This discussion was recorded on May 7, 2025. This transcript has been edited for clarity.

Robert D. Glatter, MD: Hi, and welcome. I’m Dr Robert Glatter, a member of the Medscape Emergency Medicine editorial board.

Joining me today to discuss the new MAX docuseries, The Pitt, a depiction of daily struggles and realities of life in a busy level-one trauma center, are Dr Amy Ho, an emergency physician and member of the Medscape Emergency Medicine editorial board; Dr Nicholas Cozzi, an emergency physician and medical director of EMS and disaster medicine at Rush University Medical Center in Chicago; and finally, Dr Mel Herbert, an emergency physician and founder of a popular educational podcast known as EM:RAP (Emergency Medicine: Reviews and Perspectives) , a lifelong educator, and medical consultant for The Pitt as well as ER from the early 1990s. Welcome everyone.

Amy Faith Ho, MD, MPH: Thanks for having us.

Mel E. Herbert, MD: Nice to be here.

Nicholas P. Cozzi, MD, MBA: Thank you.

Making The Pitt Real: Accuracy in Every Hour

Glatter: It’s great to have everyone here. The Pitt, in my opinion, is one of the most influential and powerful series. It’s so unique in that each episode is represented by 1 hour of an emergency department (ED) shift. That differentiates it from other past medical docudramas that you may have seen, such as ER. In reality, we know that an hour really passes quite quickly in any given shift. The show encapsulates the stressful clinical scenarios and interpersonal relationships that occur in any given ED shift, and it resonated with me and my colleagues.

Mel, I wanted to get your feedback on how you chose to proceed with advising directors and producers on the show to provide real-world scenarios that could inform the audience, as well as emergency physicians, on how we manage complex situations, specifically families and bystanders, but also accurately depict how residents interact with other residents and attending physicians.

Herbert: First of all, thanks for having me on the show. The Pitt has obviously become this huge hit, more than anybody — even we — expected. I have to give credit where credit is due. Scott Gemmill is the show creator and the show runner, and it was his idea to come up with this hourly format. He met with John Wells, the producer who did ER, and John was very clear and was like, “We don’t want to do just another medical TV show. We want to do the best one. How do we make it the best? How do we make it different? How do we make it real, but also entertaining?”

That’s when Scott came up with this idea that 1 hour of the show would be 1 hour of a shift. It was an incredibly insightful idea.

The next person is Joe Sachs, MD, an emergency physician who has been practicing for 35 years. He was the main medical writer on ER, and he brought me in for the last six seasons of ER as a consultant. About 2 years ago, Joe said, “Mel, we’re going to do this new show. I think it’s going be fantastic. Do you want to be a consultant again?” I’m like, absolutely.

On that first season, I was consultant, and that basically meant that Joe would contact me multiple times a week, sometimes multiple times a day. We would go over cases and talk about how this case would really work out and what would be the dialogue between physicians, and he’d run stuff by me.

For the second season, he said, “That’s great, but now I need you in the writers’ room.” For season 2, I’m actually a staff writer and consultant with Joe, and that’s been an incredibly fun experience. I’ve never really done it at this level — to be sitting there with the writers and actually, from day one, going through all of the cases.

The key thing is to make it accurate. That’s what we want to do. You can never be 100% accurate because it is still television, but we’re making it as accurate as possible and the doctors, nurses, and everybody loves it. Many of them say, “I can’t watch it. It’s too accurate.”

Not Just Watching, Feeling It: The Catharsis of The Pitt

Glatter: Many people are triggered by it, and my colleagues have talked about this. When they watch it, they feel like they’re in it.

Nick, let me bring you into this. Your article in Time was an excellent summary of the experience of so many of us, and you explain it as cathartic. I was hoping you could explain the catharsis and your thesis of your Time magazine article to the audience.

Cozzi: Thank you very much for the opportunity to be here. Mel, congratulations, and great job on everything you’ve done, along with Joe Sachs, on The Pitt. Time magazine approached us with that thesis: “We hear it’s too triggering for emergency physicians to watch The Pitt. They feel as though they are back at work in the department, and they don’t want to watch it. ”It’s not just emergency physicians, but anybody who works in the ER. They asked, “Dr Cozzi, do you agree with that?” I said, “No.”

Just because it’s stressful and depicts what is happening, we should not avert our gaze. We shouldn’t shield our eyes. We need the entire healthcare system and the entire country’s eyes on what is actually happening — the brokenness of our healthcare system and how emergency physicians and those who work in the ER each and every day are dealing with this struggle. That’s where Time really understood what we were trying to do.

More than anything, Mel, more than being accurate on a medical diagnosis, you pulled the curtain back and showed what’s happening with hospital boarding. You pulled the curtain back to show what’s happening with patients in the waiting room, with patients in the hallway, and with loved ones and members of their family.

What we tried to do with the Time article was provide a way for the lay public to understand hospital boarding, to understand that it’s not indifference from emergency teams, but it’s the healthcare system pushing down on too few shoulders. Thank you, Mel, and it’s a pleasure to be with you.

Tugging at the Heart of Medicine: What You Do Matters

Glatter: Amy, how did the show impact you and your colleagues? Did you feel that you were in it as you watched the episodes?

Ho: I think so. I feel what Nick said and obviously what Mel said about it being so medically accurate. To me, the pieces that tug at your heartstrings are not the medical accuracy. To be honest, I was inspired to ultrasound more because I’m like, they ultrasound everything, I should ultrasound more.

The parts that get me, my colleagues, and many women, especially, in medicine are the humanist pieces. I don’t think this is a big spoiler, but there’s a miscarriage of a physician on shift. The response that had from women who had the exact same experience — went to the bathroom, miscarried, popped back out, and saw more patients — was so true and is not talked about.

It’s those pieces of what makes emergency medicine special and what makes it hard that we don’t talk about that The Pitt brought out and gave us the feeling like we were seen. The pediatric death was another incredible example of that.

Mel, I have say that I’m a big fan of what you do and what you say on EM:RAP all the time—that what you do matters. The Pitt did an incredible storytelling of exactly that, of what you do matters.

Glatter: The storytelling is so impactful. It really resonated with me to the point where you can’t stop watching it. You go episode to episode because it’s that hour-to-hour transition and you want to know what happens next.

