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Accrued Professional Liabilities - Schedule of Accrued Professional Liability (Detail) - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2016
Dec. 31, 2015
Dec. 31, 2014
Payables and Accruals [Abstract]      
Balance at beginning of year $ 202,527 $ 168,369 $ 158,691
Assumed liabilities through acquisition   35,968  
Provision (adjustment) for losses related to Current year 38,129 39,204 39,386
Provision (adjustment) for losses related to Prior years (25,428) (25,797) (16,125)
Total provision for losses 12,701 13,407 23,261
Claim payments related to Current year (766) (1,382) (293)
Claim payments related to Prior years (12,410) (13,835) (13,290)
Total payments (13,176) (15,217) (13,583)
Balance at end of year $ 202,052 $ 202,527 $ 168,369