How ‘The Pitt’ Took Medical Drama Off Life Support
- "The Pitt" creators aimed to make the medical drama more realistic by writing the episodes in real time and focusing solely on the characters' experiences in the ER.
Doctors love the show for its accuracy, but the realism of “ The Pitt ” goes beyond integrating an unprecedented number of medical professionals into its creation. When series creator R. Scott Gemmill joined this week’s episode of the Filmmaker Toolkit podcast, he explained how he, executive producer John Wells, and star/executive producer Noah Wyle — all veterans of “ ER ” — set out to make “The Pitt” a medical drama that looked and felt more realistic, making bold creative choices that broke from procedural formula.
“It wasn’t, ‘OK, yeah, we’re going to go back [to ‘ER’] – Noah, me, John, we’ve done this, we know this,’” said Gemmill on the podcast . “And it’s exciting because you are 40 years into your career and you’re actually learning new things, and having to figure stuff out. I think that kept us really engaged.”
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One of the biggest creative choices was writing “The Pitt” in real time, with each of the 15 episodes being one hour of a 15-hour shift at the fictional Pittsburgh emergency trauma center. Each character’s personality, backstory, and arc would play out on the ER floor; the cameras would never follow them to their lives outside the hospital.
“We were very adamant about not seeing our doctors unless they were in the ER,” said Gemmill. “From a patient’s point of view, when you go to the ER, you don’t know what your doctor had for breakfast, you didn’t see him get dressed, you didn’t see him kiss his wife.”
Gemmill described the challenge for writers who couldn’t rely on “spoonfeeding the audience.” Without the usual narrative shortcuts, character had to emerge through behavior and interactions with colleagues during the intensity of a shift.
“You have to constrict your storytelling, but also be very efficient with it because you still want to tell a full arc for these characters, but you only have 15 hours within to do it,” said Gemmill.
Season 1 became a series of experiments as the creators figured out where “The Pitt” fit between a network procedural and a streaming drama. Some medical cases and arcs carried over to the next episode, but Gemmill’s team realized they also needed a set number of storylines to wrap each week, giving viewers the resolution expected from a self-contained hour of TV.
“John [Wells] still teases me because there were many times where I’d [say], ‘I’m not sure this is going work, man.’ And I didn’t, I wasn’t even sure it was going to work until I saw the first cut,” said Gemmill.
Gemmill and his team also wanted audiences to feel the realism of “The Pitt” beyond the medical jargon and graphic procedures, signaling that this show would demand something different from its viewers. That vision extended to a bold choice: no score, no music.
“The minute you put music on I find, subconsciously, you sit back a little bit,” said Gemmill. “You know you’re watching a TV show, whereas without any music in ours, you don’t have that. There’s no code to tell you, ‘Ok, you can relax now,’ or ‘You can feel funny now,’ or ‘Be emotional.’ Now you have to decide whether for yourself this scene is going to make you cry or not.”
Casting served a similar purpose. “That’s why you see a lot of new faces,” Gemmill said. “What we really wanted to do was [for it to feel like] a new show. And I mean that in the purest way. A show without music, a show that’s in real time, a show with new faces.”
For decades, Gemmill worked with brilliant, often recognizable character actors who elevated recurring and guest roles. But when building a cast around the very recognizable Wyle as Dr. Robby, he deliberately sought the opposite approach.
“There’s great actors, and I have great friends who are great actors, but I didn’t want anyone to come to [‘The Pitt’] and be like, ‘Oh, I remember them, they were so great on ‘Wings,’” said Gemmill. “We really wanted these new faces that you imprint, whatever we tell you who they are.”
Gemmill credits casting directors Cathy Sandrich Gelfond and Erica Berger, who were Emmy-nominated for Outstanding Casting for a Drama series, for pulling off the assignment.
“Cathy Sandrich and her team were amazing. We had people from Atlanta and Chicago and New York and Australia, and two from England. We really threw a really wide net,” said Gemmill. “And that’s difficult because what we’re asking my casting people to do is find me the greatest actors that have never worked before.”
“The Pitt” was nominated for 13 Emmys, including Outstanding Drama Series, Directing, Writing, Casting, Contemporary Makeup, Prosthetic Makeup, Sound Editing and Mixing, Lead Actor (Wyle), and Supporting Actress (Katherine LaNasa).
To hear R. Scott Gemmill’s full interview, subscribe to the Filmmaker Toolkit podcast on Apple , Spotify , or your favorite podcast platform . To watch the full interview, subscribe to IndieWire’s YouTube page .
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