Dr. Kelso's beautiful but unethical replacement, Dr. Maddox, shakes things up at Sacred Heart, while J.D. struggles to manage a new crop of incompetent interns and Carla helps Elliott put her ego in check.

J.D. and Turk make a huge sacrifice concerning a decade-long steak night tradition for a dying patient. Meanwhile, Dr. Maddox, the new Chief of Medicine, begins to show her true colors.

Dr. Kelso and Dr. Cox have to work together again to get rid of Dr. Maddox, while Carla faces an incompetent intern.