single placement happen — that collaboration takes the right leaders to make it happen.
We’re now, I think, in the top six or seven — I haven’t seen the updated SIA numbers. But we started from zero and got to that level. I’m very proud of what the team’s been able to accomplish.
Rajee Hari (19:16): Excellent. That’s about — you’re thirteen years into this company, right?
Matt Young (19:20): Yep.
Rajee Hari (19:20): So, I was charmed when I came to Colorado for the NALTO fly-in — unfortunately I couldn’t attend the San Antonio one. But tell me about NALTO. I was completely blown away by the organization.
Matt Young (19:36): Well, that’s very kind, and I look forward to seeing you in Park City, Utah in September.
Rajee Hari (19:40): I’m hoping to come as well — fingers crossed, I should be there.
Matt Young (19:43): Awesome. I appreciate the kind words. My involvement with NALTO started, I’m going to say, about 15 years ago — when I was already in Colorado. I obviously knew what NALTO was, but I wasn’t really in a position to donate time, nor did I have the expertise to lend at that point. So I started getting involved in the ethics committee, as well as the legislative committee and the membership committee.
Number one, I wanted good, solid relationships — even though they’re competing agencies, I always liked having good relationships. If there was ever a dispute about a placement or something that needed to be worked out, I always had a face and a name and a number I could dial. Sometimes what happens to firms that are outside NALTO is they draw a line in the sand and say, “Well, if you don’t go through us, you’re not going.” And then — remember what I talked about with the solution where everybody wins? Well, that’s the opposite. Everybody loses.
Rajee Hari (20:43): One second, for the listeners — NALTO stands for the National Association of Locum Tenens Organizations, right? So that’s what it is. Go ahead, Matt.
Matt Young (20:54): Yes. So I got involved, and I wanted solid relationships with my competitors. But our industry is so critical — I mentioned the over 50,000 physicians alone, but you’re now talking about over a million patient interactions a year performed by locum tenens physicians alone, not to mention NPs, PAs, CRNAs. This is a huge industry with such tremendous societal impact. I looked at it as a way to give back. I said, if I can help move the industry along, help educate about it, help protect it — whatever.
I started with my involvement in committees, and then I was asked to run for the board. I remember talking with some colleagues and saying, “I don’t know if you want me on there — because if this hasn’t come across, I’m originally from Boston. I say what I mean and do what I say.” I ran for the board and was elected, and contributed where it was needed. Then I was elected president of the organization — president-elect — four or five years ago, and I’ve now served almost three years. I’m passing the torch in Park City to the very talented Jarin Dana from Fusion — another fantastic human being, and they run a great organization out there.
Really, what I wanted to do in particular when I joined the board — and especially when I got into leadership — was to make NALTO known on the national stage, because we had not done that prior. It just so happens that things like the PRO Act came up for debate in the House and Senate when President Biden was elected. Whatever your opinions on labor are — your opinions on whether Uber or Lyft drivers should be employees or 1099s — your listeners, I know you’ve heard us talk about AB5 in California, which came from the Dynamex case, which basically says everybody’s an employee until proven otherwise. That’s maybe all fine and good for Uber and Lyft and Instacart, and we could certainly argue the merits of that. But one thing we do know for sure is that the vast majority of providers in our space — these physicians, and let’s bump in NPs, PAs, CRNAs; they provide excellent work as well — if they were forced to become W-2s for agencies like ours, that number would drastically be cut in half, even more than that.
So we sprang into action. We’ve teamed up with a lobbying firm in DC — we are back on Capitol Hill later this month. It was important for me, as time has gone on, to protect the industry that has not only allowed me to earn a living, but to make an impact. What I want to do is make sure the story of locum tenens is being told on the national stage. There is no better goal or pursuit for NALTO than that. If I could look back on the wonderful work this board has done, what I’m particularly proud of is: we now have 30 out of the 50 members of our Senate that we can call up, and they know what locums is.
