UTICA — On Feb. 22, Fortus Healthcare Resources, a d/b/a of Fortus Group, Inc., announced the appointment of Jeremy Enck (pronounce INK) as the new president and CEO of the health-care employment agency. Enck reports to Michael Maurizio, chairman and founder of the company.

“Fortus was a pioneer in the dialysis industry placing nephrology professionals in dialysis centers,” notes Enck, “but over the years we have diversified to provide hospitals and health-care groups with RNs (registered nurses) and LPNs (licensed practical nurses), social workers, dieticians, surgeons, clinicians, executive-level management, nephrologists, bio-med technicians, and administrators. Currently, we are continuing to diversify and grow both our travel and contract divisions.”

Enck steps into his leadership role with a company that is a fixture on the Inc. 5000 list of America’s fastest-growing companies. Maurizio founded the company in 1993 and posted $120,000 in gross revenue the first year. In 2009, Fortus generated $2.6 million; in 2012, $6.2 million; and in 2015, north of $10 million. The headquarters staff numbers 37, plus 90 contractors who are placed nationwide. Maurizio set up a real-estate company — Performance Plus, LLC — which owns the 8,000-square-foot headquarters building located at 2717 Genesee St. He also established Fortus Group Travel, Inc., an S corporation, for the travel division. In addition to its Utica location, the placement agency has offices in Charlotte, North Carolina; Richmond, Virginia; and Summerfield, North Carolina (near Greensboro).

Expansion
“Diversification is driving our growth,” says Enck. “While our permanent-placement business has remained steady, the travel division has grown dramatically. Last year alone, travel, which now represents more than half of our revenue, grew 41 percent. This year, I project adding another $4 million from Fortus Travel alone, and in 2017 more than 40 percent [in consolidated sales]. Just look at the growth in the number of contractors we’ve added. In 2014, we employed 45, in 2015 we had 70, by year’s end we’re on course to reach 130, in 2017 we should be at 180, and the following year well over 200.”

In addition to the travel division’s growth, Enck is also focused on a number of other areas. “For our larger clients, who deal with a number of staffing agencies, MSPs (managed-service provider) are becoming popular. An MSP is an outsourced agency that manages an organization’s temporary staffing, working as an unbiased management interface between the clients’ hiring managers and the staffing vendors. Fortus already has the necessary software to manage this program, which we currently use for credentialing our contractors. While MSP is in its infancy stage here, it offers a real growth opportunity. Fortus is also looking at RPO (recruitment-process outsourcing: the buyer’s brand is being promoted rather than the provider’s), which plays to our strength of providing consultative and customizable recruiting for time-limited projects that require onsite managers.”

Locum tenens physician staffing, which involves doctors temporarily substituting for others, is another area Enck is considering. “There is a growing demand for doctors to staff the nation’s hospitals,” he says. “The problem of creating an adequate supply to meet the growing demand will take decades to correct. This is a huge opportunity, but the cost of malpractice insurance is a barrier to entering the field. The key to entry is to have the volume to warrant pursuing locum tenens.”

One way to acquire the necessary volume for the temporary placement of physicians is through merger-and-acquisition (M&A) activity. “M&A is an option we are pursuing seriously,” asserts Enck. “Mike [Maurizio] has spent the last 18 months looking at staffing agencies that specialize in areas that complement our strengths. We are particularly interested in the areas of labor/delivery, ambulatory surgery, oncology, emergency medicine, and pediatrics. Mike and I work as a team: he finds the opportunities, and I vet them. We have made some offers to date, but have yet to close a deal. Clearly, a single transaction could catapult our growth.”

Enck is also following the rapid growth of high-tech in the Mohawk Valley. “I think this will be good for our recruiting,” he opines. “I can see the possibility of developing a specialty in nanotech recruiting.”

The Fortus approach
Health-care agency placement is recognized as a highly competitive industry. “We have competition from all sides,” acknowledges Enck. “The direct placement business is saturated with small companies, while the contracting field is dominated by Fortune–500 companies. Our success is tied to our experience in specialized disciplines, the personal touch with our clients, and the fact that we treat our contractors like colleagues. [To this last point], Fortus has set up a service-excellence team that responds to our contractors’ needs. It’s a 24-hour concierge service to help our contractors deal with the daily routine of renting cars, making travel arrangements, handling licensing issues, dealing with housing questions, and more. It’s the human approach that is truly appreciated by our contractors.”

Fortus extends the human approach through its use of social media. “My first impression of Fortus Healthcare Resources,” says Jillian Ducato, Fortus’s marketing/public-relations manager, “was the personal and friendly approach the recruiters used compared to other health-care recruiting agencies. Part of my efforts is to express this through our social media and other marketing efforts. Since joining the Fortus team, I have introduced focused social ads which allow us to reach our target market nationwide. I believe it’s important to utilize social media to help build the Fortus brand and to open a door of communication with our clients. Social media is an effective way of letting our clients know who we are as a company.” Enck adds: “Social-media marketing shows the power of engagement. It’s a great vehicle for bringing candidates to our recruiters. It’s like a fisherman casting a wide net.”

