Surgeon's assistant

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Surgeons at Work

The surgeon's assistant also known as an assistant surgeon or a surgical assistant performs a specialized role, as part of the clinical healthcare professional that performs surgical procedures. This role is carried out by a doctor of medicine, nurses specialized in perioperative nursing who have completed nursing credentials and certifications or an allied health professional all trained in surgery who may be expected to have undergone rigorous credentialing. Surgeon's assistant meet stringent surgical educational criteria, certification, registration and licensure requirements to be a practitioner as a surgeon's assistant. The professionals practicing as a surgeon's assistant varies internationally and each country has legal requirements for the scope of practice for the surgeon's assistant. Surgical Assistance is the clinical specialty of a surgeon's assistant in clinical practice in the United States and internationally.

Professional framework[edit]

The origins of surgeon's assistant can be traced back to the nineteenth and twentieth century. In the Navy a Surgeon's Mate who was renamed assistant surgeon in 1805 was historically the individual providing surgical assistant duties during the nineteenth century. In the twentieth century the origins of the surgeon's assistant role in the United States can be traced back to the specialized surgical teams assembled by Michael E. DeBakey during World War II. In the US for safe surgical procedures having a second doctor as an assistant surgeon has been a requirement for all mayor procedures for decades. Today the role of the assistant surgeon is carried out by surgeon’s assistant or surgical assistant.[1]

In the United States the surgeon's assistant is known as a surgical assistant, assistant surgeon and assistants-at-surgery. The surgical assistant, assistant surgeon and assistants-at-surgery, who serve as a member of the surgical team, perform tasks under the direction of surgeons and aid them in conducting surgery. The scope of practice of these tasks may include making initial incisions ("opening"), exposing the surgical site ("retracting"), stemming blood flow ("hemostasis"), surgically removing veins and arteries to be used as bypass grafts ("harvesting"), reconnecting tissue ("suturing"), and completing the operation and reconnecting external tissue ("closing"). Some of these tasks, like retraction, are relatively simple, while others, such as harvesting, are more complex. An assistant-at-surgery may perform one or more simple or complex tasks during an operation. Members of a wide range of health professions serve as assistants-at-surgery, including physician, residents in training for licensure or board certification in a physician specialty, several different kinds of nurses, and members of several other health professions. For purposes of this report, international medical graduates do not include individuals who are in U.S. residency programs or who are physicians licensed in the United States, but may include some who are certified as surgical assistants. International medical graduates are physicians who have graduated from a medical school outside the United States, Puerto Rico, or Canada. In the United States since 1994, the American College of Surgeons, with other surgical specialty organizations, has conducted studies to determine which surgical procedures require physicians as assistants-at-surgery. These studies classify surgical procedures as "almost always," "sometimes," or "almost never" requiring an assistant-at-surgery. The 2002 study classifies approximately 5,000 surgical procedures, about 1,750 of which are designated as "almost always" requiring a physician to serve as an assistant-at-surgery.[2]

The Royal Australasian College of Surgeons states that the specific role of a surgical assistant may be primarily: to act as a facilitator, to act as a facilitator and co-worker and to act as a facilitator and a consultant to the surgeon.[3] In Australia like in many countries the Surgeon's Assistant role is carried out by a Doctor of Medicine or a professional like a Perioperative Nurse Surgical Assistant.[4] The Royal College of Surgeons in England has created a curriculum framework for the education and training of Surgical Care Practitioner whom are health professionals performing minor surgeries and assisting in mayor surgeries in England.[5]


In the United States the American Medical Association,[6] American College of Surgeons[7] and The American Congress of Obstetricians and Gynecologists[8] have policy statements on the role and qualifications of surgeon's assistant.

