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Cover Page - USD ($)	12 Months Ended
Cover Page - USD ($)	Dec. 31, 2019	Feb. 14, 2020	Jun. 28, 2019
Cover [Abstract]
Document Type	10-K
Document Annual Report	true
Document Transition Report	false
Amendment Flag	false
Document Period End Date	Dec. 31, 2019
Document Fiscal Year Focus	2019
Document Fiscal Period Focus	FY
Entity Registrant Name	MEDNAX, INC.
Entity Central Index Key	0000893949
Current Fiscal Year End Date	--12-31
Entity Well-known Seasoned Issuer	Yes
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Common Stock, Shares Outstanding		84,277,494
Entity Voluntary Filers	No
Title of 12(b) Security	Common Stock
Trading Symbol	MD
Security Exchange Name	NYSE
Entity File Number	001-12111
Entity Incorporation, State or Country Code	FL
Entity Tax Identification Number	26-3667538
Entity Address, Address Line One	1301 Concord Terrace
Entity Address, City or Town	Sunrise
Entity Address, State or Province	FL
Entity Address, Postal Zip Code	33323
City Area Code	954
Local Phone Number	384-0175
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Public Float			$ 2,051,190,371

Condensed Consolidated Balance Sheets (Unaudited) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Current assets:
Cash and cash equivalents	$ 112,767	$ 25,491
Restricted cash	0	20,000
Short-term investments	74,510	21,923
Accounts receivable, net	498,869	506,723
Prepaid expenses	21,919	17,123
Other current assets	23,442	17,166
Assets held for sale	0	51,551
Total current assets	731,507	659,977
Investments	0	69,699
Property and equipment, net	94,492	90,434
Goodwill	2,710,292	4,061,439
Intangible assets, net	274,407	313,165
Operating lease right-of-use assets	82,824	0
Deferred income tax assets	162,385	21,910
Other assets	89,994	81,224
Assets held for sale	0	639,633
Total assets	4,145,901	5,937,481
Current liabilities:
Accounts payable and accrued expenses	511,866	448,567
Current portion of finance lease liabilities	130	253
Current portion of operating lease liabilities	23,317	0
Income taxes payable	6,505	30,598
Liabilities held for sale	0	23,344
Total current liabilities	541,818	502,762
Line of credit	0	739,500
Long-term debt and finance lease liabilities, net	1,730,295	1,234,781
Long-term operating lease liabilities	67,005	0
Long-term professional liabilities	226,892	209,060
Deferred income tax liabilities	57,995	95,581
Other liabilities	22,900	31,828
Liabilities held for sale	0	36,085
Total liabilities	2,646,905	2,849,597
Commitments and contingencies
Shareholders' equity:
Preferred stock; $.01 par value; 1,000 shares authorized; none issued	0	0
Common stock; $.01 par value; 200,000 shares authorized; 84,248 and 87,820 shares issued and outstanding, respectively	842	878
Additional paid-in capital	987,942	992,647
Retained earnings	510,212	2,094,359
Total shareholders' equity	1,498,996	3,087,884
Total liabilities and shareholders' equity	$ 4,145,901	$ 5,937,481

Condensed Consolidated Balance Sheets (Unaudited) (Parenthetical) - $ / shares	Dec. 31, 2019	Dec. 31, 2018
Statement of Financial Position [Abstract]
Preferred stock, par value	$ 0.01	$ 0.01
Preferred stock, shares authorized	1,000,000	1,000,000
Preferred stock, issued	0	0
Common stock, par value	$ 0.01	$ 0.01
Common stock, shares authorized	200,000,000	200,000,000
Common stock, shares issued	84,248,000	87,820,000
Common stock, shares outstanding	84,248,000	87,820,000

Consolidated Statements of Income - USD ($) shares in Thousands, $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Income Statement [Abstract]
Net revenue	$ 905,375	$ 888,675	$ 868,309	$ 851,183	$ 888,436	$ 848,759	$ 864,987	$ 852,628	$ 3,513,542	$ 3,454,810	$ 3,253,391
Operating expenses:
Practice salaries and benefits	647,968	630,309	608,962	621,539	630,048	599,326	593,047	603,955	2,508,778	2,426,376	2,227,335
Practice supplies and other operating expenses	32,009	26,950	28,016	25,791	25,870	27,249	28,329	27,403	112,766	108,851	106,444
General and administrative expenses	96,926	102,356	103,540	101,821	105,532	95,771	100,938	101,693	404,643	403,934	385,864
Depreciation and amortization	19,410	19,608	19,809	20,033	21,433	22,205	20,280	19,914	78,860	83,832	78,856
Transformational and restructuring related expenses	44,311	19,992	27,482	3,544					95,329	0	0
Goodwill impairment		1,449,215							1,449,215	0	0
Total operating expenses	840,624	2,248,430	787,809	772,728	782,883	744,551	742,594	752,965	4,649,591	3,022,993	2,798,499
(Loss) income from operations	64,751	(1,359,755)	80,500	78,455	105,553	104,208	122,393	99,663	(1,136,049)	431,817	454,892
Investment and other income	1,429	1,373	1,222	1,647	981	1,531	1,225	1,474	5,671	5,211	4,385
Interest expense	(27,677)	(29,901)	(31,080)	(30,723)	(25,448)	(21,788)	(21,618)	(19,935)	(119,381)	(88,789)	(74,556)
Equity in earnings of unconsolidated affiliates	2,304	2,249	1,990	1,236	2,277	1,766	1,257	1,525	7,779	6,825	952
Total non-operating expenses	(23,944)	(26,279)	(27,868)	(27,840)	(22,190)	(18,491)	(19,136)	(16,936)	(105,931)	(76,753)	(69,219)
(Loss) income from continuing operations before income taxes	40,807	(1,386,034)	52,632	50,615	83,363	85,717	103,257	82,727	(1,241,980)	355,064	385,673
Income tax benefit (provision)	(7,824)	125,788	(17,116)	(8,962)	(21,701)	(23,550)	(28,482)	(22,720)	91,886	(96,453)	(80,231)
(Loss) income from continuing operations	32,983	(1,260,246)	35,516	41,653	61,662	62,167	74,775	60,007	(1,150,094)	258,611	305,442
(Loss) income from discontinued operations, net of tax	(23,652)	4,330	(43,761)	(284,525)	(1,448)	3,408	4,637	3,421	(347,608)	10,018	14,930
Net (loss) income	$ 9,331	$ (1,255,916)	$ (8,245)	$ (242,872)	$ 60,214	$ 65,575	$ 79,412	$ 63,428	$ (1,497,702)	$ 268,629	$ 320,372
(Loss) income from continuing operations:
Basic	$ 0.40	$ (15.29)	$ 0.43	$ 0.48	$ 700	$ 680	$ 800	$ 650	$ (13.78)	$ 2.84	$ 3.31
Diluted	0.40	(15.29)	0.42	0.48	700	680	800	640	(13.78)	2.82	3.29
Income (loss) from discontinued operations:
Basic	(0.29)	0.05	(0.53)	(3.31)	(20.00)	40.00	50.00	40.00	(4.16)	0.11	0.16
Diluted	(0.29)	0.05	(0.52)	(3.29)	(20.00)	40.00	50.00	40.00	(4.16)	0.11	0.16
Net (loss) income:
Basic	0.11	(15.24)	(0.10)	(2.82)	0.68	0.72	0.85	0.68	(17.94)	2.95	3.47
Diluted	$ 0.11	$ (15.24)	$ (0.10)	$ (2.81)	$ 0.68	$ 0.72	$ 0.85	$ 0.68	$ (17.94)	$ 2.93	$ 3.45
Weighted average common shares:
Basic	82,592	82,441	83,234	86,073	87,810	90,984	92,987	92,859	83,495	91,104	92,431
Diluted	83,288	82,441	83,689	86,545	88,258	91,359	93,529	93,505	83,495	91,606	92,958

Consolidated Statements of Equity - USD ($)
shares in Thousands, $ in Thousands

Total

Common Stock [Member]

Additional Paid-in Capital [Member]

Retained Earnings [Member]

Balance at Dec. 31, 2016

$ 2,760,767

$ 937

$ 974,304

$ 1,785,526

Balance, Shares at Dec. 31, 2016

93,718

Net income (loss)

320,372

Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan

23,276

$ 5

23,271

Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan, shares

528

Issuance of restricted stock

$ 5

(5)

Issuance of restricted stock, shares

536

Issuance of restricted stock for acquisition consideration

2,658

$ 1

2,657

Issuance of restricted stock for acquisition consideration, shares

Stock-based compensation expense

29,573

Forfeitures of restricted stock

$ (1)

Forfeitures of restricted stock, shares

(92)

Repurchased common stock

(70,192)

$ (10)

(12,473)

(57,709)

Repurchased common stock, shares

(1,038)

Balance at Dec. 31, 2017

3,066,454

$ 937

1,017,328

2,048,189

Balance, Shares at Dec. 31, 2017

93,721

Net income (loss)

268,629

Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan

18,919

$ 5

18,914

Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan, shares

495

Issuance of restricted stock

$ 8

(8)

Issuance of restricted stock, shares

770

Stock-based compensation expense

38,703

Stock swaps

(2,661)

$ (1)

(2,660)

Stock swaps, shares

(56)

Forfeitures of restricted stock

$ (1)

Forfeitures of restricted stock, shares

(69)

Repurchased common stock

(302,160)

$ (70)

(79,631)

(222,459)

Repurchased common stock, shares

(7,041)

Balance at Dec. 31, 2018

3,087,884

$ 878

992,647

2,094,359

Balance, Shares at Dec. 31, 2018

87,820

Net income (loss)

(1,497,702)

Unrealized holding gain on investments, net of tax

^[1]

Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan

11,947

$ 5

11,942

Common stock issued under employee stock option, employee stock purchase plan and stock purchase plan, shares

533

Issuance of restricted stock

$ 11

(11)

Issuance of restricted stock, shares

1,113

Stock-based compensation expense

42,758

Stock swaps

(689)

$ 0

(689)

Stock swaps, shares

(20)

Forfeitures of restricted stock

$ (1)

Forfeitures of restricted stock, shares

(132)

Repurchased common stock

(145,280)

$ (51)

(58,706)

(86,523)

Repurchased common stock, shares

(5,066)

Balance at Dec. 31, 2019

$ 1,498,996

$ 842

$ 987,942

$ 510,212

Balance, Shares at Dec. 31, 2019

84,248

[1]	Presented within retained earnings on both the Consolidated Balance Sheets and the Consolidated Statements of Equity as the balance is immaterial.

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Cash flows from operating activities:
Net (loss) income	$ (1,497,702)	$ 268,629	$ 320,372
Loss (income) from discontinued operations	347,608	(10,018)	(14,930)
Adjustments to reconcile net income to net cash provided from operating activities:
Depreciation and amortization	78,860	83,832	78,856
Goodwill impairment	1,449,215	0	0
Amortization of premiums, discounts and issuance costs	5,672	4,572	5,514
Stock-based compensation expense	35,351	37,910	28,778
Deferred income taxes	(177,000)	(25,647)	(61,233)
Other	389	(10,903)	(3,782)
Changes in assets and liabilities:
Accounts receivable	7,854	(43,408)	10,784
Prepaid expenses and other current assets	(9,998)	(6,074)	(3,015)
Other long-term assets	37,989	68	(2,950)
Accounts payable and accrued expenses	104,161	45,943	34,882
Income taxes payable	(24,119)	(61,256)	73,050
Payments of contingent consideration liabilities	(1,170)	(1,093)	(750)
Long-term professional liabilities	9,844	(4,490)	18,478
Other liabilities	(28,487)	(3,957)	(687)
Net cash provided by operating activities—continuing operations	338,467	274,108	483,367
Net cash provided by operating activities—discontinued operations	8,170	15,817	28,011
Net cash provided by operating activities	346,637	289,925	511,378
Cash flows from investing activities:
Acquisition payments, net of cash acquired	(111,975)	(114,491)	(531,232)
Purchases of investments	(35,101)	(15,884)	(27,723)
Proceeds from maturities or sales of investments	51,105	13,710	25,410
Purchases of property and equipment	(31,881)	(30,479)	(26,150)
Proceeds from sales of businesses	249,730	22,764	0
Other	0	0	6,705
Net cash provided by (used in) investing activities—continuing operations	121,878	(124,380)	(552,990)
Net cash used in investing activities—discontinued operations	(19,423)	(18,389)	(23,623)
Net cash provided by (used in) investing activities	102,455	(142,769)	(576,613)
Cash flows from financing activities:
Borrowings on credit agreement	1,247,300	1,723,500	2,846,000
Payments on credit agreement	(1,986,800)	(2,094,500)	(2,699,000)
Proceeds from issuance of senior notes	500,000	500,000	0
Payments for financing costs	(9,194)	(7,090)	(3,525)
Payments of contingent consideration liabilities	(10,120)	(5,263)	(5,449)
Payments on finance lease obligations	(234)	(1,339)	(1,659)
Proceeds from issuance of common stock	11,258	16,258	23,276
Contribution from noncontrolling interests	0	0	894
Repurchases of common stock	(145,280)	(302,160)	(70,192)
Net cash (used in) provided by financing activities—continuing operations	(393,070)	(170,594)	90,345
Net cash used in financing activities—discontinued operations	0	(17)	(608)
Net cash (used in) provided by financing activities	(393,070)	(170,611)	89,737
Net increase (decrease) in cash and cash equivalents	56,022	(23,455)	24,502
Cash, cash equivalents and restricted cash at beginning of year	56,745	80,200	55,698
Less cash and cash equivalents of discontinued operations at end of year	0	(11,254)	(13,843)
Cash and cash equivalents and restricted cash at end of year	112,767	45,491	66,357
Supplemental disclosure of cash flow information:
Interest	95,444	82,540	73,837
Income taxes	86,268	185,416	75,427
Non-cash investing and financing activities:
Value of common stock issued for acquisitions	0	0	2,657
Equipment financed through finance leases	0	0	684
Property and equipment included in accounts payable	$ 2,400	$ 2,415	$ 1,918

General

12 Months Ended

Dec. 31, 2019

Organization, Consolidation and Presentation of Financial Statements [Abstract]

General

General:

The principal business activity of MEDNAX, Inc. (“MEDNAX” or the “Company”) and its subsidiaries is to provide neonatal, anesthesia, radiology and teleradiology, maternal-fetal and other pediatric subspecialty physician services. The Company has contracts with affiliated business corporations or professional associations, limited liability companies and partnerships (“affiliated professional contractors”), which are separate legal entities that provide physician services in certain states and Puerto Rico. The Company and its affiliated professional contractors also have contracts with hospitals and other healthcare facilities to provide physician services, which include (i)

fee-for-service

contracts, whereby hospitals and other customers agree, in exchange for the Company’s services, to authorize the Company and its healthcare professionals to bill and collect the charges for medical services rendered by the Company’s affiliated healthcare professionals, and (ii) administrative fee contracts, whereby the Company is assured a minimum revenue level.

Summary of Significant Accounting Policies

12 Months Ended

Dec. 31, 2019

Accounting Policies [Abstract]

Summary of Significant Accounting Policies

2.	Summary of Significant Accounting Policies:

Principles of Presentation

The consolidated financial statements include all the accounts of the Company and its subsidiaries combined with the accounts of the affiliated professional contractors with which the Company currently has specific management arrangements. The Company’s agreements with affiliated professional contractors provide that the term of the arrangements are in most cases permanent, subject only to termination by the Company, except in the case of gross negligence, fraud or bankruptcy of the Company. The Company has the right to receive income, both as ongoing fees and as proceeds from the sale of its interest in the Company’s affiliated professional contractors, in an amount that fluctuates based on the performance of the affiliated professional contractors and the change in the fair value of the Company’s interest in the affiliated professional contractors. The Company has exclusive responsibility for the provision of all

non-medical

services required for the

day-to-day

operation and management of the Company’s affiliated professional contractors and establishes the guidelines for the employment and compensation of the physicians. In addition, the agreements provide that the Company has the right, but not the obligation, to purchase, or to designate a person(s) to purchase, the stock of the Company’s affiliated professional contractors for a nominal amount. Separately, in its sole discretion, the Company has the right to assign its interest in the agreements. Based upon the provisions of these agreements, the Company has determined that the affiliated professional contractors are variable interest entities and that the Company is the primary beneficiary as defined in the accounting guidance for consolidation. All significant intercompany and interaffiliate accounts and transactions have been eliminated.

