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Condensed Consolidated Statements of Income - USD ($)
shares in Thousands, $ in Thousands
 3 Months Ended
Mar. 31, 2019
Mar. 31, 2018
Income Statement [Abstract]    
Net revenue $ 851,183 $ 852,628
Operating expenses:    
Practice salaries and benefits 621,539 603,955
Practice supplies and other operating expenses 25,791 27,403
General and administrative expenses 101,821 101,693
Depreciation and amortization 20,033 19,914
Transformational and restructuring related expenses 3,544 0
Total operating expenses 772,728 752,965
Income from operations 78,455 99,663
Investment and other income 1,647 1,474
Interest expense (30,723) (19,935)
Equity in earnings of unconsolidated affiliates 1,236 1,525
Total non-operating expenses (27,840) (16,936)
Income from continuing operations before income taxes 50,615 82,727
Income tax provision (8,962) (22,720)
Income from continuing operations 41,653 60,007
(Loss) income from discontinued operations, net of tax (284,525) 3,421
Net (loss) income $ (242,872) $ 63,428
Income from continuing operations:    
Basic $ 0.48 $ 0.65
Diluted 0.48 0.64
(Loss) income from discontinued operations:    
Basic (3.31) 0.04
Diluted (3.29) 0.04
Net (loss) income:    
Basic (2.82) 0.68
Diluted $ (2.81) $ 0.68
Weighted average common shares:    
Basic 86,073 92,859
Diluted 86,545 93,505