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v2.4.1.9

Consolidated Statements of Cash Flows (USD $) In Thousands, unless otherwise specified | 12 Months Ended
--- | ---
Dec. 31, 2014 | Dec. 31, 2013 | Dec. 31, 2012
Cash flows from operating activities: |  |  |
Net income | $ 317,203 us-gaap_ProfitLoss | $ 280,517 us-gaap_ProfitLoss | $ 240,907 us-gaap_ProfitLoss
Adjustments to reconcile net income to net cash provided from operating activities: |  |  |
Depreciation and amortization | 45,990 us-gaap_DepreciationDepletionAndAmortization | 39,966 us-gaap_DepreciationDepletionAndAmortization | 30,816 us-gaap_DepreciationDepletionAndAmortization
Net change in fair value of contingent consideration liabilities | (417)us-gaap_BusinessCombinationContingentConsiderationArrangementsChangeInAmountOfContingentConsiderationLiability1 | 3,656 us-gaap_BusinessCombinationContingentConsiderationArrangementsChangeInAmountOfContingentConsiderationLiability1 | 995 us-gaap_BusinessCombinationContingentConsiderationArrangementsChangeInAmountOfContingentConsiderationLiability1
Stock-based compensation expense | 31,719 us-gaap_ShareBasedCompensation | 31,288 us-gaap_ShareBasedCompensation | 28,437 us-gaap_ShareBasedCompensation
Equity in earnings of unconsolidated affiliate | (1,780)us-gaap_IncomeLossFromEquityMethodInvestments |  |
Deferred income taxes | 2,559 us-gaap_DeferredIncomeTaxExpenseBenefit | 15,920 us-gaap_DeferredIncomeTaxExpenseBenefit | 21,344 us-gaap_DeferredIncomeTaxExpenseBenefit
Changes in assets and liabilities: |  |  |
Accounts receivable | (57,018)us-gaap_IncreaseDecreaseInAccountsReceivable | (37,331)us-gaap_IncreaseDecreaseInAccountsReceivable | (17,678)us-gaap_IncreaseDecreaseInAccountsReceivable
Prepaid expenses and other assets | 1,506 us-gaap_IncreaseDecreaseInPrepaidDeferredExpenseAndOtherAssets | 212 us-gaap_IncreaseDecreaseInPrepaidDeferredExpenseAndOtherAssets | (244)us-gaap_IncreaseDecreaseInPrepaidDeferredExpenseAndOtherAssets
Other assets | 2,137 us-gaap_IncreaseDecreaseInOtherOperatingAssets | (3,541)us-gaap_IncreaseDecreaseInOtherOperatingAssets | 1,153 us-gaap_IncreaseDecreaseInOtherOperatingAssets
Accounts payable and accrued expenses | 66,039 us-gaap_IncreaseDecreaseInAccountsPayableAndAccruedLiabilities | 49,239 us-gaap_IncreaseDecreaseInAccountsPayableAndAccruedLiabilities | 16,953 us-gaap_IncreaseDecreaseInAccountsPayableAndAccruedLiabilities
Income taxes payable | 6,998 us-gaap_IncreaseDecreaseInAccruedIncomeTaxesPayable | 5,772 us-gaap_IncreaseDecreaseInAccruedIncomeTaxesPayable | (7,343)us-gaap_IncreaseDecreaseInAccruedIncomeTaxesPayable
Payments of contingent consideration liabilities | (4,071)md_PaymentOfContingentConsiderationLiabilityOperating | (1,308)md_PaymentOfContingentConsiderationLiabilityOperating | (786)md_PaymentOfContingentConsiderationLiabilityOperating
Long-term professional liabilities | 9,284 us-gaap_MalpracticeLossContingencyPeriodIncreaseDecrease | 19,797 us-gaap_MalpracticeLossContingencyPeriodIncreaseDecrease | 9,941 us-gaap_MalpracticeLossContingencyPeriodIncreaseDecrease
Other liabilities | 2,492 us-gaap_IncreaseDecreaseInOtherOperatingLiabilities | 1,211 us-gaap_IncreaseDecreaseInOtherOperatingLiabilities | 411 us-gaap_IncreaseDecreaseInOtherOperatingLiabilities
Net cash provided from operating activities | 422,641 us-gaap_NetCashProvidedByUsedInOperatingActivitiesContinuingOperations | 405,398 us-gaap_NetCashProvidedByUsedInOperatingActivitiesContinuingOperations | 324,906 us-gaap_NetCashProvidedByUsedInOperatingActivitiesContinuingOperations
Cash flows from investing activities: |  |  |
Acquisition payments, net of cash acquired | (479,394)us-gaap_PaymentsToAcquireBusinessesNetOfCashAcquired | (238,045)us-gaap_PaymentsToAcquireBusinessesNetOfCashAcquired | (441,006)us-gaap_PaymentsToAcquireBusinessesNetOfCashAcquired
Purchases of investments | (26,884)us-gaap_PaymentsToAcquireInvestments | (20,802)us-gaap_PaymentsToAcquireInvestments | (33,120)us-gaap_PaymentsToAcquireInvestments
Proceeds from sales or maturities of investments | 20,735 us-gaap_ProceedsFromSaleMaturityAndCollectionsOfInvestments | 11,011 us-gaap_ProceedsFromSaleMaturityAndCollectionsOfInvestments | 28,073 us-gaap_ProceedsFromSaleMaturityAndCollectionsOfInvestments
Purchases of property and equipment | (18,061)us-gaap_PaymentsToAcquireOtherPropertyPlantAndEquipment | (15,654)us-gaap_PaymentsToAcquireOtherPropertyPlantAndEquipment | (14,495)us-gaap_PaymentsToAcquireOtherPropertyPlantAndEquipment
Net cash used in investing activities | (503,604)us-gaap_NetCashProvidedByUsedInInvestingActivitiesContinuingOperations | (263,490)us-gaap_NetCashProvidedByUsedInInvestingActivitiesContinuingOperations | (460,548)us-gaap_NetCashProvidedByUsedInInvestingActivitiesContinuingOperations
Cash flows from financing activities: |  |  |
Borrowings on credit facility | 1,754,500 us-gaap_ProceedsFromLinesOfCredit | 911,500 us-gaap_ProceedsFromLinesOfCredit | 517,500 us-gaap_ProceedsFromLinesOfCredit