I do want to quote one of the paragraphs that Nick wrote in his Time piece. It resonates with me and hopefully with others: “For an emergency medicine physician, a typical shift is a front-row seat to the worst day of people’s lives — a whirlwind of drama, frustration, quiet victories, devastating losses, and unfiltered humanity. And then, it’s onto the next patient’s room to do it all over again.”

That really resonated with me. We do it all again because that’s our training. We’re tired, we’re fatigued, we’re hungry, but we move on to the next patient. We’re dedicated. I want to commend you on this piece because after watching the show and then reading your piece, it just really made complete sense.

Cozzi: Thank you very much. I’ve heard from physicians around the country, and those in healthcare that, like Amy said, are “feeling seen in a way that The Pitt depicts.” If my piece helps with individuals feeling that, it’s a great honor.

When I think about Noah Wyle, for example, being the star as John Carter in the 1990s show ER and now the burnished, seasoned attending physician later on in his career on The Pitt as Dr Robby, I think of the transition we’re all making in our own lives, whether we were practicing back then or now we’re taking on the next step of our journey.

People who saw ER in the 1990s and now are watching The Pitt see somebody making that full circle in his own life. Teaching, training, communicating, but not being afraid of showing emotion and being a human being in unrealized or unimaginable situations.

Amy, you brought up the loss of a child and dealing with a pandemic — themes that, for example, Mel on EM:RAP covered during COVID for emergency physicians. It wasn’t triggering, but rather created a cathartic environment where emergency clinicians felt seen. In a way, Noah Wyle has come full circle in his role as an emergency physician and also has never lost sight of not only optimism and realism, but also being able to be a human being in unimaginable situations.

On the Brink: A Character That Captures Us All

Glatter: Mel, I’ll commend you. Dr Robby’s character is so well developed. He’s on the brink every time and about to break down. He goes into a room, he’s crying, and needs another resident to pick him up. That, to me, is emblematic of the system and where we’re at. The emotional weight of what we deal with on a daily basis impacts us, and Nick’s article points to that fact.

The character development was very important here. I assume that you made that clear to the directors and producers.

Herbert: Again, I have to give real props to Joe Sachs, who is really the guy when it comes to the medical stuff.

Noah Wyle is one of the nicest human beings you’ll ever meet. He is just a good person, and he cares deeply about emergency medicine. For his arc as an actor, the most important thing he ever did was be on ER.

He’s had physicians over the years come up to him and say, “I became a doctor because of you.” “I became a nurse because of you.” He really wanted to come back because physicians and nurses were coming to him and saying, “We’re in trouble. Emergency medicine is in trouble, we’re burning out, people are dying. Could you come back?”

That’s when he got together with John Wells, Scott Gemmill, and Joe Sachs to say, “Let’s do this again. Let’s do it right.” They wanted to depict what’s it really like, not like on other TV shows, but what’s really happening — the boarding crisis, the stress, COVID, the burnout that physicians are feeling, and the systems issues — and they wanted to make that real.

Noah is such an incredible actor now. He was a pretty good actor back on ER, He is now the full professor of emergency medicine acting. He’s so good. When you see that scene where he loses it, I think every emergency physician, myself included, has been there and are just like, oh my God, that’s me.

This theme we keep hearing — which is that for the first time, emergency physicians feel like they’re being seen — is one of the most gratifying things. Family members can now look at the show and know what Dad or Mom does for a living for the first time.

Will The Pitt Inspire or Deter Future EM Docs?

Glatter: Amy, as residents and medical students are watching the show, do you think in some ways it might turn them away? The Match this year was very productive, but when you look at a show like this that depicts emergency medicine and what we deal with — obviously, there’s positives and negatives with any specialty — do you feel that it has the potential to scare away some very promising residents and medical students?

Ho: That’s a great question. I’m a millennial so I was a bit too young to watch ER, and there were really no shows until The Pitt that were as accurate. I think The Pitt will have the effect that ER did, which is actually get people more interested in emergency medicine. You see what’s really great about it, and you see the downsides of it, but it sparks something in us and what attracts us to emergency medicine. We want to make a change for the patient that is so vulnerable in front of us, that we’re helping, but we also want to make a change for the system, which is oftentimes why we get so frustrated.

The Pitt will help captivate the right people to go into emergency medicine, and in many ways, show an incredibly honest depiction for people who maybe thought they wanted to go to emergency medicine and didn’t.

Rob, you and I have talked about this on Medscape before. One of the biggest reasons for people leaving emergency medicine is because the field isn’t what they thought it was. The Pitt helps give you really honest story of what you’re getting into. It’s incredible. Yes, it’s hard at times, but you can make a difference.

Pulling Back the Curtain on a Broken System

Glatter: It’s dedication. In his 2022 article in The New England Journal of Medicine, Walter O’Donnell talks about administrative harm and the systemic issues. Addressing administrative burden is certainly relevant here.

The show opens up the whole hornet’s nest on what really is going on — a broken system, Nick, that you write about, the boarding crisis, the shortage of nurses — things that have to be addressed that are still not being addressed.

When I started practicing, these issues were there. They still have not been handled. Why isn’t there a larger movement to address the systemic issues so that personally, individuals can survive? How do we fix this broken system? What is the real key to finally gaining traction?

Cozzi: That’s an excellent question. I think about the most common questions people are asking me about The Pitt. They aren’t, “Can you really do a burr hole with an IO (ie, an intraosseous device)? Can you do that type of procedure? Is that accurate in terms of a cardiac arrest?”

What they’re asking me more often than not is, “Is that what it’s really like trying to save someone’s life, and a hospital administrator is asking you about patient satisfaction scores? Is that what it’s really like when you try to take care of a patient and there’s no beds upstairs that have nursing staff assigned to them?”

That to me is fascinating because that’s the first step. It’s getting the general public to understand beyond the resuscitations, and beyond the complex saving of lives. It’s making seen what is very complex and has been behind the barrier. When patients come to our ER, as Amy, you, and Mel know, and they see that 14-hour wait, they don’t understand. They think it’s indifference. They believe it’s because we’re not taking care of them.

This is trying to unlock that door so people could see the systemic issues that, for a long time, had been behind the curtain. The first step is the public understanding how broken this all is — the mismatch of finance, the mismatch of allocation, and the value-based system that we’re not having right now.