The American College of Surgeons states it may be necessary to utilize nonphysicians as first assistants. Surgeon's Assistants (SAs) or physician's assistants (PAs) with additional surgical training should meet national standards and be credentialed by the appropriate local authority. These individuals are not authorized to operate independently.[7] The American Medical Association states in some circumstances it is necessary to utilize appropriately trained and credentialed unlicensed physicians and non-physicians to serve as first assistants to qualified surgeons.[6] The American Congress of Obstetricians and Gynecologist states competent surgical assistants should be available for all major obstetric and gynecologic operations. It states in many cases, the complexity of the surgery or the patient's condition will require the assistance of one or more physicians to provide safe, quality care.[8]


Hospitals employ residents, international medical graduates, and all the types of nonphysician health professionals who act as Surgeon's assistants. Hospital employees likely serve as assistants-at-surgery for a majority of the procedures for which the ACS says an assistant is "almost always" necessary.[9] Assistant surgeon policy is established by individual insurance providers and are based on CMS guidelines. [10]

Most surgical procedures in the US are performed in hospitals without surgical residency programs. [1]

Most surgeon's assistants are employed by hospitals; however, a growing number are employed by physician groups, private SFA practices, medical travel agencies, or are self-employed.[11][12] According to the National Surgical Assistant Association (NSAA), the average annual salary for the non-physician surgical first assistant in 2005 ranged from $50,000 (entry level) to $150,000 annually for full-time practitioners, with top wages reaching $200,000 yearly. The American Medical Association lists the average as $75,000 yearly.[11][13]


In the United States, physicians both US graduates in surgical residency programs and international medical graduates, surgeons, physician assistants, registered nurse first assistants and surgical assistants may all be credentialed to practice as surgeon's assistant. International medical graduates in the US that are licensed, registered or certified as surgical assistants are credentialed as surgical assistants with a scope of practice limited exclusively to surgical assistance in the operating room as surgical assistants and are not credentialed to practice medicine. International medical graduates must hold a Medical Doctor Degree listed in the World Directory of Medical Schools,[14] have surgical training and hold a nationally recognized surgical assistant certificate, registration or licensure as surgical assistant. Physician assistants that have graduated can specialize in surgery by completing a PA surgical residency program[15] to specialize as surgical physician assistants.[16] Registered Nurses which have undergone nursing credentials and certifications can fill the role of surgeon's assistant and usually have completed the registered nurse first assistant program and are certified as CRNFAs.[17] For surgical assistants with an associate degree they can complete a CAAHEP program to sit for a nationally recognized surgical assistant examination. The Commission on Accreditation of Allied Health Education Programs (CAAHEP) has established and published guidelines for surgical assistants who want to be certified by completing a certified educational program. Programs which meet these criteria are able to be reviewed and obtain accreditation through CAAHEP. Currently, there are several schools in the United States which offer CAAHEP accredited surgical first assistant training programs. Additional programs are approved by the National Commission for the Certification of Surgical Assistants (NCCSA) and the American Board of Surgical Assistants (ABSA). NCCSA recognizes all Surgical Assistant Programs accredited by CAAHEP and ABHES that have completed the NCCSA Program Approval Process. These programs typically last between 12 and 24 months and lead to a Certificate of Completion or Associate of Science degree.[18] There is one Master level educational programs for surgical assistants at East Virginia Medical School.

In the United States regulation of surgeon's assistant is done through licensure, certification, or registration. Each of these regulations have different levels of educational and professional experience requirements.

In the United States and internationally surgeons also work as surgeon's assistant in addition to their surgical practices. In the United States it is common for surgeon's assistant to be credentialed as Surgical PA's, RNFA's, NP's, Licensed Assistant Surgeon and Surgical Assistants. In the United States surgical assistants can be certified nationally by the American Board of Surgical Assistants (ABSA), the National Board of Surgical Technology and Surgical Assisting (NBSTSA), and the National Commission for the Certification of Surgical Assistants (NCCSA). Registered Nurse First Assistants (RNFA) can be certified as well[19] and are referred to as CRFRA. Some states, such as Kentucky, Texas, Colorado, Illinois, and Washington DC have additional state registration and licensure requirements. When deciding which professional certification, registration or licensure to pursue, the surgical assistant practitioner should consider local legislation, facility policy, and regional practice as some credentials are preferred over others in different parts of the United States. Additionally, local laws and hospital policies may favor or require a specific credential to practice as a surgeon's assistant.