The Company is a party to a joint venture in which it owns a 37.5% economic interest and a second joint venture in which it owns a 49.0% economic interest. The Company accounts for these joint ventures under the equity method of accounting because the Company exercises significant influence over, but does not control, these entities.

November 2018, the Company announced the initiation of a process to divest its management services organization, which operated as MedData, to allow the Company to focus on its core physician services business.

On October 10, 2019, the Company entered into a securities purchase agreement

with an affiliate of Frazier Healthcare Partners

to divest MedData. The transaction closed on October 31, 2019. Pursuant to the terms and conditions of the agreement, at the closing of the transaction, the Company received a cash payment of $249.7 million,

net of

certain net working capital and similar adjustments, as well as contingent economic consideration in an indirect holding company of the buyer, the value of which is contingent on both short and long-term performance of MedData and the maximum amount payable in respect of which is $50.0 million. Upon completion of a valuation to determine the final net proceeds, the Company could re

cord an additional gain

or loss. The Company realized certain cash tax benefits from the transaction in the fourth quarter of 2019 and

anticipates additional cash tax benefits in future periods. In addition, in accordance with accounting guidance for discontinued operations, the operating results of the service line were reported as discontinued operations in the Company’s Consolidated Statements of Income for the year ended December 31, 2019. Reclassifications have been made to certain prior period financial statements and footnote disclosures to reflect the impact of discontinued operations. See Note 8

–

Discontinued Operations for more information.

Recently Adopted Accounting Pronouncements

In February 2016, the accounting guidance related to leases was issued that require an entity to recognize leased assets and the rights and obligations created by those leased assets on the balance sheet and to disclose key information about the entity’s leasing arrangements. This guidance became effective for the Company on January 1, 2019. The adoption of this guidance had a material impact on the Company’s Consolidated Balance Sheets and related disclosures, resulting from the recognition of significant right of use assets and related liabilities, primarily related to its operating lease arrangements for space in hospitals and certain other facilities for its business and medical offices. See Note 10

–

Leases for more information.

New Accounting Pronouncements

In December 2019, accounting guidance related to income taxes was issued with the goal of enhancing and simplifying various aspects of the income tax accounting guidance, including requirements related to hybrid tax regimes, deferred taxes on

step-up

in tax basis of goodwill obtained in a transaction that is not a business combination, separate financial statements of entities not subject to tax, the intraperiod tax allocation exception to the incremental approach, deferred tax liabilities on outside basis differences, and interim-period accounting for enacted changes in tax law and certain

year-to-date

loss limitations. The guidance becomes effective for the Company on January 1, 2021, including interim periods therein, with early adoption permitted, including adoption in interim or annual periods for which financial statements have not yet been issued. The Company does not believe the adoption of this new guidance will have a material impact on its Consolidated Financial Statements and related disclosures.

Accounting Estimates and Assumptions

The preparation of financial statements in conformity with accounting principles generally accepted in the United States (“GAAP”) requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenue and expenses during the reporting periods. Significant estimates and assumptions are involved in the calculation of the Company’s allowance for contractual adjustments and uncollectibles on accounts receivable, liabilities for self-insured amounts and claims incurred but not reported related to the Company’s professional liability risks and the fair value of goodwill. Actual results could differ from those estimates.

Segment Reporting

The Company changed its management structure during the third quarter of 2019 to combine its two historical operating segments into a single unified physician services operating segment.

The

results of the Company’s operations

continue to be

presented as a single reportable segment for purposes of presenting financial information in accordance with the accounting guidance for segment reporting.

The following table summarizes the Company’s net revenue from continuing operations by service line (in percentages):


	Years Ended December 31,
	2019			2018			2017
Women’s and Children’s services		50	%		49	%		50	%
Anesthesiology and related		36	%		38	%		41	%
Radiology		14	%		13	%		9	%

		100	%		100	%		100	%

Revenue Recognition

Patient service revenue is recognized at the time services are provided by the Company’s affiliated physicians. The Company’s performance obligations related to the delivery of services to patients are satisfied at the time of service. Accordingly, there are no performance obligations that are unsatisfied or partially unsatisfied at the end of the reporting period with respect to patient service revenue. Almost all of the Company’s patient service revenue is reimbursed by GHC Programs and third-party insurance payors. Payments for services rendered to the Company’s patients are generally less than billed charges. The Company monitors its revenue and receivables from these sources and records an estimated contractual allowance to properly account for the anticipated differences between billed and reimbursed amounts.

Accordingly, patient service revenue is presented net of an estimated provision for contractual adjustments and uncollectibles. The Company estimates allowances for contractual adjustments and uncollectibles on accounts receivable based upon historical experience and other factors, including days sales outstanding (“DSO”) for accounts receivable, evaluation of expected adjustments and delinquency rates, past adjustments and collection experience in relation to amounts billed, an aging of accounts receivable, current contract and reimbursement terms, changes in payor mix and other relevant information. Contractual adjustments result from the difference between the physician rates for services performed and the reimbursements by GHC Programs and third-party insurance payors for such services.

Collection of patient service revenue the Company expects to receive is normally a function of providing complete and correct billing information to the GHC Programs and third-party insurance payors within the various filing deadlines and typically occurs within 30 to 60 days of billing.

Some of the Company’s hospital agreements require hospitals to pay the Company administrative fees. Some agreements provide for fees if the hospital does not generate sufficient patient volume in order to guarantee that the Company receives a specified minimum revenue level. The Company also receives fees from hospitals for administrative services performed by its affiliated physicians providing medical director or other services at the hospital.

Accounts receivable are primarily amounts due under

fee-for-service

contracts from third-party payors, such as insurance companies, self-insured employers and patients and GHC Programs geographically dispersed throughout the United States and its territories. Concentration of credit risk relating to accounts receivable is limited by the number, diversity and geographic dispersion of the business units managed by the Company, as well as by the large number of patients and payors, including the various governmental agencies in the states in which the Company provides services. Receivables from

GHC Programs

made up approximately 20% and 19% of net accounts receivable at December 31, 2019 and 2018, respectively.

Cash and Cash Equivalents

Cash equivalents are defined as all highly liquid financial instruments with maturities of 90 days or less from the date of purchase. The Company’s cash equivalents typically consist of demand deposits, amounts on

deposit in money market accounts, and funds invested in overnight repurchase agreements. Cash equivalent balances may, at certain times, exceed federally insured limits.

Certain cash equivalents carried by the Company are subject to the fair value provisions of the accounting guidance for fair value measurements. See “Fair Value Measurements” below.

Restricted Cash

Restricted cash consists of funds in escrow related to a potential future payment for contingent consideration for an acquisition completed in 2017.

Investments

Investments consist of municipal debt securities, federal home loan securities and certificates of deposit. During the year ended December 31, 2019, the Company changed the classification of its investments from

held-to-maturity

to available for sale. Although there is no stated expectation that the investments will be sold within one year, the investments are available for use, if needed, and accordingly are classified as short-term. Such investments are carried at fair value with any unrealized gains and losses reported as a component of other accumulated comprehensive income or loss.

Prior to January 1, 2019, the Company classified its investments as

held-to-maturity

and carried such investments at amortized cost. Investments with remaining maturities of less than one year were classified as short-term and investments classified as long-term had maturities of one year to five years.

Property and Equipment

Property and equipment are recorded at original purchase cost. Depreciation of property and equipment is computed using the straight-line method over the estimated useful lives of the underlying assets. Estimated useful lives are generally 30 years for buildings; three

to seven years for medical equipment, computer equipment, software and furniture; and the lesser of the useful life or the remaining lease term for leasehold improvements and

finance

leases. Upon sale or retirement of property and equipment, the related cost and accumulated depreciation are eliminated from the respective accounts and any resulting gain or loss is included in earnings.

Business Acquisitions

The Company accounts for all business acquisitions at fair value and expenses acquisition costs as they are incurred. Any identifiable assets acquired and liabilities assumed are recognized and measured at their respective fair values on the acquisition date. If information about facts and circumstances existing as of the acquisition date is incomplete at the end of the reporting period in which a business acquisition occurs, the Company will report provisional amounts for the items for which the accounting is incomplete. The measurement period ends once the Company receives sufficient information to finalize the fair values; however, the period will not exceed one year from the acquisition date. Any adjustments to provisional amounts that are identified during the measurement period are recognized in the reporting period in which the adjustment amounts are determined.

In connection with ce

rtain acquisitions, the Company enters into agreements to pay additional amounts in cash or common stock based on the achievement of certain performance measures for up to five years ending after the acquisition dates. The Company measures this contingent consideration at fair value at the acquisition date and records such contingent consideration as a liability or equity on the Company’s Consolidated Balance

Sheets on the acquisition date. The fair value of each contingent consideration liability is remeasured at each reporting period with any change in fair value recognized as income or expense within operations in the Company’s Consolidated Statements of Income. See Note 6 for more information on the Company’s business acquisitions.

Goodwill and Other Intangible Assets

The Company records acquired assets and assumed liabilities at their respective fair values under the acquisition method of accounting. Goodwill represents the excess of purchase price over the fair value of the net assets acquired. Intangible assets with finite lives, principally physician and hospital agreements, customer relationships, patented technology and trade names, are recognized apart from goodwill at the time of acquisition based on the contractual-legal and separability criteria established in the accounting guidance. Intangible assets with finite lives are amortized on either an accelerated basis based on the annual undiscounted economic cash flows associated with the particular intangible asset or on a straight-line basis over their estimated useful lives. Intangible assets with finite lives are amortized over periods of one to 20 years.

Goodwill is tested for impairment at a reporting unit level on at least an annual basis in accordance with the subsequent measurement provisions of the accounting guidance for goodwill. The Company performs a single-step quantitative test with any goodwill impairment measured as the amount by which a reporting unit’s carrying value exceeds its fair value. The Company uses income and market-based valuation approaches to determine the fair value of its reporting units. These approaches focus on discounted cash flows and revenue and EBITDA multiples based on the Company’s market capitalization to derive the fair value of a reporting unit. Significant assumptions used in these valuations include the weighted average cost of capital discount factor, revenue growth rates and revenue and EBITDA multiples. The Company also considers the economic outlook for the healthcare services industry and various other factors during the testing process, including hospital and physician contract changes, local market developments, changes in third-party payor payments, and other publicly available information.

The Company completed its annual impairment test for 2019 in the third quarter, and based on that analysis the Company recorded a

non-cash

impairment charge of $1.45 billion, nearly all of which related to its anesthesiology reporting unit. See Note 7

–

Goodwill and Intangible Assets for more information. The Company completed annual impairment tests in the third quarter of 2018 and 2017 and determined that goodwill was not impaired in those two years.

Long-Lived Assets

The Company is required to evaluate long-lived assets, including intangible assets subject to amortization, whenever events or changes in circumstances indicate that the carrying value of the assets may not be fully recoverable. The recoverability of such assets is measured by a comparison of the carrying value of the assets to the future undiscounted cash flows before interest charges to be generated by the assets. If long-lived assets are impaired, the impairment to be recognized is measured as the excess of the carrying value over the fair value. Long-lived assets held for disposal are reported at the lower of the carrying value or fair value less disposal costs. The Company does not believe there are any indicators that would require an adjustment to such assets or their estimated periods of recovery at December 31, 2019 pursuant to current accounting standards.

Common Stock Repurchases

The Company repurchases shares of its common stock as authorized from time to time by its Board of Directors. The Company treats repurchased shares of its common stock as retired as any repurchased shares become authorized but unissued shares. The reacquisition cost of repurchased shares is recorded as a reduction in the respective components of shareholders’ equity.

Professional Liability Coverage

The Company maintains professional liability insurance policies with third-party insurers generally on a claims-made basis, subject to deductibles or self-insured retention, exclusions and other restrictions. The

Company’s self-insured retention under its professional liability insurance

program

is maintained primarily

through a wholly owned captive insurance subsidiary. The Company records an estimate of liabilities for self-insured amounts and claims incurred but not reported based on an actuarial valuation using historical loss information, claim emergence patterns and various actuarial assumptions. Liabilities for claims incurred but not reported are not discounted.

Income Taxes

The Company records deferred income taxes using the liability method, whereby deferred tax assets and liabilities are determined based on the difference between the financial statement and tax bases of assets and liabilities using enacted tax rates in effect for the year in which the differences are expected to reverse. If it is more likely than not that all or a portion of deferred tax assets will not be realized, a valuation allowance is provided against such deferred tax assets. In making such determination, the Company considers all available positive and negative evidence, including future reversals of existing taxable temporary differences, projected future taxable income,

tax-planning

strategies, and results of recent operations.

The accounting guidance for uncertain tax positions prescribes a recognition threshold and measurement attribute for financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. The guidance also requires policy disclosures regarding penalties and interest and extensive disclosures regarding increases and decreases in uncertain tax positions as a result of tax positions taken in a current or prior period, settlements with taxing authorities and any lapse of an applicable statute of limitations. Additional qualitative discussion is required for any tax position that may result in a significant increase or decrease in uncertain tax positions within a

12-month

period from the Company’s reporting date.

Stock Incentive Plans

The Company grants stock-based awards consisting primarily of restricted stock to key employees under its Amended and Restated 2008 Incentive Compensation Plan. The Company measures the cost of employee services received in exchange for stock-based awards based on grant-date fair value and allocates the resulting compensation expense over the corresponding requisite service period using the graded vesting attribution method. The Company also performs analyses to estimate forfeitures of stock-based awards on an annual basis and adjusts the estimates as necessary based on the number of awards that ultimately vest.

Net Income Per Common Share

Basic net income per common share is calculated by dividing net income by the weighted average number of common shares outstanding during the period. Diluted net income per common share is calculated by dividing net income by the weighted average number of common and potential common shares outstanding during the period. Potential common shares consist of outstanding restricted stock, deferred stock and stock options and is calculated using the treasury stock method.

Fair Value Measurements

The accounting guidance establishes a fair value hierarchy that prioritizes valuation inputs into three levels based on the extent to which inputs used in measuring fair value are observable in the market. Each fair value measurement is reported in one of three levels:

Level 1

–

inputs are based upon unadjusted quoted prices for identical instruments traded in active markets.

Level 2

–

inputs are based upon quoted prices for similar instruments in active markets, quoted prices for identical or similar instruments in markets that are not active, and model-based valuation techniques for which all significant assumptions are observable in the market or can be corroborated by observable market data for substantially the full term of the assets or liabilities.

Level 3

–

inputs are generally unobservable and typically reflect management’s estimates of assumptions that market participants would use in pricing the asset or liability. The fair values are therefore determined using model-based techniques that include option pricing models, discounted cash flow models, and similar techniques.

The following table presents information about the Company’s financial instruments that are accounted for at fair value on a recurring basis at December 31, 2019 and 2018 (in thousands):


			Fair Value
	Fair Value Category		December 31, 2019		December 31, 2018
Assets:
Money market funds		Level 1	$	16,775	$	481
Short-term investments		Level 2		74,510		—	(1)
Company-owned life insurance		Level 2		—		10,464
Mutual funds		Level 1		14,264		—
Liabilities:
Contingent consideration		Level 3		2,696		20,039

(1)	Investments were measured at carrying value as of December 31, 2018. See table below.

The following table presents information about the Company’s financial instruments that are not carried at fair value at December 31, 2019 and 2018 (in thousands):


	December 31, 2019						December 31, 2018
	Carrying Amount			Fair Value			Carrying Amount		Fair Value
Assets:
Short-term investments	$	—	(2)	$	—	(2)		21,923		21,858
Long-term investments		—	(2)		—	(2)		69,699		69,090
Liabilities:
2023 Notes		750,000			766,875			750,000		736,725
2027 Notes		1,000,000			1,025,600			500,000		482,500

(2)	Investments were measured at fair value as of December 31, 2019. See table above.

The carrying amounts of cash equivalents, accounts receivable and accounts payable and accrued expenses approximate fair value due to the short maturities of the respective instruments. The carrying value of the line of credit approximates fair value. If the Company’s line of credit was measured at fair value, it would be categorized as Level 2 in the fair value hierarchy.

