Short answer: recruiters make money in one of five ways, and which one tells you who they really work for. An in-house recruiter is paid a salary by the employer that is hiring. A contingency agency recruiter is paid a share of a placement fee that the employer owes only when a hire is made, usually a percentage of the new hire's first-year pay. A retained search consultant is paid from a retainer the client pays during the search, hire or no hire. A contract or travel staffing recruiter is paid from the margin between the hourly rate the agency bills and the wage it pays the clinician. And an outsourced recruiting provider is paid a recurring contract fee, part fixed and part tied to hires or spend. The sections below take each model from the staffing firms' own annual reports and the federal pay data, then answer the question hospital talent acquisition leaders usually mean by it: whether their internal recruiters get commission, and what a hire costs under each model.
The five revenue models at a glance
| Model | Who pays the recruiter | What the money is | When it is earned |
|---|---|---|---|
| In-house recruiter | The hiring organization | A salary, sometimes with a bonus tied to hiring goals | Every pay period, regardless of hires |
| Contingency placement | The employer, through the agency | A share of a placement fee set as a percentage of the hire's annual pay | Only when a candidate accepts and starts; refundable within a guarantee period |
| Retained search | The client, through the search firm | Salary plus a bonus on retainers of about one-third of estimated first-year pay | Over the course of the search, whether or not it closes |
| Contract, temporary and travel staffing | The hospital, through the agency's hourly bill rate | Salary plus commission from the spread between the bill rate and the clinician's pay | For every hour the clinician works on assignment |
| Outsourced recruiting (RPO, MSP, VMS) | The client, under a contract | Fixed implementation and program fees plus variable fees per hire or as a percentage of spend | Monthly, for the life of the contract |
One number stays private in every model: the recruiter's cut. None of the firms whose filings are quoted below publishes the split between a recruiter's base pay and commission, or the share of a fee the recruiter keeps, so this page quotes what they do publish, which is how the fee or margin itself is earned.
In-house recruiters: a salary, and usually no commission
A recruiter on a hospital's or company's own payroll is an employee of the organization that is hiring, and the money is a salary. The Bureau of Labor Statistics counts recruiters inside the occupation "human resources specialists", the people who "recruit, screen, and interview job applicants and place newly hired workers in jobs", with about 939,700 jobs in 2025 and growth of 6% projected from 2025 to 2035. The May 2025 medians:
| Human resources specialists, May 2025 | Median annual wage |
|---|---|
| All industries | $75,940 |
| Government (excluding state and local education and hospitals) | $84,100 |
| Professional, scientific and technical services | $82,800 |
| Manufacturing | $79,270 |
| Healthcare and social assistance | $64,130 |
| Employment services (staffing and recruiting agencies) | $60,550 |
The lowest-paid 10% earned under $47,180 and the highest-paid 10% over $128,720. These figures settle the commission question better than any job posting, because the survey's wages are straight-time gross pay that includes "incentive pay, including commissions and production bonuses" and excludes "nonproduction bonuses" such as a year-end company bonus. The healthcare and social assistance row is therefore what a hospital recruiter typically earns including any commission paid, and the employment services row is the same for agency recruiters. That the agency row sits lowest, with the widest spread in the occupation, is what a commission-weighted pay plan looks like in survey data; the hospital row is a salary that does not move with the number of hires.
Nothing requires an employer to pay commission at all. The Department of Labor's wages guidance defines a commission as "a sum of money paid to an employee upon completion of a task" and states that "the Fair Labor Standards Act (FLSA) does not require the payment of commissions." Where an in-house team has variable pay, it is normally a bonus plan tied to hiring goals, time to fill or the organization's annual results, not a fee per hire. For what that pay looks like across the career, see the salary guide for recruiters.
Contingency recruiters: a share of a fee that exists only when someone is hired
A contingency agency is paid by the employer, not the candidate, and only on a successful placement. Robert Half describes its permanent placement business this way: "Fees for successful placements are paid only by the employer" and are "generally a percentage of the new employee's annual compensation", while "no fee for placement services is charged to employment candidates." Its revenue from that business is driven by "the number of candidate placements and average fees earned per placement", and the fees are "primarily recognized when employment candidates accept offers of permanent employment", with an allowance for candidates who leave during the "90-day guarantee period".
