New Blood and Respect for Its History: How Grey's Anatomy Keeps Things Fresh After 20 Seasons

Last week, Grey’s Anatomy was renewed for a 21st season, making the ABC series television’s longest-running medical drama, and the third longest drama currently on TV after CBS’s NCIS and NBC’s Law & Order: Special Victims Unit. In the current television landscape of shows that have eight-episode seasons, that often end after three or four seasons or disappear into the ether entirely, this type of longevity is increasingly rare. 

What makes Grey’s truly stand out, however, is that the quality is still there. Meg Marinis took over as showrunner for Season 20, and not only has the series not missed a step, it is experiencing a creative resurgence. Only two of the original cast members (Chandra Wilson and James Pickens Jr.) remain part of the regular cast. Yet, for many loyal viewers, Grey’s Anatomy remains their person. The series outlasted not one, but two spin-offs: Private Practice ended its six-season run in 2013 and Station 19 will come to a close this spring after seven seasons. Grey’s is consistently one of the top 10 streamed shows.

As the truncated 20th season — the result of 2023’s dual industry strikes — reaches its midway point with “Never Felt So Alone,” it’s a great time to ponder: What is it exactly that makes this drama still so successful after 424 (and counting!) episodes?

It remains current

Grey’s Anatomy has long been on the forefront of groundbreaking television. When it premiered in 2005, it featured one of the most broadly diverse casts on network TV. Over the years the show has introduced gay characters, transgender characters, bisexual characters, and nonbinary characters. It has tackled an array of socially relevant topics including racial profiling, gun violence, human trafficking, hate crimes, Alzheimer’s disease, and sexual assault. 

In Season 19, as the right to an abortion was being stripped away state by state, the series saw Dr. Jo Wilson (Camilla Luddington) perform an abortion on a patient in almost real time, showing it for the medical procedure that it is. Dr. Miranda Bailey (Chandra Wilson) and Dr. Addison Montgomery (Kate Walsh) became the target of anti-abortion activists because of their dedication to teaching medical students about reproductive health. 

This season, Dr. Griffith (Alexis Floyd) unwittingly told a patient he was HIV-positive, leading to conversations about PrEp and sexual health. Meredith (Ellen Pompeo) is doing groundbreaking research on the causes of Alzheimer’s. Her controversial theories and clandestine studies undermine all the research conducted by her late husband Derek (Patrick Dempsey).

The medical cases are bonkers (in a good way)

In the four episodes of Season 20 so far, a man got crushed while trying to cross the Pacific Ocean in a self-propelled floating bubble. Simone (Alexis Floyd) and Lucas (Niko Terho) performed an ex-lap surgery while a self-driving car repeatedly crashed into an ambulance they were in. Linc (Chris Carmack) removed damaged spinal discs and Jo (Camilla Luddington) delivered a premature baby in the same patient basically at the same time. Arizona (Jessica Capshaw) returned to the hospital to perform surgery on a baby’s brain in utero. “So, who wants to make history?” she asked. 

It remembers its past…

Meredith may have moved to Boston, but Pompeo still narrates the series and shows up in episodes. This season has already seen the return of Levi’s (Jake Borelli) ex-boyfriend Nico (Alex Landi), and Jessica Capshaw as pediatric surgeon Dr. Arizona Robbins. While visiting Grey Sloan Memorial Hospital, Arizona name-checked both Dr. Cristina Yang (Sandra Oh) and Dr. Nicole Herman, a role played by Geena Davis in the show’s 11th season. (Alas, Arizona gave no update on her ex-wife Callie or their daughter Sofia). 

When Addison Montgomery returned in Season 18, she delivered a variation of her now-iconic line and told the interns, “And you must be the group that’s been screwing up the program.” Dr. Bailey became head of the intern program at the end of Season 20 premiere, and capped off the episode by announcing “I have five rules,” the same thing she said to the five original interns in the very first episode of the show. 

Of course, these interns are constantly making mistakes and disobeying orders just like their predecessors. “You think your class wasn’t as bad as this one?” Miranda asks Meredith in the season premiere. And let’s never forget that in the darkest days of the global pandemic, the show brought back Derek (Patrick Dempsey), George (T.R. Knight), Mark (Eric Dane) and Lexie (Chyler Leigh). Sure Meredith had to almost die for viewers to see them again but it was so worth it.

…While always looking to the future

Bailey may be back to her “five rules,” but the series is constantly reminding viewers that times have changed since she was first in charge of the intern program. “This generation, they ain’t afraid to push back,” Bailey’s husband Ben (Jason George) tells her. The show has basically had a revolving door of new interns but this last batch, introduced at the beginning of Season 19, was the perfect mix. Each one so clearly emulated the original cast while bringing just the right amount of angst and drama. The consistently strong casting allows the show to thrive despite turnover. 

The romances

This is a series built on the romance between Meredith and Derek, but the rest of the characters are swapping partners constantly. You would be forgiven if you had forgotten that not only had Amelia (Caterina Scorsone) and Linc been romantically involved but they actually had a child together. 

Many of the potential romances you can see coming all the way from the hospital parking lot. There’s no way that Natalie Morales’ Dr. Monica Beltran wasn’t brought on as a new potential romance for Amelia, who’s been so despondent that she’s been single for five minutes that she’s started having deep meaningful conversations with her cat. Jo and Linc are acting on years of simmering feelings for each other by finally embarking on a romance (too bad a patient died because they were busy hooking up). Simone and Lucas are the next-generation Meredith and Derek. On-call rooms and elevators have never been more steamy. 

Amy Amatangelo is a writer and editor. In addition to Primetimer, her work can be found in Paste Magazine, Emmy Magazine and the LA Times. She also is the Treasurer of the Television Critics Association.