Surgical Assistants

Tasks largely resist digitisation. A 16 reflects that retracting a liver edge that shifts with every ventilator breath, clamping an unexpected bleeder, harvesting a saphenous vein and closing fascia in layers are all tactile judgment calls made on tissue that never presents twice the same way — the points off the top are the genuinely scriptable parts of your shift: patient positioning per protocol, prepping and draping to a fixed sequence, sponge and needle counts, and dictated operative-note capture.

Hands-on in uncontrolled environments. 20 is the ceiling and this job earns it plainly: you are scrubbed, gowned and gloved with hands inside a body cavity, standing at a table for a six-hour case, feeling for tissue planes and pulses through gloved fingertips — there is no version of this performed from a screen.

Licensed human required and personally liable. An 11 sits just above the licensure threshold because CSA or SA-C certification plus hospital credentialing and state scope-of-practice rules put your name in the operative record as first assist, but you hold no independent practice license and the operating surgeon remains the physician of record — a hospital can restructure your role or use a resident or PA in that slot in ways it cannot do with the surgeon.

Some relationship component. A 9 recognizes that surgeons keep their preferred assistants and request them by name for complex cases because they know how you anticipate their next move, but the patient who was consented and anesthetized never met you and did not choose you — the relationship you monetize is with the attending, not the person on the table.

Meaningful discretion. 13 is the top of the discretion band without crossing into ownership: you decide in the moment how much traction the tissue will tolerate, when to cauterize versus pack, and when to tell the surgeon something looks wrong, but the decision to convert an approach, extend a resection or abort the case is not yours to make.