Investments

12 Months Ended

Dec. 31, 2019

Investments, Debt and Equity Securities [Abstract]

Investments

3.	Investments:

Investments held are summarized as follows (in thousands):


	December 31, 2019				December 31, 2018
	Short- Term		Long-Term		Short-Term		Long-Term
Corporate securities	$	32,962	$	—	$	—	$	—
Municipal debt securities		29,066		—		18,473		30,841
Federal home loan securities		8,013		—		2,000		34,393
Certificates of deposit		4,469		—		1,450		4,465

	$	74,510	$	—	$	21,923	$	69,699

Accounts Receivable and Net Revenue

12 Months Ended

Dec. 31, 2019

Text Block [Abstract]

Accounts Receivable and Net Revenue

4.	Accounts Receivable and Net Revenue:

Accounts receivable, net consists of the following (in thousands):


	December 31,
	2019			2018
Gross accounts receivable	$	1,943,664		$	1,993,395
Allowance for contractual adjustments and uncollectibles		(1,444,795	)		(1,486,672	)

	$	498,869		$	506,723

Net revenue consists of the following (in thousands):


	Years Ended December 31,
	2019		2018		2017
Net patient service revenue	$	3,091,987	$	3,067,784	$	2,915,648
Hospital contract administrative fees		396,814		363,368		315,778
Other revenue		24,741		23,658		21,965

	$	3,513,542	$	3,454,810	$	3,253,391

The following is a summary of our payor mix, expressed as a percentage of net revenue, exclusive of administrative fees and revenue related to management services and other, for the periods indicated:


	Years Ended December 31,
	2019			2018			2017
Contracted managed care		69	%		69	%		70	%
Government		24	%		24	%		23	%
Other third-parties		5	%		5	%		5	%
Private-pay patients		2	%		2	%		2	%

		100	%		100	%		100	%

Accounts receivable consist primarily of amounts due from GHC Programs and third-party insurance payors for services provided by the Company’s affiliated physicians.

Net revenue consists primarily of gross billed charges for services provided by the Company’s affiliated physicians less an estimated allowance for contractual adjustments and uncollectibles to properly account for the anticipated differences between gross billed charge amounts and expected reimbursement amounts.

The Company’s contractual adjustments and uncollectibles as a percentage of gross patient service revenue vary slightly each year depending on several factors, including improved managed care contracting, changes in reimbursement from state Medicaid programs and other GHC Programs, shifts in the percentage of patient services being reimbursed under GHC Programs and annual price increases.

The Company’s annual price increases typically increase contractual adjustments as a percentage of gross patient service revenue. This increase is primarily due to Medicaid, Medicare and other GHC Programs that generally provide for reimbursements on a

fee-schedule

basis rather than on a gross charge basis. When the Company bills these programs, like other payors, on a gross-charge basis, it also increases its provision for contractual adjustments and uncollectibles by the amount of any price increase, resulting in a higher contractual adjustment percentage.

Property and Equipment

12 Months Ended

Dec. 31, 2019

Property, Plant and Equipment [Abstract]

Property and Equipment

5.	Property and Equipment:

Property and equipment consists of the following (in thousands):


	December 31,
	2019			2018
Building	$	26,934		$	26,934
Land		6,683			6,683
Equipment and other		262,977			237,400

		296,594			271,017
Accumulated depreciation		(202,102	)		(180,583	)

	$	94,492		$	90,434

The Company recorded depreciation expense of $30.0 million, $29.3 million and $26.4 million for the years ended December 31, 2019, 2018 and 2017, respectively.

Business Acquisitions

12 Months Ended

Dec. 31, 2019

Business Combinations [Abstract]

Business Acquisitions

6.	Business Acquisitions:

During the year ended December 31, 2019, the Company completed

nine

acquisitions, consisting of

two

neonatology physician practices,

two

maternal-fetal physician practices,

one

radiology practice and

four

other pediatric subspecialty practices for total cash consideration of $112.0 million and accrued purchase consideration of $0.3 million. These acquisitions expanded the Company’s national network of physician practices. In connection with these acquisitions, the Company recorded goodwill of $98.1 million

other intangible assets consisting primarily of physician and hospital agreements of $14.0 million

and fixed assets of $0.2 million

. The Company expects that $98.1 million of the goodwill recorded during the year ended December 31, 2019 will be deductible for tax purposes.

In addition, the Company paid $11.3 million for contingent consideration in connection with prior period acquisitions. The Company also recorded a decrease of $6.6 million related to the change in fair value of a

contingent consideration agreement for which the probability of the achievement of certain performance measures was updated during the year ended December 31, 2019. This change in fair value of contingent consideration was recorded within operating expenses.

During the year ended December 31, 2018, the Company completed

nine

physician group practice acquisitions, including

five

radiology practices,

two

neonatology practices and

two

other pediatric subspecialty practices. The acquisition-date fair value of the total consideration for the nine acquisitions was $111.8 million, net of cash acquired. In connection with these acquisitions, the Company recorded goodwill of $95.0 million, other intangible assets consisting primarily of physician and hospital agreements of $17.2 million, current assets of $1.7 million and other liabilities of $2.1 million.

During the year ended December 31, 2018, in connection with certain prior-period acquisitions, the Company paid $6.4 million for contingent consideration and $1.2 million for purchase consideration that had been held back pending satisfaction of certain conditions. Of these amounts, all except for the accretion recorded during 2018 were accrued as of December 31, 2017. In addition, the Company recorded a decrease of $5.3 million related to the change in the fair value of a contingent consideration agreement for which the probability of the achievement of certain performance measures was updated. This change in fair value of contingent consideration was recorded within operating expenses.

During the year ended December 31, 2018, in connection with certain prior-period acquisitions, the Company also recorded a net increase in goodwill of $4.0 million composed of a decrease in current assets of $1.2 million, a decrease in noncurrent assets of $1.5 million and a decrease in liabilities of $0.2 million for measurement-period adjustments resulting from the finalization of acquisition accounting as well as additional cash consideration of $1.5 million related to a working capital true up.

In January 2018, the Company completed the sale of a controlling interest and the contribution of remaining assets to a joint venture related to the $46.0 million of assets held for sale at December 31, 2017. The Company accounts for its 49.0% economic interest in the joint venture as an equity method investment. The investment in this joint venture is included in other assets as presented in the Company’s Condensed Consolidated Balance Sheet.

Goodwill and Intangible Assets

12 Months Ended

Dec. 31, 2019

Goodwill and Intangible Assets Disclosure [Abstract]

Goodwill and Intangible Assets

7.	Goodwill and Intangible Assets:

Goodwill was

2.7 billion and $4.1 billion at December 31, 2019 and 2018, respectively. Goodwill is tested for impairment at a reporting unit level on at least an annual basis, in accordance with the subsequent measurement provisions of the accounting guidance for goodwill. Consistent with prior years, the Company performed its annual impairment test in the third quarter

of 2019

, specifically as of July 31, 2019. The Company changed its management structure during the third quarter of 2019 to combine its two historical operating segments into a single unified physician services operating segment. However, for goodwill testing purposes, the Company determined that its reporting units would be represented by the components that underly the unified physician services operating segment. The reporting units represent the service line medical groups of Women’s and Children’s, anesthesiology and radiology.

The Company used a combination of income and market-based valuation approaches to determine the fair value of its reporting units.

Significant assumptions used in these valuations included the weighted average cost of capital discount factor, revenue growth rate, and revenue and EBITDA multiples.

Based on the analysis performed, the Company recorded a

non-cash

impairment charge of $1.30 billion during the three months ended September 30, 2019, nearly all of which related to its anesthesiology reporting unit. Recognition of the

non-cash

charge against goodwill resulted in a tax benefit which generated an additional deferred tax asset of $147.2 million that increased the fair value of the reporting units.

An incremental

non-cash

charge is then required to reduce the reporting units to their previously determined fair value. Accordingly, the Company recorded

the

ncremental

non-cash

charge of

147.2

million for a total

non-cash

charge of $

1.45

billion. The

primary factors driving the

non-cash

impairment

charge were (i) the change in management structure effective during the third quarter resulting in reporting units one level below the Company’s single physician services operating segment, which is also its single reportable segment, (ii) the decrease in the Company’s share price used in the market capitalization reconciliation and (iii) changes in the assumptions used in the valuation analysis, specifically the discount rate used in the cash flow analysis which included a company-specific risk premium.

Intangible assets, net, consist of the following (in thousands):


	December 31, 2019
	Gross Carrying Value		Accumulated Amortization			Net Carrying Value
Physician and hospital agreements	$	384,059	$	(269,889	)	$	114,170
Customer relationships		156,530		(29,595	)		126,935
Trade names		19,990		(2,326	)		17,664
Patented and other technology		34,528		(18,890	)		15,638

	$	595,107	$	(320,700	)	$	274,407


	December 31, 2018
	Gross Carrying Value		Accumulated Amortization			Net Carrying Value
Physician and hospital agreements	$	375,344	$	(222,818	)	$	152,526
Customer relationships		156,530		(29,595	)		126,935
Trade names		19,990		(2,326	)		17,664
Patented and other technology		33,129		(17,089	)		16,040

	$	584,993	$	(271,828	)	$	313,165

During the year ended December 31, 2019, the Company recorded intangible assets related to acquisitions totaling $14.0 million, consisting primarily of physician and hospital agreements. The weighted-average amortization period for these physician and hospital agreements is approximately

eight years

Amortization expense for intangible assets was $48.9 million, $54.5 million and $52.5 million for the years ended December 31, 2019, 2018 and 2017, respectively.

Amortization expense for existing intangible assets for the next five years is expected to be as follows (in thousands):


2020	$	42,502
2021		36,502
2022		29,482
2023		24,482
2024		10,590

Discontinued Operations

12 Months Ended

Dec. 31, 2019

Discontinued Operations and Disposal Groups [Abstract]

Discontinued Operations

8.	Discontinued Operations:

In November 2018, the Company announced the initiation of a process to divest its management services organization, which operated as MedData, to allow the Company to focus on its core physician services business.

On October 10, 2019, the Company entered into a securities purchase agreement

with an affiliate of Frazier Healthcare

Partners

to divest MedData

and the

transaction closed on October 31, 2019. Pursuant to the terms and conditions of the agreement, at the closing of the transaction, the Company received a cash payment of

249.7

million,

net of

50.0

million. The operating results of the management services service line were reported as discontinued operations in the Company’s Consolidated Statements of Income for the year ended December 31, 2019 with prior periods recast to conform with the current period presentation.

The initial classification of the management services service line to assets held for sale during the three months ended March 31, 2019 impacted the net book value of the assets and liabilities expected to be transferred upon sale. The initial determination of the estimated fair value of the management services service line was based on an estimated market value along with estimated broker, accounting, legal and other costs to sell. The Company deemed the carrying amount of other assets within the service line, specifically accounts receivable and property and equipment, to represent fair value and therefore recorded a

non-cash

charge during the first quarter of 2019 of $285.0 million against goodwill, which represented the difference between the estimated fair value of the management services service line and the carrying amount of the net assets held for sale. Recognition of the charge against goodwill resulted in a tax benefit which generated an additional $36.6 million deferred tax asset that increased the fair value of the service line. An incremental

non-cash

charge is then required to reduce the service line to its previously determined fair value. Accordingly, the Company recorded the incremental

non-cash

charge of $36.6 million for a total

non-cash

charge of $321.6 million during the three months ended March 31, 2019, reducing the goodwill balance of the management services service line to zero.

During the three months ended June 30, 2019, an incremental

non-cash

charge of $50.0 million was recorded based on new information obtained during the quarter with respect to the estimated market value of the management services service line. This

non-cash

charge was recorded against amortizing intangible assets. Recognition of the incremental

non-cash

charge resulted in a tax benefit which generated an additional $16.4 million deferred tax asset that increased the fair value of the service line. An incremental

non-cash

charge is then required to reduce the service line to its previously determined fair value. Accordingly, the Company recorded the incremental

non-cash

charge of $16.4 million for a total

non-cash

charge of $66.4 million during the three months ended June 30, 2019.

During the three months ended December 31, 2019, the preliminary net proceeds for the management services service line were determined to be $242.5 million,

net of cash sold and certain working capital adjustments,

resulting in

a preliminary loss on sale of

29.1

million.

Upon completion of the valuation of the contingent economic consideration and the working capital true-up, final net proceeds will be determined, and the Company will adjust the loss on sale at that time.

The following table is a reconciliation of the major classes of assets and liabilities classified as assets and liabilities held for sale in the accompanying Consolidated Balance Sheets representing the management services service line as of December 31, 2018 (in thousands):


	December 31, 2018
Assets
Cash and cash equivalents	$	11,254
Accounts receivable, net		38,118
Prepaid expenses and other assets		2,505
Property and equipment, net		42,603
Goodwill		321,556
Intangible assets, net		275,148

	$	691,184

Liabilities
Accounts payable, accrued expenses and other liabilities	$	23,770
Deferred income taxes		35,659

	$	59,429

Income from discontinued operations, net of income taxes, as reported in the Company’s Consolidated Statements of Income for the years ended December 31, 2019, 2018 and 2017 includes net revenue of

$172.7 million, $220.9 million and $230.7 million, respectively. Operating income, excluding transaction related costs, for the years ended December 31, 2019, 2018 and 2017

was

$20.1 million, $14.0 million and $25.2 million

, respectively

Accounts Payable and Accrued Expenses

12 Months Ended

Dec. 31, 2019

Payables and Accruals [Abstract]

Accounts Payable and Accrued Expenses

9.	Accounts Payable and Accrued Expenses:

Accounts payable and accrued expenses consist of the following (in thousands):


	December 31,
	2019		2018
Accounts payable	$	39,610	$	31,059
Accrued salaries and bonuses		268,619		242,888
Accrued payroll taxes and benefits		67,268		78,415
Accrued professional liabilities		44,869		34,931
Accrued contingent consideration		2,696		18,760
Accrued interest		32,910		9,477
Other accrued expenses		55,894		33,037

	$	511,866	$	448,567

Operating Leases

12 Months Ended

Dec. 31, 2019

Leases [Abstract]

Leases of Lessee Disclosure

10.	Operating Leases:

Effective January 1, 2019, the Company adopted the new accounting guidance

for lease

using the modified retrospective method of applying the new guidance at the adoption date. The Company elected practical expedients permitted under the transition provisions, which allowed the Company to carryforward historical assessments of whether contracts are or contain leases and lease classification. Beginning with January 1, 2019, the Company’s financial position is presented under the new guidance, while the prior period financial statements were not adjusted and continue to be reported in accordance with the previous guidance.

The Company primarily leases property under operating leases and has one material equipment operating lease for an aircraft.

The Company’s property leases are primarily for its regional, medical and business offices, storage space and temporary housing for medical staff.

For leases with terms greater than 12 months, the Company records the related asset and obligation at the present value of the lease payment using a discount rate that reflects the Company’s estimated incremental borrowing rate. Certain of the Company’s leases include rental escalation clauses and renewal options that are factored into the determination of lease payments when appropriate. Operating leases for office equipment are not material, and therefore are excluded from the Company’s Consolidated Balance Sheet. Finance leases are not material but will continue to be reported on the Company’s Consolidated Balance Sheets with the

right-of-use

assets included in property and equipment, net, and the liabilities included in current portion of long-term debt and finance lease obligations.