Rajee Hari (24:11): Wow. That’s huge progress.
Matt Young (24:14): They know what it is. They know what we’re trying to do. They’re on board, but they’re waiting for the right time to strike — and I’ll expand on that in a minute. We even had a bill that we helped write get introduced in the last Congress in the House of Representatives, and we’re looking to build on that bill and that progress in this Congress. We’ve made tremendous progress. There’s a long way to go, but that’s really where we wanted to make an impact.
Rajee Hari (24:42): That’s interesting. So — you were talking about locum tenens staying 1099 rather than W-2, which is better for all. Are the doctors in line with this as well? Do you have the doctors’ commitment for this bill?
Matt Young (24:58): Yes. Part of our outreach and coalition building has been to speak to hospital associations on the hospital side, and we have a number of them willing to support our bill, which is great. On the physician-provider side, we actually have a group of physicians coming with us to DC this time around, so we will have representation — because we get that question a lot; it’s a good question: “Why would the providers care?”
They do. Because they know — with all due respect, I don’t have the qualifications to evaluate a physician’s performance and act like they’re an employee of our agency. I don’t have the expertise. They know it, I know it, I’m comfortable with it. They have the expertise. They choose what contracts they accept and decline. They choose their rate; they negotiate that. All the power is in their hands, and that’s where it should be. We want to make sure that status quo continues in the future.
Rajee Hari (25:58): Fantastic. This is exciting, Matt — just talking to you, I’m getting so much knowledge coming at me. Look at you, you’re the Energizer Bunny right there. And I did say charming — you don’t know why, but you’re a charming young man. So, moving a little bit into the small business side, having talked about All Star, your career, and how NALTO has come into your life: I want to talk about small business and your thought process there.
Take my company, for example — Protean Med. It’s pretty much a small organization, and I definitely have a lot of challenges breaking into the space because there are big wigs there. In spite of COVID, I have made some progress as well. So what can we do to leverage the resources and support provided by NALTO to make ourselves more successful and stay competitive in the industry?
Matt Young (26:54): It’s a great question. And I applaud the progress that you’ve made. The good thing about the industry is — and we get some visibility of this because NALTO receives probably two to four applications a month, or every 45 days — that tells me the industry is growing and you have new players coming into it. A lot of them are physician-owned small businesses, women-owned small businesses, veteran-owned small businesses. We welcome all of those players, because we know the massive job that’s going to need to be done as we approach the 110,000 to 140,000 physicians we’re going to be short by 2035, 2040.
I wish NALTO had the resources it has now when I started my career in Denver. If I were a startup organization today, I would apply to NALTO right away. We have an onboarding process, as you well know, to say: even though you’re new, we want to take you in, we want to share what we know. Because the last thing the locum tenens industry needs is an outlier out there W-2ing people, or not getting the proper malpractice, and stepping on landmines all over the place. It’d be a bad look for the industry as a whole.
So, what we try to do — as an example: let’s say as a small organization you don’t have a robust training and development section of your organization. NALTO provides that. We have a seminar once a month, free for NALTO members, where you can get real training — leadership training, sales training, whatever the case may be — from people that know the industry. These aren’t people that yesterday were selling washing machines. They know locums; they know how to sell locums. We get hundreds of people signed up every month. So here are these smaller organizations that say: instead of spending $90,000 a year, $70,000, whatever the number is, on a director of training and development, I already have that because I’m paying my dues to NALTO, and I get these things automatically for free.
The lobbying I just mentioned speaks for itself — here’s this group out there protecting my interests. You also have risk management: what are the landmines I can avoid when talking about malpractice for one of my providers? What are some of the things I should be doing from a credentialing or licensing standpoint? These are huge deals, and they are potential landmines. For a new company getting into this — for the dues and fees that are paid, you’ll make 50, 100 times what you would be paying, say, a consultant to tell you the same things. And by the way, you get to go to the conferences and forge these relationships — which is one of the reasons we’re talking now.