How do you have a complex conversation about hospital boarding that isn’t throwing facts at people, but in a way of putting yourself in that position if you’re the family member with your loved one in the hallway and you’re not seeing them being taken care of? That’s the first step.

That’s what The Pitt does differently than any other show is that they’re talking about those issues —staffing, nursing shortages, and the boarding crisis — in a way that’s palatable and can be received by the general nonmedical public.

From ER to Capitol Hill: Educate, Advocate, Legislate

Glatter: Amy, on a congressional level, is there any way to address what Nick is pointing to? There needs to be systemic change, legislative changes, not just at the state level but really at the national level.

Ho: Absolutely. Nick makes a good point that the first step is to educate. Educate yourselves, voters, patients, and anyone in the healthcare system, which is really all citizens.

The second step is advocate. We have multiple national organizations — the American Medical Association, the American College of Emergency Physicians (ACEP) — and most of them are very involved in the boarding crisis. There is a boarding summit. Multiple states have passed various legislation about boarding and wait times in EDs.

There is always discussion on Medicare reimbursement. There’s always discussion on value-based programs, including the Merit-based Incentive Payment System (MIPS), on which ones matter and which ones are just administrative burden. There are many national health care safety scores like Leapfrog, which is really incentivizing for hospitals to address.

All of these are avenues to advocate. You can advocate by voting. You can advocate by getting involved with your organization. You can advocate by just speaking. This is the age of social media where you can talk about it.

We’re starting to see changes. The National Boarding Summit had multiple, very discrete recommendations. Leapfrog just added ER boarding onto one of the tenets that they’re trying to get data on to help rank hospitals. We’re seeing a move because people are getting educated and then advocating.

Telling the Truth, So Change Can Begin

Glatter: Mel, have you seen any changes as a result of your national involvement in a show that’s become such an impactful type of experience for not just physicians, but for the public?

Herbert: The answer to that is yes, because of what’s happening right now. Noah, Joe, and I are constantly trying to write, and in between the writing, we’re talking to people across the country and across the world. It’s elevated this discussion and that’s the most important thing. We are not saying what the solution is. There are people with degrees in this who need to come up with these solutions.

If we can show exactly what it’s like, how bad it is, and how close it is to falling off the cliff, then maybe people like Amy can help us push it across the line. We don’t have the solutions, but we can tell you what the problems look like.

I was just interviewing Al Sacchetti, David Schriger, and Peter Vicellio— three legends in our field — and they had very different ideas about what to do. Some of them were saying we should go on strike; the only way this is going to get fixed is if we make a crisis and we fix it. There were other guys like Al Sacchetti, who was like, I can’t do that. I have to look after the patients. I can’t not be there and do this.

Part of the problem is that ER docs will always try to fix the problem. We will always go into the waiting room and try to go as fast as we can to help people. That is actually not going to fix the system. We need somebody from outside to say, “You’re going as fast as you can. We need to get you help.” If we can use this show to tell those stories in Congress or wherever it needs to be, have at it.

‘It Is Normal, but Not Acceptable’: Violence in the ED

Glatter: One thing I want to focus on is violence against healthcare workers. There’s a scene where the charge nurse gets punched in the face by a patient who retaliated for a long waiting time. That resonated with so many of us because it’s happened where I’ve worked and I’m sure where many of you have worked.

How did you set that scene? What was in your mind and how did you approach it?

Herbert: Again, that’s all to Joe. You need to know that Joe was my attending at UCLA when I first got off the boat from Australia. I love Joe. It was him and the writers sitting around like, what are the issues? Workplace violence was one of the top issues to talk about.

There was a study that came out that reported that, for ER nurses, about once in every three shifts, there is violence against them, either verbal or physical. I think it’s about three times a shift, depending on how you define it. It’s really a problem.

During COVID, it became worse. There was this weird thing where people would stop believing in science and stop believing in doctors, but then when they were critical, they would come in, ask for their ivermectin, and would be outraged when you said, “That doesn’t work. Let’s try and help you with stuff that does work.” It has become an epidemic.

It was always bad in emergency medicine. As Nicholas pointed out, we get to see people on their worst day. We get to see all of the problems of society filtered to the ED. Violence is a big problem in this country, as it is in many countries. Guess where that all comes to? It comes to the ED, and it is often then displayed against emergency physicians, nurses, and everybody that works there. It is a crisis.

I got an email recently from somebody saying, “Please be careful about how you depict this, because we don’t want people to think this is normal or it should be acceptable.” Unfortunately, it is normal. It is not acceptable.

Glatter: Absolutely. it is not acceptable. We can’t normalize it, but we have to depict it. Unless you show the public what’s truly going on, they won’t understand. As emergency physicians, we get it, and we have to put a stop to this. Legally, I believe it is a felony for attacking a health care worker. Is that correct?

Herbert: It’s state by state. Arizona has a very strong rule. One of the things that we do on The Pitt is we bring in experts to talk to the writers within the writers’ room. There is legislation in Arizona, for example. I don’t know exactly what level. Before this legislation passed, you got in more trouble for kicking the neighbor’s dog than for punching the ER nurse, literally.

In Arizona, they’ve passed these laws, and there are many more laws in other states that are working their way through the system, which as we all know is quite slow. We need things like that, and it needs to be very clear. Just because you’re pissed off, angry, and have waited a long time, violence is no way to get this fixed. You could be in big trouble if you pursue that.

Glatter: Absolutely. Nick, in your ED, are you seeing quite a bit of violence against healthcare workers?

Cozzi: Every day, whether it’s physical violence or the violence that Mel so eloquently stated is happening. Perhaps gender-specific differences, with women being more likely to experience that violence, suggestive comments, and things of that nature that are being underreported. Mel answering that person’s letter, saying that it is normal but not acceptable is absolutely the right solution.

I think back to Time in the early 1990s. They had a cover article that said the ED is at the brink. We’re in 2025 and the ED is still at the brink, but it’s worsened because of the social issues that we’re talking about.

Healthcare workers and those in the ED did not choose law enforcement. No one should feel unsafe going to work every day that their lives are in trouble. We had an emergency physician in Chicago that got stabbed in the chest during a patient encounter a few months ago. Luckily, he survived, and I understand he’s doing well.