The table below presents the operating lease-related

right-of-use

assets and related liabilities recorded on the Company’s balance sheet and the weighted average remaining lease term and discount rate as of December 31, 2019 (dollars in thousands):


	December 31, 2019
Assets:
Operating lease right-of-use assets	$	82,824
Liabilities:
Current portion of operating lease liabilities		23,317
Long-term portion of operating lease liabilities		67,005
Other Information:
Weighted-average remaining lease term		5.0 years
Weighted average discount rate		5.3	%

The table below presents certain information related to the lease costs for operating leases during the year ended December 31, 2019 (in thousands):


	Year Ended December 31, 2019
Operating lease costs	$	30,236
Variable lease costs		4,869
Other equipment rent		2,480
Other operating lease costs		4,578

Total operating lease costs	$	42,163

The table below presents supplemental cash flow information related to operating leases during the year ended December 31, 2019 (in thousands):


	December 31, 2019
Operating cash flows for operating leases	$	41,532

The table below reconciles the undiscounted cash flows for each of the first five years and total of the remaining years to the operating lease liabilities recorded on the balance sheet as of December 31, 2019 (in thousands):


	December 31, 2019
2020	$	25,060
2021		23,270
2022		18,433
2023		13,794
2024		8,420
Thereafter		13,207

Total minimum lease payments		102,184
Less: Amount of payments representing interest		(11,862	)

Present value of future minimum lease payments		90,322
Less: Current obligations		(23,317	)

Long-term portion of operating leases	$	67,005

Accrued Professional Liabilities

12 Months Ended

Dec. 31, 2019

Health Care Organizations [Abstract]

Accrued Professional Liabilities

11.	Accrued Professional Liabilities:

At December 31, 2019 and 2018, the Company’s total accrued professional liabilities of $271.8 million and $244.0 million, respectively, included incurred but not reported loss reserves of $187.3 million and

$139.1 million, respectively, and loss reserves for reported claims of $84.5 million and $104.9 million, respectively. Of the total liability, $44.9 million is classified as a current liability within accounts payable and accrued expenses in the Consolidated Balance Sheet. In addition, there is a corresponding insurance receivable of $29.8 million recorded as a component of other assets for certain professional liability claims that are covered by third-party insurance policies.

The activity related to the Company’s total accrued professional liability for the years ended December 31, 2019, 2018, and 2017 is as follows (in thousands):


	Years Ended December 31,
	2019			2018			2017
Balance at beginning of year	$	243,991		$	250,187		$	202,052
Assumed liabilities through acquisition		—			1,276			20,716
Provision (adjustment) for losses related to:
Current year		57,495			34,483			41,291
Prior years		23,191			10,299			9,983

Total provision for losses		80,686			44,782			51,274
Claim payments related to:
Current year		(3,044	)		(555	)		(712	)
Prior years		(49,873	)		(51,699	)		(23,143	)

Total payments		(52,917	)		(52,254	)		(23,855	)

Balance at end of year	$	271,760		$	243,991		$	250,187

The net increase in the Company’s total accrued professional liability for the year ended December 31, 2019 was primarily related to overall unfavorable trends in the Company’s claims experience that impacted its provision for losses. The net decrease in the Company’s total accrued professional liability for the year ended December 31, 2018 was primarily related to an increase in claims payments made in the current year, partially offset by overall unfavorable trends in the Company’s claims experience that impacted its provision for losses.

Line of Credit, Long-Term Debt and Finance Lease Obligations

12 Months Ended

Dec. 31, 2019

Debt Disclosure [Abstract]

Line of Credit, Long-Term Debt and Capital Lease Obligations

12.	Line of Credit, Long-Term Debt and Finance Lease Obligations:

On March 28, 2019, the Company amended and restated its Credit Agreement to reduce the size of the revolving credit facility, extend the maturity and make other technical and conforming changes. As amended and restated, the Credit Agreement provides for a $1.2 billion unsecured revolving credit facility and includes a $37.5 million

sub-facility

for the issuance of letters of credit. The Credit Agreement matures on March 28, 2024 and is guaranteed by substantially all of the Company’s subsidiaries and affiliated professional associations and corporations. At the Company’s

option, borrowings under the Credit Agreement will bear interest at (i) the alternate base rate (defined as the higher of (a) the prime rate, (b) the Federal Funds Rate plus 1/2 of 1.00% and (c) LIBOR for an interest period of one month plus 1.00%) plus an applicable margin rate ranging from 0.125% to 0.750% based on

the Company’s

consolidated leverage ratio or (ii) the LIBOR rate plus an applicable margin rate ranging from 1.125% to 1.750% based on

the Company’s

consolidated leverage ratio. The Credit Agreement also calls for other customary fees and charges, including an unused commitment fee ranging from 0.150% to 0.200% of the unused lending commitments, based on

the Company’s

consolidated leverage ratio.

The Credit Agreement contains customary covenants and restrictions, including covenants that require

the Company

to maintain a minimum interest charge ratio, not to exceed a specified consolidated leverage ratio and to comply with laws, and restrictions on the ability

of the Company

to pay dividends and make certain other distributions, as specified therein. Failure to comply with these covenants would constitute an event of default under the Credit Agreement, notwithstanding the ability of the

ompany to meet its debt service obligations. The Credit Agreement also includes various customary remedies for the lenders following an event of default, including the acceleration of repayment of outstanding amounts under the Credit Agreement.

In December 2015, the Company completed a private offering of $750.0 million aggregate principal amount of 2023 Notes. In November 2018, the Company completed a private offering of $500.0 million aggregate principal amount of 2027 Notes and in February 2019, the Company completed a private offering

$500.00 million aggregate principal amount of Additional

2027

Notes. At December 31, 2019, the outstanding balance on the 2027 Notes was

$1.0 billion. The Company’s obligations under the 2023 Notes and the 2027 Notes are guaranteed on an unsecured senior basis by the same subsidiaries and affiliated professional contractors that guarantee the Credit Agreement.

Interest on the 2023 Notes accrues at the rate of 5.25% per annum, or $39.4 million, and is payable semi-annually in arrears on June 1 and December 1. Interest on the 2027 Notes accrues at the rate of 6.25% per annum, or $62.5 million, and is payable semi-annually in arrears on January 15 and July 15.

As of December 31, 2019, the Company may redeem all or a portion of the 2023 Notes, at the redemption prices of 101.313% in 2020 and 100% in 2021 and thereafter, plus accrued and unpaid interest to the redemption date.

At any time prior to January 15, 2022, the Company may redeem all or a portion of the 2027 Notes at a redemption price equal to 100% of the principal amount of the notes being redeemed plus an applicable redemption premium and accrued and unpaid interest to the redemption date. In addition, at any time prior to January 15, 2022, the Company may redeem up to 35% of the aggregate principal amount of the 2027 Notes at a redemption price of 106.250% of the principal amount thereof, plus accrued and unpaid interest, if any, to the redemption date, using proceeds from one or more equity offerings. On or after January 15, 2022, the Company may redeem all or a portion of the 2027 Notes, at the redemption prices of 104.688% in 2022, 103.125% in 2023, 101.563% in 2024 and 100% in 2025 and thereafter, plus accrued and unpaid interest to the redemption date.

The indenture under which the 2023 Notes and the 2027 Notes are issued, among other things, limits our ability to (1) incur liens and (2) enter into sale and lease-back transactions, and also limits our ability to merge or dispose of all or substantially all of our assets, in all cases, subject to a number of customary exceptions. Although we are not required to make mandatory redemption or sinking fund payments with respect to the 2023 Notes

and

the 2027 Notes, upon the occurrence of a change in control of MEDNAX, we may be required to

repurchase the 2023 Notes or the 2027 Notes at a purchase price equal to

101

% of the aggregate principal amount of the 2023 Notes and the 2027 Notes repurchased plus accrued and unpaid interest.

The carrying value of the Company’s long-term debt was $1.7 billion and $2.0 billion at December 31, 2019 and 2018, respectively, and consisted of the following (in thousands):


	December 31, 2019
	Principal		Unamortized Debt Issuance Costs			Total
Senior n otes	$	1,750,000	$	(19,762	)	$	1,730,238
Revolving line of credit		—		(2,664	)		(2,664	)

Total	$	1,750,000	$	(22,426	)	$	1,727,574


	December 31, 2018
	Principal		Unamortized Debt Issuance Costs			Total
Senior n otes	$	1,250,000	$	(15,408	)	$	1,234,592
Revolving line of credit		739,500		(4,274	)		735,226

Total	$	1,989,500	$	(19,682	)	$	1,969,818

The Company presents issuance costs related to long-term debt liabilities, other than revolving credit arrangements, as a direct deduction from the carrying value of that long-term debt. The Company has outstanding letters of credit which reduced the amount available under the Credit Agreement by $0.2 million at December 31, 2019. At December 31, 2019, the Company had an available balance on its Credit Agreement of $1.2 billion.

The carrying values of the Company’s variable rate revolving line of credit approximates fair value due to the short-term nature of the interest rates. The estimated fair value of the Company’s 2023 Notes and 2027 Notes were estimated using trading prices as of December 31, 2019 and 2018, respectively, as Level 2 inputs to estimate fair value and are summarized as follows (in thousands):


	December 31,
	2019		2018
2023 Notes	$	766,875	$	736,725
2027 Notes		1,025,600		482,500

The Company’s finance lease obligations consist of the following (in thousands):


	December 31,
	2019			2018
Finance lease obligations	$	188		$	441
Less: Current portion		(130	)		(253	)

Long-term portion	$	58		$	188

Income Taxes

12 Months Ended

Dec. 31, 2019

Income Tax Disclosure [Abstract]

Income Taxes

13.	Income Taxes:

The components of the income tax provision (benefit) are as follows (in thousands):


	December 31,
	2019			2018			2017
Federal:
Current	$	73,333		$	95,955		$	122,379
Deferred		(141,359	)		(21,386	)		(63,981	)

		(68,026	)		74,569			58,398

State:
Current		11,777			26,145			19,084
Deferred		(35,637	)		(4,261	)		2,749

		(23,860	)		21,884			21,833

Total	$	(91,886	)	$	96,453		$	80,231

The Company files its tax return on a consolidated basis with its subsidiaries, and its affiliated professional contractors file tax returns on an individual basis.

Beginning on January 1, 2018, the Company’s statutory tax rate was reduced from 35.0% to 21.0% as a result of legislation enacted under the Tax Cuts and Jobs Act of 2017 (“TCJA”). The effective tax rate

for continuing operations

was 7.4%,

27.2% and 20.8% for the years ended December 31, 2019, 2018 and 2017, respectively.

During the three months ended September 30, 2019, a $213.7 million income tax

charge

was

recognized

relating to the nondeductible portion of the Company’s non-cash goodwill impairment charge.

During the three months ended December 31, 2017, the Company recorded a $70.0 million income tax benefit related to the reduction of its net deferred tax liability resulting from the reduction in the corporate tax rate under the TCJA.

The differences between the effective rate and the United States federal income tax statutory rate are as follows:


	December 31,
	2019			2018			2017
Tax at statutory rate		21.00	%		21.00	%		35.00	%
State income tax, net of federal benefit		3.85			4.35			3.38
Non-deductible expenses		(0.22	)		0.42			0.48
Change in accrual estimates relating to uncertain tax positions		0.36			0.02			—
Capital loss on liquidation		1.79			—			—
Change in valuation allowance		(1.73	)		—			—
Impairments		(17.16	)		—			—
Other, net		(0.49	)		1.70			0.10
Change in tax law		—			(0.32	)		(18.16	)

Income tax provision		7.40	%		27.17	%		20.80	%

All of the Company’s deferred tax assets and liabilities are classified as long-term. The significant components of deferred income tax assets and liabilities are as follows (in thousands):


	December 31,
	2019			2018
Allowance for uncollectible accounts	$	202,464		$	194,299
Reserves and accruals		72,132			56,583
Stock-based compensation		11,393			9,201
Loss carryforwards		36,017			24,864
Property and equipment		388			—
Other		631			1,197

Deferred tax assets before valuation allowance		323,025			286,144
Less: Valuation allowance		(24,139	)		(2,628	)

Deferred tax assets, net of valuation allowance		298,886			283,516

Gross deferred tax liabilities:
Amortization		(119,481	)		(247,239	)
Accounting method changes		(74,684	)		(109,418	)
Accrual to cash adjustment		—			(39	)
Other		(331	)		(491	)

Total deferred tax liabilities		(194,496	)		(357,187	)

Net deferred tax assets ( liabilities )	$	104,390		$	(73,671	)

The Company’s net deferred tax assets were $104.4 million as of December 31, 2019, as compared to net deferred tax liabilities of $73.7 million at December 31, 2018. The increase in net deferred tax assets of $178.1 million during the year ended December 31, 2019 was primarily related to the deferred tax benefit from the Company’s

non-cash

goodwill impairment charge recorded during the

year

ended

December 31

, 2019.

The increase in the Company’s valuation allowance during the year ended December 31, 2019 was primarily related to a capital loss carryforward generated during 2019.

Beginning January 1, 2017, excess tax benefits or deficiencies associated with the exercise of stock options, the vesting of restricted and deferred stock and the purchase of shares under the Company’s

non-qualified

employee stock purchase plan are recognized as income tax benefits or expenses in the income statement in the

reporting period in which they occur instead of an increase or decrease to additional

paid-in-capital.

For the years ended December 31, 2019, 2018 and 2017, income tax expense of $3.9 million, $1.4 million and $0.2 million, respectively, was recognized for excess tax deficiencies.

During the year ended December 31, 2019, the Company generated a $68.0 million capital loss carryforward which expires in 2024. As of December 31, 2019, the Company has provided a $17.1 million valuation allowance against this deferred tax asset based on management’s determination that it is more

likely

than

not

that the tax benefits related to this asset will not be realized. Additionally, the

Company has net operating loss

carryforwards

for federal and state tax purposes totaling $

75.4

million, $

100.7

million and $

114.5

million at December

2019

2018

and

2017

, respectively. With respect to the December

201

balance, $

38.7

million expires at various times from

2021

through

2039

, and $

36.7

million does not expire.

As of December

2019

2018

and

2017

, the Company’s liability for uncertain tax positions, excluding accrued interest and penalties, was $

7.4

million, $

11.2

million and $

11.0

million, respectively. As of December

2019

, the Company had $

7.1

million of uncertain tax positions that, if recognized, would favorably impact its effective tax rate.

The following table summarizes the activity related to the Company’s liability for uncertain tax positions for the years ended December 31, 2019, 2018 and 2017 (in thousands):


	Years Ended December 31,
	2019			2018			2017
Balance at beginning of year	$	11,185		$	10,972		$	9,469
Increases related to prior year tax positions		369			385			2,284
Decreases related to prior year tax positions		—			—			(143	)
Increases related to current year tax positions		1,700			2,900			1,430
Decreases related to lapse of statutes of limitation		(5,845	)		(3,072	)		(2,068	)

Balance at end of year	$	7,409		$	11,185		$	10,972

During the years ended December 31, 2019 and 2018, the Company

decreased its liability for uncertain tax positions by a total of $3.8 million and

increased its liability for uncertain tax positions by $0.2 million, respectively, primarily related to additional taxes on current and prior year positions, partially offset by the expiration of statutes of limitation. In addition, the Company anticipates that its liability for uncertain tax positions will increase by $2.0 million over the next 12 months.

The Company includes interest and penalties related to income tax liabilities in income tax expense. The impact to income tax expense related to penalties and interest was not material during the years December 31, 2019, 2018 and 2017.

At December 31, 2019 and 2018, the Company’s accrued liability for interest and penalties related to income tax liabilities totaled $0.6 million

and

$1.1 million, respectively.

The Company is currently subject to U.S. Federal and various state income tax examinations for the tax years 2015 through 2018.

Common and Common Equivalent Shares

12 Months Ended

Dec. 31, 2019

Earnings Per Share [Abstract]

Common and Common Equivalent Shares

14.	Common and Common Equivalent Shares:

The calculation of shares used in the basic and diluted net income per share calculation for the years ended December 31, 2019, 2018, and 2017 is as follows (in thousands):


	Years Ended December 31,
	2019		2018		2017
Weighted average number of common shares outstanding		83,495		91,104		92,431
Weighted average number of dilutive common share equivalents (a)		—		502		527

Weighted average number of common and common equivalent shares outstanding		83,495		91,606		92,958

Antidilutive securities not included in the diluted net income per common share calculation		516		214		107

(a)	Due to a loss for the year ended December 31, 2019, no incremental shares are included because the effect would be antidilutive.

Stock Incentive Plans and Stock Purchase Plans

12 Months Ended

Dec. 31, 2019

Disclosure of Compensation Related Costs, Share-based Payments [Abstract]

Stock Incentive Plans and Stock Purchase Plans

15.	Stock Incentive Plans and Stock Purchase Plans:

On May 16, 2019, the Company’s shareholders approved the Company’s Amended and Restated 2008 Incentive Compensation Plan (the “Amended and Restated 2008 Incentive Plan”). The amendments, among other things, increased the number of shares of common stock reserved for delivery under the under the Amended and Restated 2008 Incentive Plan from 19.5

million

shares to 27.8

million

shares, as well as extended the expiration date to ten years from the effective date of approval. The Amended and Restated 2008 Incentive Plan provides for grants of stock options, stock appreciation rights, restricted stock,

deferred

stock, and other stock-related awards and performance awards that may be settled in cash, stock or other property.

