Good Money vs Good Leverage: The Income Stacking Playbook with Donovan Miske | Episode 54

Physicians are often told that the path to higher income is simple: work more hours. More shifts. More patients. More call. But that approach has limits—and often leads to burnout. In this episode, Donovan Miske of Kona Medical Consulting explains a different strategy: intentional income stacking. Instead of pursuing random side hustles, Donovan helps physicians design revenue streams that compound together and create leverage over time. We discuss how physicians can move beyond trading time for money by exploring opportunities such as ancillary clinics, expert witness consulting, fractional leadership roles, and emerging opportunities like AI model training. Donovan also introduces the 1.5x rule, a framework physicians can use to evaluate whether a side opportunity is actually worth their time. This conversation challenges physicians to rethink how they build income—and to realize they often have far more control over their careers than they believe. What We Cover The difference between side hustles and income stacking Why working more shifts has a ceiling Examples of physician side income opportunities Medical legal consulting and expert witness work Fractional chief medical officer roles AI training opportunities for physicians GLP-1 clinics and ancillary clinic models Micro-clinics designed to be sold later The 1.5x rule for evaluating opportunities The difference between good money and good leverage Key-man risk and why physicians must build teams When a side income stream can replace clinical income Common mistakes physicians make when launching businesses The mindset shift required when leaving employed medicine About Donovan Miske Donovan Miske is the founder of Kona Medical Consulting, a managed services organization that helps physicians launch, scale, and structure medical businesses outside of traditional employment. Through his work, Donovan advises physicians on building ancillary clinics, developing income stacks, structuring ownership opportunities, and creating business systems that allow medical practices to operate more efficiently and profitably. His focus is helping physicians move beyond trading time for money by identifying opportunities that generate leverage, equity, and long-term financial growth. Kona Medical Consulting works with physicians across multiple specialties to design sustainable business models, reduce administrative burden, and build healthcare ventures that can operate independently of a physician’s daily clinical workload. Additional Resources  Download the PSLF Hacks Checklist Book a free financial wellness session with James Get access to exclusive physician financial tools at www.imwealth.com 1% of IM Wealth’s revenue is dedicated to providing scholarship funds to medical students. Learn more about the Meaningful Journeys Scholarship and how you can join the fight here. Learn more about the impact IM Wealth is making in the lives of physicians here. Gain FREE immediate access to all of IM Wealth’s exclusive physician financial wellness resources here. About the Show: 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. Find and follow the show on YouTube.  About James Nutter: 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. Follow James on Instagram.  Disclaimer 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. A Physician’s Guide to Wealth Podcast — Brought to you by IM Wealth: Helping physicians take control of their money so they can live a purposeful life.For more resources, visit IMWealth.com.Advisory services offered through Commonwealth Financial Network®, a Registered Investment Adviser.