ROYAL PAINS centers on a young E.R. doctor who, after being wrongly blamed for a patient's death, moves to the Hamptons and becomes the reluctant "doctor for hire" to the rich and famous. When the attractive administrator of the local hospital asks him to treat the town's less fortunate, he finds himself walking the line between doing well for himself and doing good for others.

Taylor Brooks is a young, overachieving coed at a posh New England college whom decides to pledge the secret society The Skulls whom her father and many of the faculty are members and whom her older brother died years earlier during an initiation practice. But Taylor's willingness to break the all-male Skulls taboo of pledging as the first woman to do so put her at odds with the other pledges and alumni members. When she finally succeeds in fulfilling her membership despite inference from the Skull members, she soon finds herself in hot water when her boyfriend is found murdered, and she's accused of the crime. Taylor must find a way to prove her innocence and find the real killer despite the fact that no one around her can be trusted.

Malcolm King is a wealthy and arrogant businessman whose ex-wife to be has plans to take him for everything he's worth in their divorce settlement. Determined to avoid losing his fortune to her, Malcolm plans his own kidnapping with the help of his dim-witted mistress and her ex-con brother. Unfortunately for Malcolm, he is not the only one with a kidnapping plot.

The next door neighbors Nell Bedworth and Woody Deane have opposite behaviors and hate each other: the virgin geek Nell is polite, sensitive and well-prepared to go to Yale, while Woody is rude and his greatest expectation is to join a mediocre university due to his abilities playing football. When Nell and Woody are assigned to visit a museum together, they argue in front of a statue of an Aztec god. During the night, their souls swap bodies, bringing difficult situations to them. They first try to damage each others reputation in high school, but soon they discover that their dream of joining college can only happen with mutual respect and support.