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Consolidated Statements of Cash Flows (USD $)
In Thousands, unless otherwise specified
 12 Months Ended
Dec. 31, 2013
Dec. 31, 2012
Dec. 31, 2011
Cash flows from operating activities:      
Net income $ 280,517 $ 240,907 $ 217,997
Adjustments to reconcile net income to net cash provided from operating activities:      
Depreciation and amortization 39,966 30,816 25,292
Net change in fair value of contingent consideration liabilities 3,656 995 1,083
Stock-based compensation expense 31,288 28,437 27,092
Deferred income taxes 15,920 21,344 8,063
Changes in assets and liabilities:      
Accounts receivable (37,331) (17,678) (48,993)
Prepaid expenses and other assets 212 (244) (3,433)
Other assets (3,541) 1,153 3,932
Accounts payable and accrued expenses 49,239 16,953 21,480
Income taxes payable 5,772 (7,343) 6,704
Payments of contingent consideration liabilities (1,308) (786) (350)
Long-term professional liabilities 19,797 9,941 9,843
Other liabilities 1,211 411 1,959
Net cash provided from operating activities 405,398 324,906 270,669
Cash flows from investing activities:      
Acquisition payments, net of cash acquired (238,045) (441,006) (154,885)
Purchases of investments (20,802) (33,120) (42,526)
Proceeds from sales or maturities of investments 11,011 28,073 38,170
Purchases of property and equipment (15,654) (14,495) (31,332)
Net cash used in investing activities (263,490) (460,548) (190,573)
Cash flows from financing activities:      
Borrowings on line of credit 911,500 517,500 512,500
Payments on line of credit (1,028,500) (402,500) (630,000)
Payments for amendment of line of credit    (2,397) (1,970)
Payments of contingent consideration liabilities (10,365) (9,445) (6,211)
Payments on capital lease obligations (99) (136) (463)
Excess tax benefit from exercises of stock options and vesting of restricted and deferred stock 18,579 6,494 7,031
Proceeds from issuance of common stock 28,697 28,810 31,362
Repurchases of common stock (51,863)      
Net cash (used in) provided from financing activities (132,051) 138,326 (87,751)
Net increase (decrease) in cash and cash equivalents 9,857 2,684 (7,655)
Cash and cash equivalents at beginning of year 21,280 18,596 26,251
Cash and cash equivalents at end of year 31,137 21,280 18,596
Supplemental disclosure of cash flow information:      
Interest 3,312 2,044 2,569
Income taxes 126,411 129,636 119,261
Non-cash financing activities:      
Equipment financed through capital leases       $ 751