That’s just one story of so many. We see it every week and every day around this country. There has to be an opportunity. I’m very thankful that the airline industry has found the opportunities to understand the violence happening on airplanes or in airports, and how those individuals are being dealt with in a very firm fashion.

If we’re bound by the Emergency Medical Treatment & Labor Act (EMTALA), a federal mandate to evaluate anybody who walks through our doors, then there should be federal things on our books to be able to protect our workers, with caveats for those who do not have medical decision-making capacity and those experiencing crisis in different ways.

We have to find unique solutions, and this is one of the areas that I think is different from the early 1990s because of the way society perhaps has caught up. We can’t waste this moment that Mel, Joe, and Noah have provided us at this time.

Glatter: I agree. Amy, any thoughts you want to add to that?

Ho: Workplace violence is a huge problem, extremely common, and rampantly underreported. Luckily, the majority of states have a felony or some kind of zero tolerance law, so this is an instance where advocacy has really worked.

The piece that The Pitt really helps with is people who are angry because they’ve been waiting, and they think the charge nurse, the attending, or whichever staff member is representative of that and part of that. What the Pitt does beautifully is it divorces the staff, who are just as frustrated, from this concept of the system.

Since The Pitt came out, I’ve already had patients that I see in the ED, where they’ll be in the hallway and will tell me, “Wow, this is just like The Pitt,” and they mean it positively. They are in a hallway bed and they kind of understand why in a way. They’re not mad at me, which is this change that I’ve really seen since the show came out. That’s been an incredible testament to what it means for not only us in the field, but also for laypeople in understanding what is healthcare today.

Tough Training, Tender Tensions: The Struggles of Residency

Glatter: One last thing I do want to discuss is how residents relate to other residents. This was depicted in the show — showing toxicity, microaggressions, and other things that were tolerated. This is an area that was well documented in the show, Mel, and is so important to highlight.

Herbert: Residency is hard. You just think about these poor young adults who have gone through high school and achieved at the highest level. Then they go through college, achieve at the highest level, then go through med school, achieve at the highest level. They have hundreds of thousands of dollars’ worth of debt and then they do residency, and they’re sleep deprived and shifting from days to nights. It’s a very difficult job, and trying to depict that is really important.

My experience, though, is that residents are really good to each other. In general, overwhelmingly really good to each other. There are some that sort of crack. When you see that resident that’s having these microaggressions toward other residents, your first thought should not be that this is a bad person. Your first thought should be that this person is struggling. How do we help them? It is a very difficult thing.

At LA County years ago, we did a snap survey of over 60 residents, and 30% of them had had suicidal ideation in the past month. Just think about that — 30% of them. It’s a tough job. I think residency directors are much better now than they used to be about understanding the mental health of the residents and being much more in tune with it. I hope that comes through in season 2.

Unpacking the Backpack: Why Every Emergency Physician Needs Support

Glatter: Absolutely. We’re looking forward to that. Amy and Nick, I want to get your thoughts about mental health in your EDs. How is that approached, and is there an acute awareness as Mel is describing?

Ho: Every person that goes into emergency medicine, just like any person, has their own demons. What emergency medicine forces you to do is it not only puts you in a pressure cooker just by the setting, the time issues, and many frustrations, but oftentimes it puts you face to face with some of your own weaknesses and some of your own fears. It’s very obvious in the show when a resident is triggered by something that she clearly experienced in her own life, and now a patient is reflecting back to her something that she herself had been extremely traumatized by.

We all have that. One of the most interesting things to me is that we also all develop a callus to it. In order to be able to move on from a devastating trauma in a room into a low-acuity knee sprain or something similar, and put on a happy face and think about patient satisfaction, our ability to emotionally task switch like that is very unnatural. It’s a defense mechanism we come up with, which means that when we leave shift, often times we take that emotional whiplash and we just put it aside.

As Nick was saying, maybe this is why people can’t watch it. In many ways, what’s best for us is to stop, reflect, think about it, and honor the feelings that you had in that moment. Even though you had to put them aside so you can keep working, come back and honor those feelings so that you can process them and realize that being a person and being human is what also makes you a great doctor. Don’t get rid of that.

You see that with so many of the characters in The Pitt in a way that is just so beautifully written because in different various stages of my life and of my training, I have experienced those exact same iterations that the different characters go through.

Cozzi: I remember when Damar Hamlin had a cardiac arrest on the Buffalo Bills field, and 50,000 people saw him in cardiac arrest and the excellent display of medical teamwork and communication that ultimately saved his life. We talked about the psychological impact of every one of those individuals in the stands, and we’re not minimizing that. What they saw was a traumatic event, but like Amy eloquently discussed, that’s something that happens every day and the ability to task switch is a defense mechanism.

There are still opportunities for us to do much more when it comes to mental health. We’re still looked at as superheroes, but we’re not. We’re human beings. We bring our own issues into work every day — struggles with our spouse, difficulties with our own children — that are traumatizing to us in and of themselves.

Second, there are still areas around the country for credentialing that are mistreating emergency physicians as it relates to mental health struggles and being on prescription medication, and we have to make that okay. We can’t make emergency physicians want to hide the humanity of their own lives because they feel ashamed about it. That’s part of the problem.

I wonder, Mel, what we would do right now if we asked emergency physicians in training, or even those practicing, what the rates of self-harm, suicidal ideation, or just overall fatigue as it relates to dealing in this own crisis, having your own issues, and having to hide them. We have to do more work.

Herbert: I can tell you that every emergency physician I talk to is burnt out, is feeling the struggle, and has moral injury. I’ve talked often about the fact that I developed severe depression and suicidality at the end of my career. I had to get ketamine and it really helped. I don’t like to talk about it because of my position, but I feel like I need to talk about it.

When I go to ACEP, I get overwhelmed with people saying, “Thank you for talking about that. I have the same thing. I need to get help.” It’s underrecognized and we don’t want to talk about it. We’re supposed to be superhuman, but we are not.

I was talking to the Lorna Breen Foundation yesterday, Lorna Breen, as many as you know, was an ER doc, the head of her department, who died by suicide at the beginning of COVID because she couldn’t cope. We talked about the fact that ER docs have this backpack, and we throw these things into the backpack.

