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Accrued Professional Liabilities - Schedule of Accrued Professional Liability (Detail) - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2018
Dec. 31, 2017
Dec. 31, 2016
Payables and Accruals [Abstract]      
Balance at beginning of year $ 250,187 $ 202,052 $ 202,527
Assumed liabilities through acquisition 1,276 20,716  
Provision (adjustment) for losses related to Current year 34,483 41,291 38,129
Provision (adjustment) for losses related to Prior years 10,299 9,983 (25,428)
Total provision for losses 44,782 51,274 12,701
Claim payments related to Current year (555) (712) (766)
Claim payments related to Prior years (51,699) (23,143) (12,410)
Total payments (52,254) (23,855) (13,176)
Balance at end of year $ 243,991 $ 250,187 $ 202,052