Rajee Hari (29:51): Absolutely — I tend to agree.
Matt Young (29:54): I enjoyed meeting you guys when you were out there, and I want you to do well. Because you’re going to reflect locums — the industry as a whole — in a positive light. That’s what I want, not only as president of NALTO, but as a managing partner and board member at All Star. I want people doing locums the right way. I want the industry to continue to thrive. Someone out there going rogue and doing things in an unethical manner doesn’t help anybody.
Rajee Hari (30:22): I agree. We also need someone to handhold us, which is something NALTO does. That’s why I said I was blown away — everyone is welcoming, I could reach out to so many people, and advice was given without hesitation. I was introduced to people. It’s a tough industry for all, but at least I have people I can connect to. But do you have any kind of mentoring program within NALTO, where you connect a young entrepreneur with a veteran in the industry — kind of like a buddy system?
Matt Young (31:04): Funny you bring that up, because our membership committee is always looking to improve not only the welcoming of the onboarding process, but what happens after that. One of the things we’ve done is assign somebody from our membership committee or our board of directors, depending on how many are needed — for a NALTO firm that’s coming to the conference for the first time, or the first time this year, or that hasn’t come in a couple of years — because every situation is different; sometimes the dates don’t match up correctly, et cetera.
Now, is there a formal mentorship program? That’s an interesting idea, and I’d love to take that to the board and the membership committee. I think these things in the past have almost happened organically — and that’s not to say we shouldn’t formalize it. I get questions all the time, and I certainly don’t have all the answers either. Some of the largest companies in the country — I’ll exchange emails with them: “What do you think about what’s going on in Kentucky with their state legislation?” These are companies much larger than mine, and yet we’re all collaborating on these ideas. So I guess the mentorship never stops; it keeps going.
What I would recommend to folks that have just joined for the first time: get involved with a committee that interests you. We all meet once a month, and you get to know these folks — that just happens over time. But that being said, it’s an interesting idea, and outside of what I already mentioned about mentoring people through their membership process and their first conference, I think we could certainly expand on that. It’s a good point.
Rajee Hari (32:50): Thank you. So — you talked about landmines just now, when you were mentioning new organizations. Can you give some examples of landmines that people have stepped onto that actually brought them down, and things they can avoid? A small organization like mine — what are the landmines I should be looking out for, and how can I avoid them?
Matt Young (33:15): Yeah, it’s a great question. Somebody gave a TED talk once, I think, on $100,000 mistakes — that’s like our example of what we’re doing right now. Sometimes it can be more than $100,000. Some things we go over at NALTO in pretty granular detail:
Don’t sign bad contracts. Sometimes it is better to walk away from a bad contract than sign things that give you this massive cloud of liability that will follow you for a number of years — whether that’s indemnification language or certain types of insurance requirements that really only belong in the W-2 staffing world. We’ve seen a lot of that. I think the reason for that in particular is a lot of MSP/VMS players that have been in the nursing world and other staffing verticals have started to come in. There’s nothing wrong with that — we welcome it — but I think they cookie-cuttered their agreements and made locums like nursing, or locums like light industrial, or locums like IT. And they’re completely different types of placements, both in complexity and, in my opinion, importance too. IT professionals are needed and their work is very much appreciated, but I think we would agree that if you’re taken in an ambulance to a facility, a doctor being there is probably a little bit more important, right?
So you have contractual issues, like I just mentioned. You certainly have the landmine of physicians sometimes saying, “I’ll carry my own malpractice.” Bad idea — never do it. Because remember, in your client contracts, you are warranting that they are carrying it. How do you know if they pay their bill? I’m not saying they wouldn’t, but there’s no way you’re going to follow up on that. What about tail coverage? Are you sure they’re going to cover that? Because as you well know, the statute of limitations for an OBGYN case can be 17 years. So you’re telling me you’re going to follow up with them for the next 13 years to make sure they renewed their med mal and paid their tail? No. That’s another example of this liability. Just think about it: let’s say an OBGYN goes to work for your firm. You trust that person to procure their own med mal. And then all of a sudden they don’t, and a lawsuit comes in. Guess who’s named? You are. And you will be coming out of pocket for that, because you have no face sheet — you have no proof that you covered yourself.