Dead baby? Let’s just throw that in the backpack. A 32-year-old woman dying of cancer? Let’s just throw that in the backpack.

If you don’t unpack that thing, it will catch up with you. Nobody gets away from this. For many of us, like for my generation, you just chuck it in the backpack. Let’s not deal with that. It will catch up with you.

I honestly believe that every ER doc and every ER nurse should be in some form of therapy for the duration of their career, from day one until it’s over, and then for 5 years afterward, because this is not a normal job. It’s not normal.

Glatter: Therapy is so critical. It’s not just a debrief or a huddle after a difficult case. It goes deeper. I agree with you, Mel, that therapy should be something that is almost required because of the nature of the work we do. We have to be able to talk about it and to at least describe our struggles.

I appreciate you sharing with our audience your personal journey and struggles because that resonates with all of us. I truly appreciate that.

Herbert: This is the most important thing to me right now. I see so many ER docs struggling, and I don’t know an ER doc that doesn’t have a dead baby story. I, for years, still can see the faces of the kids that have died on my shift. Even now, you can hear it in my voice. It doesn’t go away. You just have to learn to cope with it and get help if you need it. We’re all the same. We have all got this experience.

If we all get therapy, and this is a really important point, if it’s mandatory that we are all in therapy and we’re all getting help, guess what? The stigma’s gone. Even if you’re mandated to write something about that on your credentialing, if we all do it, we’re done.

A Final Word: Seeing Ourselves Through a Different Lens

Glatter: I want to thank everyone for a very impactful and very insightful discussion. These topics are obviously so important to emergency physicians, and they resonate. The show is such an important teaching tool, in my opinion. In season 2, I’m looking forward to seeing what struggles and what events happen because based on season 1. It really will provide a real good springboard to go forward.

Any other final thoughts?

Herbert: I’ve got one to tell you. I’m very excited to tell you that Noah Wyle and Joe Sachs are coming to ACEP. We’re going to do a little panel after the keynote where we’ll take questions from the audience, and then Noah is going to walk around a little bit in the trade area. It’ll be an opportunity for people to talk to the real geniuses behind the show, including Noah and Joe, and there are many others. If you can make it, it’s on September 7 at around 10:00 AM MST.

Ho: I’ll say coming off a late shift to do this on a fairly early morning, it is worth saying that what we do, to us, loses the shininess because we do it every day. It feels routine. To be able to see ourselves the way other people see us, which is that it’s a little crazy and erratic, but boy does it have really great and long-standing impact. Remember that as you walk into your next shift.

Cozzi: Echoing that, it wouldn’t be my final word, it will be Mel’s final word — what you do matters. I think this eloquently displays that.

Glatter: Excellent. Thank you all again. I truly appreciate your time. Many thanks.

Robert D. Glatter, MD, is an assistant professor of emergency medicine at Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York. He is a medical advisor for Medscape and hosts the Hot Topics in EM series.

Mel Herbert, MD, a professor of emergency medicine at the UCLA School of Medicine, is widely recognized for his innovative spirit, global impact, and commitment to education. He is the founder of EM:RAP, a pioneering medical education platform, and EM:RAP GO, a nonprofit organization that delivers free emergency medicine education to clinicians in more than 160 countries. A passionate advocate for making excellence accessible, Herbert explores this theme in his book, The Extraordinary Power of Being Average. Beyond the clinical world, he has lent his expertise as a medical consultant to television, including the iconic series ER and the current Max original The Pitt.

Nicholas Cozzi, MD, MBA, is an emergency physician, EMS medical director, and assistant professor at Rush University Medical Center in Chicago, Illinois. He is a co–course director for Practice Essentials of Emergency Medicine and leads several key modules, including reimbursement and operations. Cozzi is dedicated to expanding access to business education for emergency physicians and cofounded the Health Careers Pipeline Program, which has helped over 130 Michigan high school students pursue health careers.

Amy Faith Ho, MD, MPH, is a practicing emergency physician, board certified in emergency medicine and clinical informatics. In addition to working clinical shifts as an attending physician, she is a faculty member at John Peter Smith Hospital and teaches resident physicians and medical students. She has multiple publications in peer-reviewed journals on both clinical outcomes and operations. A frequent lecturer for state and national medical organizations, she has a passion for health policy and medical humanities, and is a nationally published writer and speaker.

In the pilot episode of HBO’s new medical drama The Pitt, a dedicated ER doctor is reprimanded for his low Press Ganey patient satisfaction scores. The interaction—cold and superficial—angers the main character, Noah Wylie’s Dr. Michael “Robby” Robinavitch. His defense is that the numbers don’t matter; all that counts is his ability to save his patients’ lives.

As a longtime practicing physician, I can tell you that this fictional doctor’s frustration resonates deeply with real health care providers across America. When they are taking care of patients, deeply ill or otherwise, all that should matter is the patient in front of them. Everything else is a distraction, including data that supposedly describes the quality, safety and efficiency of their care.

But as an experienced health care manager (and the chief medical officer of Press Ganey), I can tell you that individual physicians rarely save or lose patients’ lives on their own. And they don’t earn or lose patients’ trust on their own, either. Health care is a team sport, and data describes the performance of those teams over time.

Physicians are often like the fictional character on The Pitt—inclined to dismiss data that they know does not really capture their personal work or impact. In fact, as someone deeply interested in data, I would say that it is more difficult to measure the impact of physicians than quarterbacks on football teams.

In the pilot episode of HBO’s medical drama The Pitt, Dr. Michael “Robby” Robinavitch, portrayed by Noah Wyle (above), is a dedicated ER doctor who is reprimanded for his low Press Ganey patient satisfaction scores. In the pilot episode of HBO’s medical drama The Pitt, Dr. Michael “Robby” Robinavitch, portrayed by Noah Wyle (above), is a dedicated ER doctor who is reprimanded for his low Press Ganey patient satisfaction scores. Warrick Page/Max

What we can measure is how well the teams perform. However, we tend to organize analyses of patient data around their physicians because medical claims are submitted in those physicians’ names. The resulting report cards look like they are about the doctors, while they are really about the teams working with them.

