While most cardiologists now work for hospitals and health systems, we continue to work with a number of cardiology groups that are not employed, nor do they intend to be. Some cannot become employed due to state regulations or because they are part of a multispecialty group. Others simply treasure their independence. Even still, shrinking reimbursement and crushing cost pressures are pushing more private practice physicians to take stock of their options. And although employment is typically the simplest alignment model, this column highlights alternative affiliation arrangements that offer similar benefits to cardiologists while preserving their independence.