The last one I’ll use: when a company is going from small to medium and medium to large, if you’re not prepared for that growth and the amount of funds you will need to cover not only provider payroll, but your internal payroll. And look — you asked about things that have changed in the last 20 years: it’s more expensive to book a day now than it’s ever been. You have a lot of different costs and regulatory concerns. You have VMS fees. The margins have tightened a little bit. We all deal with it, but you don’t want to cut corners and leave yourself open liability — a landmine you could step on. So make sure you have your funding in place for when your company does grow. Look at your projections and say: if and when we hit this BHAG, this goal, what does my company look like then? And what am I going to need to have in place before that happens? Because you can be a victim of your own success pretty easily.
Rajee Hari (36:43): I totally agree with you. So, coming back to small industry entrepreneurs — what are the top three qualities you think an entrepreneur should have to be successful in this space?
Matt Young (36:56): This may be a little cliché, but persistence. As I explained, any entrepreneur has to be a salesperson, in my opinion. That doesn’t mean you’ll be cold-calling hospitals and doctors for 20 years, but that said — can you get in front of a potential provider or a potential client and sell your services, and sell them well? Can you negotiate well, meaning make the deal happen? I always chuckle when one of our consultants books their first days, and I’ll be the first to applaud that — I’m like, congratulations, now your work just begins.
Rajee Hari (37:34): That’s true.
Matt Young (37:36): There are so many steps that have to be done for you to have a successful placement. So: persistence.
Then, you have to have empathy. You have to always picture yourself in someone else’s shoes. How can I massage this deal to make sense — and let’s look in the mirror: it’s got to make sense for you if you’re a recruiter, or a consultant, or a client rep, or a leader, whatever the case may be. But it has to make sense for the provider, and it has to make sense for the facility. Otherwise, someone’s going to be unhappy, and the person’s never going to be booked again. So can you have empathy and be persistent?
And then — I don’t know if this is the best way to say this — you have to be vulnerable. What I mean by that is you have to build vulnerability-based trust with your people, to say: I’m here in the trenches with you. This is what I’ve been through to help build this business. It’s kind of like, come with me, everybody. There’s that old drawing about the difference between a boss and a leader: the boss is the guy whipping the stagecoach, and the leader is the one out front going, “All right, let’s go,” and pulling it. Two different types of people. The 1980s-90s celebrated boss charging through the wall isn’t something that’s accepted anymore — and we could argue the merits of the good and the bad of that — but no one’s going to follow somebody who is just an order-giver. Have you built up that trust with your people? And the best way to build that, in my opinion, is to go up there and say: hey, I’ve screwed up too. This is where I’ve made my mistakes. And if I don’t know the answer, I will tell you I don’t know the answer. Because I’ve got news for you: if you go out there and pretend you know the answer, there are enough people in any size audience to know that you’re full of it. They’ll figure it out.
Rajee Hari (39:36): Yeah. They can see through the BS, for sure.
Matt Young (39:38): A hundred percent. There are probably more, but those are the three that popped into my mind right away.
Rajee Hari (39:43): Thank you. I think you nailed it — those three seem to be the common traits that take a person forward or backward, depending on what they have. Has there been any aha moment in your life? Something that’s been like, “Wow, this is it”?
Matt Young (40:01): It’s funny, because when you’re part of startups in particular, you’re so busy putting out fires and getting to the next goal. I admit this too — and I know this isn’t a therapy session, though it’s going to sound like it — I don’t think I’ve spent enough time to smell the proverbial roses. It’s like the saying: you’ll sleep when you’re dead. I probably should sleep more, too.
