Timely stories, inspiring legions of medical students and empowering women (and its cast): showrunner Krista Vernoff and star Ellen Pompeo and the rest of the cast talk with The Hollywood Reporter about breaking 'ER's' record as TV's longest-running medical drama.

Two weeks before Grey's Anatomy's March 2005 series debut, star Ellen Pompeo thought her ABC medical drama was, in her words, "dead in the water."

"The day the network changed our title to Complications it was like someone died in here," leading lady Pompeo tells The Hollywood Reporter from the show's L.A. set during an early January visit.

The title change would not stick. Two days later, ABC would revert back to Grey's Anatomy and, now, 14 years and 332 episodes later, Grey's Anatomy, with Thursday's installment, will break ER's status as TV's longest-running primetime medical drama.

It's a feat that creator Shonda Rhimes and showrunner Krista Vernoff, who spent the first seven seasons working under the former, never expected during the show's early days.

"After we produced 10 of our 12 episodes that first year, I went away to make a pilot and my assistant stayed behind in L.A. and she called me and said, 'They're making us pack up our offices.' They made us move out. They didn't think we were getting a season two," says Vernoff, who worked with former ER showrunner John Wells on Showtime's Shameless before being handpicked by Rhimes to take over Grey's in season 14. "We owe a huge debt of gratitude to ER — without it, Grey's wouldn't exist.… We have surprised everybody — and ourselves. The staying power is amazing."

And the Seattle-set drama really does have some staying power. Seriously. It ranks as ABC's No. 1 series for the 2018-19 broadcast season with an impressive average of a 3.1 rating among the advertiser-coveted adults 18-49 demographic. Grey's is also, sources say, one of Netflix's top performing acquired series. The streamer has helped bring in a new legion of viewers that further propels first-run originals on ABC. What's more, Grey's has global reach: It is the key asset among all the Shondaland shows that have been licensed in more than 235 territories worldwide and dubbed in more than 67 languages. Grey's remains a top performer for foreign broadcasters and has been adapted into localized versions in Mexico, Colombia and Turkey. The series remains a top-performing U.S. drama abroad.

"It's a $4 billion business and it's everywhere in the world," says Pompeo, who ranks as TV's highest-paid leading lady on a primetime drama series with $20 million per season (plus points of the show's lucrative backend and producing fees). Adds Vernoff: "Shonda says I'm leading a multibillion-dollar worldwide corporation but if I think about that for too long, I won't be able to get out of bed!"

Global Reach

Every single one of the current 11 Grey's series regulars has a story about the impact of their show. Most of them include anecdotes from viewers — and their children — about entering the medical field and becoming surgeons and nurses because of Grey's. "Graduating female surgeons have gone through the roof since Grey's Anatomy started," says Caterina Scorsone, who is the only (primetime, live-action) actor to start on a spinoff as series regular and wind up holding the same status on the original series.

Kevin McKidd — who was originally cast as a love interest for Sandra Oh's Cristina Yang and has now appeared in more Grey's episodes than the Killing Eve star did during her tenure — was recognized a few years ago on a dirt road in the "middle of nowhere in Mozambique," where he was helping a doctor friend improve conditions at a local hospital. "To see that in the farthest reaches of a very poor and struggling country there was this show that inspires people was pretty emotional," he says.

TV legend Debbie Allen, who exec produces, directs and has a recurring role, says she's now approached more about her time on Grey's than her iconic part on Fame. "I was in Cuba and accosted by these young girls who were screaming, 'Catherine Avery!'" she says with a laugh.

Giacomo Gianniotti, who has been a regular since season 12, is now repeatedly spotted in his home of Italy. "Because I'm Italian, there's this pride — like one of us made it to America and made it on our show that we watch," he says. "I traveled to Kenya doing some volunteer work this summer and a lot of people approached me to say they love Grey's. The reach is just huge."

Sums up Pompeo, who had an impact offscreen when she fought for her record-breaking salary: "Everywhere I go I get, 'My daughter is a surgeon because of you.'"

Empowering From the Start

Grey's was the first TV series creator Rhimes got on the air. (ABC previously passed on a Rhimes drama about female war correspondents).Grey's broke out in season two and became a cultural phenomenon, contributing terms like "vajayjay" and "McDreamy" to pop culture. Grey's has also birthed two spinoffs — Private Practice, which ran for six seasons and 111 episodes — and Station 19, which is currently in its second season on ABC. The success of Grey's has led to other opportunities for Rhimes, who really broke out with ABC's political soap Scandal. That series built on Rhimes' penchant for color blind casting on Grey's. (Former star Isaiah Washington nearly played the McDreamy part that went to Patrick Dempsey, while network execs expected Oh's role of Cristina to be played by a white actress.)

"When they had me come in to read for the role of chief of surgery, I hadn't seen an African American in that kind of role before," says James Pickens Jr., who remembers sitting next to Rhimes at the 2005 upfronts when she hoped to get five or seven episodes on the air. "Grey's is more than just entertainment. Shonda always wanted to make sure that the show impacted the landscape in a way that we hadn't seen before on TV. I like to think that Grey's had a big part in how the industry casts shows."