A contingency recruiter's income inherits those mechanics exactly. The recruiter is paid a base salary, or a draw recovered from future commission, plus a percentage of each fee the agency collects. Because the fee is a percentage of first-year pay, a placement at $150,000 is worth more than one at $60,000, which is why contingency desks gravitate to higher-paid and harder-to-fill roles. And because the fee can be clawed back when a hire leaves inside the guarantee period, the recruiter's commission is usually paid after the start date, not at acceptance. The fee percentage for non-executive roles is negotiated per client and no firm publishes a schedule, so any specific percentage you read elsewhere is one agency's quote. The per-hire arithmetic is set out in how much do recruiters make per hire.
Retained search: paid during the search, not for the hire
Retained firms are the exception to "paid on placement". Heidrick & Struggles explains the two categories in its annual report: "Executive search firms are generally separated into two broad categories: retained search and contingency search." Retained firms "are paid a retainer for their services equal to approximately one-third of the estimated first year compensation for the position to be filled", whereas "contingency search firms are compensated only upon successfully placing a recommended candidate." Korn Ferry's filing puts its own fees the same way: fee revenue from executive and professional search "is generally one-third of the estimated first-year cash compensation", an "uptick fee" is billed when the compensation awarded exceeds the estimate, and the firm recognizes that revenue "over the course of a search and when we are legally entitled to payment". Any work it does take on a contingent basis is recognized "once the contingency is resolved".
So a retained consultant is paid a salary and a bonus tied to the retainers they originate and the searches they complete, and the firm's money arrives in instalments while the search runs. The client is buying the search, not the placement. That makes retained search the most predictable model for the firm and the most expensive per hire for the client, which is why it is reserved for executive and hard-to-fill senior roles.
Contract and travel staffing: the margin on every hour
Most of the staffing industry is not placement at all. The American Staffing Association lists the industry's services as "predominantly" temporary and contract staffing, recruiting and permanent placement, outsourcing and outplacement, and human resource consulting, and counts nearly 2.2 million temporary and contract employees working for staffing companies in an average week of 2024. In this model the clinician is the agency's employee and the agency sells their hours. Robert Half states that "the contract talent engagement professionals are employees of Robert Half and are paid by Robert Half" and that "the customer pays a fixed rate only for hours worked"; the key drivers of that revenue are "average hourly bill rates and the number of hours worked". If the client later hires the person outright, "the client typically pays a one-time fee for such conversions."
The recruiter's money is the spread between the bill rate and the wage. AMN Healthcare, a nurse, allied and locum tenens staffing company, reports a cost of revenue that "consists predominantly of compensation, benefits, housing, travel and allowance costs" for the healthcare professionals it places, and gross margins of 28.3% in 2025 and 30.8% in 2024. That gross margin is the pool the agency's overhead, profit and recruiter commissions all come out of, and it is earned for as long as the clinician stays on assignment. A travel nurse recruiter is therefore paid to keep clinicians on contract with the agency's clients, assignment after assignment, which is a different incentive from filling a permanent role once. Locum tenens works the same way with a twist: AMN notes that its locum tenens professionals are independent contractors rather than employees, so the agency bills the facility and pays the physician as a contractor.
Outsourced recruiting: a contract fee, fixed and variable
The fifth model sells the recruiting function itself. Korn Ferry describes recruitment process outsourcing revenue as "generated through two distinct phases": implementation fees recognized "over the period that the related implementation services" are delivered, and then "the post-implementation recruitment phase", which "represents end-to-end recruiting services to clients for which there are both fixed and variable fees". A managed services program takes over a hospital's contingent labor instead: AMN says its MSP arrangements accounted for about 48% of its 2025 consolidated revenue, and that roughly $1.4 billion of client spend flowed through its vendor management system programs, "for which we typically earn a fee as a percentage of spend". Under these contracts the recruiters are the provider's employees, paid a salary by the provider, and the provider's money is a monthly program fee plus a variable piece that rises with hires made or agency hours bought.
