Physicians are burning out—not because they don’t care, but because the system has stripped them of agency. In this episode, James Nutter sits down with Donovan Miske of Kona Medical Consulting to unpack why private practice feels unsustainable, how administrative burden quietly drains time, money, and energy, and what doctors can do to reclaim control without selling out to hospital systems. This is a candid, systems‑level conversation about freedom in medicine—and what it actually takes to get there.
Medicine wasn’t supposed to feel like this.
In this wide‑ranging conversation, James and Donovan pull back the curtain on why so many physicians feel trapped—overtrained professionals reduced to overworked note‑takers, buried under administrative chaos and shrinking margins. Donovan explains how the modern healthcare system has shifted power away from physicians and toward bureaucracy, creating burnout by design.
They explore why the usual “solutions” (hospital employment, concierge medicine, or walking away entirely) aren’t the only options—and often aren’t sustainable at scale. Instead, Donovan introduces a third path: rebuilding practices with the right structure, systems, and economies of scale so physicians can operate at the top of their license again.
From bleeding time and money through poor workflows, staffing instability, and under‑optimized revenue cycle management, to overlooked opportunities like value‑based contracts and AI‑driven operations, this episode reframes private practice as something that can work—if it’s built intentionally.
The conversation closes on a more human note: what freedom in medicine really means, how silence and space factor into a life well lived, and why reclaiming agency is about more than income—it’s about sustainability, purpose, and peace.
Donovan Miske is the founder of Kona Medical Consulting, a national managed service organization (MSO) helping independent physicians regain control of their practices. His work focuses on operational efficiency, revenue optimization, staffing stability, and long‑term scalability—so physicians can practice medicine without being consumed by the business of medicine.
Private practice isn’t dying—it’s evolving. Physicians don’t need to choose between burnout and selling out. With the right structure, systems, and support, autonomy in medicine is still possible.
This isn’t just another finance podcast—it’s a movement. We’re challenging the status quo, cutting through the noise, and giving physicians real strategies to take control of their money and their future.
Because true wealth isn’t just about numbers—it’s about freedom.
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James Nutter is on a mission to help physicians reclaim their financial power. With a deep understanding of the unique challenges doctors face, he provides real-world strategies that cut through the noise and lead to lasting financial freedom.
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The opinions expressed in this podcast are for informational and educational purposes only and do not constitute financial, legal, or tax advice. Any financial decisions should be made in the context of your unique circumstances and in partnership with a trusted financial advisor who understands your personal plan.