In the United States there are two states that license surgeon's assistant which are: District of Columbia and Texas. In the District of Columbia there is also a licensure requirement for surgeon's assistant.[20] The Texas Medical Board regulates licensure for surgeon's assistants in Texas. The Texas Medical Board grants licensure to become licensed surgeon's assistants (LSAs) once the following requirements have been met:

  • Minimum education of an Associate's Degree from a 2 or 4-year institution or greater:
  • One of the four educational pathways below:
  1. Graduation from a CAAHEP accredited Surgical Assisting educational program[21]
  2. Registered Nurse First Assisting program[17]
  3. Surgical Physician Assistant Program [15][22]
  4. Full Medical School (and receipt of a Physician's Degree).
  • Worked 2000 hours within the last 3 years as a Surgical Assistant.
  • Taken and passed one of the three national certifying exams.
  • Have a current national Board Certification.
  • Have never been convicted of a felony or crime of moral turpitude.
  • 100% honest and forthcoming on the application.

The surgeon's assistant is a critically important surgical team member in the majority of surgery performed in the United States and internationally. Patients undergoing surgery should be aware of the surgeon and surgeon's assistant who will be performing their surgical procedure. Surgeon's assistants work as surgical practitioners in surgical procedures which are team-based, role-specific and outcomes driven encounters.

The surgical team works in the operating room and the team members are made up of surgeon, surgeon's assistant, anesthesia provider, circulator nurse and surgical technologist. The surgeon and surgeon's assistant are the team members performing surgery on the patient.[23]


  1. ^ a b "Are Cutbacks on Surgeons Risking Patients' Lives? - TIME". 23 October 2009. 
  2. ^ One or more of the preceding sentences incorporates text from a publication in the public domain: "Medicare: Payment Changes are Needed for Assistants-at-Surgery. Report to Congressional Committees. GAO-04-97.". U.S. General Accounting Office. (Not copyrighted). Retrieved 25 October 2014. 
  3. ^ "Position paper: surgical assistant" (PDF). Royal Australasian College of Surgeons. October 2006. Retrieved 20 December 2014. 
  4. ^ "Position Description- Perioperative Nurse Surgical Assistant" (PDF). Australian Association of Nurse Surgical Assistants. 2012. Retrieved 20 December 2014. 
  5. ^ "The Curriculum Framework for the Surgical Care Practitioner: February 2014". Royal College of Surgeons of England. February 2014. Retrieved 20 December 2014. 
  6. ^ a b "AMA - H-475.986 Surgical Assistants other than Licensed Physicians". 8 October 2013. 
  7. ^ a b "Statements on Principles". American College of Surgeons. 
  8. ^ a b "Statement on Surgical Assistants". 
  9. ^ One or more of the preceding sentences incorporates text from a publication in the public domain: "Medicare: Payment Changes are Needed for Assistants-at-Surgery. Report to Congressional Committees. GAO-04-97.". U.S. General Accounting Office. (Not copyrighted). Retrieved 25 October 2014.
  10. ^
  11. ^ a b "Allied Health: Surgical Assistant" (PDF). American Medical Association. Retrieved 16 June 2011. 
  12. ^ "Surgical Assisting". Association of Surgical Assistants. Retrieved June 5, 2011. 
  13. ^ "NSAA Salary Survey Letter" (PDF). National Surgical Assistant Association. Retrieved June 5, 2011. 
  14. ^ "World Directory of Medical Schools". 
  15. ^ a b "PA Residency Programs". 
  16. ^ "PA Masters Programs". 
  17. ^ a b "First Assisting (RNFA)". Association of periOperative Registered Nurses. Retrieved 20 December 2014. 
  18. ^ "Surgical Assistant Programs". Surgical Assistant Resource. Retrieved 16 June 2011. 
  19. ^ "First Assisting (RNFA)". 
  20. ^
  21. ^ "Surgical Assisting". Commission on Accreditation of Allied Health Education Programs (CAAHEP). Retrieved 20 December 2014. 
  22. ^ Surgical Physician Assistant program
  23. ^ "The Evolution of Surgery The Story of 'Two Poems'". Journal of the American Medical Association. Retrieved 25 October 2014. 

External links[edit]