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	$ 317,203us-gaap_ProfitLoss	$ 280,517us-gaap_ProfitLoss	$ 240,907us-gaap_ProfitLoss
Adjustments to reconcile net income to net cash provided from operating activities:
Depreciation and amortization	45,990	39,966	30,816
Net change in fair value of contingent consideration liabilities	(417)	3,656	995
Stock-based compensation expense	31,719us-gaap_ShareBasedCompensation	31,288us-gaap_ShareBasedCompensation	28,437us-gaap_ShareBasedCompensation
Equity in earnings of unconsolidated affiliate	(1,780)
Deferred income taxes	2,559us-gaap_DeferredIncomeTaxExpenseBenefit	15,920us-gaap_DeferredIncomeTaxExpenseBenefit	21,344us-gaap_DeferredIncomeTaxExpenseBenefit
Changes in assets and liabilities:
Accounts receivable	(57,018)	(37,331)	(17,678)
Prepaid expenses and other assets	1,506	212	(244)
Other assets	2,137	(3,541)	1,153
Accounts payable and accrued expenses	66,039	49,239	16,953
Income taxes payable	6,998	5,772	(7,343)
Payments of contingent consideration liabilities	(4,071)	(1,308)	(786)
Long-term professional liabilities	9,284	19,797	9,941
Other liabilities	2,492	1,211	411
Net cash provided from operating activities	422,641	405,398	324,906
Cash flows from investing activities:
Acquisition payments, net of cash acquired	(479,394)	(238,045)	(441,006)
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	11,011	28,073
Purchases of property and equipment	(18,061)	(15,654)	(14,495)
Net cash used in investing activities	(503,604)	(263,490)	(460,548)
Cash flows from financing activities:
Borrowings on credit facility	1,754,500us-gaap_ProceedsFromLinesOfCredit	911,500us-gaap_ProceedsFromLinesOfCredit	517,500us-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)	(10,365)	(9,445)
Payments on capital lease obligations	(159)	(99)	(136)
Excess tax benefit from exercises of stock options and vesting of restricted and deferred stock	17,462	18,579	6,494
Proceeds from issuance of common stock	42,876	28,697	28,810
Contribution from noncontrolling interests	1,025
Repurchases of common stock	(488,429)	(51,863)
Net cash provided from (used in) financing activities	97,754	(132,051)	138,326
Net increase in cash and cash equivalents	16,791	9,857	2,684
Cash and cash equivalents at beginning of year	31,137	21,280	18,596
Cash and cash equivalents at end of year	47,928	31,137	21,280
Supplemental disclosure of cash flow information:
Interest	7,323us-gaap_InterestPaidNet	3,312us-gaap_InterestPaidNet	2,044us-gaap_InterestPaidNet
Income taxes	161,841us-gaap_IncomeTaxesPaidNet	126,411us-gaap_IncomeTaxesPaidNet	129,636us-gaap_IncomeTaxesPaidNet
Non-cash financing activities:
Equipment financed through capital leases	$ 1,244us-gaap_CapitalLeaseObligationsIncurred

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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.

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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.

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The cash inflow associated with the sale, maturity and collection of all investments such as debt, security and so forth during the period.

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The consolidated profit or loss for the period, net of income taxes, including the portion attributable to the noncontrolling interest.

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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.

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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).

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The aggregate amount of noncash, equity-based employee remuneration. This may include the value of stock or unit options, amortization of restricted stock or units, and adjustment for officers' compensation. As noncash, this element is an add back when calculating net cash generated by operating activities using the indirect method.

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