https://www.nytimes.com/2026/06/29/upshot/assistant-surgeons-loophole-pay.html
It takes a surgeon around three hours to remove a cancerous prostate gland. Most sit behind a console, using joysticks to control a surgical robot with tiny clamps, scissors and other tools on its four arms.
An assistant stands at the bedside to place the robot’s arms, suction out fluids, and swap instruments at the surgeon’s instruction.
For those services, the standard fee paid by most health insurers is 16 percent of the surgeon’s earnings. But across the country, assistants are sometimes earning up to 25 times what the doctor makes, according to data reviewed by The New York Times and interviews with officials who manage large health plans.
They do it by capitalizing on a law intended to protect patients from surprise billing by providers not in their insurance plan. Under the law, those providers can file for arbitration, where they are able to make a case for much higher payments than they could otherwise receive from health plans.
In March, for example, a surgical assistant in Dallas earned $50,456 through arbitration for a prostate removal operation. The surgeon, who accepted the patient’s insurance, earned $1,843.
The assistants outearning primary surgeons are sometimes doctors but more often nurses or physician assistants.