Fury was a stunt, probably to quell slander about their discontinuity. A stunt is not real life, it's fake effort for a prearrange single moment in time.
Almost 30 people died or "left" on camera (I counted once.).
Despite the Doctor's ramping, Kes was the CMO, and Tom Paris after her, with their nursing/medic qualifications.
If Kim had spent a year or two training to be a REAL Doctor, or even a Chef... He would have been a full Lieutenant, in charge of a larger department with more responsibility.
When Chell took over Neelix's full time Job, who do you think then did Chell's old full time job?
The bad thing that Janeway must have been doing was consolidating duties and job titles, therefore giving the higher ranks more work becuase the lower ranks still needed to an awful lot of unavoidable grunt work they couldn't be promoted away from.