While Enck attributes Fortus’s success to experience, the personal touch, and the service-excellence team, he saves his highest praise for the staff. “We have a terrific leadership team,” he intones. “Mike and I are supported by Melaina Cannistra as account manager; Kathy Cano, director of compliance and human resources; Andy Barberio, senior account executive and surgery-team leader; Rebecca Urtz, senior account executive and recruiting coordinator; and Victor Gerace, expediency-team coordinator. We also enjoy a very talented … [production staff]. Fortunately, there are plenty of smart and well-educated people [living in the Mohawk Valley] where there are limited opportunities for good-paying jobs. Fortus invests a good deal of time and money training each hire to be knowledgeable and to be sure new employees fit our corporate culture … No one becomes a salesperson unless first starting as a recruiter: that’s the only way to understand the business. We also stress promoting from within, so our employees see opportunities for advancement. In an industry noted for its high employee turnover, we enjoy a very low turnover which tells me our policies are working.” Enck also has praise for local professionals who help the company grow. “We work with the Bank of Utica and First Niagara Bank for our financial needs, Kowalcyk, Deery & Broadbent, [LLP] for our legal services, and Vin Gilroy oversees our accounting.”

Changing health-care landscape
Enck is very optimistic about the health-care-placement industry and Fortus’s current position. “Health care is experiencing the perfect storm,” quips Enck. “Health-care staffing has been growing because more people are being covered by insurance at the same time the Baby Boomers are aging. Add to this a growing regulatory burden and a changing reimbursement methodology, which are requiring increased staffing in order to comply. Then [throw into the mix] … the number of doctors and nurses who are retiring. [In short,] demand is increasing while supply is decreasing. It’s a crisis for the country, but a tremendous opportunity for Fortus.”
Enck’s observation is borne out by industry research. According to a first-quarter 2016 report by Capstone Partners, LLC, a mid-market, investment-banking firm specializing in health-care staffing, the $14.9 billion industry is highly fragmented with more than 2,200 firms, many operating only on a local or regional basis. The report notes that M&A activity remains brisk, especially with companies that specialize in higher-growth segments and those positioned to capitalize on clinician shortages. Capstone notes that publicly traded health-care staffing companies are currently trading at a 30 percent-plus premium with a median EBITDA (earnings before interest, taxes, depreciation and amortization) multiple of 11.5x.

Patricia Pittman, coordinator of the GW Health Workforce Institute at George Washington University, writes recently that by 2022, nearly one in eight U.S. jobs is projected to be in the health-care sector. Pittman points to demographics and technology as the primary drivers, with much of the growth coming in non-hospital settings. Even so, she forecasts a 14 percent increase in hospital employment between 2012 and 2022, which means adding another 826,000 health-care jobs. LinkedIn’s “2015 Job Changers” reports that Millennials present another challenge for health-care providers, because they, more than previous generations, are looking for opportunities for advancement and challenging work. LinkedIn finds that this cohort is quite willing to change jobs, a burden for the providers and a windfall for placement agencies.

The U.S. Bureau of Labor Statistics (BLS) calculates that over the next few years 526,800 nurses will retire, with a significant portion retiring in 2016. In addition to retirement putting pressure on the supply of clinicians, many states are passing laws mandating physicians to work fewer hours. It’s likely that RNs will undertake more duties traditionally reserved for doctors. Conclusion: nurses are hot property, and recruiters will have to be creative to attract talent. Other staffing trends include a growing demand for technicians and a new demand for employees with “soft skills” such as listening, communicating, and good customer service. The last trend is growing from a benchmark that formerly only measured the technical aspects of care to one that now also measures customer satisfaction.

Enck’s optimism is also confirmed by a November 2015 report entitled “Healthcare Staffing Market Overview,” published by Harris Williams & Co., a middle-market, investment bank. Its research indicates that this industry is growing at a compounded annual growth rate of 6.6 percent, which includes allied health, per-diem nursing, travel nursing, and locum tenens. Average weekly pay rates for each category are: allied health, $1,280; per-diem, $720 (assumes two days worked per week); travel, $1,080; and locum tenens, $7,250. The study, which notes that hospital personnel costs now consume 54 percent of total annual expenses, also shows that “health-care facilities are moving to an operating base of fixed labor supplemented with a component of variable labor in order to align staffing costs with patient-census variability.” Harris Williams goes on to cite the focus on improved quality, which is also driving demand for skilled personnel. One striking statistic is the rapidly rising shortage of nurses and physicians. In 2012, 41 percent of U.S. hospitals reported an RN vacancy of more than 5 percent; in 2015 the number jumped to 66 percent reporting. In 2013 the country posted a physician shortage of 11,000; the projected shortfall in 2025 is 72,800, with a growing geographic imbalance.

Enck’s background
Enck was born in Oneonta and graduated high school there in 1998. He received an associate degree in sports medicine from Morrisville State College and in 2002, a bachelor’s degree from Mansfield University. His early employment included stints in Oneonta and Cooperstown at A.O. Fox Hospital’s HealthLinks @ Foxcare and selling cars for his uncle, Gary Enck. In 2004, while considering a move to North Carolina, Enck met the president of Milford Academy, which was planning a move to New Berlin, New York from its location in Connecticut. He joined Milford as a coach, which included some recruiting of athletes. Fortus reached out to Enck in February 2007, attracted by the “recruiting experience” listed on his résumé. His response was total surprise, since he didn’t know there was a staffing industry and didn’t consider himself a recruiter. After being interviewed for four months, Enck landed a job at Fortus as a project coordinator working with key account managers on nationwide health-care searches. In early 2009, he took over responsibility for the travel division, which had been created in 2006 and was experiencing problems. In 2010, Maurizio promoted him to VP of sales with responsibility for the hiring and development of the entire sales force. Enck resides with his wife and two sons in New Hartford.

Fortus is sitting in the catbird seat. Demand for qualified, health-care professionals is far outstripping supply, and the providers are desperate for help. Enck refers to this as the perfect storm. Every storm needs a captain to steer the ship, and Maurizio has chosen well. Enck sees unlimited opportunities with Fortus, which has a solid reputation both with clients and contractors, is financially strong, and has a clear vision to plot a path to continuous growth.