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The main plot line was Dr. Cox struggling in his new position as Chief of Medicine. Dr. Cox is slowly becoming everything he hated about Kelso, even getting in the way of J.D.'s ability to treat his pateint. Ah, J.D. is becoming Cox and Cox is becoming Kelso, get it? Dr. Cox also made a humorous list of people allowed in his office and people not allowed. People allowed included Carla, while people not allowed included J.D. Cox slowly is becoming better friends with the only man that can understand his predicament, Dr. Kelso. He even goes over to Kelso's house with a six pack to hang out at night! Wow.
The side plot of this episode was with Elliot and the nurses. Though the nurses try to send Carla in to Cox to use his love of her to hire more nurses and not force them to do overtime. She fails. But meanwhile, Elliot is finally able to have a truce with the nurses.
Through out the episode, the Janitor is messing with Cox by trying to make him hold up a picture frame. Apparently he does this to anyone who gets an office since he wants one so bad. Very funny when Cox gets him back in the end by making him hold up the frame.
Oh and sadly, Turk was missing from this episode, but J.D. uses the new intern Katie to communicate with him at the beginning. Kinda funny.