But you have these landmark things that happen in the development of an organization, when you go from infancy to adolescence, and adolescence to adulthood. I remember when we moved from a small office that we leased, and we purchased an office building. We got to be like 80 employees — which to us was, can you believe we’re 80? And here we are at probably almost 380 now. I remember sitting there — and again, it’s certainly not like Wall Street, but we used to buy all used office furniture and really put everything we had back into the business. And yet here we were, and we knew that in order to be competitive and attract employees, we needed a nicer space. So we invested the money and we built this space. And it was like — yeah, I think we’re getting there. But never, ever did I say, “We’ve made it.” I don’t think I ever will. And that’s probably not a healthy thing, but—
Rajee Hari (41:35): Yeah, I was about to say — is that good or bad?
Matt Young (41:38): You know, I don’t know. I’ve just been very lucky and very blessed to work with a great group of people — both at All Star, and obviously that’s the most important thing that I do, but even my time with NALTO. I’ve got to be honest with you: when I step down in September, that’s going to be strange.
Rajee Hari (41:57): I’m sure you’re going to find a hundred different things to do, knowing you. Next thing you know, you may have something else on your plate, and I’ll be like, “Wow, Matt — do you ever stop?” That’s what I’m going to ask you.
Matt Young (42:08): That’s kind of you to say. I appreciate it.
Rajee Hari (42:10): I have a very interesting question about mergers and acquisitions. It’s very common in the industry — you see it increasingly happening. How do you see M&A activity impacting the locum tenens sector specifically?
Matt Young (42:29): Well, a lot of it’s already happened. There are not many at, call it, $75–80 million and above. You almost have this gap: you have a lot of zero-to-$30-million companies, then a massive gap in that middle ground, and then you have the top dogs that have done a lot of the acquiring.
That being said, during COVID things slowed down a little bit from an M&A perspective, and rightfully so. According to the conversations I’ve had through NALTO and All Star, there’s a heavy appetite from both private equity and strategic buyers to come in and acquire profitable locum firms with good cultures and great P&Ls, et cetera. I don’t see that slowing down anytime soon. This is the Rolls-Royce of staffing. What I mean by that is physicians not only have tremendous societal impact — they are also revenue-producing folks for hospitals.
I’m always very careful to say it like this: you cannot run a well-functioning hospital without tremendous nurses. Nursing, through the pandemic, rightfully got their due — they’re part of the heroes of healthcare, no question. But from a P&L standpoint, providers — physicians in particular — are the folks that keep the doors open from a revenue-producing standpoint. That’s why they command a premium, and that’s why, from a staffing standpoint, we command a premium. The supply-and-demand issue is just way off. And that’s only going to get worse, because not only is the supply of physicians not where it needs to be, but you have aging baby boomers, and you have — unfortunately — not the healthiest population. It was one of the reasons the United States struggled with COVID more than some other countries: in comparison, we’re not as healthy. We have a bigger obesity issue in this country than in other parts of the world.
So you have a number of private equity folks and strategics that will continue to look to acquire those firms. I don’t see it slowing down anytime soon. I think this industry — with the current structure, current margins, current business landscape — has a runway for at least the next decade and a half, or more. Which is also one of the reasons, by the way, that we’re very passionate about keeping these folks as 1099s. Because if all of a sudden they all became W-2s, the industry would change like that, overnight. Of course we would pivot — our firms would pivot — but the cost would go up for the hospitals, and there’d be fewer folks to choose from. And who wins there? Nobody wins.
Rajee Hari (45:31): Nobody wins, right. So do you think technology like AI, or all the new software coming in, is going to impact the traditional way of recruiting in this industry?
