# Norfolk hospital's $5M doctor salary raises questions about pay system  
**Published:** 2026-06-05T10:00:00.000Z  
**Source:** [Flatwater Free Press](https://flatwaterfreepress.org/faith-questioned-norfolk-nonprofit-hospital-paid-a-doctor-nearly-5-million-is-it-a-symptom-of-a-flawed-system/)  
**AI-generated:** yes (claude-haiku-4-5-20251001)  
**Canonical:** https://lincolne.news/article/norfolk-hospital-s-5m-doctor-salary-raises-questions-about-pay-system

LINCOLN, Neb. — A Norfolk nonprofit hospital's decision to pay a gastroenterologist nearly $5 million in 2024 has prompted scrutiny of physician compensation practices and raised questions about whether bonus structures tied to procedure volume are appropriate for tax-exempt organizations.

Faith Health in Norfolk paid gastroenterologist Fadi Rzouq $4.9 million, making him the state's highest-paid nonprofit employee that year, [according to an investigation by Flatwater Free Press](https://flatwaterfreepress.org/faith-questioned-norfolk-nonprofit-hospital-paid-a-doctor-nearly-5-million-is-it-a-symptom-of-a-flawed-system/). The hospital also paid plastic surgeon Tristan Hartzell $3.8 million, the second-highest nonprofit salary in Nebraska.

Approximately 79% of Rzouq's compensation came from bonuses and incentives tied to relative value units, or RVUs, a system that calculates physician productivity based on the number and complexity of procedures performed. The hospital reported that physicians' "production bonuses" were tied to RVU amounts, with payouts depending on the doctor's base salary.

State Auditor Mike Foley called the figures "eye-popping" and "inexplicable," according to Flatwater Free Press. Matthew Bechtold, a Missouri gastroenterologist with over 20 years of experience, said the highest salary he has heard for a gastroenterologist is about $1.5 million, typically for nationally prominent physicians.

"I don't ever hear of $5 million in our field," Bechtold told Flatwater Free Press.

The RVU-based compensation model has drawn criticism from medical professionals and healthcare analysts for incentivizing volume over quality. Critics argue that [the system may reward physicians for performing more procedures rather than focusing on patient outcomes](https://www.whitecoatinvestor.com/rvu-compensation-models-for-physicians/). A former patient of Rzouq alleged that the doctor performed an extra procedure without his permission, fueling concerns about the incentive structure.

Faith Health's Chief Operating Officer Brian Blecher said the hospital sets salaries based on market data and that recruiting and retaining physicians in Norfolk, a city of about 26,000, is challenging. He noted that physicians at other hospitals also earn bonuses for hard work.

A 2021 lawsuit against Rzouq and the hospital alleged negligence in the care of a patient who died, but the parties settled with no admission of liability.

Lawrence Kim, past president of the American Gastroenterological Association Institute, told Flatwater Free Press that the $5 million figure is "well above the norm" and "significantly higher than the revenue a single gastroenterologist would be expected to generate for a hospital."

Rzouq declined an interview but is now listed as on staff at a medical clinic in Texas, according to his professional profile. Hartzell, the plastic surgeon, said he is a "highly specialized surgeon" who performs "complex procedures for patients from across Nebraska and around the country."

## Sources

- [Flatwater Free Press](https://flatwaterfreepress.org/faith-questioned-norfolk-nonprofit-hospital-paid-a-doctor-nearly-5-million-is-it-a-symptom-of-a-flawed-system/)

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This article was generated by AI (claude-haiku-4-5-20251001) based on source material from Flatwater Free Press, enriched with 3 web searches. The original source is available at https://flatwaterfreepress.org/faith-questioned-norfolk-nonprofit-hospital-paid-a-doctor-nearly-5-million-is-it-a-symptom-of-a-flawed-system/.