Physicians have a lot to do with how their teams perform, but I don’t think they should view themselves as “players” akin to quarterbacks. In my new book, Social Capital in Healthcare, I argue that they should see themselves more like chief financial officers (CFOs) for social capital for the web of relationships among their colleagues, their patients and their patients’ families.

Social capital is not a term used often in health care, but it is as essential to health care excellence as financial capital is for building new buildings. Human capital means the people with the training that enable organizations to open those buildings or staff new programs. Social capital is how those people interact—with each other and with their infrastructure, enabling the organization to deliver care that is reliably safe and excellent.

To be “CFO for social capital” means physicians assuming leadership and ensuring that their teams function like real teams. On real teams, everyone knows each other. Everyone speaks up when something might be going wrong. Everyone feels like they belong. And everyone would cringe at the thought of disappointing their colleagues.

Social capital isn’t just theoretical, and it doesn’t fall from the sky—it’s a practical asset that delivers measurable results, and it has to be earned and built over time. I actually believe that it is more important than financial capital, because money can be borrowed or gifted from the outside; no one can give an organization trust and teamwork and high reliability.

So, my take is that the physician in this television show shouldn’t just shrug off his Press Ganey data, but he shouldn’t take it as a personal affront, either. He should see it as performance information for his group and know that they have work to do. That work to build social capital means rounding and huddling regularly, discussing cases proactively or even starting a weekly cross-team lunch ritual. It may mean social events together to strengthen their relationships.

All that can and must wait until the patient needing immediate attention, whether in an hourlong drama or in real life, is stabilized. But the key point is that the path forward isn’t just about individual excellence or better metrics—it’s about rebuilding the social fabric that enables true health care success on both ends of the stethoscope.

Now the Chief Medical Officer at Press Ganey, Dr. Thomas Lee has more than three decades of experience in healthcare performance improvement as a practicing physician, a leader in provider organizations, a researcher, and a health policy expert. He recently published the book Social Capital in Healthcare, where he describes a new and powerful framework for improving healthcare, arguing that managers should approach the work of building trust, teamwork, and high reliability with the same intensity and discipline as CFOs use when managing the finances of their organizations.

Noah Wyle

Opinion contributor

I’ve spent a lot of my life wearing scrubs, although I never passed Anatomy 101.

On “The Pitt,” I play an attending physician in a high-intensity emergency department. It’s fiction, but it’s grounded in real stories – shaped by medical advisers who’ve lived them and delivered with reverence for the professionals we’re honored to represent.

Still, it wasn’t until my mother, a retired nurse, watched a scene where my character lists the names of patients he couldn’t save that I truly grasped the emotional weight of this work, as she shared a flood of stories she’s carried silently for decades. I’ve never seen her respond that way to something I’ve acted in.

And she’s not alone. Since the show premiered, I’ve heard from countless health care workers who’ve told me they finally feel seen. Their stories echo the same themes: exhaustion, compassion and a system that threatens to make their life’s work unsustainable.

Their stories have stayed with me. And that’s why I jumped at the chance when I was approached by FIGS, a health care apparel company with a history of standing up for the health care workforce, to go to Capitol Hill with them this week. While on Capitol Hill, I will advocate alongside a group of FIGS ambassadors made up of 18 extraordinary nurses, doctors, students and other health care professionals.

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Health care workers need help from Congress

As part of this grassroots effort, we’re urging lawmakers to act on three urgent, bipartisan issues that are making health care workers’ jobs, and their lives, harder than they need to be: lack of mental health support, crushing administrative burden and financial strain.

Our message is simple: Without a supported, protected and fairly treated workforce, there is no patient care. Whatever other important issues are being debated, this has to be a priority.

Health care workers are experiencing burnout at staggering levels. Half of physicians and nurses report being burned out, and health care workers face a 32% higher risk of suicide than the general population. Even when support exists, many fear that seeking help could jeopardize their license, career or reputation.

That issue has hit home for many of the health care professionals who will join me in Washington. One nurse said she struggled with depression and anxiety due to the conditions at work and came close to taking her own life. A doctor described dental students whose teeth were ground away by stress. And an oncology nurse shared the heartbreaking story of a young cancer patient who died because of the paperwork delays in getting him the lifesaving medication he needed.

That’s why one of our priorities is reauthorization and funding of the Dr. Lorna Breen Health Care Provider Protection Act, which includes federal mental health programs for health care workers as well as grants for peer support, training and institutional culture change, especially in rural and underserved areas.

The law was enacted in 2022 on a nearly unanimous bipartisan basis. But unfortunately, it expired in 2024. It should now be reauthorized with just as much support as it received initially.

Prior authorization threatens patients’ health

At the same time, administrative red tape is strangling the system. Physicians and their staff spend nearly two full business days each week dealing with prior authorization – essentially asking insurance companies for permission to treat their patients.

One ambassador, a primary care provider, told us she spends nearly half her day fighting insurance denials and filling out duplicative forms – far more time than she spends with patients.

These delays don’t just cause frustration: 1 in 4 physicians say prior authorization has led to serious patient harm. We’re urging Congress to move forward with reforms that help put clinical judgment back where it belongs: in the hands of trained professionals.

And then there’s pay. Fewer than 6 in 10 health care workers feel fairly compensated, and only 38% see any link between their performance and their paycheck.

That disconnect is pushing people out of the field and fueling dangerous shortages.

Another ambassador, a resident physician, described working 80-hour weeks while struggling to afford groceries. Stories like hers are why FIGS is championing the Awesome Humans Act, a proposed federal tax credit to provide frontline health care workers with meaningful financial relief.

These aren’t partisan issues. They’re practical ones. And they’re urgent. Because when our health care professionals are burned out, buried in paperwork or forced to leave the field altogether, we all pay the price.

I’m not a policymaker. I’m not a clinician. But I’ve spent my career listening to those who are, and I’ve seen the difference they make when it matters most: after a car accident, during cancer treatment, in delivery rooms and at the end of life.

This week, I’ll stand with them in the halls of Congress, and I’ll be proud to do it with my mom and 18 other amazing health care workers.

To anyone who’s ever benefited from the knowledge, care and courage of a health care professional, now’s the time to show up for them and take action. They’ve had our backs. It’s time we have theirs.

Noah Wyle is an actor, writer, producer and director who currently stars in “The Pitt.”

