Nonprofit hospital paid a doctor nearly $5 million. Is it a symptom of a flawed system?

Faith Health, a nonprofit hospital in Norfolk, Nebraska, paid its gastroenterologist Fadi Rzouq nearly $5 million in 2024, making him the highest-paid employee among Nebraska-based nonprofits that year. The hospital also paid a plastic surgeon $3.8 million, with both figures primarily driven by bonuses tied to procedure volume, measured through relative value units (RVUs). Critics, including Nebraska State Auditor Mike Foley and a retired health insurance CEO, Steven Martin, called the compensation 'eye-popping' and 'excessive,' questioning whether nonprofit hospitals should pay such high salaries. Rzouq, who no longer works at Faith Health, earned over $3 million annually since 2021, with 79% of his 2024 pay coming from bonuses. His compensation structure mirrors a common industry practice criticized for rewarding higher procedure counts rather than patient outcomes. A former patient told the Flatwater Free Press that Rzouq performed an extra procedure without permission, though the hospital did not address this claim. Faith Health’s Chief Operating Officer, Brian Blecher, defended the pay, citing recruitment challenges in Norfolk, a city of 26,000 in northeast Nebraska, and stating salaries are based on market data. Medical professionals expressed shock at the salary. Matthew Bechtold, a Missouri-based gastroenterologist with 20 years of experience, said he had never heard of a $5 million salary in the field, noting that even nationally prominent physicians typically earn around $1.5 million. Rzouq’s profile lists him as board-certified in gastroenterology, with training from the University of Washington and fellowships at the University of Kansas Medical Center. He currently works at a clinic in Texas and owns a $2.6 million home in Norfolk, which is listed for sale. Faith Health’s tax filings show that physicians’ bonuses are tied to RVUs, a metric used by insurers and the federal government to value medical procedures. Critics argue this system may incentivize unnecessary procedures to boost earnings. The hospital declined to comment on specific concerns, including the former patient’s allegation, and did not provide further details on how bonuses are calculated or justified. State Auditor Foley, whose office oversees state payments to nonprofits, called the compensation 'inexplicable,' while Martin questioned whether such high pay aligns with nonprofit principles. The case has sparked broader discussions about transparency and fairness in hospital compensation, particularly in rural areas where recruiting doctors is difficult. While Faith Health argues its pay practices are standard, the unusually high figures have drawn scrutiny from regulators, former executives, and medical professionals alike. The hospital’s rebranding to Faith Health in 2024 has not addressed concerns over its financial disclosures or pay structures.