Supplemental Consolidating Financial Information (Details 3) (USD $)	3 Months Ended		6 Months Ended
	Jun. 30, 2013	Jun. 30, 2012	Jun. 30, 2013	Jun. 30, 2012
Cash flows from operating activities
Net (loss) income	$ (19,485,000)	$ (18,968,000)	$ (38,862,000)	$ (27,364,000)
Adjustments to reconcile net (loss) income to net cash provided by (used in) operating activities:
Depreciation			26,222,000	25,637,000
Amortization			4,269,000	5,806,000
Deferred rent expense			422,000	549,000
Deferred income taxes			(1,138,000)	(702,000)
Stock-based compensation			345,000	3,012,000
Provision for doubtful accounts	2,015,000	4,800,000	5,090,000	9,861,000
Loss on the sale of property and equipment			76,000	22,000
Gain on the sale of an interest in a joint venture	(1,460,000)		(1,460,000)
Amortization of termination of interest rate swap				958,000
Write-off of loan costs				525,000
Early extinguishment of debt		4,473,000		4,473,000
Termination of derivative interest rate swap agreements				(972,000)
Loss on foreign currency transactions			34,000	18,000
Loss on foreign currency derivative contracts			242,000	220,000
Amortization of debt discount			391,000	417,000
Amortization of loan costs			2,731,000	2,609,000
Equity interest in net loss (earnings) of joint ventures	208,000	158,000	332,000	539,000
Distribution received from unconsolidated joint ventures				9,000
Changes in operating assets and liabilities:
Accounts receivable and other current assets			(9,677,000)	(18,102,000)
Income taxes payable			(261,000)	(441,000)
Inventories and other current assets			(461,000)	(713,000)
Prepaid expenses			46,000	1,111,000
Accounts payable and other current liabilities			8,822,000	(2,701,000)
Accrued deferred compensation			656,000	602,000
Accrued expenses / other current liabilities			5,795,000	6,314,000
Net cash provided by operating activities			3,614,000	11,687,000
Cash flows from investing activities
Purchases of property and equipment			(17,769,000)	(16,298,000)
Acquisition of medical practices			(22,848,000)	(23,742,000)
Restricted cash associated with initial deposit in the potential acquisition of medical practices			(5,001,000)
Proceeds from the sale of property and equipment			4,000	27,000
Loans to employees			(153,000)	(115,000)
Contribution of capital to joint venture entities			(542,000)	(225,000)
Proceeds from the sale of equity interest in a joint venture			1,460,000
Payment of foreign currency derivative contracts			(171,000)	(432,000)
Premiums on life insurance policies			(626,000)	(518,000)
Change in other assets and other liabilities			5,000	7,000
Net cash used in investing activities			(45,641,000)	(41,296,000)
Cash flows from financing activities
Proceeds from issuance of debt			83,880,000	434,061,000
Principal repayments of debt			(45,501,000)	(369,903,000)
Repayments of finance obligation			(99,000)	(53,000)
Proceeds from noncontrolling interest holders - redeemable and non-redeemable			765,000
Cash distributions to noncontrolling interest holders-redeemable and non-redeemable			(650,000)	(2,018,000)
Payments of loan costs				(14,225,000)
Net cash provided by financing activities			38,395,000	47,862,000
Effect of exchange rate changes on cash and cash equivalents			(19,000)	(5,000)
Net (decrease) increase in cash and cash equivalents			(3,651,000)	18,248,000
Cash and cash equivalents, beginning of period			15,410,000	10,177,000
Cash and cash equivalents, end of period	11,759,000	28,425,000	11,759,000	28,425,000
Parent
Cash flows from operating activities
Net (loss) income	(23,187,000)	(22,363,000)	(44,942,000)	(32,797,000)
Adjustments to reconcile net (loss) income to net cash provided by (used in) operating activities:
Stock-based compensation			345,000	3,012,000
Equity interest in net loss (earnings) of joint ventures	23,032,000	21,436,000	44,596,000	31,776,000
Changes in operating assets and liabilities:
Accounts receivable and other current assets				3,000
Income taxes payable			1,000
Intercompany payable / receivable			(17,000)	(2,133,000)
