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Condensed Consolidated Statements of Cash Flows (Unaudited) (USD $)
In Thousands, unless otherwise specified
 3 Months Ended
Mar. 31, 2014
Mar. 31, 2013
Cash flows from operating activities:    
Net income $ 63,660 $ 55,367
Adjustments to reconcile net income to net cash used in operating activities:    
Depreciation and amortization 10,370 9,144
Net change in fair value of contingent consideration liabilities 346 242
Stock-based compensation expense 8,071 7,284
Deferred income taxes (387) (4,372)
Changes in assets and liabilities:    
Accounts receivable (30,292) (15,754)
Prepaid expenses and other assets (1,480) 1,363
Other assets 341 (87)
Accounts payable and accrued expenses (131,370) (107,724)
Income taxes payable 26,076 27,629
Payments of contingent consideration liabilities (2,779) (29)
Long-term professional liabilities 6,419 7,148
Other liabilities 1,203 1,373
Net cash used in operating activities (49,822) (18,416)
Cash flows from investing activities:    
Acquisition payments, net of cash acquired (69,375) (1,295)
Purchases of investments (3,904) (12,018)
Proceeds from sales or maturities of investments 3,635 2,015
Purchases of property and equipment (4,570) (4,337)
Net cash used in investing activities (74,214) (15,635)
Cash flows from financing activities:    
Borrowings on line of credit 371,500 295,500
Payments on line of credit (150,500) (255,500)
Payments of contingent consideration liabilities (645) (381)
Payments on capital lease obligations (25) (30)
Excess tax benefit from exercises of stock options 1,935 2,414
Proceeds from issuance of common stock 7,398 5,193
Repurchases of common stock (116,989)  
Net cash provided from financing activities 112,674 47,196
Net (decrease) increase in cash and cash equivalents (11,362) 13,145
Cash and cash equivalents at beginning of period 31,137 21,280
Cash and cash equivalents at end of period $ 19,775 $ 34,425