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Condensed Consolidated Statements Of Cash Flows (USD $)
In Thousands, unless otherwise specified
 6 Months Ended
Jun. 30, 2012
Jun. 30, 2011
Cash flows from operating activities:    
Net income $ 108,894 $ 101,397
Adjustments to reconcile net income to net cash provided from operating activities:    
Depreciation and amortization 14,800 11,813
Accretion of contingent consideration liabilities 517 544
Stock-based compensation expense 13,089 13,205
Deferred income taxes 10,324 4,187
Changes in assets and liabilities:    
Accounts receivable (10,532) (12,637)
Prepaid expenses and other assets (740) 41
Other assets 540 2,721
Accounts payable and accrued expenses (57,733) (52,170)
Income taxes payable (3,312) 2,421
Long-term professional liabilities 6,720 6,763
Other liabilities 2,466 2,557
Net cash provided from operating activities 85,033 80,842
Cash flows from investing activities:    
Acquisition payments, net of cash acquired (64,869) (11,533)
Purchases of investments (14,113) (7,922)
Proceeds from maturities of investments 10,800 16,055
Purchases of property and equipment (6,821) (23,419)
Net cash used in investing activities (75,003) (26,819)
Cash flows from financing activities:    
Borrowings on line of credit 246,000 240,000
Payments on line of credit (275,000) (320,500)
Payment of contingent consideration liabilities (4,903) (3,700)
Payments on capital lease obligations (86) (354)
Excess tax benefit from exercises of stock options and vesting of restricted stock 3,706 5,143
Proceeds from issuance of common stock 13,803 23,101
Net cash used in financing activities (16,480) (56,310)
Net decrease in cash and cash equivalents (6,450) (2,287)
Cash and cash equivalents at beginning of period 18,596 26,251
Cash and cash equivalents at end of period $ 12,146 $ 23,964