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Condensed Consolidated Statements Of Cash Flows (USD $)
In Thousands, unless otherwise specified
 3 Months Ended
Mar. 31, 2012
Mar. 31, 2011
Cash flows from operating activities:    
Net income $ 48,350 $ 45,456
Adjustments to reconcile net income to net cash used in operating activities:    
Depreciation and amortization 7,113 5,781
Accretion of contingent consideration liabilities 265 265
Stock-based compensation expense 7,036 6,512
Deferred income taxes (11,136) 1,263
Changes in assets and liabilities:    
Accounts receivable (6,329) (6,775)
Prepaid expenses and other assets 2,155 (250)
Other assets (21) 2,499
Accounts payable and accrued expenses (114,362) (89,718)
Income taxes payable 30,323 15,176
Long-term professional liabilities 2,934 4,116
Other liabilities 1,556 1,214
Net cash used in operating activities (32,116) (14,461)
Cash flows from investing activities:    
Acquisition payments, net of cash acquired (28,095) (10,083)
Purchases of investments (5,576) (7,600)
Proceeds from sales or maturities of investments 7,200 4,850
Purchases of property and equipment (2,920) (20,250)
Net cash used in investing activities (29,391) (33,083)
Cash flows from financing activities:    
Borrowings on line of credit 133,000 147,500
Payments on line of credit (78,500) (117,500)
Payments on capital lease obligations (43) (95)
Payment of contingent consideration liabilities (410)  
Excess tax benefit from exercises of stock options and vesting of restricted stock 1,990 302
Proceeds from issuance of common stock 9,262 6,135
Net cash provided from financing activities 65,299 36,342
Net increase (decrease) in cash and cash equivalents 3,792 (11,202)
Cash and cash equivalents at beginning of period 18,596 26,251
Cash and cash equivalents at end of period $ 22,388 $ 15,049