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Accrued Professional Liabilities - Additional Information (Detail) - USD ($)
$ in Thousands
Dec. 31, 2018
Dec. 31, 2017
Dec. 31, 2016
Dec. 31, 2015
Payables and Accruals [Abstract]        
Total accrued professional liability $ 243,991 $ 250,187 $ 202,052 $ 202,527
Accrued professional liability incurred but loss reserves not reported for claims 139,100 138,500    
Accrued professional liability incurred and loss reserves reported for claims 104,900 111,700    
Accrued professional liabilities 34,931 $ 37,912    
Insurance receivables $ 16,700