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Selected Quarterly Financial Information (Tables)
 12 Months Ended
Dec. 31, 2019
Quarterly Financial Information Disclosure [Abstract]  
Summary of Company's Selected Quarterly Financial Information
The following tables set forth a summary of the Company’s selected quarterly financial information for each of the four quarters ended December 31, 2019 and 2018 (in thousands, except for per share data):
 
2019 Quarters
 
  
First
 
  
Second
 
  
Third
 
  
Fourth
 
Net revenue
  $
851,183
    $
 
 
868,309
    $
888,675
    $
905,375
 
                                 
Operating expenses:
   
     
     
     
 
Practice salaries and benefits
   
621,539
     
608,962
     
630,309
     
647,968
 
Practice supplies and other operating expenses
   
25,791
     
28,016
     
26,950
     
32,009
 
General and administrative expenses
   
101,821
     
103,540
     
102,356
     
96,926
 
Depreciation and amortization
   
20,033
     
19,809
     
19,608
     
19,410
 
Transformational and restructuring related expenses
   
3,544
     
27,482
     
19,992
     
44,311
 
Goodwill impairment
   
—  
      
—  
      
1,449,215
     
—  
 
 
                                
Total operating expenses
   
772,728
     
787,809
     
2,248,430
     
840,624
 
 
                                
Income (loss) from operations
   
78,455
     
80,500
     
(1,359,755
 )    
64,751
 
Investment and other income
   
1,647
     
1,222
     
1,373
     
1,429
 
Interest expense
   
(30,723
 )    
(31,080
 )    
(29,901
 )    
(27,677
 )
Equity in earnings of unconsolidated affiliates
   
1,236
     
1,990
     
2,249
     
2,304
 
 
                                
Total
non-operating
expenses
    
(27,840
 )    
(27,868
 )    
(26,279
 )    
(23,944
 )
 
                                
Income (loss) from continuing operations before income taxes
   
50,615
     
52,632
     
(1,386,034
 )    
40,807
 
Income tax (provision) benefit
   
(8,962
 )    
(17,116
 )    
125,788
     
(7,824
 )
 
                                
Income (loss) from continuing operations
   
41,653
     
35,516
     
(1,260,246
 )    
32,983
 
(Loss) income from discontinued operations, net of tax
   
(284,525
 )    
(43,761
 )    
4,330
     
(23,652
)
 
                                
Net (loss) income
  $
(242,872
 )   $
 (8,245
 )   $
(1,255,916
 )   $
9,331
 
 
                                
Per common and common equivalent share data (1):
   
     
     
     
 
Income (loss) from continuing operations:
   
     
     
     
 
Basic
  $
0.48
    $
0.43
    $
 (15.29
 )   $
0.40
 
 
                                
Diluted
  $
0.48
    $
0.42
    $
 (15.29
 )   $
0.40
 
 
                                
(Loss) income from discontinued operations:
   
     
     
     
 
Basic
  $
 (3.31
 )   $
 (0.53
 )   $
0.05
    $
(0.29
)
 
                                
Diluted
  $
 (3.29
 )   $
 (0.52
 )   $
0.05
    $
(0.29
)
 
                                
Net (loss) income:
   
     
     
     
 
Basic
  $
 (2.82
 )   $
 (0.10
 )   $
 (15.24
 )   $
0.11
 
 
                                
Diluted
  $
 (2.81
 )   $
 (0.10
 )   $
 (15.24
 )   $
0.11
 
 
                                
Weighted average common shares:
   
     
     
     
 
Basic
   
86,073
     
83,234
     
82,441
     
82,592
 
 
                                
Diluted
   
86,545
     
83,689
     
82,441
     
83,288
 
                                 
(1) Basic and diluted per share amounts are computed for each of the periods presented. Accordingly, the sum of the quarterly per share amounts may not agree with the full year amount.
  
2018 Quarters
 
  
First
 
  
Second
 
  
Third
 
  
Fourth
 
Net revenue
  $
852,628
     
864,987
    $
848,759
    $
888,436
 
 
                                
Operating expenses:
   
     
     
     
 
Practice salaries and benefits
   
603,955
     
593,047
     
599,326
     
630,048
 
Practice supplies and other operating expenses
   
27,403
     
28,329
     
27,249
     
25,870
 
General and administrative expenses
   
101,693
     
100,938
     
95,771
     
105,532
 
Depreciation and amortization
   
19,914
     
20,280
     
22,205
     
21,433
 
 
                                
Total operating expenses
   
752,965
     
742,594
     
744,551
     
782,883
 
 
                                
Income from operations
   
99,663
     
122,393
     
104,208
     
105,553
 
Investment and other income
   
1,474
     
1,225
     
1,531
     
981
 
Interest expense
   
(19,935
 )    
(21,618
 )    
(21,788
 )    
(25,448
 )
Equity in earnings of unconsolidated affiliates
   
1,525
     
1,257
     
1,766
     
2,277
 
 
                                
Total
non-operating
expenses
    
(16,936
 )    
(19,136
 )    
(18,491
 )    
(22,190
 )
 
                                
Income from continuing operations before income taxes
   
82,727
     
103,257
     
85,717
     
83,363
 
Income tax provision
   
(22,720
 )    
(28,482
 )    
(23,550
 )    
(21,701
 )
 
                                
Income from continuing operations
   
60,007
     
74,775
     
62,167
     
61,662
 
Income (loss) from discontinued operations, net of tax
   
3,421
     
4,637
     
3,408
     
(1,448
 )
 
                                
Net income
  $
63,428
     
79,412
    $
65,575
    $
60,214
 
 
                                
Per common and common equivalent share data (2):
   
     
     
     
 
Income from continuing operations:
   
     
     
     
 
Basic
  $
0.65
    $
0.80
    $
0.68
    $
0.70
 
 
                                
Diluted
  $
0.64
    $
0.80
    $
0.68
    $
0.70
 
 
                                
Income (loss) from discontinued operations:
   
     
     
     
 
Basic
  $
0.04
    $
0.05
    $
0.04
    $
(0.02
 )
 
                                
Diluted
  $
0.04
    $
0.05
    $
0.04
    $
(0.02
 )
 
                                
Net income:
   
     
     
     
 
Basic
  $
0.68
    $
0.85
    $
0.72
    $
0.68
 
 
                                
Diluted
  $
0.68
    $
0.85
    $
0.72
    $
0.68
 
 
                                
Weighted average common shares:
   
     
     
     
 
Basic
   
92,859
     
92,987
     
90,984
     
87,810
 
 
                                
Diluted
   
93,505
     
93,529
     
91,359
     
88,258
 
 
                                
(2) Basic and diluted per share amounts are computed for each of the periods presented. Accordingly, the sum of the quarterly per share amounts may not agree with the full year amount.