By Jackson Murphy

“The Pitt,” a medical drama that premiered on Max last month, has earned much acclaim as it follows a team of clinicians working in the emergency department of a fictional hospital in Pittsburgh.

Each episode represents an hour-long installment of a 15-hour shift led by attending physician Dr. Michael Robinavitch, played by Noah Wyle of “ER” fame. Clinicians praise the show for its depiction of work in an emergency department, its focus on front line providers, and its portrayal of the challenges they face.

It is worth saying that I am not a healthcare worker, and there are many with first-hand experience who are better suited to speak to the show’s accuracy. What I can say is that “The Pitt” addresses several issues prevalent in our current healthcare environment that we help our clients communicate about each day.

Here are three major themes through the first several episodes of the show (minor spoiler warning ahead).

Hospital Capacity Crisis:

The scenes introducing Pittsburgh Trauma Medical Center paint a familiar picture for hospitals nationwide. A group of medical students and interns tour the crowded waiting room on their first day, where they learn some patients wait 8-12 hours for a bed to open after they are triaged. “Is it always this busy?” one student asks.

“Uh, no. It gets a lot busier,” the resident training them replies.

“As you can see, our house is always packed,” Dr. Robinavitch (staff and patients call him Dr. Robby) later says as he begins rounding with his team. “And our department is mostly clogged with boarders. Those are admitted patients waiting for a room upstairs, sometimes for days.”

This all happens within the first ten minutes of the first episode. A hospital stretched beyond its capacity and staff straining to keep up with demand is the predominant theme throughout the series.

It is also the predominant concern of hospitals across Massachusetts and New England. Hospitals are struggling to discharge patients to post-acute care, bottlenecking access for people who need to be admitted, as Dr. Robby alluded to. Workforce shortages across all parts of the healthcare system and a lack of availability for primary care contribute to this crisis. We see all these issues manifest with each episode of The Pitt, as the waiting room continues to fill up, and as patients are treated in the hallways.

Burnout, Depression, and Physician Wellbeing:

Physician burnout has been a widely reported public health crisis for well over a decade. Doctors continue to leave medicine, often due to time-consuming administrative burdens such as billing or documenting in the electronic medical record. But it is also a product of larger frustrations with the healthcare system that obstruct patient care and are out of physicians’ control.

 “The Pitt” does not shy away from this issue. A tense conversation between Dr. Robby and another attending physician early in the first episode alludes to the fact that doctors are at a higher risk of suicide and suicidal ideation than the general population. At multiple points, we flash back to Dr. Robby’s traumatic experiences working in the ED during the height of the COVID-19 pandemic – a crisis that caused physician burnout rates to reach record highs nationwide.

After he compassionately supports a family fulfilling their father’s end-of-life wishes, Dr. Robby fights a panic attack as he remembers trying to prevent his mentor’s passing from COVID. We see him try to push forward, prioritizing the patients and staff in his ED over his own wellbeing – despite the gentle urging of his colleague to take care of himself.

Racial Health Disparities:

Throughout the show, we see examples of how systemic racism in healthcare harms patients and creates disparities for communities of color. In the second episode, EMTs restrain a Black woman who has sickle cell disease as they bring her into the emergency department on a stretcher. They ignore her excruciating pain and mischaracterize her sickle cell crisis as an attempt to obtain drugs, threatening to call the police. A resident physician steps in to administer needed pain medication and apologizes to the patient for how she was treated. We later learn the doctor is researching racial disparity in the ER and hopes to improve how her hospital treats patients with sickle cell disease.

In other instances, a resident remarks that the legal consequences for the parents of a four-year-old who ingested weed gummies would be more severe if they were not white. Later in the season we watch a mother’s appreciation when she learns her teenage son is about to be treated by a physician who looks like them. “This is the doctor you want. I promise you,” she says when her son asks if a “dude doctor” can treat his testicular torsion instead.

Looking Ahead

As of this week, we are only just over a third of the way through Dr. Robby’s 15-hour shift. But several other timely issues are making their way into the storyline. There are hints of a consolidating healthcare market. There are pressures to balance time spent building patient relationships with volume of people seen – all while improving patient satisfaction scores and coding thoroughly in the electronic medical record.

It will be interesting to see what other issues come into play as the season progresses. Perhaps insurance reimbursement and payor mix? Or how home health might prevent some of these patients from needing the ED?

By centering this team of clinicians in its story, “The Pitt” shows us what is happening in our healthcare landscape, and hopefully builds more awareness towards fixing the problems facing healthcare providers each day.