From Medicaid to measles: How "The Pitt" creator makes an accurate medical drama

HBO Max’s hit medical drama “The Pitt” was born out of a conversation about why R. Scott Gemmill would “never do another medical show.”

Gemmill is the showrunner and creator of “The Pitt,” which he also executive produces along with Noah Wyle and John Wells. The trio worked together on “ER.”

“Marketplace” host Kai Ryssdal met Gemmill on the Warner Brothers Studios lot in Burbank, California, where most of “The Pitt” is filmed. Ryssdal and Gemmill sat down in the writers’ room. The following is an edited transcript of their conversation.

Kai Ryssdal: Let’s talk about that thing behind you. It looks for all the world like an architectural drawing, like actual plans for a hospital ER. Except clearly it’s for the show. You’ve got, I guess, characters and people in places and all sorts of things on multicolored stickies up there. What’s going on there?

R. Scott Gemmill: This is how we plan out our show. You know, we have to track everyone and where they are. These are all patients. You can see they've all got tags on them that also tell what episode they're in. So we can tell, you know, when they're coming, when they're going. All of us writers have these at home. You can’t write without the map. And then you have counters or players for all the actors, and we just move them around, like Risk, as you figure it out. Because our show is very kinetic and so in order to keep that going, you have to know the set very well. And you have to know that if I want to have Robbie and Dana have a conversation, you know, starting in room 20, that ends at the hub, I better make sure that dialogue covers that distance. So you’ll see us down there, all the writers, talking to themselves as they walk the set.

Ryssdal: You've been in TV for a long time. You’ve done “JAG” and obviously “ER” and “NCIS.” What was it about doing this project that got you to come back to a thing that, honestly, you've mastered kind of, right?

Gemmill: Yeah, yeah. Ironically enough, this came out of a conversation of why I would never do another medical show. And I listed a bunch of reasons, and thought of one maybe that I would do. And then it just transformed into, you know, once it sort of hit upon the real time aspect, changed everything. And what we wanted to do was, we had the opportunity to create a new medical show from scratch, and so that was exciting, because you are inheriting nothing — other than, I had Noah and John.

Ryssdal: Did you know it was going to work?

Gemmill: No. I didn't bring any of my writers from my other shows with me. I didn't bring anyone with me because I was afraid it wasn't going to work, and I didn't want people to take on a job at my behest and then have it fail. And we wrote and shot the whole first season without any air date, so we didn't know when we're going to be on the air. We didn't know if people going to like it. There was no feedback, really.

Ryssdal: This is your first streaming thing. What do you think?

Gemmill: I think it’s fun. So far so good. I just wrote a pilot for a network show, and it was one of the most difficult things I've done.

Ryssdal: Like just now, recently? Aren’t you busy enough?

Gemmill: Yeah, well it was a favor. But it was so weird. I’ve been off leash for a couple years. I enjoy this, it’s fun.

Ryssdal: About the show. It’s a medical drama, yes, but for my money and for the program I work on, it’s a workplace drama, right? These people are doing a job.

Gemmill: Yup, and you never go home with them.

Ryssdal: That’s what I wanted to ask about! You only see them in the workplace. How come?

Gemmill: Because I think that's your experience when you're in the ER. You don't know what that doctor had for breakfast. You just show up and you hope to God he's going to save you, you know? And I think it made it much more realistic, much more immersive. You know, we really wanted to focus on the emergency department and not so much — on the doctors, of course, but only in their work environment, because that's where we see them.

Ryssdal: Speaking of doctors, you have a lot of them on set, on staff.

Gemmill: I do. We have one on set every day, but we rotate them out. So we have four or five that rotate out because they're all working. So they have to, you know, do the real medicine when they're not doing our fake medicine. And then this year, we'll have three doctors in the writers room, and that makes it so authentic, because we're working with real doctors all the time. And we are also working with experts and other doctors, especially this time of year. We're just starting Season three. We talk to a lot of experts in the medical field about, you know, anything that’s coming up.

