MSP vs VMS in healthcare staffing: how hospitals buy travel nurses and locums, and where agencies get in

For a staffing agency, the MSP and VMS are the front door to most large hospitals. A median 86.7% of travel nurse staffing revenue flowed through MSP or VMS programs in 2025, according to Staffing Industry Analysts (SIA).¹ This guide explains how those programs work from the agency's side, and the routes in when you are not on the program.

MSP vs VMS in healthcare staffing: the short answer

The MSP is people and process. The VMS is software. SIA defines an MSP as the company that becomes the primary manager of a client's contingent workforce program, and a VMS as the web application used to buy and manage staffing from third-party suppliers.²

Most hospitals that use an MSP run it on a VMS. Some hospitals run a VMS without an MSP, and their own staff manage the agencies.

What an MSP does in a hospital's contract labor program

An MSP takes over the work of buying contract labor. When a unit needs a travel nurse, the request goes to the MSP. The MSP releases it to approved agencies, screens the candidates they submit, presents the best ones to the hiring manager, checks credentials and compliance, and handles onboarding, time and billing.

MSPs come in two models, and the difference matters to an agency.

• Vendor-neutral. The MSP does not supply clinicians itself. It releases orders to approved agencies on the same terms. Vendor-neutral programs are 53% of global MSP spend, according to SIA.³
• Master vendor. A staffing company runs the program and fills orders with its own clinicians first, then subcontracts the rest to other agencies. AMN Healthcare describes its MSPs as staffing-led and vendor-neutral: it places its own clinicians and fills the rest through other agencies.⁴

What a VMS does, and who pays the VMS fee

The VMS is the system of record. Orders go out through it, agencies submit candidates in it, managers approve timesheets in it, and invoices come out of it.

The agency usually pays. SIA reports that 90% of North American MSP spend is supplier-funded, and that 74% of MSP clients pay a fee set as a percentage of spend.³ AMN's VMS products, ShiftWise Flex, Medefis and b4health, earn a fee as a percentage of spend.⁴ That fee comes out of the agency's bill rate, which is why rate cards and markups decide whether an order is worth filling.

How vendor tiering decides which agency sees a travel nurse order first

Tiering is how a program decides which agencies see an order and when. SIA defines it as inviting vendors to fill orders in a set order, often with time triggers.²

Tier 1 agencies get the order first. If they do not fill it within the window, it goes to tier 2, and so on. Agencies move up or down tiers based on scorecard results, usually:

• Fill rate. The share of released orders you fill.
• Speed. How fast you submit qualified candidates.
• Quality. How many submissions the manager interviews and hires.
• Compliance. Whether credentials, documents and timesheets are complete and on time.

How hospitals buy travel nurse staffing through MSP and VMS programs

Hospitals leaned on travel nurses hard after 2020. The median hospital spent 4.7% of its nurse labor expense on contract travel nurses in 2019 and 38.6% in January 2022, according to the AHA.⁵ Contract labor expense rose 258% from 2019 to 2022.⁶

To control that spend, many hospitals moved travel nursing into MSP and VMS programs, with set bill rates and one channel for every order. Cross Country Healthcare says its travel contracts typically run 13 weeks.⁷ The need starts with nurse managers and the nurse staffing office; the MSP and VMS decide which agencies get the order.

How hospitals buy locum tenens coverage, and why credentialing sets the pace

Locum tenens works differently. Coverage is requested by department chairs and service lines, and no physician can work until the hospital credentials them and grants privileges. The CMS conditions of participation require the medical staff to examine every candidate's credentials and recommend appointment to the governing body.⁸

MSPs play a smaller role here. SIA reports that MSPs handled 38% and standalone VMS platforms 9% of advanced practice staffing revenue in its 2024 survey.⁹ Some hospitals do run a locum MSP. Natividad Medical Center in California sought one exclusive locum tenens MSP managing several agencies, and scored proposals 30% on credentialing and compliance, 30% on ability to meet needs and 10% on cost.¹⁰

Who at the hospital is involved in contract labor decisions

No single title owns contract labor everywhere. Public MSP RFPs show the pattern of who is involved:

1. Nursing leadership drives demand for travel nurses: the CNO, nurse directors and the staffing office.
2. Department chairs and the medical staff office drive locum demand and control credentialing.
3. Finance watches the spend, since labor was 56% of hospital expenses in 2024.¹¹
4. Procurement or contracts runs the MSP bid, and a technical evaluation team scores it, as in Grady Health System's MSP RFP.¹²
5. HR often owns the contingent workforce program day to day.

How a staffing agency gets into a hospital's MSP program

Getting on the program is a vendor onboarding process, not a sale to the hospital.

1. 1

   Find the MSP and VMS

   Learn which MSP runs the program and which VMS it uses.

2. 2

   Apply to the MSP as a vendor

   Meet its requirements: licenses, insurance, credentialing standards, compliance documents.

3. 3

   Sign the vendor agreement

   Accept the rate card and the fee.

4. 4

   Register on the VMS

   Get access to the hospital's orders.

5. 5

   Earn your tier

   Fill orders fast and clean, and move up the scorecard.

Time it to the contract. Public MSP contracts run three years plus renewal options at Grady and Natividad, so the program changes hands on a cycle.¹²¹⁰ County and district hospitals post those RFPs publicly.

Direct contracts, GPO staffing agreements and other routes outside the MSP

The MSP is the main door, but not the only one.

• Hospitals without an MSP. Smaller hospitals often contract with agencies directly.
• VMS-only hospitals. Agencies register on the VMS and work with the hospital's own staff.
• Subcontracting. Under a master vendor, you fill the orders the vendor cannot. Cross Country notes that intermediaries subcontract to it and other agencies.⁷
• GPO staffing agreements. In 2015, Premier awarded AMN a three-year sole-source contract covering travel and per diem nursing, locum tenens and MSP services.¹³ AMN lists GPOs among the intermediaries that can limit its direct access to clients.⁴ See how GPO contracts work.
• Direct roles the MSP does not cover. Locums and hard-to-fill specialties are often carved out.

Read the award terms before you count on a direct agreement. JPS Health Network's contingent labor MSP RFP says the award can replace earlier contracts and GPO agreements for the same services.¹⁴

How to find which MSP or VMS a hospital uses

Hospitals rarely post this on their websites, so piece it together.

1. Search public RFPs and board minutes. County and district hospitals publish MSP bids and awards.
2. Read press releases. MSPs and health systems announce new programs.
3. Read job postings. Travel job boards often name the program or VMS behind an order.
4. Check the parent system. A health system often runs one program for all its hospitals. See who owns a hospital.
5. Ask. The nurse staffing office or contract labor manager will usually tell you.

Then find the people. Dmand AI maps 1.6K+ health systems and IDNs down to 997K+ sites of care, with the CNOs, nurse directors, administrators and medical staff leaders at each facility, and the 7.4M+ HCPs you may place, searchable by specialty and site.

US healthcare staffing market size: travel nursing, locum tenens and allied in 2026

SIA expects the US healthcare staffing market to grow 1% to $39.0 billion in 2026 and 3% to $40.1 billion in 2027, after three years of decline.¹⁵ It projects travel nursing up 2% and locum tenens up 4% in 2026.

In its 2025 report, SIA put 2025 travel nursing at $14.2 billion and locum tenens at $9.6 billion, with locum tenens the fastest-growing segment.¹⁶ SIA revised its 2025 total in the 2026 report, so compare figures from the same report.