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Condensed Consolidated Statements of Cash Flows (Unaudited) (USD $)
In Thousands, unless otherwise specified
 9 Months Ended
Sep. 30, 2014
Sep. 30, 2013
Cash flows from operating activities:    
Net income $ 228,923 $ 201,543
Adjustments to reconcile net income to net cash provided from operating activities:    
Depreciation and amortization 32,088 29,475
Net change in fair value of contingent consideration liabilities (506) 1,316
Stock-based compensation expense 23,914 23,189
Equity in earnings of unconsolidated affiliate (875)  
Deferred income taxes 10,410 19,340
Changes in assets and liabilities:    
Accounts receivable (49,996) (24,748)
Prepaid expenses and other assets (3,168) (911)
Other assets 1,680 (3,008)
Accounts payable and accrued expenses (12,573) (3,343)
Income taxes payable 5,502 4,866
Payments of contingent consideration liabilities (3,851) (630)
Long-term professional liabilities 9,575 17,349
Other liabilities 2,711 1,711
Net cash provided from operating activities 243,834 266,149
Cash flows from investing activities:    
Acquisition payments, net of cash acquired (346,071) (193,545)
Purchases of investments (19,604) (18,866)
Proceeds from sales or maturities of investments 14,500 6,313
Purchases of property and equipment (11,405) (12,684)
Net cash used in investing activities (362,580) (218,782)
Cash flows from financing activities:    
Borrowings on line of credit 1,084,000 832,000
Payments on line of credit (823,500) (852,500)
Payments of contingent consideration liabilities (9,550) (5,680)
Payments on capital lease obligations (84) (76)
Excess tax benefit from exercises of stock options 11,159 10,357
Proceeds from issuance of common stock 24,140 15,357
Contribution from noncontrolling interests 1,025  
Repurchases of common stock (127,759) (51,863)
Net cash provided from (used in) financing activities 159,431 (52,405)
Net increase (decrease) in cash and cash equivalents 40,685 (5,038)
Cash and cash equivalents at beginning of period 31,137 21,280
Cash and cash equivalents at end of period $ 71,822 $ 16,242