What this means if you run a healthcare talent acquisition team
Each model prices a hire differently. A contingency fee scales with the hire's salary and is owed per placement. A retainer is owed whether or not the search closes. A travel contract carries the agency's margin on every hour, for months. An outsourcing contract converts recruiting into a recurring line item with a variable tail. Your own recruiters cost a salary, the healthcare and social assistance median above, that does not rise with the number of hires; what limits them is capacity, because sourcing passive clinicians one at a time is the work the other four models are paid to absorb.
That capacity gap is what Betterleap is built for. The agent searches 35M+ healthcare professionals, checks licensure through 25+ state board partnerships, drafts a personalized outreach sequence, sends it from the recruiter's own mailbox and follows up until the candidate replies, then re-engages the past applicants and silver medalists already in your ATS (25+ integrations). Community Health Network reported a 35% increase in sourcing efficiency and about ten hours a week saved per recruiter; FOX Rehabilitation saw email open rates rise from under 10% to 50-60%. None of it carries a per-placement fee, a retainer or an hourly margin. To see what your salaried team could source on its own roles, request a demo, and for the playbook itself, read how to source passive nurse candidates.
Sources
- U.S. Bureau of Labor Statistics, Occupational Outlook Handbook: Human Resources Specialists, May 2025 wages and 2025-35 projections, read 19 October 2026.
- U.S. Bureau of Labor Statistics, Occupational Employment and Wage Statistics, May 2025 technical notes (what the survey's wages include), read 19 October 2026.
- U.S. Department of Labor, Wages: Commissions, read 19 October 2026.
- Robert Half Inc., Form 10-K for the year ended 31 December 2025, filed 13 February 2026, read 19 October 2026.
- Korn Ferry, Form 10-K for the fiscal year ended 30 April 2026, filed 26 June 2026, read 19 October 2026.
- Heidrick & Struggles International, Form 10-K for the year ended 31 December 2024, filed 3 March 2025, read 19 October 2026.
- AMN Healthcare Services, Form 10-K for the year ended 31 December 2025, filed 20 February 2026, read 19 October 2026.
- American Staffing Association, Staffing Industry Statistics, 2024 figures, read 19 October 2026.
- Betterleap: betterleap.com, case studies for Community Health Network and FOX Rehabilitation.
Frequently asked questions
How do recruiters make money?
In one of five ways. In-house recruiters earn a salary from the employer. Contingency agency recruiters earn a share of a placement fee, a percentage of the hire's first-year pay that the employer owes only when a hire is made. Retained search consultants are paid from a retainer of about one-third of estimated first-year compensation, paid during the search. Contract and travel staffing recruiters earn commission from the margin between the hourly bill rate and the clinician's pay. Outsourced recruiting providers earn fixed program fees plus variable fees per hire or as a percentage of spend.
Do internal recruiters get commission?
Usually not. An internal (in-house) recruiter is a salaried human resources specialist, sometimes with a bonus tied to hiring goals or the organization's annual plan. Federal law does not require commission at all. The Bureau of Labor Statistics' May 2025 median for the occupation is $75,940 a year across all industries and $64,130 in healthcare and social assistance, and those figures already include any commission or production bonus that was paid.
Do recruiters get paid if the candidate is not hired?
It depends on the model. A contingency recruiter does not: the placement fee is owed only when a candidate accepts and starts, and it can be refunded if the hire leaves inside a guarantee period. A retained search firm does: its retainer is paid during the search whether or not it closes. In-house recruiters are paid their salary either way.
How do travel nurse recruiters make money?
From the agency's margin. The clinician is the agency's employee, the hospital pays an hourly bill rate for hours worked, and the agency pays the clinician's wage, housing, travel and benefits out of that rate. AMN Healthcare reported gross margins of 28.3% in 2025. The recruiter's commission comes out of that spread and continues for as long as the clinician stays on assignment.
Does the recruiter's fee come out of the candidate's salary?
No. Placement fees are paid by the employer; Robert Half's filing states that "no fee for placement services is charged to employment candidates." In contract and travel staffing the clinician is paid by the agency, which bills the hospital a higher rate and keeps the difference.