Under the Amended and Restated 2008 Incentive Plan, options to purchase shares of common stock may be granted at a price not less than the fair market value of the shares on the date of grant. The options must be exercised within 10 years from the date of grant and generally become exercisable on a pro rata basis over a three-year period from the date of grant. The Company issues new shares of its common stock upon exercise of its stock options. Restricted stock awards generally vest over periods of three years upon the fulfillment of specified service-based conditions and in certain instances performance-based conditions. Deferred stock awards generally vest upon the satisfaction of specified performance-based conditions and service-based conditions. The Company recognizes compensation expense related to its restricted stock and deferred stock awards ratably over the corresponding vesting periods. At December 31, 2019, the Company had 8.3 million shares available for future grants and awards under its Amended and Restated 2008 Incentive Plan.

Under the Company’s 1996

Non-Qualified

Employee Stock Purchase Plan, as amended (the “ESPP”), employees are permitted to purchase the Company’s common stock at 85% of market value on January 1st, April 1st, July 1st and October 1st of each year. Under the Company’s 2015

Non-Qualified

Stock Purchase Plan (the “SPP”), certain eligible

non-employee

service providers are permitted to purchase the Company’s common stock at 90% of market value on January 1st, April 1st, July 1st and October 1st of each year.

Each of the ESPP and the SPP provide for the issuance of an aggregate of 2.6 million shares of the Company’s common stock less the number of shares of common stock purchased under the other plan. The Company recognizes stock-based compensation expense for the discount received by participating employees and

non-employee

service providers. During the year ended December 31, 2019, 0.5 million shares in

the

aggregate were issued under the ESPP and SPP. At December 31, 2019, the Company had approximately 1.1 million shares in

the

aggregate reserved for issuance under the ESPP and SPP.

The Company recognized $35.4 million, $37.9 million and $28.8 million of stock-based compensation expense related to its stock incentive plans, the ESPP and the SPP during the years ended December 31, 2019, 2018 and 2017, respectively.

The activity related to the Company’s restricted stock and deferred stock awards and the corresponding weighted average grant-date fair values for the year ended December 31, 2019 are as follows:


	Number of Shares			Weighted Average Fair Value
Non-vested shares at January 1, 2019		1,310,853		$	54.46
Awarded		1,112,773		$	33.28
Forfeited		(137,091	)	$	48.37
Vested		(563,420	)	$	55.96

Non-vested shares at December 31, 2019		1,723,115		$	40.77

The aggregate fair value of the restricted and deferred stock that vested during the years ended December 31, 2019, 2018 and 2017 was $31.5 million, $27.4 million and $29.3 million, respectively.

The weighted average grant-date fair value of restricted and deferred stock awards that were granted during the years ended December 31, 2019, 2018 and 2017 was $33.28, $51.99 and $54.22, respectively.

At December 31, 2019, the total stock-based compensation cost related to

non-vested

restricted and deferred stock remaining to be recognized as compensation expense over a weighted-average period of 1.4 years was $22.1 million.

The Company did not grant any stock options in 2019, 2018 or 2017, and all stock-based compensation cost related to stock options has been recognized. The activity and certain other information related to the Company’s outstanding stock option awards for the year ended December 31, 2019 are as follows:


	Number of Stock Options			Weighted Average Exercise Price		Weighted Average Remaining Contractual Term (in years)		Aggregate Intrinsic Value (in millions)
Outstanding at January 1, 2019		112,976		$	27.65
Exercised		(40,168	)	$	18.87			$	0.6

Outstanding and exercisable at December 31, 2019		72,808		$	32.49		0.8	$	—

The aggregate intrinsic value of stock options exercised during the years ended December 31, 2019, 2018 and 2017 was $0.6 million, $2.8 million and $5.5 million, respectively.

The cash proceeds received from the exercise of stock options for the years ended December 31, 2019, 2018 and 2017 were $0.1 million, $3.7 million and $4.8 million, respectively.

Common Stock Repurchase Programs

12 Months Ended

Dec. 31, 2019

Text Block [Abstract]

Common Stock Repurchase Programs

16.	Common Stock Repurchase Programs:

In July 2013, the Company’s Board of Directors authorized the repurchase of shares of the Company’s common stock up to an amount sufficient to offset the dilutive impact from the issuance of shares under the Company’s equity compensation programs. The share repurchase program allows the Company to make open

market purchases from

time-to-time

based on general economic and market conditions and trading restrictions. The repurchase program also allows for the repurchase of shares of the Company’s common stock to offset the dilutive impact from the issuance of shares, if any, related to the Company’s acquisition program. No shares were purchased under this program during the year ended December 31, 2019.

In August 2018, the Company announced that its Board of Directors had authorized the repurchase of up to $500.0 million of the Company’s common stock in addition to its existing share repurchase program, of which $250.0 million remained available for repurchase as of December 31, 2018. Under this program, during the year ended December 31, 2019, the Company repurchased approximately 5.1 million shares of its common stock for $145.3 million, inclusive of 96,918 shares withheld to satisfy minimum statutory withholding obligations of $2.5 million in connection with the vesting of restricted stock during the year ended December 31, 2019.

During the year ended December 31, 2018, the Company repurchased approximately 7.0 million shares of its common stock for approximately $302.2 million, inclusive of 54,909 shares withheld to satisfy minimum statutory withholding obligations of $2.5 million in connection with the vesting of restricted stock and exercises of stock options during the second quarter of 2018.

The Company intends to utilize various methods to effect any future share repurchases, including, among others, open market purchases and accelerated share repurchase programs. The amount and timing of repurchases will depend upon several factors, including general economic and market conditions and trading restrictions.

Retirement Plans

12 Months Ended

Dec. 31, 2019

Retirement Benefits [Abstract]

Retirement Plans

17.	Retirement Plans:

The Company maintains four qualified contributory savings plans as allowed under Section 401(k) of the Internal Revenue Code and Section 1165(e) of the Puerto Rico Income Tax Act of 1954 (the “401(k) Plans”). The 401(k) Plans permit participant contributions and allow elective and, in certain situations,

non-elective

Company contributions based on each participant’s contribution or a specified percentage of eligible wages.

Participants may defer a percentage of their annual compensation subject to the limits defined in the 401(k) Plans. The Company recorded expense of $43.0 million, $54.6 million and $50.1 million for the years ended December 31, 2019, 2018 and 2017, respectively, primarily related to the 401(k) Plans.

Commitments and Contingencies

12 Months Ended

Dec. 31, 2019

Commitments and Contingencies Disclosure [Abstract]

Commitments and Contingencies

18.	Commitments and Contingencies:

The Company expects that audits, inquiries and investigations from government authorities and agencies will occur in the ordinary course of business. Such audits, inquiries and investigations and their ultimate resolutions, individually or in the aggregate, could have a material adverse effect on the Company’s business, financial condition, results of operations, cash flows and the trading price of its securities. The Company has not included an accrual for these matters as of December 31, 2019 in its Consolidated Financial Statements, as the variables affecting any potential eventual liability depend on the currently unknown facts and circumstances that arise out of, and are specific to, any particular future audit, inquiry and investigation and cannot be reasonably estimated at this time.

In the ordinary course of business, the Company becomes involved in pending and threatened legal actions and proceedings, most of which involve claims of medical malpractice related to medical services provided by the Company’s affiliated physicians. The Company’s contracts with hospitals generally require the Company to indemnify them and their affiliates for losses resulting from the negligence of the Company’s affiliated physicians. The Company may also become subject to other lawsuits which could involve large claims and significant costs. The Company believes, based upon a review of pending actions and proceedings, that the outcome of such legal actions and proceedings will not have a material adverse effect on its business, financial condition, results of operations, cash flows and the trading price of its securities. The outcome of such actions and proceedings, however, cannot be predicted with certainty and an unfavorable resolution of one or more of them could have a material adverse effect on the Company’s business, financial condition, results of operations, cash flows and the trading price of its securities.

Although the Company currently maintains liability insurance coverage intended to cover professional liability and certain other claims, the Company cannot assure that its insurance coverage will be adequate to cover liabilities arising out of claims asserted against it in the future where the outcomes of such claims are unfavorable. With respect to professional liability risk, the Company generally self-insures a portion of this risk through its wholly owned captive insurance subsidiary. Liabilities in excess of the Company’s insurance coverage, including coverage for professional liability and certain other claims, could have a material adverse effect on the Company’s business, financial condition, results of operations, cash flows and the trading price of its securities.

Selected Quarterly Financial Information

12 Months Ended

Dec. 31, 2019

Quarterly Financial Information Disclosure [Abstract]

Selected Quarterly Financial Information

19.	Selected Quarterly Financial Information (Unaudited):

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.

Summary of Significant Accounting Policies (Policies)

12 Months Ended

Dec. 31, 2019

Accounting Policies [Abstract]

Principles of Presentation

non-medical

services required for the

day-to-day

On October 10, 2019, the Company entered into a securities purchase agreement

with an affiliate of Frazier Healthcare Partners

net of

cord an additional gain

or loss. The Company realized certain cash tax benefits from the transaction in the fourth quarter of 2019 and

–

Discontinued Operations for more information.

Recently Adopted Accounting Pronouncements

–

Leases for more information.

New Accounting Pronouncements

step-up

year-to-date

Accounting Estimates and Assumptions

Segment Reporting

The Company changed its management structure during the third quarter of 2019 to combine its two historical operating segments into a single unified physician services operating segment.

The

results of the Company’s operations

continue to be

presented as a single reportable segment for purposes of presenting financial information in accordance with the accounting guidance for segment reporting.

The following table summarizes the Company’s net revenue from continuing operations by service line (in percentages):


	Years Ended December 31,
	2019			2018			2017
Women’s and Children’s services		50	%		49	%		50	%
Anesthesiology and related		36	%		38	%		41	%
Radiology		14	%		13	%		9	%

		100	%		100	%		100	%

Revenue Recognition

Accounts receivable are primarily amounts due under

fee-for-service

GHC Programs

made up approximately 20% and 19% of net accounts receivable at December 31, 2019 and 2018, respectively.

Cash and Cash Equivalents

deposit in money market accounts, and funds invested in overnight repurchase agreements. Cash equivalent balances may, at certain times, exceed federally insured limits.

Certain cash equivalents carried by the Company are subject to the fair value provisions of the accounting guidance for fair value measurements. See “Fair Value Measurements” below.

Restricted Cash

Restricted cash consists of funds in escrow related to a potential future payment for contingent consideration for an acquisition completed in 2017.

Investments

held-to-maturity

Prior to January 1, 2019, the Company classified its investments as

held-to-maturity

Property and Equipment

to seven years for medical equipment, computer equipment, software and furniture; and the lesser of the useful life or the remaining lease term for leasehold improvements and

finance

Business Acquisitions

In connection with ce

Goodwill and Other Intangible Assets

The Company completed its annual impairment test for 2019 in the third quarter, and based on that analysis the Company recorded a

non-cash

impairment charge of $1.45 billion, nearly all of which related to its anesthesiology reporting unit. See Note 7

–

Long-Lived Assets

Common Stock Repurchases

Professional Liability Coverage

Company’s self-insured retention under its professional liability insurance

program

is maintained primarily

Income Taxes

tax-planning

strategies, and results of recent operations.

12-month

period from the Company’s reporting date.

Stock Incentive Plans

Net Income Per Common Share

Fair Value Measurements

Level 1

–

inputs are based upon unadjusted quoted prices for identical instruments traded in active markets.

Level 2

–

Summary of Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2019

Accounting Policies [Abstract]

Schedule of Net Revenue by Service Line

The following table summarizes the Company’s net revenue from continuing operations by service line (in percentages):


	Years Ended December 31,
	2019			2018			2017
Women’s and Children’s services		50	%		49	%		50	%
Anesthesiology and related		36	%		38	%		41	%
Radiology		14	%		13	%		9	%

		100	%		100	%		100	%

Schedule of Fair Value, Assets and Liabilities Measured on Recurring Basis

The following table presents information about the Company’s financial instruments that are accounted for at fair value on a recurring basis at December 31, 2019 and 2018 (in thousands):


			Fair Value
	Fair Value Category		December 31, 2019		December 31, 2018
Assets:
Money market funds		Level 1	$	16,775	$	481
Short-term investments		Level 2		74,510		—	(1)
Company-owned life insurance		Level 2		—		10,464
Mutual funds		Level 1		14,264		—
Liabilities:
Contingent consideration		Level 3		2,696		20,039

(1)	Investments were measured at carrying value as of December 31, 2018. See table below.

Financial Instruments Measured At Carrying Amount

The following table presents information about the Company’s financial instruments that are not carried at fair value at December 31, 2019 and 2018 (in thousands):


	December 31, 2019						December 31, 2018
	Carrying Amount			Fair Value			Carrying Amount		Fair Value
Assets:
Short-term investments	$	—	(2)	$	—	(2)		21,923		21,858
Long-term investments		—	(2)		—	(2)		69,699		69,090
Liabilities:
2023 Notes		750,000			766,875			750,000		736,725
2027 Notes		1,000,000			1,025,600			500,000		482,500

(2)	Investments were measured at fair value as of December 31, 2019. See table above.

Investments (Tables)

12 Months Ended

Dec. 31, 2019

Investments, Debt and Equity Securities [Abstract]

Schedule of Investments

Investments held are summarized as follows (in thousands):


	December 31, 2019				December 31, 2018
	Short- Term		Long-Term		Short-Term		Long-Term
Corporate securities	$	32,962	$	—	$	—	$	—
Municipal debt securities		29,066		—		18,473		30,841
Federal home loan securities		8,013		—		2,000		34,393
Certificates of deposit		4,469		—		1,450		4,465

	$	74,510	$	—	$	21,923	$	69,699

Accounts Receivable and Net Revenue (Tables)

12 Months Ended

Dec. 31, 2019

Text Block [Abstract]

Schedule of Accounts Receivable, Net

Accounts receivable, net consists of the following (in thousands):


	December 31,
	2019			2018
Gross accounts receivable	$	1,943,664		$	1,993,395
Allowance for contractual adjustments and uncollectibles		(1,444,795	)		(1,486,672	)

	$	498,869		$	506,723

Schedule of Net Revenue

Net revenue consists of the following (in thousands):


	Years Ended December 31,
	2019		2018		2017
Net patient service revenue	$	3,091,987	$	3,067,784	$	2,915,648
Hospital contract administrative fees		396,814		363,368		315,778
Other revenue		24,741		23,658		21,965

	$	3,513,542	$	3,454,810	$	3,253,391

Schedule of Percentage of Net Revenue


	Years Ended December 31,
	2019			2018			2017
Contracted managed care		69	%		69	%		70	%
Government		24	%		24	%		23	%
Other third-parties		5	%		5	%		5	%
Private-pay patients		2	%		2	%		2	%

		100	%		100	%		100	%

Property and Equipment (Tables)

12 Months Ended

Dec. 31, 2019

Property, Plant and Equipment [Abstract]

Schedule of Property and Equipment

Property and equipment consists of the following (in thousands):


	December 31,
	2019			2018
Building	$	26,934		$	26,934
Land		6,683			6,683
Equipment and other		262,977			237,400

		296,594			271,017
Accumulated depreciation		(202,102	)		(180,583	)

	$	94,492		$	90,434

Goodwill and Intangible Assets (Tables)

12 Months Ended

Dec. 31, 2019

Goodwill and Intangible Assets Disclosure [Abstract]

Summary of Intangible Assets, Net

Intangible assets, net, consist of the following (in thousands):


	December 31, 2019
	Gross Carrying Value		Accumulated Amortization			Net Carrying Value
Physician and hospital agreements	$	384,059	$	(269,889	)	$	114,170
Customer relationships		156,530		(29,595	)		126,935
Trade names		19,990		(2,326	)		17,664
Patented and other technology		34,528		(18,890	)		15,638

	$	595,107	$	(320,700	)	$	274,407


	December 31, 2018
	Gross Carrying Value		Accumulated Amortization			Net Carrying Value
Physician and hospital agreements	$	375,344	$	(222,818	)	$	152,526
Customer relationships		156,530		(29,595	)		126,935
Trade names		19,990		(2,326	)		17,664
Patented and other technology		33,129		(17,089	)		16,040

	$	584,993	$	(271,828	)	$	313,165

Amortization Expenses for Existing Intangible Assets for the Next Five Years

Amortization expense for existing intangible assets for the next five years is expected to be as follows (in thousands):


2020	$	42,502
2021		36,502
2022		29,482
2023		24,482
2024		10,590

Discontinued Operations (Tables)

12 Months Ended

Dec. 31, 2019

Discontinued Operations and Disposal Groups [Abstract]

Disposal Groups, Including Discontinued Operations


	December 31, 2018
Assets
Cash and cash equivalents	$	11,254
Accounts receivable, net		38,118
Prepaid expenses and other assets		2,505
Property and equipment, net		42,603
Goodwill		321,556
Intangible assets, net		275,148

	$	691,184

Liabilities
Accounts payable, accrued expenses and other liabilities	$	23,770
Deferred income taxes		35,659

	$	59,429

- Definition

Tabular disclosure of information related to a disposal group. Includes, but is not limited to, a discontinued operation, disposal classified as held-for-sale or disposed of by means other than sale or disposal of an individually significant component.