Payments on credit facility | (1,213,500)us-gaap_RepaymentsOfLinesOfCredit | (1,028,500)us-gaap_RepaymentsOfLinesOfCredit | (402,500)us-gaap_RepaymentsOfLinesOfCredit
Payments for credit facility financing costs | (4,281)us-gaap_PaymentsOfFinancingCosts |  | (2,397)us-gaap_PaymentsOfFinancingCosts
Payments of contingent consideration liabilities | (11,740)md_PaymentOfContingentConsiderationLiabilityFinancing | (10,365)md_PaymentOfContingentConsiderationLiabilityFinancing | (9,445)md_PaymentOfContingentConsiderationLiabilityFinancing
Payments on capital lease obligations | (159)us-gaap_RepaymentsOfLongTermCapitalLeaseObligations | (99)us-gaap_RepaymentsOfLongTermCapitalLeaseObligations | (136)us-gaap_RepaymentsOfLongTermCapitalLeaseObligations
Excess tax benefit from exercises of stock options and vesting of restricted and deferred stock | 17,462 us-gaap_ExcessTaxBenefitFromShareBasedCompensationFinancingActivities | 18,579 us-gaap_ExcessTaxBenefitFromShareBasedCompensationFinancingActivities | 6,494 us-gaap_ExcessTaxBenefitFromShareBasedCompensationFinancingActivities
Proceeds from issuance of common stock | 42,876 us-gaap_ProceedsFromIssuanceOfCommonStock | 28,697 us-gaap_ProceedsFromIssuanceOfCommonStock | 28,810 us-gaap_ProceedsFromIssuanceOfCommonStock
Contribution from noncontrolling interests | 1,025 us-gaap_ProceedsFromMinorityShareholders |  |
Repurchases of common stock | (488,429)us-gaap_PaymentsForRepurchaseOfCommonStock | (51,863)us-gaap_PaymentsForRepurchaseOfCommonStock |
Net cash provided from (used in) financing activities | 97,754 us-gaap_NetCashProvidedByUsedInFinancingActivitiesContinuingOperations | (132,051)us-gaap_NetCashProvidedByUsedInFinancingActivitiesContinuingOperations | 138,326 us-gaap_NetCashProvidedByUsedInFinancingActivitiesContinuingOperations
Net increase in cash and cash equivalents | 16,791 us-gaap_CashAndCashEquivalentsPeriodIncreaseDecrease | 9,857 us-gaap_CashAndCashEquivalentsPeriodIncreaseDecrease | 2,684 us-gaap_CashAndCashEquivalentsPeriodIncreaseDecrease
Cash and cash equivalents at beginning of year | 31,137 us-gaap_CashAndCashEquivalentsAtCarryingValue | 21,280 us-gaap_CashAndCashEquivalentsAtCarryingValue | 18,596 us-gaap_CashAndCashEquivalentsAtCarryingValue
Cash and cash equivalents at end of year | 47,928 us-gaap_CashAndCashEquivalentsAtCarryingValue | 31,137 us-gaap_CashAndCashEquivalentsAtCarryingValue | 21,280 us-gaap_CashAndCashEquivalentsAtCarryingValue
Supplemental disclosure of cash flow information: |  |  |
Interest | 7,323 us-gaap_InterestPaidNet | 3,312 us-gaap_InterestPaidNet | 2,044 us-gaap_InterestPaidNet
Income taxes | 161,841 us-gaap_IncomeTaxesPaidNet | 126,411 us-gaap_IncomeTaxesPaidNet | 129,636 us-gaap_IncomeTaxesPaidNet
Non-cash financing activities: |  |  |
Equipment financed through capital leases | $ 1,244 us-gaap_CapitalLeaseObligationsIncurred |  |

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- Definition Amount of cash inflow (outflow) from operating activities, excluding discontinued operations. Operating activity cash flows include transactions, adjustments, and changes in value not defined as investing or financing activities. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 28 -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3602-108585 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 24 -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3521-108585 Reference 3: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 25 -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3536-108585 + Details
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- Definition The cash outflow to reacquire common stock during the period. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Financing Activities -URI http://asc.fasb.org/extlink&oid=6513228 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 15 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3291-108585 + Details
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- Definition The cash outflow for loan and debt issuance costs. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Financing Activities -URI http://asc.fasb.org/extlink&oid=6513228 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 15 -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3291-108585 + Details
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- Definition The cash outflow associated with the acquisition of a business, net of the cash acquired from the purchase. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Investing Activities -URI http://asc.fasb.org/extlink&oid=6516133 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 13 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3213-108585 + Details
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- Definition The cash outflow associated with the purchase of all investments (debt, security, other) during the period. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Investing Activities -URI http://asc.fasb.org/extlink&oid=6516133 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 13 -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3213-108585 + Details
