A realistic guide to how first assistants are hired and paid, based on experience evaluating staff, contract, part-time, and dual-role opportunities. I am sharing this from the perspective of a Navy-trained surgical professional with more than two decades in the operating room and experience as both a CST and CSFA.

There Is No Single First-Assistant Employment Model

Surgical first assistants may work as hospital employees, surgery-center employees, members of private surgical groups, independent or agency contractors, per diem staff, or dual-role CST/CSFAs.

The job title alone does not tell you how the position works. Before comparing rates, understand who schedules you, who grants privileges, who provides benefits, which surgeons you cover, and whether your hours are guaranteed.

Employed Positions

A staff position may include base pay, benefits, paid time off, retirement contributions, call pay, differentials, and predictable employment.

The tradeoff may be lower hourly pay than some contract work and less control over assignments. Ask whether you will be used consistently as a first assistant or frequently assigned to scrub without a rate difference.

PRN and Part-Time Roles

PRN and part-time work can provide flexibility and a higher hourly rate, especially for experienced assistants who do not need full benefits.

I have valued part-time first-assistant work because it can keep me connected to surgery while leaving time and energy for other goals. However, limited hours require financial planning, and schedules may change with case volume.

Contract and Private-Group Work

Contract work may pay more but can involve credentialing expenses, taxes, insurance, unpaid time, cancellations, and administrative responsibility.

Private surgical groups may use assistants regularly with specific surgeons. These roles can create strong working relationships, but the schedule may depend heavily on one practice’s volume.

Dual CST-CSFA Positions

Some employers value a person who can scrub or assist. That flexibility can make you useful across the schedule.

It can also become a way for the facility to receive two skill sets at one rate. Ask how often you will function in each role and how compensation reflects the advanced responsibility.

What Affects Pay

Compensation can vary by location, specialty, experience, certification, employment model, call, schedule, facility type, and local demand.

Complex specialties, reliable call coverage, and the ability to work independently after orientation may strengthen your position. However, a rare skill only has financial value when employers in that market need it.

Compare the Complete Package

Look beyond the hourly rate. Include health insurance, retirement match, paid leave, malpractice coverage, credentialing fees, parking, travel, call burden, overtime, cancellation risk, and unpaid gaps.

A lower rate with consistent hours and minimal call may support your life better than a higher rate tied to constant unpredictability.

Related reading: How to Negotiate Surgical Tech Pay.

Negotiate Based on Value

Explain your years of experience, credentials, specialties, first-assistant utilization, call availability, and ability to support different services.

I have learned to ask how the rate was determined and whether all relevant experience was counted. An offer is not a command. You can counter, request clarification, or decline.

Research Current Market Data Carefully

The Bureau of Labor Statistics reports national occupational data for surgical assistants and technologists, but local rates can differ significantly. Use current job postings, multiple recruiters, professional contacts, and direct employer ranges.

Be careful comparing employee wages with contractor gross pay. Taxes, benefits, expenses, and unpaid time make them different financial models.

Choose the Job That Supports the Career You Want

The highest rate is not always the best opportunity. Consider whether the position builds specialty experience, protects your body, supports your schedule, and moves you toward your long-term plan.

First assisting should expand your options—not trap you in a more demanding version of the same burnout.

Related reading: Aging as a Surgical First Assistant.

Frequently Asked Questions

Do CSFAs always earn more than CSTs?

Often, but not always. Local demand, employment model, utilization, and employer pay structures determine the actual difference.

Should I accept a dual-role position?

It can be valuable when the job description, staffing, and compensation are clear. Ask how frequently each role is used.

Is contractor pay directly comparable to employee pay?

No. Contractors may need to cover taxes, benefits, insurance, credentialing, unpaid time, and business expenses from the gross rate.

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