Ryssdal: Are you writing it or shooting?

Gemmill: We’re done shooting. And today we have our first writers meeting for Season three.

Ryssdal: Do you still write?

Gemmill: Oh yeah. That’s the best part of the whole job.

Ryssdal: I read somewhere that you sleep like eight at night to two in the morning and write in the middle of the night. Is that true?

Gemmill: Yeah I do a biphasic sleep cycle. It works. It happened during hiatus, I was not sleeping well, and I was getting really pissed off, and so I was like, “If you're going to be up, you're going to work.” And I actually got a lot of work done, went back to bed, woke up, started my day, had a whole day's worth of writing done.

Ryssdal: Part of what makes this show work is the verisimilitude, right? Obviously, the medical stuff and the injuries, and you see it all, and you guys have done a great job with prostheses and all that. But there's AI in season two, and there's the Medicaid cuts in season two. There was the measles outbreak in season one, which you guys were ahead happening in actual, real life. Clearly you’re thinking about real world stuff as you write this show.

Gemmill: Well, what happens when we talk to the experts, regardless of what field of medicine they're in, we talk to them about what scares them, what keeps them up at night. And then when we extrapolate where things were going, being in the head of the measles epidemic was not being overly prescient. It was just, nobody's getting vaccinated. Eventually this is going to hit a turning point, a tipping point. And so I think we look at things like that. You cut people's Medicare and Medicaid, they're not going to have a primary care physician. When they do get sick, they're going to be really sick, and the only place they're going to go is the ER. So it's going to put even more strain on the system, which is going to be even harder on the nurses and the doctors. So it's just about looking at the real world situations and then thinking about how they're going to play out.

Ryssdal: I watched your Emmy speech from a year ago when you won Best Drama, and you made a point at the end of that speech of honoring and dedicating it to health care workers. You said, you know, “honor them, trust them, protect them,” I think, is what you said. Why?

Gemmill: Well, we wouldn't be here without them. I mean, I wouldn't be here without them. And you know this sort of show is kind of a love letter, I think, to the health care workers for what they do. A lot of my friends are doctors and nurses, and I just think it's a wonderful profession. We deserve to give them the credit they deserve.

Ryssdal: Did it start that way? I mean, you read about Noah Wyle and him actually going to Pittsburgh and medical centers there and people treating him like an actual rock star. Did that surprise you?

Gemmill: Yeah, that surprised me, because I think our show was a slow build. We kind of came out of nowhere, and a lot of it was word of mouth. And a lot of it was word of mouth from the health care professionals. And if anyone embraced the show, that's who we wanted, because that's who it was sort of meant for and dedicated to. And if we can do well by them, then half our job is done.

Ryssdal: You’re working on season three now. You’re gonna start writing and shooting soon enough I suppose.

Gemmill: June 11, I think.

Ryssdal: You gonna ride this for a while?

Gemmill: Oh yeah. I mean, I was on my last show for 14 seasons. For me, I think a very important part of my job is to keep a show on the air as long as possible, to keep people employed for as long as they want to work. And so I stay with a job until they turn the lights out.

Ryssdal: Talk to me about that ecosystem. Because this show now, and you and Wells and Noah Wyle, are kind of economic engines of the whole infrastructure of the show. Do you think about that?

Gemmill: Sometimes. I focus mostly on the storytelling. The other parts are gravy. If the storytelling is good and people are enjoying it, then everything else will fall into place I think.

Ryssdal: A word here about the business of this business, and you can dodge this one if you want to. The Paramount, Netflix, Warner Brothers, goat rope, for want of a better word, has now been resolved. What's your worry factor on that? Or are you just keeping your head down and doing your job?

Gemmill: Yeah, I don’t really worry about it. You know, it’ll change the business side of it. But it won’t change what we do. You know, our job is to still tell stories that touch on the human condition and move people. To me, it's kind of like a divorce. You know it's coming. You just hope you get through it and see what happens so you can move forward.