+ References

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Reference 3: http://fasb.org/us-gaap/role/ref/legacyRef
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Reference 4: http://fasb.org/us-gaap/role/ref/legacyRef
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-Section 45
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Reference 5: http://fasb.org/us-gaap/role/ref/legacyRef
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-Topic 205
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Reference 6: http://fasb.org/us-gaap/role/ref/legacyRef
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-Topic 205
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-URI http://asc.fasb.org/extlink&oid=109222650&loc=SL51721665-107760

Reference 7: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 360
-SubTopic 10
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-URI http://asc.fasb.org/extlink&oid=109226691&loc=d3e2941-110230

Reference 8: http://fasb.org/us-gaap/role/ref/legacyRef
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-Name Accounting Standards Codification
-Topic 205
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Reference 9: http://fasb.org/us-gaap/role/ref/legacyRef
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-Name Accounting Standards Codification
-Topic 205
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-URI http://asc.fasb.org/extlink&oid=109222650&loc=SL51721683-107760

Reference 10: http://fasb.org/us-gaap/role/ref/legacyRef
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-Name Accounting Standards Codification
-Topic 205
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-URI http://asc.fasb.org/extlink&oid=109222650&loc=d3e1361-107760

Reference 11: http://fasb.org/us-gaap/role/ref/legacyRef
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-Topic 205
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-URI http://asc.fasb.org/extlink&oid=109222650&loc=SL51721671-107760

Reference 12: http://fasb.org/us-gaap/role/ref/legacyRef
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-URI http://asc.fasb.org/extlink&oid=109222650&loc=SL51721673-107760

Reference 13: http://fasb.org/us-gaap/role/ref/legacyRef
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-Name Accounting Standards Codification
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+ Details

Accounts Payable and Accrued Expenses (Tables)

12 Months Ended

Dec. 31, 2019

Payables and Accruals [Abstract]

Schedule of Accounts Payable and Accrued Expenses

9.	Accounts Payable and Accrued Expenses:

Accounts payable and accrued expenses consist of the following (in thousands):


	December 31,
	2019		2018
Accounts payable	$	39,610	$	31,059
Accrued salaries and bonuses		268,619		242,888
Accrued payroll taxes and benefits		67,268		78,415
Accrued professional liabilities		44,869		34,931
Accrued contingent consideration		2,696		18,760
Accrued interest		32,910		9,477
Other accrued expenses		55,894		33,037

	$	511,866	$	448,567

Operating Leases (Tables)

12 Months Ended

Dec. 31, 2019

Leases [Abstract]

Operating Lease Related Assets And Liabilities And Other Related Information

The table below presents the operating lease-related

right-of-use

assets and related liabilities recorded on the Company’s balance sheet and the weighted average remaining lease term and discount rate as of December 31, 2019 (dollars in thousands):


	December 31, 2019
Assets:
Operating lease right-of-use assets	$	82,824
Liabilities:
Current portion of operating lease liabilities		23,317
Long-term portion of operating lease liabilities		67,005
Other Information:
Weighted-average remaining lease term		5.0 years
Weighted average discount rate		5.3	%

Lease, Cost

The table below presents certain information related to the lease costs for operating leases during the year ended December 31, 2019 (in thousands):


	Year Ended December 31, 2019
Operating lease costs	$	30,236
Variable lease costs		4,869
Other equipment rent		2,480
Other operating lease costs		4,578

Total operating lease costs	$	42,163

Operating Leases Cash Flow Related Information

The table below presents supplemental cash flow information related to operating leases during the year ended December 31, 2019 (in thousands):


	December 31, 2019
Operating cash flows for operating leases	$	41,532

Lessee, Operating Lease, Liability, Maturity


	December 31, 2019
2020	$	25,060
2021		23,270
2022		18,433
2023		13,794
2024		8,420
Thereafter		13,207

Total minimum lease payments		102,184
Less: Amount of payments representing interest		(11,862	)

Present value of future minimum lease payments		90,322
Less: Current obligations		(23,317	)

Long-term portion of operating leases	$	67,005

Accrued Professional Liabilities (Tables)

12 Months Ended

Dec. 31, 2019

Health Care Organizations [Abstract]

Schedule of Accrued Professional Liability

The activity related to the Company’s total accrued professional liability for the years ended December 31, 2019, 2018, and 2017 is as follows (in thousands):


	Years Ended December 31,
	2019			2018			2017
Balance at beginning of year	$	243,991		$	250,187		$	202,052
Assumed liabilities through acquisition		—			1,276			20,716
Provision (adjustment) for losses related to:
Current year		57,495			34,483			41,291
Prior years		23,191			10,299			9,983

Total provision for losses		80,686			44,782			51,274
Claim payments related to:
Current year		(3,044	)		(555	)		(712	)
Prior years		(49,873	)		(51,699	)		(23,143	)

Total payments		(52,917	)		(52,254	)		(23,855	)

Balance at end of year	$	271,760		$	243,991		$	250,187

Line of Credit, Long-Term Debt and Finance Lease Obligations (Tables)

12 Months Ended

Dec. 31, 2019

Debt Disclosure [Abstract]

Schedule of Long-Term Debt

The carrying value of the Company’s long-term debt was $1.7 billion and $2.0 billion at December 31, 2019 and 2018, respectively, and consisted of the following (in thousands):


	December 31, 2019
	Principal		Unamortized Debt Issuance Costs			Total
Senior n otes	$	1,750,000	$	(19,762	)	$	1,730,238
Revolving line of credit		—		(2,664	)		(2,664	)

Total	$	1,750,000	$	(22,426	)	$	1,727,574


	December 31, 2018
	Principal		Unamortized Debt Issuance Costs			Total
Senior n otes	$	1,250,000	$	(15,408	)	$	1,234,592
Revolving line of credit		739,500		(4,274	)		735,226

Total	$	1,989,500	$	(19,682	)	$	1,969,818

Summary of Estimated Fair Value of Notes

The estimated fair value of the Company’s 2023 Notes and 2027 Notes were estimated using trading prices as of December 31, 2019 and 2018, respectively, as Level 2 inputs to estimate fair value and are summarized as follows (in thousands):


	December 31,
	2019		2018
2023 Notes	$	766,875	$	736,725
2027 Notes		1,025,600		482,500

Schedule of Financial Lease Obligations

The Company’s finance lease obligations consist of the following (in thousands):


	December 31,
	2019			2018
Finance lease obligations	$	188		$	441
Less: Current portion		(130	)		(253	)

Long-term portion	$	58		$	188

Income Taxes (Tables)

12 Months Ended

Dec. 31, 2019

Income Tax Disclosure [Abstract]

Summary of Components of Income Tax Provision

The components of the income tax provision (benefit) are as follows (in thousands):


	December 31,
	2019			2018			2017
Federal:
Current	$	73,333		$	95,955		$	122,379
Deferred		(141,359	)		(21,386	)		(63,981	)

		(68,026	)		74,569			58,398

State:
Current		11,777			26,145			19,084
Deferred		(35,637	)		(4,261	)		2,749

		(23,860	)		21,884			21,833

Total	$	(91,886	)	$	96,453		$	80,231

Schedule of Differences Between Effective Rate and United States Federal Income Tax Statutory Rate

The differences between the effective rate and the United States federal income tax statutory rate are as follows:


	December 31,
	2019			2018			2017
Tax at statutory rate		21.00	%		21.00	%		35.00	%
State income tax, net of federal benefit		3.85			4.35			3.38
Non-deductible expenses		(0.22	)		0.42			0.48
Change in accrual estimates relating to uncertain tax positions		0.36			0.02			—
Capital loss on liquidation		1.79			—			—
Change in valuation allowance		(1.73	)		—			—
Impairments		(17.16	)		—			—
Other, net		(0.49	)		1.70			0.10
Change in tax law		—			(0.32	)		(18.16	)

Income tax provision		7.40	%		27.17	%		20.80	%

Significant Components of Deferred Income Tax Assets and Liabilities

All of the Company’s deferred tax assets and liabilities are classified as long-term. The significant components of deferred income tax assets and liabilities are as follows (in thousands):


	December 31,
	2019			2018
Allowance for uncollectible accounts	$	202,464		$	194,299
Reserves and accruals		72,132			56,583
Stock-based compensation		11,393			9,201
Loss carryforwards		36,017			24,864
Property and equipment		388			—
Other		631			1,197

Deferred tax assets before valuation allowance		323,025			286,144
Less: Valuation allowance		(24,139	)		(2,628	)

Deferred tax assets, net of valuation allowance		298,886			283,516

Gross deferred tax liabilities:
Amortization		(119,481	)		(247,239	)
Accounting method changes		(74,684	)		(109,418	)
Accrual to cash adjustment		—			(39	)
Other		(331	)		(491	)

Total deferred tax liabilities		(194,496	)		(357,187	)

Net deferred tax assets ( liabilities )	$	104,390		$	(73,671	)

Schedule of Activity Related to Gross Unrecognized Tax Benefits

The following table summarizes the activity related to the Company’s liability for uncertain tax positions for the years ended December 31, 2019, 2018 and 2017 (in thousands):


	Years Ended December 31,
	2019			2018			2017
Balance at beginning of year	$	11,185		$	10,972		$	9,469
Increases related to prior year tax positions		369			385			2,284
Decreases related to prior year tax positions		—			—			(143	)
Increases related to current year tax positions		1,700			2,900			1,430
Decreases related to lapse of statutes of limitation		(5,845	)		(3,072	)		(2,068	)

Balance at end of year	$	7,409		$	11,185		$	10,972

Common and Common Equivalent Shares (Tables)

12 Months Ended

Dec. 31, 2019

Earnings Per Share [Abstract]

Schedule of Calculation of Shares Used in Basic and Diluted Net Income Per Share

The calculation of shares used in the basic and diluted net income per share calculation for the years ended December 31, 2019, 2018, and 2017 is as follows (in thousands):


	Years Ended December 31,
	2019		2018		2017
Weighted average number of common shares outstanding		83,495		91,104		92,431
Weighted average number of dilutive common share equivalents (a)		—		502		527

Weighted average number of common and common equivalent shares outstanding		83,495		91,606		92,958

Antidilutive securities not included in the diluted net income per common share calculation		516		214		107

(a)	Due to a loss for the year ended December 31, 2019, no incremental shares are included because the effect would be antidilutive.

Stock Incentive Plans and Stock Purchase Plans (Tables)

12 Months Ended

Dec. 31, 2019

Disclosure of Compensation Related Costs, Share-based Payments [Abstract]

Schedule of Restricted Stock and Deferred Stock Awards

The activity related to the Company’s restricted stock and deferred stock awards and the corresponding weighted average grant-date fair values for the year ended December 31, 2019 are as follows:


	Number of Shares			Weighted Average Fair Value
Non-vested shares at January 1, 2019		1,310,853		$	54.46
Awarded		1,112,773		$	33.28
Forfeited		(137,091	)	$	48.37
Vested		(563,420	)	$	55.96

Non-vested shares at December 31, 2019		1,723,115		$	40.77

Schedule of Activity and Certain Other Information Related to Stock Option Awards

The activity and certain other information related to the Company’s outstanding stock option awards for the year ended December 31, 2019 are as follows:


	Number of Stock Options			Weighted Average Exercise Price		Weighted Average Remaining Contractual Term (in years)		Aggregate Intrinsic Value (in millions)
Outstanding at January 1, 2019		112,976		$	27.65
Exercised		(40,168	)	$	18.87			$	0.6

Outstanding and exercisable at December 31, 2019		72,808		$	32.49		0.8	$	—

Selected Quarterly Financial Information (Tables)

12 Months Ended

Dec. 31, 2019

Quarterly Financial Information Disclosure [Abstract]

Summary of Company's Selected Quarterly Financial Information


	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.

Summary of Significant Accounting Policies - Additional Information (Detail) - USD ($) $ in Millions		12 Months Ended
	Oct. 10, 2019	Dec. 31, 2019	Dec. 31, 2018
Summary Of Significant Accounting Policies [Line Items]
Equity method ownership percentage in joint venture			49.00%
Cash Payments Received On Divestiture Of MedData	$ 249.7
Equity consideration in the parent company of Buyer	$ 50.0
Cash and cash equivalents maturity description		90
Additional amounts to be paid in cash or common stock based on achievement of performance measures within period, maximum years		5 years
Accumulated Non cash impairment charge of goodwill		$ 1,450.0
Unnamed Corporate Joint Venture One [Member]
Summary Of Significant Accounting Policies [Line Items]
Equity method ownership percentage in joint venture		37.50%
Unnamed Corporate Joint Venture Two [Member]
Summary Of Significant Accounting Policies [Line Items]
Equity method ownership percentage in joint venture		49.00%
Government Contracts Concentration Risk [Member] \| Accounts Receivable [Member]
Summary Of Significant Accounting Policies [Line Items]
Percentage of net accounts receivable		20.00%	19.00%
Buildings [Member]
Summary Of Significant Accounting Policies [Line Items]
Property and equipment estimated useful lives, years		30 years
Maximum [Member]
Summary Of Significant Accounting Policies [Line Items]
Short-Term investments maturity period, in years		1 year
Intangible assets finite lives		20 years
Maximum [Member] \| Medical Equipment [Member]
Summary Of Significant Accounting Policies [Line Items]
Property and equipment estimated useful lives, years		7 years
Maximum [Member] \| Computer Equipment [Member]
Summary Of Significant Accounting Policies [Line Items]
Property and equipment estimated useful lives, years		7 years
Maximum [Member] \| Software and Software Development Costs [Member]
Summary Of Significant Accounting Policies [Line Items]
Property and equipment estimated useful lives, years		7 years
Maximum [Member] \| Furniture [Member]
Summary Of Significant Accounting Policies [Line Items]
Property and equipment estimated useful lives, years		7 years
Minimum [Member]
Summary Of Significant Accounting Policies [Line Items]
Intangible assets finite lives		1 year
Minimum [Member] \| Medical Equipment [Member]
Summary Of Significant Accounting Policies [Line Items]
Property and equipment estimated useful lives, years		3 years
Minimum [Member] \| Computer Equipment [Member]
Summary Of Significant Accounting Policies [Line Items]
Property and equipment estimated useful lives, years		3 years
Minimum [Member] \| Software and Software Development Costs [Member]
Summary Of Significant Accounting Policies [Line Items]
Property and equipment estimated useful lives, years		3 years
Minimum [Member] \| Furniture [Member]
Summary Of Significant Accounting Policies [Line Items]
Property and equipment estimated useful lives, years		3 years

Summary of Significant Accounting Policies - Schedule of Net Revenue by Service Line (Detail) - Product Concentration Risk [Member] - Sales Revenue, Services, Net [Member]	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Segment Reporting Information [Line Items]
Net revenue in percentage	100.00%	100.00%	100.00%
Neonatology and Other Pediatric Subspecialties [Member]
Segment Reporting Information [Line Items]
Net revenue in percentage	50.00%	49.00%	50.00%
Anesthesiology And Related [Member]
Segment Reporting Information [Line Items]
Net revenue in percentage	36.00%	38.00%	41.00%
Radiology And Teleradiology [Member]
Segment Reporting Information [Line Items]
Net revenue in percentage	14.00%	13.00%	9.00%

