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Consolidated Statements of Income - USD ($)
shares in Thousands, $ in Thousands
 3 Months Ended 12 Months Ended
Dec. 31, 2020
Sep. 30, 2020
Jun. 30, 2020
Mar. 31, 2020
Dec. 31, 2019
Sep. 30, 2019
Jun. 30, 2019
Mar. 31, 2019
Dec. 31, 2020
Dec. 31, 2019
Dec. 31, 2018
Income Statement [Abstract]                      
Net revenue $ 416,630 $ 460,635 $ 415,441 $ 441,245 $ 458,600 $ 454,913 $ 439,154 $ 427,092 $ 1,733,951 $ 1,779,759 $ 1,723,107
Operating expenses:                      
Practice salaries and benefits 284,772 309,904 282,985 316,279 300,073 301,306 284,627 294,753 1,193,940 1,180,759 1,125,671
Practice supplies and other operating expenses 24,235 22,440 20,173 23,842 23,223 22,581 25,402 24,705 90,690 95,911 92,475
General and administrative expenses 54,671 66,346 60,488 67,442 59,194 63,284 63,011 59,023 248,947 244,512 232,218
Depreciation and amortization 7,692 7,195 6,751 6,803 7,101 6,408 6,239 6,183 28,441 25,931 24,355
Transformational and restructuring related expenses 12,955 34,291 10,479 16,076 28,865 12,766 16,820 2,439 73,801 60,890 0
Total operating expenses 384,325 440,176 380,876 430,442 418,456 406,345 396,099 387,103 1,635,819 1,608,003 1,474,719
Income from operations 32,305 20,459 34,565 10,803 40,144 48,568 43,055 39,989 98,132 171,756 248,388
Investment and other income 4,849 10,534 3,576 (1,046) 909 802 726 1,249 17,913 3,686 3,051
Interest expense (27,302) (27,250) (28,265) (27,665) (27,657) (29,909) (31,013) (30,349) (110,482) (118,928) (92,945)
Equity in earnings of unconsolidated affiliates 504 282 305 494 517 786 503 464 1,585 2,270 7,714
Net non-operating expenses (21,949) (16,434) (24,384) (28,217) (26,231) (28,321) (29,784) (28,636) (90,984) (112,972) (82,180)
Income from continuing operations before income taxes 10,356 4,025 10,181 (17,414) 13,913 20,247 13,271 11,353 7,148 58,784 166,208
Income tax provision (5,869) (6,677) (3,097) (1,085) (3,986) (7,360) (6,744) 1,514 (16,728) (16,576) (44,694)
(Loss) income from continuing operations 4,487 (2,652) 7,084 (18,499) 9,927 12,887 6,527 12,867 (9,580) 42,208 121,514
(Loss) income from discontinued operations, net of tax (68,783) (38,392) (679,520) (213) (596) (1,268,803) (14,772) (255,739) (786,908) (1,539,910) 147,115
Net (loss) income $ (64,296) $ (41,044) $ (672,436) $ (18,712) $ 9,331 $ (1,255,916) $ (8,245) $ (242,872) $ (796,488) $ (1,497,702) $ 268,629
(Loss) income from continuing operations:                      
Basic $ 0.05 $ (0.03) $ 0.08 $ (0.22) $ 0.12 $ 0.16 $ 0.08 $ 0.15 $ (0.11) $ 0.50 $ 1.33
Diluted 0.05 (0.03) 0.08 (0.22) 0.12 0.16 0.08 0.15 (0.11) 0.50 1.33
(Loss) income from discontinued operations:                      
Basic (0.81) (0.46) (8.14)   (0.01) (15.39) (0.18) (2.97) (9.44) (18.44) 1.62
Diluted (0.81) (0.46) (8.11)   (0.01) (15.31) (0.18) (2.96) (9.44) (18.33) 1.60
Net (loss) income:                      
Basic (0.76) (0.49) (8.06) (0.22) 0.11 (15.23) (0.10) (2.82) (9.55) (17.94) 2.95
Diluted $ (0.76) $ (0.49) $ (8.03) $ (0.22) $ 0.11 $ (15.15) $ (0.10) $ (2.81) $ (9.55) $ (17.83) $ 2.93
Weighted average common shares:                      
Basic 84,316 83,862 83,490 82,799 82,592 82,441 83,234 86,073 83,395 83,495 91,104
Diluted 85,082 83,862 83,744 82,799 83,288 82,883 83,689 86,545 83,395 84,011 91,606