Photo: Warwick Page/Max

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TV shows responded to the pandemic in various ways. Many didn’t acknowledge it, and others took a direct approach, shooting an entire episode over Zoom (hello, Mythic Quest). Now, nearly five years after lockdown began, we have reached a point where television explores the long-lasting ramifications. During press for The Pitt, Noah Wyle has repeatedly said that the idea was born during quarantine. This alone sets it apart from ER (speaking of which, there is an update on the lawsuit against The Pitt creative team). As we can see in “3:00 PM,” the impact of this fraught time on first responders goes beyond Dr. Robby’s PTSD and the flashbacks that have been giving additional context. Events in chairs at the start of the episode are rife with reactionary language (“You fucking Fauci zombie,” one woman yells at another) and discord about masks and vaccines.

The fight is quickly broken up and resets the overall mood after the particularly tough conclusion to the previous episode. It isn’t that “Hour Nine” is a light-hearted affair (this is still The Pitt), but it stresses having to get on with the shift. The waiting room is also a reminder of patients who have been there since the first episode (like Mr. Driscoll) and that the hospital employees inevitably have to play peacemakers along with their actual healthcare roles—see also Dr. Collins with the abortion storyline a few weeks ago. No wonder nerves are fried, and tension is high.

What follows are the observations I took from this ninth episode.

“3:00 PM” is the second episode written by Wyle this season! It is easy to take what Wyle is doing for granted on screen, so I want to highlight a small yet impactful moment when Dr. Robby gathers the team for a debrief after the drowning death. He recalls the first day of his residency at Big Charity in New Orleans, and the moment his voice breaks during this story underscores how closure in this job is a Sisyphean task. It feels accurate that the “pep” talk is interrupted. “You just gave a speech titled ‘How to literally bury your feelings,’” teases Dana soon after. However, this is another moment where Robby’s experience makes him a great leader—even if he doesn’t have the right words to say because they don’t exist.

Speaking of teaching, last week in the comments, there was praise for how the senior staff explains procedures (and how this, in turn, teaches the audience). I agree with this summation, but I also struggled with Dr. Langdon’s huge, unprofessional blow-up at Dr. Santos. This combative back-and-forth has been building. Yet, watching him pull her apart so publicly is unpleasant—especially over something she hadn’t done. Part of me wonders if this is a way to even the scales somewhat, as Santos still leans unsympathetic. Or, at the very least, it highlights that Langdon’s approach to supervising Mel is worlds apart. Even after Robby’s dressing down, Langdon refers to Mel as “my least problematic trainee,” showing his bias. Offsetting the personality clash with this lovely scene between Mel and Langdon (and Crosby the dog) reads like purposeful whiplash. Langdon recognizes Mel is struggling after the drowning death, giving her space and then a stress-free road-rash task.

The patient that causes Langdon to resort to shaming, belittling, and insulting is the first to come from PittFest (though probably not the last), and the MDMA overdose offers additional Santos backstory, who witnessed something similar with one of her friends. The tub setup (and sourcing all of the cafeteria’s ice) is a fun touch, showing how resourceful trauma centers must be. Nudity doesn’t come across as gratuitous, and getting insight into these procedures is fascinating.

Photo: Warwick Page/Max

Even though Nick Bradley’s storyline has ended, a few recurring faces have been around since the first episode: Earl, Mr. Driscoll, and Theresa. Earl is hurt during the waiting room melee and gets front-row seats to Victoria’s extremely awkward attempt at flirting with Nurse Mateo Diaz. She crashes and burns. It is a cringy delight while demonstrating that The Pitt can do romantic interludes within the real-time format. Victoria confides in Dana (like all the smart people on this show) in an interaction that allows Shabana Azeez to show her comedic abilities.

Speaking of Dana, she has many small victories this week that speak to her experience and temperament, which is why the end scene with Mr. Driscoll is so shocking. The violence isn’t a surprise, but the target is: I figured Mateo would be on the receiving end of his fists. Instead, laying that combative groundwork was a misdirect, and it is one of the most unexpected cliffhangers of the season.

“CHiPs! Know your television history,” Dana tells Mateo when he asks who Erik Estrada is. Dana was already a favorite of mine, and then she said these magic words. If it wasn’t already love, it is now.

The incel kid storyline is ticking along, and someone (probably Dr. McKay) has called the cops, much to Robby’s anger. The concerned mother, Theresa, is now talking to the police. McKay’s tendency to make snap judgments or rely on her instincts is a pattern—whether right or wrong. The curious relationship between the assistant and her pregnant boss ends on a sour note, with Piper claiming she is okay. Ambiguity is part of the (purposeful) limitations of the format that never leaves the hospital grounds, and McKay is frustrated with the outcome. It looks like Piper took one of the pens with a hidden hotline number, but we are in the dark about what will happen next. McKay also gets called out on her bias in diagnosing a patient earlier that day, demonstrating her blind spots. McKay doesn’t think she judged the woman because of her weight but concedes that she will look out for this in the future, and this measured response to criticism is welcome.

Photo: Warwick Page/Max

Hospital resources are limited, but there are workarounds involving street teams. McKay is part of one, and Whitaker volunteers after a second encounter with Mr. Krakozhia. It turns out that the man who peed on Whitaker in the fourth episode (or “10:00 AM”) wasn’t high on meth: he just hadn’t taken his schizophrenia medication (he is unhoused and uninsured). Whitaker covers himself from head-to-toe in protective gear but removes it as Mr. Kakozhia is lucid, extremely apologetic, and ashamed. While their original scene is part of Whitaker getting covered in different fluids (to emphasize how green he is), the resolution is touching. It depicts the horrors of the healthcare system and individuals trying to make a difference. They formulate a workable plan so this doesn’t happen again, and Whitaker’s offer to join the street team is genuine. Howell calibrates Whitaker’s naivety so it doesn’t fall into “aw, shucks” territory with every reaction. I, too, would be thrilled to find out that the street team gets “cool jackets.” There is a second dollop of med student-nurse flirting, and Whitaker is a tad more suave than Victoria.