Summary of Significant Accounting Policies - Schedule of fair value on a recurring basis (Detail) - Fair Value, Measurements, Recurring [Member] - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Fair Value, Inputs, Level 1 [Member]
Assets:
Money market funds	$ 16,775	$ 481
Mutual funds	14,264	0
Fair Value, Inputs, Level 2 [Member]
Assets:
Short-term investments	74,510	0
Company-owned life insurance	0	10,464
Fair Value, Inputs, Level 3 [Member]
Liabilities:
Contingent consideration	$ 2,696	$ 20,039

Summary of Significant Accounting Policies - Schedule of financial instruments that are not carried at fair value (Detail) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Assets:
Carrying Amount, Short-term investments	$ 0	$ 21,923
Carrying Amount, Long-term Investments	0	69,699
Assets:
Fair Value, Short-term investments		21,858
Fair Value, Long-term investments		69,090
2023 Notes [Member]
Liabilities:
Notes Payable	750,000	750,000
Liabilities:
Notes Payable Fair Value Disclosure	766,875	736,725
2027 Notes [Member]
Liabilities:
Notes Payable	1,000,000	500,000
Liabilities:
Notes Payable Fair Value Disclosure	$ 1,025,600	$ 482,500

Investments - Schedule of Investments (Detail) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Schedule of Avaliable-For-Sale Securities [Line Items]
Short-Term	$ 74,510	$ 21,923
Long-Term	0	69,699
Corporate Securities [Member]
Schedule of Avaliable-For-Sale Securities [Line Items]
Short-Term	32,962	0
Long-Term	0	0
Municipal Debt Securities [Member]
Schedule of Avaliable-For-Sale Securities [Line Items]
Short-Term	29,066	18,473
Long-Term	0	30,841
Federal Home Loan Securities [Member]
Schedule of Avaliable-For-Sale Securities [Line Items]
Short-Term	8,013	2,000
Long-Term	0	34,393
Certificates of Deposit [Member]
Schedule of Avaliable-For-Sale Securities [Line Items]
Short-Term	4,469	1,450
Long-Term	$ 0	$ 4,465

Accounts Receivable and Net Revenue - Schedule of Accounts Receivable, Net (Detail) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Receivables [Abstract]
Gross accounts receivable	$ 1,943,664	$ 1,993,395
Allowance for contractual adjustments and uncollectibles	(1,444,795)	(1,486,672)
Accounts receivable, net	$ 498,869	$ 506,723

Accounts Receivable and Net Revenue - Schedule of Net Revenue (Detail) - USD ($) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Disaggregation of Revenue [Abstract]
Net revenue	$ 905,375	$ 888,675	$ 868,309	$ 851,183	$ 888,436	$ 848,759	$ 864,987	$ 852,628	$ 3,513,542	$ 3,454,810	$ 3,253,391
Net patient service revenue [Member]
Disaggregation of Revenue [Abstract]
Net revenue									3,091,987	3,067,784	2,915,648
Hospital contract administrative fees [Member]
Disaggregation of Revenue [Abstract]
Net revenue									396,814	363,368	315,778
Other revenue [Member]
Disaggregation of Revenue [Abstract]
Net revenue									$ 24,741	$ 23,658	$ 21,965

Accounts Receivable and Net Revenue - Schedule of Net Patient Service Revenue by Type of Payor (Detail)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	100.00%	100.00%	100.00%
Contracted Managed Care [Member]
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	69.00%	69.00%	70.00%
Government [Member]
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	24.00%	24.00%	23.00%
Other Third-Parties [Member]
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	5.00%	5.00%	5.00%
Private-Pay Patients [Member]
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	2.00%	2.00%	2.00%

Property Plant and Equipment - Schedule of Property and Equipment (Detail) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Property, Plant and Equipment [Abstract]
Building	$ 26,934	$ 26,934
Land	6,683	6,683
Equipment and other	262,977	237,400
Property and equipment, gross	296,594	271,017
Accumulated depreciation	(202,102)	(180,583)
Property and equipment, net	$ 94,492	$ 90,434

Property and Equipment - Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Property, Plant and Equipment [Line Items]
Recorded depreciation expense	$ 30.0	$ 29.3	$ 26.4

Business Acquisitions - Additional Information (Detail) $ in Millions	12 Months Ended
	Dec. 31, 2019 USD ($) Number	Dec. 31, 2018 USD ($) Number	Dec. 31, 2017 USD ($)
Business Acquisition [Line Items]
Total business acquisition consideration	$ 112.0	$ 111.8
Contingent consideration payments related to prior-period acquisitions	11.3	$ 6.4
Goodwill deductible for tax purposes	$ 98.1
Assets held for sale			$ 46.0
Sale of equity method investments		49.00%
Number Of Physician Group Practices Acquired \| Number	9	9
Number Of Neonatology Practices Acquired \| Number	2	2
Number Of Pediatric Subspecialty Practices Acquired \| Number	4	2
Number Of Radiology Practices Acquired \| Number	1	5
Number Of Maternal-fetal Medicine Practices Acquired \| Number	2
Change in the fair value of a contingent consideration		$ 5.3
Accrued Purchase Consideration	$ 0.3
Purchase consideration payments related to prior-period acquisitions		1.2
Physician Group [Member]
Business Acquisition [Line Items]
Goodwill	98.1	95.0
Other intangible assets	14.0	17.2
Fixed assets	0.2
Change in the fair value of a contingent consideration	$ 6.6
Decrease in current assets		1.7
Other Liabilities		2.1
Prior Period Acquisitions [Member]
Business Acquisition [Line Items]
Decrease in current assets		1.2
Net increase in goodwill resulting from finalization of tax acquisition accounting		4.0
Additional cash consideration related to a working capital true up		1.5
Decrease in noncurrent assets		1.5
Decrease in liabilities		$ 0.2

Goodwill and Intangible Assets - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Sep. 30, 2019	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Goodwill And Other Intangible Assets [Line Items]
Goodwill		$ 2,710,292	$ 4,061,439
Non cash impairment charge of goodwill	$ 1,449,215	1,449,215	0	$ 0
Goodwill recognition of deferred tax asset		147,200
Goodwill incremental impairment charges		147,200
Accumulated Non cash impairment charge of goodwill		1,450,000
Intangible assets related to acquisitions		14,000
Amortization expense for intangible assets		$ 48,900	$ 54,500	$ 52,500
Physician And Hospital Agreements [Member]
Goodwill And Other Intangible Assets [Line Items]
Weighted average amortization period		8 years
Anaesthesiology Reporting Unit [Member]
Goodwill And Other Intangible Assets [Line Items]
Non cash impairment charge of goodwill	$ 1,300,000

Goodwill and Intangible Assets - Summary of Intangible Assets, Net (Detail) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	$ 595,107	$ 584,993
Accumulated Amortization	(320,700)	(271,828)
Net Carrying Value	274,407	313,165
Physician And Hospital Agreements [Member]
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	384,059	375,344
Accumulated Amortization	(269,889)	(222,818)
Net Carrying Value	114,170	152,526
Customer Relationships [Member]
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	156,530	156,530
Accumulated Amortization	(29,595)	(29,595)
Net Carrying Value	126,935	126,935
Trade Names [Member]
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	19,990	19,990
Accumulated Amortization	(2,326)	(2,326)
Net Carrying Value	17,664	17,664
Patented and Other Technology [Member]
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	34,528	33,129
Accumulated Amortization	(18,890)	(17,089)
Net Carrying Value	$ 15,638	$ 16,040

Goodwill and Intangible Assets - Amortization Expenses for Existing Intangible Assets for the Next Five Years (Detail) $ in Thousands	Dec. 31, 2019 USD ($)
Goodwill and Intangible Assets Disclosure [Abstract]
Amortization expense for existing other intangible assets, 2020	$ 42,502
Amortization expense for existing other intangible assets, 2021	36,502
Amortization expense for existing other intangible assets, 2022	29,482
Amortization expense for existing other intangible assets, 2023	24,482
Amortization expense for existing other intangible assets, 2024	$ 10,590

Discontinued Operations - Additional Information (Detail) - USD ($) $ in Millions		3 Months Ended			12 Months Ended
	Oct. 10, 2019	Dec. 31, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Asset Impairment Charges			$ 66.4	$ 285.0	$ 50.0
Deferred Tax Assets, Goodwill and Intangible Assets			16.4	36.6
Net proceeds for the management services service line	$ 249.7	$ 242.5
Preliminary gain loss on sale		$ 29.1
Net Revenue					172.7	$ 220.9	$ 230.7
Operating Income From Discontinued Operations					20.1	$ 14.0	$ 25.2
Deferred Tax Assets Goodwill [Member]
Asset Impairment Charges			16.4	$ 36.6	$ 321.6
Deferred Tax Assets Intangible Assets [Member]
Asset Impairment Charges			$ 50.0

Discontinued Operations - Schedule of Management Services Service Line (Detail) $ in Thousands	Dec. 31, 2018 USD ($)
Assets
Cash and cash equivalents	$ 11,254
Accounts receivable, net	38,118
Prepaid expenses and other assets	2,505
Property and equipment, net	42,603
Goodwill	321,556
Intangible assets, net	275,148
Total Assets	691,184
Liabilities
Accounts payable, accrued expenses and other liabilities	23,770
Deferred income taxes	35,659
Total Liabilities	$ 59,429

Accounts Payable and Accrued Expenses - Schedule of Accounts Payable and Accrued Expenses (Detail) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Payables and Accruals [Abstract]
Accounts payable	$ 39,610	$ 31,059
Accrued salaries and bonuses	268,619	242,888
Accrued payroll taxes and benefits	67,268	78,415
Accrued professional liabilities	44,869	34,931
Accrued contingent consideration	2,696	18,760
Accrued interest	32,910	9,477
Other accrued expenses	55,894	33,037
Accounts payable and accrued expenses, total	$ 511,866	$ 448,567

Operating Leases - Schedule of operating lease-related right-of-use assets and related liabilities recorded on the Company's balance sheet and the weighted average remaining lease term and discount rate (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Assets:
Operating lease right-of-use assets	$ 82,824	$ 0
Liabilities:
Current portion of operating lease liabilities	23,317	0
Long-term portion of operating lease liabilities	$ 67,005	$ 0
Other Information:
Weighted-average remaining lease term	5 years
Weighted average discount rate	5.30%

Operating Leases - Schedule of lease costs for operating leases (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2019 USD ($)
Operating lease costs	$ 30,236
Variable lease costs	4,869
Other equipment rent	2,480
Other operating lease costs	4,578
Total operating lease costs	$ 42,163

Operating Leases - Schedule of supplemental cash flow information related to operating leases (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2019 USD ($)
Operating cash flows for operating leases	$ 41,532

Operating Leases - Schedule of operating lease liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
2020	$ 25,060
2021	23,270
2022	18,433
2023	13,794
2024	8,420
Thereafter	13,207
Total minimum lease payments	102,184
Less: Amount of payments representing interest	(11,862)
Present value of future minimum lease payments	90,322
Less: Current obligations	(23,317)	$ 0
Long-term portion of operating leases	$ 67,005	$ 0

Accrued Professional Liabilities - Additional Information (Detail) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Payables and Accruals [Abstract]
Total accrued professional liability	$ 271,760	$ 243,991	$ 250,187	$ 202,052
Accrued professional liability incurred but loss reserves not reported for claims	187,300	139,100
Accrued professional liability incurred and loss reserves reported for claims	84,500	104,900
Accrued professional liabilities	44,869	$ 34,931
Insurance receivables	$ 29,800

Accrued Professional Liabilities - Schedule of Accrued Professional Liability (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Payables and Accruals [Abstract]
Balance at beginning of year	$ 243,991	$ 250,187	$ 202,052
Assumed liabilities through acquisition	0	1,276	20,716
Provision (adjustment) for losses related to Current year	57,495	34,483	41,291
Provision (adjustment) for losses related to Prior years	23,191	10,299	9,983
Total provision for losses	80,686	44,782	51,274
Claim payments related to Current year	(3,044)	(555)	(712)
Claim payments related to Prior years	(49,873)	(51,699)	(23,143)
Total payments	(52,917)	(52,254)	(23,855)
Balance at end of year	$ 271,760	$ 243,991	$ 250,187

Line of Credit, Long-Term Debt and Finance Lease Obligations - Additional Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Feb. 28, 2019	Dec. 31, 2018	Nov. 30, 2018	Dec. 31, 2015
Debt Instrument [Line Items]
Line of Credit facility, maturity date	Mar. 28, 2024
Long term debt	$ 1,727,574		$ 1,969,818
Letters of credit outstanding amount	200
Line of Credit facility, available balance	$ 1,200,000
Minimum [Member]
Debt Instrument [Line Items]
Debt instrument, variable interest rate	0.15%
Maximum [Member]
Debt Instrument [Line Items]
Debt instrument, variable interest rate	0.20%
Alternate Base Rate [Member] \| Federal Funds Rate [Member]
Debt Instrument [Line Items]
Debt instrument, interest rate	Federal Funds Rate plus 1/2 of 1.00%
Alternate Base Rate [Member] \| LIBOR [Member]
Debt Instrument [Line Items]
Debt instrument, interest rate	LIBOR for an interest period of one month plus 1.00%
Debt instrument, variable interest rate	1.00%
Applicable Margin Rate [Member] \| LIBOR [Member] \| Minimum [Member]
Debt Instrument [Line Items]
Debt instrument, variable interest rate	0.125%
Applicable Margin Rate [Member] \| LIBOR [Member] \| Maximum [Member]
Debt Instrument [Line Items]
Debt instrument, variable interest rate	0.75%
Unsecured Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Line of Credit facility, borrowing capacity	$ 1,200,000
Letters of Credit [Member]
Debt Instrument [Line Items]
Line of Credit facility, borrowing capacity	$ 37,500
5.25% Senior Unsecured Notes Due 2023 [Member]
Debt Instrument [Line Items]
Aggregate principal amount of debt					$ 750,000
Debt instrument interest rate	5.25%				5.25%
Debt instrument maturity date description	payable semi-annually in arrears on June 1 and December 1
Debt instrument, maturity year	2023
Long term debt	$ 1,730,238		$ 1,234,592
Interest accrued periodically	$ 39,400
5.25% Senior Unsecured Notes Due 2023 [Member] \| Change In Control [Member]
Debt Instrument [Line Items]
Redemption percentage of principal amount	101.00%
5.25% Senior Unsecured Notes Due 2023 [Member] \| Redemption in 2020 [Member]
Debt Instrument [Line Items]
Redemption percentage of principal amount	101.313%
5.25% Senior Unsecured Notes Due 2023 [Member] \| Redemption in 2021 and Thereafter [Member]
Debt Instrument [Line Items]
Redemption percentage of principal amount	100.00%
6.25% Senior Unsecured Notes Due 2027 [Member]
Debt Instrument [Line Items]
Aggregate principal amount of debt		$ 500,000		$ 500,000
Debt instrument interest rate	6.25%			6.25%
Debt instrument maturity date description	payable semi-annually in arrears on January 15 and July 15
Debt instrument, maturity year	2027
Long term debt	$ 1,000,000
Interest accrued periodically	$ 62,500
6.25% Senior Unsecured Notes Due 2027 [Member] \| Change In Control [Member]
Debt Instrument [Line Items]
Redemption percentage of principal amount	101.00%
6.25% Senior Unsecured Notes Due 2027 [Member] \| Redemption Before 2022 [Member]
Debt Instrument [Line Items]
Redemption percentage of principal amount	100.00%
6.25% Senior Unsecured Notes Due 2027 [Member] \| Redemption Before 2022 [Member] \| Redeem up to 35% of Aggregate Principal Amount [Member]
Debt Instrument [Line Items]
Redemption percentage of principal amount	35.00%
Redemption price percentage of aggregate principal amount redeemed	106.25%
6.25% Senior Unsecured Notes Due 2027 [Member] \| Redemption in 2022 [Member]
Debt Instrument [Line Items]
Redemption percentage of principal amount	104.688%
6.25% Senior Unsecured Notes Due 2027 [Member] \| Redemption in 2023 [Member]
Debt Instrument [Line Items]
Redemption percentage of principal amount	103.125%
6.25% Senior Unsecured Notes Due 2027 [Member] \| Redemption in 2024 [Member]
Debt Instrument [Line Items]
Redemption percentage of principal amount	101.563%
6.25% Senior Unsecured Notes Due 2027 [Member] \| Redemption in 2025 and Thereafter [Member]
Debt Instrument [Line Items]
Redemption percentage of principal amount	100.00%

