The provision of nuclear cardiology services in private-practice settings is probably currently the fastest growing segment of nuclear medicine. One reason is that myocardial perfusion scintigraphy, by determining which patients require coronary angiography and revascularization, has the potential to help a cardiology practice complete more successfully in the managed-care environment. Private practices can establish their own patient databases to determine how scintigraphic findings correlate with patient outcomes and with findings if coronary angiography is performed. Based on these data, pressure can be exerted to modify clinical responses to optimize the relationship between scintigraphic findings, quality of clinical care, and cost-effective patient management. To succeed in a managed-care setting, nuclear cardiologists must demonstrate that, without their services, the quality of cardiac care would be lower and the cost of caring for patients with heart disease would be higher. As in other settings, nuclear cardiologists in private practice must be involved managerially so they will be active participants in the development of clinical-care guidelines and the negotiation of capitated and other types of managed-care contracts.