Frequently asked questions

Across health systems that later became Clasp partners, first-year clinical turnover most often sat in the 15–30% range at the time of first contact. Industry-wide first-year rates are published annually, with last year’s indicating an average turnover rate of 18.5%, with first year turnover averages even higher at a whopping 29.5%. First-year turnover is usually higher than the all-tenure rate, which is why organizations reporting a low overall number can still have a significant early-tenure problem.

Premium labor is any staffing that costs more per hour than an employed staff clinician. It covers travel and agency clinicians, locum tenens, overtime, incentive or bonus shifts, sitters, and contracted per-diem coverage. Health systems track it as a single line because the drivers are shared: every category rises when positions sit vacant. Premium labor is typically the fastest-moving line on a hospital's labor budget, which is why finance teams watch it more closely than base wages.

Agency bill rates include the clinician's pay plus the agency's margin, recruiting cost, housing and travel stipends where applicable, and the premium for short-notice availability. Rates vary widely by specialty, geography, and contract length.

Roughly $66,000 more per year per full-time equivalent. The 2026 NSI National Health Care Retention & RN Staffing Report puts the average travel RN at $189,758 annually against $123,676 for an employed RN. The gap widens in high-demand specialties and in markets where housing stipends are large. At that differential, converting twenty travel positions to permanent staff represents an opportunity to save over a million dollars annually.

Rate negotiation, internal float pools, and shift-scheduling changes can reduce agency costs somewhat, but agency use is driven by open positions, so the spend ties directly to vacancy rates. Reducing it durably requires either filling the positions or reducing the number that open. Most systems pursue both.

Sign-on bonuses may improve offer acceptance rates, though Clasp’s student focus groups have indicated that many candidates are suspicious of sign-on bonuses given the frequently-used clawback period. The payment is taxed as ordinary income, is typically received in the first pay periods, and creates no ongoing incentive once received. Clawback provisions are enforceable in some states and not others, and enforcement is inconsistent in practice. Studies show sign on bonuses with a ROI of −72%, or about $2,800 of realized value per $10,000 spent.

Most systems work through four levers in sequence: measure contingent spend by unit and channel, consolidate vendors under benchmarked rates, build internal float capacity, and then address the vacancy and turnover driving the demand. The first three lower the price of coverage; only the fourth lowers the amount of coverage needed.

The American Hospital Association reported $51.1 billion in hospital contract staffing spend in 2023, within total labor costs that account for roughly 56% of hospital expenses. Contract labor spend has declined from its pandemic peak at most systems but remains well above pre-2020 levels.

For most roles, no. Applications to many clinical training programs exceed available seats — nurse anesthesia programs accept roughly 25% of applicants. The constraints are training capacity and clinical rotation availability on the supply side, and attrition on the demand side. Respiratory therapy is a partial exception, where program applications have been lower.

The roles Clasp partners most often name are imaging and radiology technologists, respiratory therapists, registered nurses, CRNAs, and the therapy disciplines (PT, OT, SLP). These share small national graduating cohorts, a limited number of accredited programs, and regional gaps where no program exists within commuting distance. Vacancies in surgical services and imaging also constrain revenue directly, since procedures cannot run without full staffing.

The most commonly cited reasons are the gap between training and practice readiness, workload beyond what a new graduate was prepared for, inadequate preceptor support, and schedules that offer little control. Compensation is often the reason they choose where to go next, and most first-year leavers move to another employer rather than out of clinical practice.

That distinction matters for how employers respond. Transition-to-practice support reduces the impulse to leave; a financial commitment the clinician has not yet fully earned changes the math on acting on it. Programs that pair both address the decision and the trigger, rather than one or the other.

They improve offer acceptance rates. The evidence for retention past the commitment period is weak. The payment is taxed as ordinary income, arrives in the first pay periods, and creates no further incentive once received. One published analysis puts the effective return at −72%, or roughly $2,800 of realized value per $10,000 spent. Clasp's own student focus groups also found many candidates view sign-on bonuses with suspicion because of the attached clawback period.

Enforceability varies by state and by how the agreement is written, and practice varies further: many employers hold clawback rights they rarely exercise, because pursuing a departing clinician generates poor word-of-mouth in a small professional community and requires heavy manual lift from the team to recoup. Candidates price this uncertainty in. Clasp's focus groups found the clawback period is one of the main reasons candidates discount the headline value of a sign-on bonus.

Four approaches dominate: raising base compensation, differentiating on schedule flexibility and control, investing in career progression and specialty training, and building pipelines that reach candidates before they enter the open market. The first is the fastest to copy and the easiest for a larger competitor to beat. The last is the hardest to displace, which is why systems with established school partnerships tend to hold their markets even against better-funded competitors. More health systems are investing in student-loan repayment as a differentiated offer to compete for healthcare students who are doing the math on how they’ll cover the cost of their education after graduation.

Rarely on base pay. The approaches that work are usually speed of hiring, scope of practice and variety, schedule predictability, direct access to leadership, and offers a large system's standardized total rewards package cannot easily flex — a program tailored to an individual candidate is structurally easier for a 900-person organization than for one running a single compensation framework across thirty thousand employees.

