We Finna Be in the Pitt: An ER Doctor’s Review of The Pitt

HBO Max’s The Pitt is a medical drama that has taken television by storm. Each season of the Emmy-winning show follows a day in a Pittsburgh emergency room, with each episode comprising an hour of one shift. The Pitt has received lots of praise for its realistic portrayal of emergency medicine and for highlighting the nuanced issues American healthcare faces in a post COVID-19 world. Is this praise warranted? 

John Wiesenfarth, MD, is an attending physician with the Hawaii Permanente Medical Group. Wiesenfarth has been working in emergency medicine for 28 years and gave his insight and opinions on the show. “There’s a Facebook group of emergency medicine docs, and a lot of chatter about The Pitt is having your family watch it, because that’s the closest thing to explaining what your job is like,” Wiesenfarth said. 

“A Nice Move” by MTSOfan, available under CC BY-NC-SA 2.0 at Flickr.

The show’s accuracy can be attributed to its production team, which comprises healthcare professionals. Joe Sachs, MD, a writer and producer for The Pitt, is an ER physician who obtained his master's in filmmaking while in medical school. Mel Herbert, MD, is another writer and medical adviser for the show. Herbert is an emergency physician and author who has developed new ways of educating ER doctors, including EM Rap, which is an emergency medicine audio series for emergency physicians. 

Sachs and Herbert, along with the rest of the team of medical advisors, help with script writing, scene choreography, props, effects, and set design to create a realistic show that makes viewers feel like they are working in an emergency room. “You got two guys that actually have been doing emergency medicine for a long time and they're kind of tied into the pulse of emergency medicine across the nation. So I think they do a very good job at bringing those issues to light,” Wiesenfarth said.

A recurring theme in The Pitt is the struggle of striking a balance between profit and quality patient care. The show’s first season unravels a complex relationship between attending physician Michael Robinavitch (Robby) and the hospital’s chief medical officer, Gloria Underwood. The two engage in a game of ideological ping pong, with Underwood expressing repeated frustration with his team’s low patient satisfaction scores while Robby attributes them to long wait-times and understaffing, which are in her administrative hands.

 “I can tell you understaffing is a big issue… a lot of people, because of money-making, understaff knowing that most people go into medicine for altruistic reasons,” Wiesenfarth said. “Administration expects people to step it up the best way they can, and by applying the pressure of being understaffed, they know they can get more work out of people.” 

Because of the pressure placed on physicians to go through patients quickly, social workers are essential to supporting patients emotionally. “I actually love the social workers,” Wiesenfarth said, "because they fill a void that is hard to fill. We’re constantly multitasking and, as you see, running from one issue to the next. Social workers can sometimes spend a little more time with the patient.”

 Kiara, the emergency department’s in-house social worker, provides vital support to patients and physicians in The Pitt. Over the course of the show, we see her provide patients with numerous kinds of support, from financial to grief counseling. When the physicians see patients experiencing sexual assault, trafficking, abuse, or neglect, Kiara is seen spearheading the team’s response to the situation. 

The Pitt also portrays numerous patients who are ‘boarded’ in spare hallways for hours at a time. ‘Boarding’ refers to the process of patients being held in the Emergency Department, even after they have been treated, due to the understaffing of inpatient wards. “[The hospital] doesn't want to staff beds unless they're gonna be used, because they don't want to lose money,” Wiesenfarth said. “When they say there's no beds upstairs, what it means is they didn't staff the beds.” 

Myrna and Earl are two boarded patients who become semi-regulars in The Pitt. The characters continually make comedic appearances despite having already received medical treatment, highlighting boarding as a consequence of chronic understaffing in American healthcare today. 

In episode 6 of the show, Underwood introduces Robby to Tracy Morris, regional manager of a private equity contract firm called ECG America. She says that if Robby can’t improve the hospital’s patient satisfaction scores, they’ll consider ECG’s offer to buy the ER. Private equity firms in healthcare use investor funds to buy, staff, and manage facilities. 

The presence of private equity in American emergency departments has grown in recent decades, along with ethical concerns regarding the profit-driven model. In 2022, NBC reported that over 40% of the country’s emergency departments were staffed by private equity staffing firms. 

“The rich guys realize that there's a lot of money in this, and doctors are bad business people, so private equity is coming in and buying up these doctor groups,” Wiesenfarth said. “So that’s kind of the business in medicine, and it’s a little uglier than you think.” In The Pitt, Morris boasts that hundreds of ER’s owned by ECG have seen improvements in patient satisfaction and turnover, while Robby criticizes her firm for prioritizing profits above all else. 

A recent report by the American Medical Association found that emergency medicine physicians experience higher rates of burnout than any other specialty, with 49.8% experiencing at least one symptom of burnout. “I think the burnout wasn't as much of an issue when I started 30 years ago, probably over the last 15 or 20 years, and I don't know if that's just societal pressures, or the pressure of corporate America coming in and taking over emergency departments,” said Wiesenfarth. 

In The Pitt, Robby shows repeated symptoms of burnout, with his fragmented mental state preventing him from running the ER smoothly. Robby has multiple panic attacks throughout the shift, becoming increasingly agitated in his interactions with both staff and patients. 

To combat burnout, Wiesenfarth emphasizes the importance of self-care. Robby decides to take a motorcycle trip sabbatical at the end of season 2, which mirrors Wiesenfarth’s own experiences as he once hiked Everest Base Camp with a few of his coworkers. “I'm like, you know what? I need this. My kids are grown, and I just need my getaway,” Wiesenfarth said. 

Wiesenfarth transferred to Kaiser Permanente Maui from his original site in Sacramento a few years ago and continues to practice medicine part-time. “Nobody's measuring me on how many patients I see, how fast I see them. I can go, you know what?
 I got all the time in the world.” Wiesenfarth said. “That has been very psychically healing.” 

The Pitt stands out amongst other medical dramas for its commitment to accuracy and its exploration of hard-hitting social issues. Healthcare workers, including Wiesenfarth, think the show can educate viewers about emergency medicine and foster a greater appreciation for those who keep ERs running.

By Bella Leite, Pranu Niraula, and Joyana Saha