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Condensed Consolidated Statements of Cash Flows (USD $)
In Thousands, unless otherwise specified
 9 Months Ended
Sep. 30, 2013
Sep. 30, 2012
Cash flows from operating activities:    
Net income $ 201,543 $ 174,804
Adjustments to reconcile net income to net cash provided from operating activities:    
Depreciation and amortization 29,475 22,725
Accretion of contingent consideration liabilities 1,316 763
Stock-based compensation expense 23,189 20,441
Deferred income taxes 19,340 16,731
Changes in assets and liabilities:    
Accounts receivable (24,748) (20,119)
Prepaid expenses and other assets (911) 1,789
Other assets (3,008) 754
Accounts payable and accrued expenses (3,343) (14,699)
Income taxes payable 4,866 (158)
Long-term professional liabilities 17,349 14,063
Other liabilities 1,711 2,641
Net cash provided from operating activities 266,779 219,735
Cash flows from investing activities:    
Acquisition payments, net of cash acquired (193,545) (202,362)
Purchases of investments (18,866) (21,099)
Proceeds from maturities of investments 6,313 23,963
Purchases of property and equipment (12,684) (9,947)
Net cash used in investing activities (218,782) (209,445)
Cash flows from financing activities:    
Borrowings on line of credit 832,000 401,500
Payments on line of credit (852,500) (382,500)
Payment of contingent consideration liabilities (6,310) (4,903)
Payments on capital lease obligations (76) (121)
Excess tax benefit from exercises of stock options and vesting of restricted stock and deferred stock 10,357 4,435
Proceeds from issuance of common stock 15,357 18,827
Repurchases of common stock (51,863)   
Net cash (used in) provided from financing activities (53,035) 37,238
Net (decrease) increase in cash and cash equivalents (5,038) 47,528
Cash and cash equivalents at beginning of period 21,280 18,596
Cash and cash equivalents at end of period $ 16,242 $ 66,124