A 28-year-old psychiatrist. A dozen low-risk medical directorships. $800K in independent revenue on top of a hospital salary — built mostly during residency. James Nutter sits down with Donovan Miske of Kona Medical Consulting to break down exactly how it's done, and why most physicians wait until they're already burned out to start.
Most physicians don't have an income problem. They have an optionality problem.
In this episode, James Nutter is joined by Donovan Miske — CEO and founder of Kona Medical Consulting and advisor to over 12,000 physicians across four countries — for a candid, story-driven conversation on what it actually takes to build freedom outside the hospital walls.
Donovan walks through the three core pathways physicians use to stack independent income — medical directorships, locums work, and simple clinics — plus a few obscure ones most doctors have never considered (event medicine at major festivals, hotel-associated physicians for high-profile guests, personal physicians with a tiny private roster). He shares the hard-earned lessons too: the doctor who quit his hospital job before a credentialing board could meet and spent three months in financial freefall, and the now-infamous "dry cleaning" doctor who optimized his way toward bankruptcy by treating an income problem like an expense problem.
Then James and Donovan dig into the playbook that changed one young psychiatrist's life — how thoughtful stacking during residency, prioritizing low risk over high comp, and forming a separate professional entity early built a runway most attendings never get.
If you've ever felt like you're floating down a river with no paddle, this episode is the paddle.
About the Guest
Donovan Miske is the CEO and founder of Kona Medical Consulting — named, fittingly, after his dog. Before launching Kona, Donovan ran a hospitality MSO, and his pivot into medicine started with a single favor: looking into a failing clinic on the brink of bankruptcy. He uncovered embezzlement, built a recovery game plan rooted in hospitality operations, and discovered an entire industry hungry for that kind of forensic, systems-level thinking. That first engagement evolved into Kona's Business Wellness Exam — now run more than a thousand times. Kona's MSO clients consistently operate in the top decile of MGMA DataDrive performance, with average clinic overhead around 41%.
📍 Learn more or book a free consult: https://www.konamedicalconsulting.com (mention the podcast for extended consult time)
Top 5 Takeaways
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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