Did you miss Ardent Partners’ recent FOWX podcast featuring a discussion with Kelly Rakowski, CEO of Trio Workforce Solutions? The conversation tackled the impact of the extended workforce in healthcare, the pathways ahead for AI in workforce management, and how VMS platforms are serving as “strategic hubs” for contingent workforce management.
In Part One of this three-part article series, we highlight the major discussion points and a link to the full event.
The healthcare workforce has undergone a remarkable transformation over the past decade, shaped by shifting patient demands, structural workforce shortages, new care delivery models, and the seismic shock of the COVID-19 pandemic. Few industries were as deeply affected as healthcare, where contingent labor (particularly travel nurses and locum tenens physicians) became an essential strategic lever for maintaining operations and protecting patient care. As Kelly Rakowski, CEO of Trio Workforce Solutions, explains, the story of healthcare staffing today cannot be told without understanding the forces that converged before, during, and after the pandemic.
Fragility of the Healthcare Workforce
Even before COVID-19, the use of contingent staffing had been steadily increasing. Healthcare has always faced unpredictable demand, shaped by seasonality, regional demographics, and emergent public health needs. Volume spikes in respiratory illnesses during winter months, fluctuating elective procedure schedules, and migration patterns in states like Florida or Arizona create inherent variability in staffing needs. Rather than staff for the highest-demand peaks (an approach that would be financially unsustainable), health systems historically staffed to the median and relied on contingent clinicians to smooth the variability. Travel nursing emerged as the dominant mechanism for filling these short-term shortages, structured around the familiar 13-week assignment model that historically aligned to maternity leaves and later became the staffing industry standard.
However, a more complex challenge was simultaneously brewing: a widening gap between the supply and demand for clinical talent. Retirements among physicians and nurses were increasing, and post-graduate medical education slots (controlled by federal regulation) limited the influx of new physicians. Nursing schools faced their own bottlenecks, primarily a shortage of qualified faculty. This created structural workforce fragility well before COVID-19 accelerated the crisis.
When the pandemic hit, contingent staffing became a national lifeline. Historic surges in patient acuity required tens of thousands of travel nurses and locum clinicians to rapidly shift to hotspots across the country. At the same time, clinicians were contracting COVID-19 themselves or quarantining, further widening staffing gaps. Utilization skyrocketed, and so did compensation rates, reflecting the risk environment and dire need. Health systems confronted unprecedented expenses while also suspending elective procedures, which is their primary revenue engine.
External Workforce Prioritization
As the pandemic receded, several powerful dynamics persisted. First, burnout skyrocketed. Many clinicians retired early or left the profession entirely, cementing long-term shortages. Second, permanent staff began demanding flexibility similar to the rest of the labor market, catalyzing internal travel programs, float pools, and hybrid workforce models. Third, the visibility of contingent labor costs dramatically increased. Boards of directors and senior executives, many of whom were never historically involved in staffing decisions, now saw workforce resilience as a top organizational priority. Industry surveys of healthcare CEOs repeatedly place workforce challenges at the very top of strategic concerns.
Today, while bill rates have normalized to pre-pandemic levels (adjusted for inflation and new compensation baselines), utilization remains elevated, registering roughly 50% higher than before COVID-19. Health systems are incorporating contingent labor into long-term workforce strategies rather than treating it as a temporary emergency tool. Innovation has accelerated: internal staffing agencies are emerging within large systems, local gig-based marketplaces are gaining traction, and multi-skilled float pools are helping improve flexibility without over-extending permanent staff.
Yet complexity remains exceptionally high. Credentialing, licensure, compliance standards, and cultural fit are all vital, especially because clinical roles involve life-or-death responsibility. Technology is increasingly relied upon to support precision matching, skills verification, experience alignment, and predictive staffing needs. The rise of AI-enhanced tools is helping heal long-standing inefficiencies that were once managed manually across spreadsheets, fragmented systems, and siloed operational teams.
A New Era for Healthcare Staffing
Healthcare’s contingent workforce is no longer a secondary staffing strategy; it is a cornerstone of workforce resilience. As Rakowski emphasizes, the industry must now focus on optimizing the entire workforce, including permanent, local flexible, and contingent, through smarter models, stronger technology, and a more human-centered approach. The pandemic accelerated what was already inevitable: healthcare staffing has entered a new era defined by adaptability, strategic workforce planning, and a commitment to ensuring safe, high-quality care despite ongoing shortages.
The future will belong to organizations that understand how to integrate flexibility with operational excellence — and how to support clinicians with the tools, data, and environments they need to thrive.
