I Was Offered An Autism Clinic That Was a Guaranteed Cash Cow

I shared recently that I was canned from a school consulting gig that I actually very much enjoyed. As the Big Man Above would have it, I’ve since received nearly 10 different offers for work doing the exact same thing. This is one of the upsides of working in healthcare, I suppose: with America’s mental and physical health deteriorating at the rates it has, you can essentially get fired on Monday morning and secure another job come dinner.One of the options pitched was an objectively legitimate one. In looking solely at the financials, like profit & loss statements and profit margins, the business was a cash cow. I’ve long since imagined there being a metaphorical vehicle to the life I ultimately want to live: living and playing on 5 acres of land in Tennessee with my husband, with an animal rescue for abandoned and abused cats, dogs, horses, and goats. Cash flow would have been nearly guaranteed from day one, all without my having to conduct much of any clinical work. This opportunity was the convenient Delorean, jet-setting to future-Kayla.Thanks for reading Operation: Replace My Salary! Subscribe for free to receive new posts and support my work.My default reaction to getting fired was, “Well, I guess I need to find a way to make my own money again!” I’m a project and fractional work sort of gal in the sense that I thrive on start-up sweat equity and short stints with strict expiration dates. I do not like being hired for indefinite time periods (i.e., like any and all therapy sort of work) in which the end of services is unclear (are we done in 5 months? 5 years? Ever?) Knowing this about myself, owning and operating full-blown businesses is not in the cards for me.This seemed like any regular season in my life, to start a random business, because I’ve done it so many times before. I decided to launch a home-service based business for seniors that offers DoorDash-like help for flat rates: tech set-up, garage clear-outs, laundry pick-up and drop-off, etc. Within that same week of My Grand Firing, the offers I received (all related to my degrees) were paying no less than $80 an hour. Opportunity, as it seems, shows up after action… not before.The autism clinic opportunity, on paper, was airtight. Hardly a breezy 20 minutes from home, the clinic didn’t even have drywall up yet, and was ripe for a woman’s interior touch. I was introduced to construction workers on-site who immediately asked for my vision of the layout. Because I can’t share many details about it and don’t wish to make any statements about the investors, what I’ll say is this: it was a dream, no-brainer opportunity for many die-hard applied behavior analysts I know in the autism world.Autism clinics (or ABA clinics) are cash cows. Healthcare is a cash cow industry as it is, but ABA, in particular, shits money. Not only is there high demand (1 in 31 kids have an autism diagnosis, and all pediatricians recommend ABA as the frontline treatment), the revenue is highly predictable, recurrent, and long-lasting.Services on average begin at age 2 and do not stop, at least for most families, until the child “ages out” at age 22. That’s two decades of guaranteed money. Some ABA companies have even instituted policies around 15 hours per week being the minimum commitment required for treatment.For the owner of the autism business, the passive revenue secured from the technicians running the daily, hours-long sessions is colossal. Sessions typically run from a minimum of 2 hours upwards of 5-6 hours---for one child. We can’t share insurance rates publicly, but I’ll paint a picture like so: technicians bill anywhere from 20 hours a week on the low end to 40 hours a week on the high end. Technicians are the ABA version of a physicians assistant or nurse. Further, Medicaid rates, which are public, pay anywhere from $60-$80 an hour for a technician-run-billable-hour; technicians only need a high school diploma to “practice”. The business owner, then, can sneak away paying techs near-minimum-wage and pocket the remaining, say, $40-$60 per hour from their couch or from a cabana in Tulum.Rational brain said, “Kayla, are you stupid? You’ve been wanting out of the field for years. This is your ticket. This is your literal voucher to that farm life you’ve been envisioning for so long.” The business meets the criteria for everything new business owners and serial entrepreneurs want: recurrent revenue, predictable revenue, highly scalable operations.So I said hell fucking no.I already know the healthcare, insurance-billing path that so many of us hold in the same respect as taxes, as inflation, as meetings that could have been emails. Billable hour systems across all of healthcare reward revenue and profit margin growth, rather than treatment which is creative, innovative, or even beneficial. Cures and preventative measures do not make money, and competence fails to result in increased revenue. Your credential, your pulse, and your Medicaid billing ID will do just fine.A good opportunity does not guarantee a good outcome, let alone a good life. Something highly profitable means next to nothing if the work itself sucks you dry. I’ve wrangled with this a lot; Do we follow our passions? I think that’s definitely stupid. But I also wonder if going to work solely to make money is equally misguided. Competence paired with mastery of a skill usually develop into passion later on; Would I ever grow passionate about, say, accounting and number figures had my parents forced me to become a CPA? There’s no way of knowing.These days, I only choose to be exceptional in how I treat people and in domains that actually interest me. I took a Working Genius Assessment that analyzes what my strengths and frustrations are as it relates to work, and found that most jobs I’ve had are built entirely around my frustrations (compliance, procedural execution, documentation… and having to support, motivate, and push people to do things they said they’d do.) If this is of interest to people, I’m happy to share the full report.Right now I’ve gotten lots of asks about lots of different things. I love all of them:1. Developing AI integration for financials for a business who is struggling to remain profitable2. Meal prep service for moms of big families who struggle to come up with meal ideas3. Continuing CEU development for BCBAs4. Paid writing gigs (ghostwriting, helping to develop copy for flyers and websites)Clarity and certainty are not coming to save you. They’re things you create, one test at a time. None of us can optimize for happiness or even fulfillment, so maybe looking at our lives as experiments amenable to some tampering is the better way to go.So let’s help each other: no more ideas. Just action. One test is all it takes.Thanks for reading Operation: Replace My Salary! Subscribe for free to receive new posts and support my work. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit honestlyunorthodox.substack.com