Matt Young (45:47): Yeah, I think it’s going to impact — it’s just like anything else. The first time you jump on ChatGPT and you talk about AI, your first inclination — it’s kind of like the Ford assembly line the first time they had a robot build something. It’s certainly a disruptor. But at the end of the day, I think the firms that learn to use it in the most effective way will really benefit from it, and those who choose to ignore it will face those consequences.
From a physician standpoint, for example — AI is designed to pick up patterns. I’m not an expert in it, but I know enough to be dangerous. Physician care will always be physician care. I think we’re a long way away from a robot walking down the hall providing patient care — that’s not what AI is. But what I will say: take radiology, for example. When they’re looking at a scan, could AI be taught, under the supervision of a radiologist, how to detect patterns better and maybe diagnose cancer earlier, something like that? I know that’s been discussed a lot; that seems to be a place it could go relatively quickly. And there’s a massive shortage of radiologists, so maybe that’s a good thing — and then some of those folks could repurpose to other specialties, just as an example. So I think it’s a reallocation more than something we should fear.
In terms of the business as a whole — could AI help write emails to help us recruit people? I guess. But I still think — and I’m old-fashioned — one of the greatest joys of me being in this industry is the lifelong friendships I’ve had with clients and providers. The people I recruited from original cold calls — I’ve been to their weddings. I’ve had beers with them. I’ve been to conferences with them. I’ve gone into business with them. It’s just one of those things where I don’t think anything will ever substitute the human interaction piece. Some of the busywork could be done by AI, but I don’t see it as a massive disruptor for what we do every day.
Rajee Hari (47:52): Interesting. So, is there anything you want to use as a concluding message to the audience? Because I know you have a lot to say — you have this huge legislation with NALTO, and so much experience in the field.
Matt Young (48:14): Yes. Whether you’re a NALTO member, a physician, or a healthcare organization: like it or not, with the supply-and-demand issue, locum tenens will be a thing. I think over 90% of HCOs use locum tenens. As I mentioned, it’s over 50,000 physicians alone — never mind NPs, PAs, and CRNAs. We need these folks to continue to be out there, in particular in rural and underserved areas, providing care. We want to protect that.
“How do I get involved?” I’m so happy you asked. If you go to www.nalto.org/action, it literally takes 30 seconds. You plug in your information and your address, and it will automatically send emails that say: we care about these folks. We know they’re providing care. Let’s keep the status quo. Do whatever you want with the Uber and Lyft drivers — we’re not making any judgments about that. But we want to make sure that, God forbid, if there’s an accident, or someone in my family is in a rural area and needs care, that someone from your firm, my firm, any one of the NALTO firms will be able to provide that care. Because without that, we’re talking about the difference between life and death here. We want to protect the industry, protect the ability for these providers to continue to provide this care nationwide.
I welcome everybody to go to that website. Reach out to me on LinkedIn, reach out to me via email — I’m on the NALTO website. I’m happy to take you through it. We need as many people involved as possible, because one thing I have learned going through this process on Capitol Hill: they all love the idea, but they don’t necessarily want to be first. What that means is we need three or four or five people from different parts of the country — Democrat and Republican — to come together, and then this thing can really get moving.
The last thing I’ll say: there are a lot of things that are partisan. I am proud to say that H.R. 7881 was supported on a bipartisan basis by both Democrats and Republicans, which is a rarity in this polarizing time. So if you could reach out to your representatives, it would be greatly appreciated. We’d love your support.
Rajee Hari (50:22): Thank you so much, Matt. That was great — I really appreciate your time. This one hour just flew by. I asked for 20 minutes, I’m so sorry — we spoke for an hour, and as you said, I could talk to you for more than an hour as well. But I know you have another meeting to go to.
Thanks for listening, everyone. Thank you, Matt, for being on the show — I appreciate it. Don’t forget to subscribe to Protean Pulse. We are on Spotify as well — you can search for Protean Pulse — and remember to leave us your feedback. I will see you in the next episode. Don’t miss the beat!