Whitaker also gets to flex another area of expertise this week: being raised on a farm. The rats are back, and I had mostly forgotten rodents have been on the loose since Episode 2. Earlier, it is adorable that Robby tries (and fails) to distract Dr. Collins so she doesn’t see the creatures she is afraid of, and I might be shipping these two. Having a dog in the ER is another palate cleanser to last week’s trauma, and Crosby (named after David) also serves a practical purpose. Many terriers are ratters, so it makes sense that Crosby beelines for the rodent. Whitaker finishes the job: do no harm doesn’t apply here. The leaping-in reaction indicates Whitaker is growing more confident as the shift progresses, and each med student shows character development. Yes, the Santos journey is bumpy, yet I don’t think they simply repeat story beats. How is everyone else feeling about the med students? In fact, how are you finding the way the overall ensemble is being fleshed out?

Courtesy: HBO Max

R. Scott Gemmill vowed that the next TV show he created wasn’t going to leave the comfort of a soundstage and shoot on-location.

“So I knew that it was either going to be [on] a rocket ship or [in] a hospital,” he says.

Gemmill, whose previous work includes 14 seasons on NCIS: Los Angeles and eight season on ER, ended up creating the new drama The Pitt, which does, in fact, take place in a hospital.

Told in real-time over the course of 15 episodes, The Pitt follows a staff of healthcare workers as they toil through one 15 hour shift in an extremely busy big city emergency room.

The series stars Noah Wyle as Dr. Michael ‘Robby’ Robinavitch, along with Tracy Ifeachor, Patrick Ball, Katherine LaNasa, Supriya Ganesh, Fiona Dourif, Taylor Dearden, Gerran Howell, Shabana Azeez and Isa Briones.

Wyle also serves as an executive producer alongside Gemmill and John Wells, who also worked with Wyle on Wyle’s first series, the wildly successful medical drama ER, which debuted over 30 years ago and still is considered one of the best dramas ever on television.

Gemmill says that the idea for the series actually began with a conversation that he had with another writer during which he stated that he would never do a medical show.

“Then, after listing all the reasons, I thought, ‘maybe there’s one way I would do it,’ and so the first person I called or texted was Noah. And he said, ‘Let’s go talk to John,’ and it just went from there. It was just fun to reconnect with these guys and to try to go back to a world that we had worked in before.”

But, he says that the trio had to figure out how things in the medical field had evolved to accurately portray the field as it is now.

Wyle points out that, “The pandemic changed everything,” adding, “I was getting a lot of mail from people, first responders, about how difficult their daily lives were and who was getting sick and who was getting treated, and I pivoted a lot of that to John and said, ‘There’s something happening here that’s probably worth talking about again.’”

For Wells, it was about being able to, “actually show what these incredible physicians and nurses do all day long. We’re trying to make it feel as if you’re right on the shoulder of someone [working in the ER]. It’s a version of a [first responder] ride-along, but with emergency room personnel.”

However, it’s not all about obscure medical conditions and patient treatment, says Wells. It’s really about the people working in the facility.

“You want these people to be the people that, when you get to the hospital, when you get to the emergency room, are actually going to take care of you, your family, your children, the people you love. I think people really want to have that experience.”

And, Wells feels that the length of the season will help viewers in getting to that level of trust with the staff. “I also think that we’ve got a thing that’s going where audiences want to connect with shows and be able to come back to that family of people over a number of episodes. I love a good short limited series, but at the end of it, I’m like, ‘I want to spend more time with those people,’ so we’re trying in these 15 episodes to really get you to know who all these people are.‘’

NBCUniversal via Getty Images

For Wyle, stepping back into the role of playing a medical profession after having played Dr. John Carter on ER for 15 seasons felt both familiar and new.

“It was so crazy putting [a stethoscope around my neck] the first time [on this show]. It’s like I have a groove in the back of my neck that it just clicks into place. It’s uncanny.”

Reflecting a bit more on how being on this new medical series feels, Wyle admits, “It would be rare for another actor to have an opportunity to revisit something that was such a huge part of their early career and that was so ingrained in their tissues and then get to play that instrument again with a little wisdom and maturity and hear the tone and how it’s changed over the years. It’s been really rewarding.”

What Wyle says he has seen are changes how people consume television . “[I think] that the level of sophistication that audiences bring to their viewing has really accelerated in the last couple of years. People have become so familiar with narrative devices and tropes and patterns that out of respect for them, you have to up your game in the way that you tell something to make it seem fresh.”

And on this series, Wyle is right in the heart of that challenge with his work writing and producing. “One of the most gratifying things I’ve been involved with in my whole career was getting to be in the writing room and learn how the sausage gets made and how thoughtfully these things are put together.”

Reminiscing a bit, Wyle says, “We showed up two weeks early [for this show] to start medical boot camp on Stage 16 [on the Warner Brothers lot], which looks out across at Stage 11 where we’d spent 15 years of our life [doing ER], and that 200 feet felt like 200 years. It felt like 20 pounds. It felt like a thousand miles. It’s really heady.”

But, he says that being a doctor on The Pitt is ‘a totally different acting exercise,’ than his time on ER.

“This is building a pressure cooker hour by hour, degree by degree, ingredient by ingredient, playing with levels of fatigue and an ability to compartmentalize things that need to be compartmentalized. This has been a wonderful psychological examination of one guy having one of the worst days of his life and the presence required in just that exercise.”

While it’s been years since ER, Wyle does feel that there is something to the saying that, ‘the more things change, the more they stay the same,’ as he ruminates, “I remember [that in] 1994, ERs were the primary source of health care for most Americans. 22 million Americans didn’t have health insurance. That was part of what went into our show’s popularity, was how relevant it was at the time. And here we are 30 years later, talking about the exact same issues, except the problems have gotten a bit worse.”

For Wyle, the current status of the healthcare industry, and its perception, factors into his desire to be a part of The Pitt, and he hopes that the show will, in some way, bring about change, even if it’s nothing more than a shift in perspective. “You know, we are still playing catch up from the nuclear bomb that was dropped on the medical community in 2020 [with Covid], and it’s going to take a while to right this ship. So, part of doing this was to shine the spotlight back on this community and to hopefully inspire the next generation of health care workers to want to go into these jobs because we are going to need them. Our system is fragile. It is as fragile as the quality of support we give our practitioners.”

New episodes of ‘The Pitt’ debut on Thursdays at 9pm et on Max.