The chief surgeon is a hospital's head of all surgical resources, particularly operating rooms. Although a hospital may have several surgical departments, each with their own department head, distribution of such resources is solely at the discretion of the chief surgeon, who may decide which cases constitute an emergency and get priority, and which physicians within the hospital have surgical privileges in addition to their hospital privileges.
Much of a chief surgeon's job is administrative rather than involving the practice of medicine, but the position is always held by a board certified surgeon.
As a general rule, each physician at a hospital has a certain amount of "surgical time" where they can book the use of an operating room. This time is often very valuable because it allows an individual surgeon to perform more procedures. When such time becomes available due to the departure or suspension of a surgeon, it is usually the chief surgeon who has the final say as to who the time is allocated to.