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Condensed Consolidated Statements of Cash Flows (USD $)
In Thousands
 6 Months Ended
Jun. 30, 2011
Jun. 30, 2010
Cash flows from operating activities:    
Net income $ 101,397 $ 87,621
Adjustments to reconcile net income to net cash provided from operating activities:    
Depreciation and amortization 11,813 9,786
Accretion of contingent consideration liabilities 544 449
Stock-based compensation expense 13,205 12,434
Deferred income taxes 4,187 5,416
Changes in assets and liabilities:    
Accounts receivable (12,637) (14,539)
Prepaid expenses and other assets 41 3,353
Other assets 2,721 (902)
Accounts payable and accrued expenses (52,170) (75,935)
Income taxes payable 2,421 14,063
Long-term professional liabilities 6,763 5,466
Other liabilities 2,557 2,875
Net cash provided from operating activities 80,842 50,087
Cash flows from investing activities:    
Acquisition payments, net of cash acquired (11,533) (58,535)
Purchases of investments (7,922) (5,195)
Proceeds from maturities of investments 16,055 4,100
Purchases of property and equipment (23,419) (7,220)
Net cash used in investing activities (26,819) (66,850)
Cash flows from financing activities:    
Payments on line of credit (320,500) (330,000)
Borrowings on line of credit 240,000 338,000
Payments of contingent consideration liabilities (3,700) (1,600)
Payments on capital lease obligations (354) (148)
Excess tax benefit from exercises of stock options and vesting of restricted stock 5,143 2,138
Proceeds from issuance of common stock 23,101 8,011
Net cash (used in) provided from financing activities (56,310) 16,401
Net decrease in cash and cash equivalents (2,287) (362)
Cash and cash equivalents at beginning of period 26,251 26,503
Cash and cash equivalents at end of period $ 23,964 $ 26,141