The harder constraint is employer brand. Students in a region often know the two largest systems by name and nothing else, so a smaller employer can lose candidates it would have won on the merits simply by never entering consideration. That makes distribution as important as the offer itself: reaching students during their program rather than at graduation, showing up through channels students already use, and leading with a differentiator specific enough to be remembered. Student loan repayment does both jobs here — it is uncommon enough to create recall, and substantial enough to offset a pay gap. Clasp helps amplify employer brand through TikTok and Instagram influencers, virtual career fairs, strategic partnerships, and more.

Clasp recently surveyed 1,000 healthcare students and 31% ranked student loan repayment assistance as a top-2 factor in choosing their first job. It's third overall behind only salary and flexibility. Consistently across other workforce surveys clinicians also indicate manager quality, schedule control, safe staffing ratios, career progression, and compensation. Employer-of-choice status is measured most reliably by voluntary turnover rate and new-graduate capture rate rather than by survey scores alone.

Time-to-fill is usually constrained by candidate supply rather than process, so process improvements have a ceiling. Where supply is the constraint, the effective levers are widening the geographic search, recruiting earlier in the education cycle so candidates are identified before they enter the open market, and building repeatable school relationships that produce a predictable annual cohort. Systems that recruit only from the active applicant pool are competing for the same candidates as everyone within commuting distance.

An employer sets an offer amount and a commitment term for a target set of roles. Clasp sources candidates through its school network, creator channels, and events, presenting the employer's open roles in the employer's branding, and trains recruiters to position the value of loan repayment in order to better convert candidates. A candidate who accepts signs an agreement committing to work for that employer for the term. Once the clinician is on payroll, the employer funds monthly student loan payments and Clasp facilitates payments directly to the loan servicer. Payments continue for the length of the commitment and stop if employment ends.

None of those. Clasp does not place contract workers, does not charge a percentage of salary, and does not replace an internal talent acquisition function. It operates as an extension to your existing recruiting team by providing an additional sourcing channel plus a loan repayment administration and employee engagement layer. The employer's recruiters run interviews, extend offers, and own the candidate relationship.

Academic medical centers, children's hospitals, regional and rural health systems, outpatient and inpatient therapy groups, skilled nursing and long-term care operators, home health agencies, imaging companies, optometry groups, and veterinary networks. Care setting affects program design — offer size, commitment length, which schools are targeted — more than it affects whether the model applies.

An arrangement in which an employer makes payments toward an employee's existing student loan balance as a benefit or recruiting incentive. If an employer elects into the program, up to $5,250 per employee per year can be excluded from the employee's taxable income under Section 127.

Yes. Sourcing is a mix of local, regional, and national, and the unique draw of student loan repayment as a recruiting tool tends to attract talent from outside an employers’ typical reach. One imaging pilot produced 30+ applicants from 13+ states over ten weeks. Whether out-of-state candidates can be hired depends on licensure: compact states allow faster transfer, non-compact states require separate licensure before the clinician can practice.

Working backward from the hire date. For most clinical roles, candidates make employment decisions as early as six to eighteen months before graduation, so a pipeline that begins at graduation is already late. The components are school relationships that give consistent access to each cohort, visibility with students early enough to matter, a reason to choose one employer over the others recruiting the same class, and a mechanism that holds the commitment at the time of the decision, at the start date, and after hire.

A program that develops clinicians from within the organization rather than hiring them from the external market — funding an LPN to become an RN, a PTA to become a PT, or an ICU nurse to enter a CRNA program. The defining risk is that an employer funds a credential and loses the employee to a competitor once it's earned, which is why Clasp helps employers support the employee during school and retain them after graduation in their new role by helping to repay the student loans required to complete the training.

Capture rate — the share of graduates from local programs a system successfully hires — improves mainly through earlier contact and differentiated offers. Systems that meet students during their first clinical year, maintain relationships with program directors and career services, and offer something competitors don't consistently report higher capture than those recruiting from the applicant pool at graduation. Systems in markets with few local programs typically have to recruit nationally to hit headcount regardless of local capture rate.

Payments stop. Because student loan repayment is made monthly, the employer has paid only for months already worked. There is no clawback process, which derisks the dollars for you, and eliminates a key objection held by candidates.

No. Payments are made monthly for months already worked, so there is nothing to recover and no recovery process to run. This is a deliberate difference from sign-on bonuses, where the clawback provision is both an administrative burden for the employer and a reason candidates discount the offer.

After the clinician is on payroll. If a candidate does not graduate, does not pass licensure, or does not start, no payments are made.

The standard approach compares program cost against avoided replacement cost, using the organization's own turnover rate and cost-per-hire rather than published averages. A complete model includes premium labor avoided during vacancy, overtime displaced, and the revenue effect where vacancies constrain capacity — the last is frequently omitted and is often the largest term for procedural and imaging roles. Programs are usually modelled over at least three years, since first-year cost is front-loaded and retention benefits accrue later.

