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Condensed Consolidated Statements of Income (USD $)
In Thousands, except Per Share data, unless otherwise specified
 3 Months Ended 9 Months Ended
Sep. 30, 2013
Sep. 30, 2012
Sep. 30, 2013
Sep. 30, 2012
Income Statement [Abstract]        
Net patient service revenue $ 554,730 $ 473,134 $ 1,586,625 $ 1,345,280
Operating expenses:        
Practice salaries and benefits 346,879 292,030 1,008,002 840,242
Practice supplies and other operating expenses 19,445 17,606 58,361 52,547
General and administrative expenses 54,654 48,200 162,573 143,269
Depreciation and amortization 10,461 7,925 29,475 22,725
Total operating expenses 431,439 365,761 1,258,411 1,058,783
Income from operations 123,291 107,373 328,214 286,497
Investment income 372 422 1,170 1,215
Interest expense (1,507) (624) (4,369) (2,026)
Income before income taxes 122,156 107,171 325,015 285,686
Income tax provision 45,198 41,261 123,472 110,882
Net income $ 76,958 $ 65,910 $ 201,543 $ 174,804
Net income:        
Basic $ 1.55 $ 1.35 $ 4.07 $ 3.60
Diluted $ 1.52 $ 1.32 $ 3.99 $ 3.53
Weighted average shares:        
Basic 49,753 48,938 49,511 48,569
Diluted 50,589 49,809 50,481 49,570