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Accrued Professional Liabilities - Schedule of Accrued Professional Liability (Detail) - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2017
Dec. 31, 2016
Dec. 31, 2015
Payables and Accruals [Abstract]      
Balance at beginning of year $ 202,052 $ 202,527 $ 168,369
Assumed liabilities through acquisition 20,716   35,968
Provision (adjustment) for losses related to Current year 41,291 38,129 39,204
Provision (adjustment) for losses related to Prior years 9,983 (25,428) (25,797)
Total provision for losses 51,274 12,701 13,407
Claim payments related to Current year (712) (766) (1,382)
Claim payments related to Prior years (23,143) (12,410) (13,835)
Total payments (23,855) (13,176) (15,217)
Balance at end of year $ 250,187 $ 202,052 $ 202,527