Three structural differences. The payment recurs monthly rather than arriving once, so it remains visible and top of mind. It is applied directly to a loan balance, so the clinician sees the balance decrease and the impact on their budget each month. And the unpaid remainder of the commitment represents money not yet received, which is forfeited on departure.

In a Clasp survey of 1,000 clinicians, 31% of healthcare students rank student loan repayment assistance as a top-2 factor in choosing their first job. That beats sign-on bonuses (11%), mentorship (13%), company culture (12%), and mission (17%). It's third overall behind only salary and flexibility. Some employers offer both, with a smaller sign-on alongside student loan repayment, while others eliminate sign-on bonuses completely.

Clinicians who sign pre-graduation enter employment already committed to a multi-year term. At onboarding, the program terms are reviewed with the employee. During employment, Clasp sends monthly payment confirmations, tracks progress against the commitment, and provides financial wellness content and engagement communications.

This is a predictable attrition point, usually at 12, 18, or 24 months, and it is often the largest single cluster of voluntary departures in a cohort. The clinician has satisfied the obligation, has a year or two of experience that makes them more marketable than at hire, and has no remaining financial reason to stay. Employers address it by introducing a second commitment-backed incentive before the first expires rather than after, since a clinician already in conversation with a recruiter is difficult to retain with a counteroffer. Alternatively, employers can spread spend over a longer retention period, and create loyalty over time through ongoing investment in talent, rather than a one-time bonus that’s long gone at the end of the commitment period.

Clasp operates programs in states and regions that do not typically attract inbound relocation. Results vary by market. During evaluation, Clasp provides applicant-to-goal data from partners in comparable geographies rather than a general projection, and will advise against proceeding where the market is unlikely to generate sufficient applicant volume.

Clasp’s new-grad talent program is designed for candidates within roughly 24 months of graduation. Clasp also offers student loan repayment for current employees at any tenure.

Imaging is one of the tightest allied health markets, with small program cohorts, limited accredited programs per state, and modality-specific credentialing that narrows the pool further for CT, MRI, and nuclear medicine. Local graduating classes are frequently in the single digits, so most systems have to recruit regionally or nationally to fill. It’s estimated that nearly 40% of radiologic technologists are career changers, meaning they may carry debt from previous education, even if not incurring high levels of debt for their new role as a rad tech. Employers who offer loan repayment can reduce concern around a career pivot and enable more aspiring clinicians to enter the field.

Respiratory therapy differs from most clinical shortage roles: program applications have been lower rather than seat-constrained, so the pipeline is genuinely smaller rather than artificially capped. Fewer programs, smaller cohorts, and lower awareness of the profession among prospective students all contribute. This makes early engagement — reaching students during the program rather than at graduation — more important for RT than for roles with excess applicant demand. It’s estimated that nearly 40% of respiratory therapists are career changers, meaning they may carry debt from previous education, even if not incurring high levels of debt for their new role as a respiratory therapist. Employers who offer student loan repayment can reduce concern around a career pivot and enable more aspiring clinicians to enter the field.

Therapy recruiting competes on debt load more than most clinical disciplines: doctoral-level PT programs commonly produce six-figure balances against starting salaries well below those of comparably credentialed roles. Outpatient practices also compete directly with health systems and home health for the same graduates. Practices that reach students during clinical rotations and offer something addressing the debt-to-salary gap typically convert better than those posting at graduation.

A provision of the Internal Revenue Code that allows employers to provide up to $5,250 per employee per year in educational assistance, including student loan repayment, excluded from the employee's taxable income. The student loan repayment application was made permanent in recent legislation and is expected to be indexed for inflation beginning in 2027. Amounts above the annual limit are treated as taxable wages. Clasp is not a tax advisor; confirm treatment with your own counsel.

Cash added to payroll is fully taxable to the employee and subject to payroll tax for the employer. The exclusion requires that the payment be made for education loan repayment, which means an employer paying through payroll must separately document that the funds were applied to a qualifying loan. Clasp pays servicers directly, which produces that documentation as a byproduct.

One consolidated invoice per month covering all participants, remitted once. Clasp facilitates distribution to each participant's student loan servicer and returns reports covering payments made, participant status, and the taxable/non-taxable split. The employer maintains participant eligibility and status in a web portal for which Clasp will provide training and resources.

No integration is required; the portal is accessed through a browser. Clasp does not access patient data in any way, and is SOC2 compliant. Where an organization's procurement process requires a security review or mutual NDA regardless, Clasp is happy to support in completing that process.

Federal and private education loans. Clasp supports approximately 95% of U.S. loan servicers. Non-education debt is not eligible.

Yes. Clasp does not access patient data of any kind. Where an organization's procurement process requires a security review or mutual NDA, Clasp supports that process.

Administrators process payments for a benefit the employer has already designed and staffed. Clasp uses student loan repayment as a differentiator in your candidate sourcing and integrates school relationships, a content creator network, virtual career fairs, brand marketing and more. Clasp supports participant engagement in the program on an ongoing basis.

Usually not. Some partners run Clasp alongside an existing education benefits vendor. In the event that scope overlaps, Clasp will map the overlap during evaluation.