Net cash provided by operating activities			(17,000)	(139,000)
Cash flows from financing activities
Net (decrease) increase in cash and cash equivalents			(17,000)	(139,000)
Cash and cash equivalents, beginning of period			168,000	184,000
Cash and cash equivalents, end of period	151,000	45,000	151,000	45,000
RTS
Cash flows from operating activities
Net (loss) income	(23,032,000)	(21,436,000)	(44,596,000)	(31,443,000)
Adjustments to reconcile net (loss) income to net cash provided by (used in) operating activities:
Amortization				1,855,000
Deferred income taxes			(240,000)	(77,000)
Amortization of termination of interest rate swap				958,000
Write-off of loan costs				525,000
Early extinguishment of debt		4,473,000		4,473,000
Termination of derivative interest rate swap agreements				(972,000)
Loss on foreign currency derivative contracts			242,000	220,000
Amortization of debt discount			381,000	417,000
Amortization of loan costs			2,731,000	2,609,000
Equity interest in net loss (earnings) of joint ventures	3,104,000	(5,390,000)	5,234,000	(12,162,000)
Changes in operating assets and liabilities:
Income taxes payable			1,179,000	1,299,000
Prepaid expenses			(77,000)	(102,000)
Intercompany payable / receivable			914,000	(31,414,000)
Accounts payable and other current liabilities			(232,000)	92,000
Accrued expenses / other current liabilities			(355,000)	4,610,000
Net cash provided by operating activities			(34,819,000)	(59,112,000)
Cash flows from investing activities
Restricted cash associated with initial deposit in the potential acquisition of medical practices			(5,001,000)
Intercompany notes to / from affiliates			(2,100,000)
Contribution of capital to joint venture entities			(542,000)
Distributions received from joint venture entities			299,000	754,000
Payment of foreign currency derivative contracts			(171,000)	(432,000)
Change in other assets and other liabilities			1,000	1,000
Net cash used in investing activities			(7,514,000)	323,000
Cash flows from financing activities
Proceeds from issuance of debt			82,500,000	433,345,000
Principal repayments of debt			(40,000,000)	(360,360,000)
Payments of loan costs				(14,225,000)
Net cash provided by financing activities			42,500,000	58,760,000
Net (decrease) increase in cash and cash equivalents			167,000	(29,000)
Cash and cash equivalents, beginning of period			124,000	39,000
Cash and cash equivalents, end of period	291,000	10,000	291,000	10,000
Subsidiary Guarantors
Cash flows from operating activities
Net (loss) income	(3,028,000)	5,152,000	(5,005,000)	11,895,000
Adjustments to reconcile net (loss) income to net cash provided by (used in) operating activities:
Depreciation			22,928,000	22,555,000
Amortization			3,556,000	3,191,000
Deferred rent expense			324,000	425,000
Deferred income taxes			230,000	81,000
Provision for doubtful accounts	1,049,000	3,943,000	2,993,000	6,925,000
Loss on the sale of property and equipment			40,000	22,000
Gain on the sale of an interest in a joint venture	(1,460,000)		(1,460,000)
Amortization of debt discount			10,000
Equity interest in net loss (earnings) of joint ventures	2,620,000	(425,000)	3,139,000	(1,382,000)
Distribution received from unconsolidated joint ventures				9,000
Changes in operating assets and liabilities:
Accounts receivable and other current assets			(1,978,000)	(10,822,000)
Income taxes payable			(1,567,000)	(1,298,000)
Inventories and other current assets			(632,000)	(453,000)
Prepaid expenses			(96,000)	950,000
Intercompany payable / receivable			(3,605,000)	27,780,000
Accounts payable and other current liabilities			7,953,000	(2,460,000)
Accrued deferred compensation			524,000	513,000
Accrued expenses / other current liabilities			7,384,000	1,613,000
Net cash provided by operating activities			34,738,000	59,544,000
Cash flows from investing activities
Purchases of property and equipment			(14,928,000)	(13,609,000)
Acquisition of medical practices			(22,848,000)	(23,692,000)
Proceeds from the sale of property and equipment			4,000	27,000
Loans to employees			(153,000)	(115,000)
