At county general, at least, the Chief Resident position was an additional position AFTER the residency. It was more like Chief of the Residents. It lasted one year. Mark and Doug were the same year, The year after their Residencies completed, Mark went on to be Chief Resident, and Doug received a fellowship under Bernstein.
I imagine it was done this way to save the hospital money by not having to add their best candidates to the faculty right away. The doctors who receive the honor are happy because it looks good on their resume, and theoretically gives them a leg up over their peers applying for the faculty positions next year. It would be especially important for someone who desired to stay at County General, and not apply elsewhere.
It's possible that Carter applied for the position again after completing it the first time around. Maybe they didn't have any exceptional talent from the year before.
It's also possible that since he got the position late the first time, they extended it so he could get the required number of hours to get a certificate, (if that's what those in the position receive at the end). It's a teaching hospital after all, and I suppose it would be affiliated with a university of some sort. Those who complete a Chief Residency position might therefore get something like a 'certificate of leadership in medicine'.
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