Consolidated Statements of Cash Flows - USD ($)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Operating activities:
Net income	$ 8,212,484	$ 13,015,917
Adjustments for:
Depreciation of property, equipment and intangibles	35,009,070	31,486,055
Stock-based compensation	976,962	2,800,750
Unrealized foreign exchange	8,925	(4,494)
Deferred income tax expense (recovery)	(3,440,121)	(2,407,176)
Change in fair value of contingent consideration	2,861,204	971,627
Accretion on contingent consideration and deferred consideration	133,450	166,575
Amortization of deferred financing fees	276,260	260,363
Gain on equity investment	(1,766,968)
Change in current tax receivable (payable)	939,779	(1,936,436)
Change in trade and other receivables	1,376,733	(3,981,491)
Change in prepaid expenses	132,290	171,911
Change in inventories	53,220	20,902
Change in trade and other payables	121,615	101,379
Change in employee benefits	110,654	326,681
Cash provided by operating activities	45,005,557	40,992,563
Financing activities
Proceeds from member loans	19,600	303,351
Repayment of member loans		(662,568)
Repayment of short-term advances	(26,783)
Repayment of notes payable and bank indebtedness	(82,550,000)	(14,250,000)
Proceeds on bank indebtedness	81,641,370	22,800,000
Payment of deferred financing fees	(839,892)
Payment of deferred consideration	(1,100,000)	(1,000,000)
Payment of earn-out obligation	(4,795,822)
Distributions to non-controlling interest	(15,825,600)	(19,289,740)
Proceeds from the issuance of shares relating to stock-based compensation	426,366
Repurchase of shares for cancellation	(4,742,595)	(3,774,856)
Cash used in financing activities	(27,793,356)	(15,873,813)
Investing activities
Acquisition of property and equipment	(59,508)	(35,105)
Deferred asset acquisition costs	(59,249)	(116,025)
Acquisition of equity interest from non-controlling interest	(9,924,381)
Acquisition of anesthesia services providers	(15,052,058)	(27,509,811)
Distribution received from equity investment	136,650
Purchase adjustment relating to anesthesia service providers acquired in prior periods	4,366,000
Cash used in investing activities	(20,592,546)	(27,660,941)
Effects of foreign exchange on cash and cash equivalents	2,116	2,252
Decrease in cash and cash equivalents	(3,378,229)	(2,539,939)
Cash and cash equivalents, beginning of year	9,946,945	12,486,884
Cash and cash equivalents, end of year	6,568,716	9,946,945
Supplemental disclosure of cash interest and taxes paid:
Cash interest paid	(3,055,374)	(3,180,808)
Lease payments made	(369,262)	(292,235)
Non-cash acquisition financing	(800,985)
Taxes paid	$ (4,127,443)	$ (7,055,498)