{
  "source": "Cooked Index — occupational AI risk register",
  "page": "https://cookedindex.com/jobs/surgical-assistants/",
  "methodology": "https://cookedindex.com/methodology",
  "notice": "Verdicts are re-examined as evidence accumulates. Re-fetch before relying on this; the page above always carries the current score.",
  "scored_at": "2026-08-11",
  "model": "claude-opus-5",
  "occupation": {
    "title": "Surgical Assistants",
    "soc_code": "29-9093",
    "category": "Healthcare",
    "us_employment": 22270,
    "median_annual_wage": 66800
  },
  "verdict": "SAFE",
  "risk_resistance": 69,
  "contested": false,
  "near_boundary": false,
  "dimensions": {
    "task_resistance": 16,
    "embodiment": 20,
    "liability_shield": 11,
    "trust_premium": 9,
    "judgment_accountability": 13
  },
  "reasoning": {
    "task_resistance": "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.",
    "embodiment": "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.",
    "liability_shield": "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.",
    "trust_premium": "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.",
    "judgment_accountability": "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."
  },
  "rationale": "Surgical assistants spend their shifts inside open body cavities — retracting tissue, controlling bleeding, harvesting grafts, suturing and closing under a surgeon's direction — which is exactly the fine-motor work in a deformable, unpredictable field that surgical robotics still cannot do autonomously. The automatable slice is the paperwork tier: operative note drafting, instrument and implant documentation, preference-card and case-cart planning. Certification (CSA/SA-C) plus state scope rules and hospital credentialing keep a specific accountable human in the sterile field, though the shield is regulatory and thinner than a physician license.",
  "outlook": "Demand grows with surgical volume from an aging population; AI takes the notes and the case prep, while your hands stay in the field for the whole decade.",
  "what_would_raise_it": {
    "levers": [
      {
        "dimension": "liability_shield",
        "change": "More states adopting statutory licensure/registration for surgical assistants on the Texas (Occupations Code Ch. 206) and Illinois/Washington/Kentucky model — a titled license with a board, disciplinary authority and personal scope-of-practice liability rather than mere hospital credentialing. ASA/NSAA have active state-by-state licensure campaigns; each new state law converts a credentialing norm into a legal requirement.",
        "plausibility": "plausible",
        "would_add": 4
      },
      {
        "dimension": "liability_shield",
        "change": "CMS or major commercial payers conditioning first-assistant reimbursement (modifier -AS / 80-82 assistant-at-surgery claims) on a specific named, certified/licensed non-physician assistant, so the claim itself requires an identifiable accountable human in the field. Partially in place already; tightening the credential requirement rather than allowing 'qualified per hospital policy' would harden it.",
        "plausibility": "plausible",
        "would_add": 3
      },
      {
        "dimension": "liability_shield",
        "change": "Malpractice carriers or Joint Commission requiring documented counts, retained-object attestation, and robotic docking/undocking signed by a credentialed assistant separately from the surgeon — making the assistant a named signer on an event the insurer prices.",
        "plausibility": "plausible",
        "would_add": 2
      },
      {
        "dimension": "judgment_accountability",
        "change": "Formal recognition of the surgical assistant as the bedside owner of robotic-platform emergencies — port placement conflicts, collision, emergent undocking and conversion to open — written into hospital robotics credentialing and vendor training, as intuitive-console surgeons are physically away from the patient.",
        "plausibility": "already happening",
        "would_add": 3
      },
      {
        "dimension": "task_resistance",
        "change": "Task-mix shift: ambient AI scribes (Abridge, Nuance DAX) absorbing operative note drafting, implant logging and preference-card/case-cart planning leaves the residual job almost entirely sterile-field judgment and hands, which raises the share of the day AI cannot do.",
        "plausibility": "already happening",
        "would_add": 2
      }
    ],
    "ceiling_note": "Trust premium has no realistic route — patients choose surgeons and hospitals, never learn the assistant's name, and cannot select or pay extra for one. Embodiment is already maxed at 20 and cannot rise. The binding risk is not automation but substitution by cheaper credentials (residents, PAs, RN circulators cross-trained as first assists) and by surgeon-controlled robotic platforms that reduce the number of hands needed per case."
  },
  "adjudication": null,
  "employment_history": {
    "points": [
      {
        "y": 2021,
        "emp": 17250,
        "wage": 48320
      },
      {
        "y": 2022,
        "emp": 18650,
        "wage": 57290
      },
      {
        "y": 2023,
        "emp": 18780,
        "wage": 59160
      },
      {
        "y": 2024,
        "emp": 22860,
        "wage": 60290
      },
      {
        "y": 2025,
        "emp": 22270,
        "wage": 66800
      }
    ],
    "from": 2021,
    "to": 2025,
    "change_pct": 29.1,
    "comparable_from": 2021,
    "spans_soc_revision": false
  },
  "pivots": [],
  "license": "https://cookedindex.com/terms"
}