Intercompany notes to / from affiliates			(396,000)
Contribution of capital to joint venture entities			(935,000)	(225,000)
Distributions received from joint venture entities			776,000	3,043,000
Proceeds from the sale of equity interest in a joint venture			1,460,000
Premiums on life insurance policies			(493,000)
Change in other assets and other liabilities			(6,000)	(32,000)
Net cash used in investing activities			(37,519,000)	(34,603,000)
Cash flows from financing activities
Principal repayments of debt			(3,526,000)	(7,969,000)
Repayments of finance obligation			(99,000)	(53,000)
Net cash provided by financing activities			(3,625,000)	(8,022,000)
Net (decrease) increase in cash and cash equivalents			(6,406,000)	16,919,000
Cash and cash equivalents, beginning of period			6,545,000	733,000
Cash and cash equivalents, end of period	139,000	17,652,000	139,000	17,652,000
Subsidiary Non-Guarantors
Cash flows from operating activities
Net (loss) income	1,212,000	4,208,000	3,051,000	7,285,000
Adjustments to reconcile net (loss) income to net cash provided by (used in) operating activities:
Depreciation			3,294,000	3,082,000
Amortization			713,000	760,000
Deferred rent expense			98,000	124,000
Deferred income taxes			(1,128,000)	(693,000)
Provision for doubtful accounts	966,000	857,000	2,097,000	2,936,000
Loss on the sale of property and equipment			36,000
Loss on foreign currency transactions			34,000	18,000
Equity interest in net loss (earnings) of joint ventures	2,000	2,000	(7,000)	(10,000)
Changes in operating assets and liabilities:
Accounts receivable and other current assets			(7,699,000)	(7,283,000)
Income taxes payable			126,000	(442,000)
Inventories and other current assets			171,000	(260,000)
Prepaid expenses			219,000	263,000
Intercompany payable / receivable			2,708,000	5,767,000
Accounts payable and other current liabilities			1,101,000	(333,000)
Accrued deferred compensation			132,000	89,000
Accrued expenses / other current liabilities			(1,234,000)	91,000
Net cash provided by operating activities			3,712,000	11,394,000
Cash flows from investing activities
Purchases of property and equipment			(2,841,000)	(2,689,000)
Acquisition of medical practices				(50,000)
Intercompany notes to / from affiliates			2,496,000
Premiums on life insurance policies			(133,000)	(518,000)
Change in other assets and other liabilities			10,000	38,000
Net cash used in investing activities			(468,000)	(3,219,000)
Cash flows from financing activities
Proceeds from issuance of debt			1,380,000	716,000
Principal repayments of debt			(1,975,000)	(1,574,000)
Proceeds from equity contribution			1,700,000
Cash distributions to shareholders			(1,725,000)	(5,815,000)
Net cash provided by financing activities			(620,000)	(6,673,000)
Effect of exchange rate changes on cash and cash equivalents			(19,000)	(5,000)
Net (decrease) increase in cash and cash equivalents			2,605,000	1,497,000
Cash and cash equivalents, beginning of period			8,573,000	9,221,000
Cash and cash equivalents, end of period	11,178,000	10,718,000	11,178,000	10,718,000
Eliminations
Cash flows from operating activities
Net (loss) income	28,550,000	15,471,000	52,630,000	17,696,000
Adjustments to reconcile net (loss) income to net cash provided by (used in) operating activities:
Deferred income taxes				(13,000)
Equity interest in net loss (earnings) of joint ventures	(28,550,000)	(15,465,000)	(52,630,000)	(17,683,000)
Cash flows from investing activities
Contribution of capital to joint venture entities			935,000
Distributions received from joint venture entities			(1,075,000)	(3,797,000)
Net cash used in investing activities			(140,000)	(3,797,000)
Cash flows from financing activities
Proceeds from equity contribution			(1,700,000)
Proceeds from noncontrolling interest holders - redeemable and non-redeemable			765,000
Cash distributions to noncontrolling interest holders-redeemable and non-redeemable			(650,000)	(2,018,000)
Cash distributions to shareholders			1,725,000	5,815,000
Net cash provided by financing activities			$ 140,000	$ 3,797,000