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Condensed Consolidated Statements of Income (USD $)
In Thousands, except Per Share data, unless otherwise specified
 3 Months Ended 6 Months Ended
Jun. 30, 2013
Jun. 30, 2012
Jun. 30, 2013
Jun. 30, 2012
Income Statement [Abstract]        
Net patient service revenue $ 529,180 $ 449,530 $ 1,031,895 $ 872,146
Operating expenses:        
Practice salaries and benefits 331,922 275,951 661,123 548,212
Practice supplies and other operating expenses 19,416 17,956 38,916 34,941
General and administrative expenses 54,601 48,200 107,919 95,069
Depreciation and amortization 9,870 7,687 19,014 14,800
Total operating expenses 415,809 349,794 826,972 693,022
Income from operations 113,371 99,736 204,923 179,124
Investment income 396 365 798 793
Interest expense (1,673) (848) (2,862) (1,402)
Income before income taxes 112,094 99,253 202,859 178,515
Income tax provision 42,876 38,709 78,274 69,621
Net income $ 69,218 $ 60,544 $ 124,585 $ 108,894
Net income:        
Basic $ 1.40 $ 1.25 $ 2.52 $ 2.25
Diluted $ 1.37 $ 1.22 $ 2.47 $ 2.20
Weighted average shares:        
Basic 49,558 48,543 49,434 48,408
Diluted 50,549 49,545 50,471 49,474