Line of Credit, Long-Term Debt and Finance Lease Obligations - Schedule of Long-Term Debt (Detail) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Debt Instrument [Line Items]
Debt instrument principal amount	$ 1,750,000	$ 1,989,500
Unamortized debt issuance cost	(22,426)	(19,682)
Long term debt	1,727,574	1,969,818
5.25% Senior Unsecured Notes Due 2023 [Member]
Debt Instrument [Line Items]
Debt instrument principal amount	1,750,000	1,250,000
Unamortized debt issuance cost	(19,762)	(15,408)
Long term debt	1,730,238	1,234,592
Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Debt instrument principal amount		739,500
Unamortized debt issuance cost	$ (2,664)	(4,274)
Long term debt		$ 735,226

Line of Credit, Long-Term Debt and Finance Lease Obligations - Summary of Estimated Fair Value of Notes (Detail) - Level 2 [Member] - Estimate of Fair Value Measurement [Member] - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
5.25% Senior Unsecured Notes Due 2023 [Member]
Debt Instrument Fair Value [Line Items]
Estimated fair value	$ 766,875	$ 736,725
6.25% Senior Unsecured Notes Due 2027 [Member]
Debt Instrument Fair Value [Line Items]
Estimated fair value	$ 1,025,600	$ 482,500

Line of Credit, Long-Term Debt and Financial Lease Obligations - Schedule of Financial Lease Obligations (Detail) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Debt Disclosure [Abstract]
Finance lease obligations	$ 188	$ 441
Less: Current portion	(130)	(253)
Long-term portion	$ 58	$ 188

Income Taxes - Summary of Components of Income Tax Provision (Detail) - USD ($) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Income Tax Disclosure [Abstract]
Federal, Current									$ 73,333	$ 95,955	$ 122,379
Federal, Deferred									(141,359)	(21,386)	(63,981)
Federal income tax provision, Total									(68,026)	74,569	58,398
State, Current									11,777	26,145	19,084
State, Deferred									(35,637)	(4,261)	2,749
State income tax provision, Total									(23,860)	21,884	21,833
Income tax provision, Total	$ 7,824	$ (125,788)	$ 17,116	$ 8,962	$ 21,701	$ 23,550	$ 28,482	$ 22,720	$ (91,886)	$ 96,453	$ 80,231

Income Taxes - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended		12 Months Ended
	Sep. 30, 2019	Dec. 31, 2017	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Income Tax [Line Items]
Tax at statutory rate				21.00%	21.00%	35.00%
Effective tax rate				7.40%	27.17%	20.80%
Effective income tax rate reconciliation nondeductible portion of goodwill impairment charge	$ 213,700
Income tax benefit resulting from the reduction of deferred tax liabilities		$ (70,000)
Increase (decrease) in net deferred tax liability				$ 178,100
Income tax expense for excess tax deficiencies				3,900	$ 1,400	$ 200
Net operating loss carryforwards for federal and state tax		114,500		75,400	100,700	114,500
Operating loss carryforwards subject to expiration					38,700
Operating loss carryforwards not subject to expiration					36,700
Uncertain tax position liability		$ 10,972		7,409	11,185	$ 10,972	$ 9,469
Unrecognized tax benefits that would impact effective tax rate					7,100
Increase (decrease) in uncertain tax position				3,800	200
Company's accrued liability for interest and penalties related to income tax liabilities				600	1,100
Deferred tax assets				104,390
Net deferred tax liabilities					$ 73,671
Capital losses incurred				$ 68,000
Capital loss carryforwards, expiration date				2024
Capital loss carryforwards, valuation allowance				$ 17,100
Earliest Tax Year [Member]
Income Tax [Line Items]
Federal and state income tax examinations				2015
Latest Tax Year [Member]
Income Tax [Line Items]
Federal and state income tax examinations					2018
Scenario, Forecast [Member]
Income Tax [Line Items]
Increase (decrease) in uncertain tax position			$ 2,000
Minimum [Member]
Income Tax [Line Items]
Expiration period of operating loss carryforwards				2021
Maximum [Member]
Income Tax [Line Items]
Expiration period of operating loss carryforwards				2039

Income Taxes - Schedule of Differences Between Effective Rate and United States Federal Income Tax Statutory Rate (Detail)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Income Tax Disclosure [Abstract]
Tax at statutory rate	21.00%	21.00%	35.00%
State income tax, net of federal benefit	3.85%	4.35%	3.38%
Non-deductible expenses	(0.22%)	0.42%	0.48%
Change in accrual estimates relating to uncertain tax positions	0.36%	0.02%
Capital loss on liquidation	1.79%
Change in valuation allowance	(1.73%)
Impairments	(17.16%)
Other, net	(0.49%)	1.70%	0.10%
Change in tax law		(0.32%)	(18.16%)
Income tax provision	7.40%	27.17%	20.80%

Income Taxes - Significant Components of Deferred Income Tax Assets and Liabilities (Detail) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Income Tax Disclosure [Abstract]
Allowance for uncollectible accounts	$ 202,464	$ 194,299
Reserves and accruals	72,132	56,583
Stock-based compensation	11,393	9,201
Loss carryforwards	36,017	24,864
Property and equipment	388	0
Other	631	1,197
Deferred tax assets before valuation allowance	323,025	286,144
Less: Valuation allowance	(24,139)	(2,628)
Deferred tax assets, net of valuation allowance	298,886	283,516
Gross deferred tax liabilities:
Amortization	(119,481)	(247,239)
Accounting method changes	(74,684)	(109,418)
Accrual to cash adjustment		(39)
Other	(331)	(491)
Total deferred tax liabilities	(194,496)	(357,187)
Net deferred tax assets	$ 104,390
Net deferred tax liabilities		$ (73,671)

Income Taxes - Schedule of Activity Related to Gross Unrecognized Tax Benefits (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Income Tax Disclosure [Abstract]
Balance at beginning of year	$ 11,185	$ 10,972	$ 9,469
Increases related to prior year tax positions	369	385	2,284
Decreases related to prior year tax positions			(143)
Increases related to current year tax positions	1,700	2,900	1,430
Decreases related to lapse of statutes of limitation	(5,845)	(3,072)	(2,068)
Balance at end of year	$ 7,409	$ 11,185	$ 10,972

Common and Common Equivalent Shares - Schedule of Calculation of Shares Used in Basic and Diluted Net Income Per Share (Detail) - shares shares in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Earnings Per Share [Abstract]
Weighted average number of common shares outstanding	82,592	82,441	83,234	86,073	87,810	90,984	92,987	92,859	83,495	91,104	92,431
Weighted average number of dilutive common share equivalents										502	527
Weighted average number of common and common equivalent shares outstanding	83,288	82,441	83,689	86,545	88,258	91,359	93,529	93,505	83,495	91,606	92,958
Antidilutive securities not included in the diluted net income per common share calculation									516	214	107

Stock Incentive Plans and Stock Purchase Plans - Additional Information (Detail) - USD ($) $ / shares in Units, $ in Millions	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017	May 16, 2019	May 15, 2019
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock, aggregate shares authorized	200,000,000	200,000,000
Stock-based compensation expense	$ 35.4	$ 37.9	$ 28.8
Aggregate fair value of restricted and deferred stocks vested	$ 31.5	$ 27.4	$ 29.3
Weighted average grant-date fair value of restricted and deferred stock awards granted	$ 33.28	$ 51.99	$ 54.22
Aggregate intrinsic value of stock options exercised	$ 0.6	$ 2.8	$ 5.5
Cash proceeds received from the exercise of stock options	$ 0.1	$ 3.7	$ 4.8
Stock Option [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period	3 years
Stock Option [Member] \| Maximum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period of options, maximum years	10 years
Restricted Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period	3 years
Restricted and Deferred Stock Units [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unrecognized compensation expense related to non-vested restricted stock, weighted-average period in years	1 year 4 months 24 days
Unrecognized compensation expense related to non-vested restricted shares	$ 22.1
1996 Non-Qualified Employee Stock Purchase Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of market value of common stock at which employees are permitted to purchase	85.00%
2015 Non-Qualified Stock Purchase Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of market value of common stock at which employees are permitted to purchase	90.00%
Amended and Restated 2008 Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share based compensation authorized shares				27,800,000	19,500,000
Amended and Restated 2008 Plan [Member] \| Stock Option [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares available for future grants and awards under Stock Incentive Plans	8,300,000
1996 Non-Qualified Employee Stock Purchase Plan and 2015 Non-Qualified Stock Purchase Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock, aggregate shares authorized	2,600,000
Aggregate number Shares issued under Stock Purchase Plans	500,000
Common stock, reserved for issuance	1,100,000

Stock Incentive Plans and Stock Purchase Plans - Schedule of Restricted Stock and Deferred Stock Awards (Detail) - $ / shares	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Number of Shares, Non-vested shares at January 1, 2019	1,310,853
Number of Shares, Awarded	1,112,773
Number of Shares, Forfeited	(137,091)
Number of Shares, Vested	(563,420)
Number of Shares, Non-vested shares at December 31, 2019	1,723,115	1,310,853
Weighted Average Fair Value, Non-vested shares at January 1, 2019	$ 54.46
Weighted Average Fair Value, Awarded	33.28	$ 51.99	$ 54.22
Weighted Average Fair Value, Forfeited	48.37
Weighted Average Fair Value, Vested	55.96
Weighted Average Fair Value, Non-vested shares at December 31, 2019	$ 40.77	$ 54.46

Stock Incentive Plans and Stock Purchase Plans - Schedule of Activity and Certain Other Information Related to Stock Option Awards (Detail) - USD ($) $ / shares in Units, $ in Millions	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Number of Shares, Outstanding at January 1, 2019	112,976
Number of Shares, Exercised	(40,168)
Number of Shares, Outstanding at December 31, 2019	72,808	112,976
Number of Shares, Exercisable at December 31, 2019	72,808
Weighted Average Exercise Price, Outstanding at January 1, 2019	$ 27.65
Weighted Average Exercise Price, Exercised	18.87
Weighted Average Exercise Price, Outstanding at December 31, 2019	32.49	$ 27.65
Weighted Average Exercise Price, Exercisable at December 31, 2019	$ 32.49
Weighted Average Remaining Contractual Term (in years), Outstanding at December 31, 2019	9 months 18 days
Weighted Average Remaining Contractual Term (in years), Exercisable at December 31, 2019	9 months 18 days
Aggregate Intrinsic Value, Exercised	$ 0.6	$ 2.8	$ 5.5

Common Stock Repurchase Programs - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Jun. 30, 2018	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017	Aug. 31, 2018
Common Stock [Line Items]
Common stock authorized for repurchase					$ 500,000
Common stock repurchased		$ 145,280	$ 302,160	$ 70,192
Company's Common stock repurchased			250,000
Common Stock [Member]
Common Stock [Line Items]
Common stock repurchased		$ 51	$ 70	$ 10
Repurchased common stock, shares		5,066,000	7,041,000	1,038,000
Restricted Stock [Member]
Common Stock [Line Items]
Number of shares withheld to satisfy minimum statutory tax withholding obligations	54,909	96,918
Amount withheld to satisfy minimum statutory tax withholding obligations	$ 2,500	$ 2,500

Retirement Plans - Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Retirement Benefits [Abstract]
Expense of retirement plans related to the 401(k) Plans	$ 43.0	$ 54.6	$ 50.1

Selected Quarterly Financial Information - Summary of Company's Selected Quarterly Financial Information (Detail) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Quarterly Financial Information Disclosure [Abstract]
Net revenue	$ 905,375	$ 888,675	$ 868,309	$ 851,183	$ 888,436	$ 848,759	$ 864,987	$ 852,628	$ 3,513,542	$ 3,454,810	$ 3,253,391
Practice salaries and benefits	647,968	630,309	608,962	621,539	630,048	599,326	593,047	603,955	2,508,778	2,426,376	2,227,335
Practice supplies and other operating expenses	32,009	26,950	28,016	25,791	25,870	27,249	28,329	27,403	112,766	108,851	106,444
General and administrative expenses	96,926	102,356	103,540	101,821	105,532	95,771	100,938	101,693	404,643	403,934	385,864
Depreciation and amortization	19,410	19,608	19,809	20,033	21,433	22,205	20,280	19,914	78,860	83,832	78,856
Transformational and restructuring related expenses	44,311	19,992	27,482	3,544					95,329	0	0
Goodwill impairment		1,449,215							1,449,215	0	0
Total operating expenses	840,624	2,248,430	787,809	772,728	782,883	744,551	742,594	752,965	4,649,591	3,022,993	2,798,499
Income (loss) from operations	64,751	(1,359,755)	80,500	78,455	105,553	104,208	122,393	99,663	(1,136,049)	431,817	454,892
Investment and other income	1,429	1,373	1,222	1,647	981	1,531	1,225	1,474	5,671	5,211	4,385
Interest expense	(27,677)	(29,901)	(31,080)	(30,723)	(25,448)	(21,788)	(21,618)	(19,935)	(119,381)	(88,789)	(74,556)
Equity in earnings of unconsolidated affiliates	2,304	2,249	1,990	1,236	2,277	1,766	1,257	1,525	7,779	6,825	952
Total non-operating expenses	(23,944)	(26,279)	(27,868)	(27,840)	(22,190)	(18,491)	(19,136)	(16,936)	(105,931)	(76,753)	(69,219)
Income (loss) from continuing operations before income taxes	40,807	(1,386,034)	52,632	50,615	83,363	85,717	103,257	82,727	(1,241,980)	355,064	385,673
Income tax (provision) benefit	(7,824)	125,788	(17,116)	(8,962)	(21,701)	(23,550)	(28,482)	(22,720)	91,886	(96,453)	(80,231)
Income (loss) from continuing operations	32,983	(1,260,246)	35,516	41,653	61,662	62,167	74,775	60,007	(1,150,094)	258,611	305,442
(Loss) income from discontinued operations, net of tax	(23,652)	4,330	(43,761)	(284,525)	(1,448)	3,408	4,637	3,421	(347,608)	10,018	14,930
Net (loss) income	$ 9,331	$ (1,255,916)	$ (8,245)	$ (242,872)	$ 60,214	$ 65,575	$ 79,412	$ 63,428	$ (1,497,702)	$ 268,629	$ 320,372
Income (loss) from continuing operations, Basic	$ 0.40	$ (15.29)	$ 0.43	$ 0.48	$ 700	$ 680	$ 800	$ 650	$ (13.78)	$ 2.84	$ 3.31
Income (loss) from continuing operations, Diluted	0.40	(15.29)	0.42	0.48	700	680	800	640	(13.78)	2.82	3.29
(Loss) income from discontinued operations, Basic	(0.29)	0.05	(0.53)	(3.31)	(20.00)	40.00	50.00	40.00	(4.16)	0.11	0.16
(Loss) income from discontinued operations, Diluted	(0.29)	0.05	(0.52)	(3.29)	(20.00)	40.00	50.00	40.00	(4.16)	0.11	0.16
Earnings (loss) per share, Basic	0.11	(15.24)	(0.10)	(2.82)	0.68	0.72	0.85	0.68	(17.94)	2.95	3.47
Earnings (loss) per share, Diluted	$ 0.11	$ (15.24)	$ (0.10)	$ (2.81)	$ 0.68	$ 0.72	$ 0.85	$ 0.68	$ (17.94)	$ 2.93	$ 3.45
Weighted average shares, Basic	82,592	82,441	83,234	86,073	87,810	90,984	92,987	92,859	83,495	91,104	92,431
Weighted average shares, Diluted	83,288	82,441	83,689	86,545	88,258	91,359	93,529	93,505	83,495	91,606	92,958