A scoliosis surgery. Surgeon earned $8,016. The assistant standing next to him got $196,566. That is a 24x multiple in favor of the person holding the retractor.
It is not a one-off. Texas prostatectomy: surgeon $1,843, assistant $50,456. NJ breast reconstruction: surgeon $2,707, assistant $111,000. Same law, same arbitration channel, same result.
The mechanism: No Surprises Act arbitration. Assistants stay out of network on purpose. Arbitrators evaluate their claims in isolation, with no visibility into what the surgeon on the same case collected.
One Wisconsin spinal fusion was split into 11 separate arbitration filings. They won all 11. Total payout: ~$196k. Insurer estimate under standard rates: ~$11k. That is unbundling dressed in arbitration clothing.
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