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- Definition The cash outflow for acquisition of or capital improvements of property, plant and equipment, used to produce goods or deliver services, and not otherwise defined in the taxonomy. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Investing Activities -URI http://asc.fasb.org/extlink&oid=6516133 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 13 -Subparagraph (c) -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3213-108585 + Details
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- Definition The cash inflow from the additional capital contribution to the entity. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Financing Activities -URI http://asc.fasb.org/extlink&oid=6513228 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 14 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3255-108585 + Details
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- Definition Amount of cash inflow from contractual arrangement with the lender, including but not limited to, letter of credit, standby letter of credit and revolving credit arrangements. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 235 -SubTopic 10 -Section S99 -Paragraph 1 -Subparagraph (SX 210.4-08.(f)) -URI http://asc.fasb.org/extlink&oid=26873400&loc=d3e23780-122690 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher SEC -Name Regulation S-X (SX) -Number 210 -Section 08 -Paragraph f -Article 4 Reference 3: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Financing Activities -URI http://asc.fasb.org/extlink&oid=6513228 Reference 4: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 14 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3255-108585 + Details
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- Definition Amount of cash inflow from a noncontrolling interest. Includes, but is not limited to, purchase of additional shares or other increase in noncontrolling interest ownership. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 14 -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3255-108585 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Financing Activities -URI http://asc.fasb.org/extlink&oid=6513228 + Details
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- Definition The cash inflow associated with the sale, maturity and collection of all investments such as debt, security and so forth during the period. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 12 -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3179-108585 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Investing Activities -URI http://asc.fasb.org/extlink&oid=6516133 + Details
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- Definition The consolidated profit or loss for the period, net of income taxes, including the portion attributable to the noncontrolling interest. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 810 -SubTopic 10 -Section 55 -Paragraph 4K -URI http://asc.fasb.org/extlink&oid=35736750&loc=SL4591552-111686 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 810 -SubTopic 10 -Section 45 -Paragraph 19 -URI http://asc.fasb.org/extlink&oid=7656940&loc=SL4569616-111683 Reference 3: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 810 -SubTopic 10 -Section 50 -Paragraph 1A -Subparagraph (a),(c) -URI http://asc.fasb.org/extlink&oid=18733093&loc=SL4573702-111684 Reference 4: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 810 -SubTopic 10 -Section 55 -Paragraph 4J -URI http://asc.fasb.org/extlink&oid=35736750&loc=SL4591551-111686 + Details
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- Definition Amount of cash outflow for payment of an obligation from a lender, including but not limited to, letter of credit, standby letter of credit and revolving credit arrangements. + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 235 -SubTopic 10 -Section S99 -Paragraph 1 -Subparagraph (SX 210.4-08.(f)) -URI http://asc.fasb.org/extlink&oid=26873400&loc=d3e23780-122690 Reference 2: http://www.xbrl.org/2003/role/presentationRef -Publisher SEC -Name Regulation S-X (SX) -Number 210 -Section 08 -Paragraph f -Article 4 Reference 3: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 15 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3291-108585 Reference 4: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Glossary Financing Activities -URI http://asc.fasb.org/extlink&oid=6513228 + Details
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- Definition The cash outflow for the obligation for a lease meeting the criteria for capitalization (with maturities exceeding one year or beyond the operating cycle of the entity, if longer). + References Reference 1: http://www.xbrl.org/2003/role/presentationRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 15 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=31042434&loc=d3e3291-108585 + Details
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