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Condensed Consolidated Statements of Income (Unaudited) - USD ($)
shares in Thousands, $ in Thousands
 3 Months Ended
Mar. 31, 2018
Mar. 31, 2017
Income Statement [Abstract]    
Net revenue $ 901,857 $ 835,597
Operating expenses:    
Practice salaries and benefits 631,830 572,385
Practice supplies and other operating expenses 30,655 27,796
General and administrative expenses 108,776 103,765
Depreciation and amortization 26,163 25,614
Total operating expenses 797,424 729,560
Income from operations 104,433 106,037
Investment and other income 1,464 576
Interest expense (19,935) (17,752)
Equity in earnings of unconsolidated affiliates 1,525 797
Total non-operating expenses (16,946) (16,379)
Income before income taxes 87,487 89,658
Income tax provision (24,059) (34,967)
Net income $ 63,428 $ 54,691
Net income:    
Earnings per share, Basic $ 0.68 $ 0.59
Earnings per share, Diluted $ 0.68 $ 0.59
Weighted average common shares:    
Basic 92,859 92,360
Diluted 93,505 93,143