In addition to Rhimes' breakout success — she left her longtime home at ABC Studios last year for a $300 million Netflix overall deal — the cast has also been able to add to their skill sets. Grey's has launched directing careers for stars including showrunner Vernoff, Pompeo (who made her debut in season 14), Jesse Williams, McKidd and Chandra Wilson, the latter of whom helmed Thursday's record-breaking hour. (Former star Sarah Drew also earned an Emmy nomination last year for directing a Grey's digital short.)

"The atmosphere here is if you want to try something, you're encouraged," says Wilson, who along with Pompeo, Justin Chambers and Pickens is one of the four remaining original stars.

For Williams, that outlook has also afforded him the opportunity to build up his own businesses. "Grey's has made a home for me so that I can launch three tech companies and can go on speaking tours and live a life. A lot of that has to do with being on a show that's run by women and people who can actually multitask," says Williams, who will direct again this season.

Grey's has also created a safe space for its (many!) pregnant stars, who have always been afforded job security. Wilson, for her part, thought she'd be written out of the series when she told Rhimes of her pregnancy early on in the show's run. Instead, it was written into Bailey's season two storyline (and the character's son is now old enough to have been featured in a season 14 episode exploring unconscious bias).

"Instead of shunning it and hoping you don't get pregnant, I watch producers actively encourage all of our actors to have a family," Williams says. "That is the formula and secret for longevity: feeding into a healthy life and happiness instead of running from it or trying to press you out of it."

Opening Hearts, Changing Minds

Beyond creating a new legion of directors and producers (Pompeo has an overall deal with ABC Studios and produces both Grey's and Station 19), the long-running medical drama has made an impact onscreen with empowering storylines. More recently, Grey's has explored domestic violence with Camilla Luddington's Jo, unconscious bias and new stories for transgender characters. Grey's this season features a same-sex relationship with its first openly gay male surgeon (Alex Landi, whose Nico is romancing Jake Borelli's intern, Schmitt) as part of its "Season of Love." The latter is especially true for Pompeo's Meredith, who is now exploring serious relationships after losing her "person" when Dempsey's Derek was shockingly killed off back in season 11.

"The most empowering storyline for me has been to portray a woman who has lost the love of their life and what does life look like having to continue on after losing the right side of your body? Did his departure mean I no longer mattered or my magic and chemistry was somehow gone? We saw that I could stand on my own and that women who do lose their partners or children, there is a way for people to go on. To be able to portray someone who could go through the hardest thing you could go through — the death of a loved one — and to be able to portray the survival of that is the most meaningful," a tearful Pompeo says, comparing Meredith's loss to the passing of her own mother at a young age. "After that, you think you can't go on.… So it's all come full circle."

Other castmembers point to medical storylines that have helped viewers diagnose loved ones. Wilson is especially proud of the cyclic vomiting syndrome episode, while Chambers singles out exploring mental illness with Alex's mother in a storyline first planted in the show's early days. But all involved can point to several subjects the series has explored that have helped open minds and let viewers see versions of themselves on TV.

"Callie and Arizona's wedding was a really big deal and you think of the different countries that the episode was broadcast in and they may not have thought they were ready for big things like that," Williams says. "Whether it was the transgender young woman I just met who felt like she was included because she saw a trans patient whose storyline wasn't focused on her trans-ness, or the police violence episode — which is close to the work that I do — the running theme is allowing people to feel seen and considered."

And sometimes the impact Grey's is making is subtler than a storyline or patient.

"I've had black women say that I'm the reason they decided to go natural with their hair," says Kelly McCreary, who has played Meredith's half-sister, Maggie, since the end of season 10. "If seeing me onscreen representing our hair in its natural state freed viewers from any ideas they had about that being bad, unattractive or unprofessional or whatever else they're trying to feed us about it, that's remarkable."

Doing Something New (That Still Feels Familiar)

Everyone on the Grey's call sheet will give credit for the show's creative and ratings resurgence to Vernoff, who as Chambers says, "hit a refresh button and reinvigorated the show." Kim Raver, who reprises her role as Teddy after previously serving as a series regular for seasons six through eight, feels the same old-school energy now that she did a decade ago and credits Vernoff for "infusing the quintessential Shonda Rhimes vibe of it." And while Vernoff smiles when told of the cast's kind words for her work, she is aware of the power that comes with writing for a beloved character like Pompeo's Meredith Grey.

"When Meredith Grey speaks, people listen," says Vernoff, who recently signed a big overall deal with ABC Studios. "There is so much darkness and so much to be frightened of and this show has so much impact. People have grown up with Meredith. So, my goal is to have a voice on the planet and to have an impact: to change hearts and minds."

Vernoff is aware that she is already achieving that impact. The showrunner — who has been outspoken about timely issues surrounding Hollywood including the #MeToo movement, salary parity and more — recalled a recent conversation with Rhimes in which the Grey's creator shared a story from a makeup artist who noted that his brother is a Korean gay man and was moved to see himself represented onscreen. Other highlights include hearing from a current Grey's writers PA who wrote a letter sharing a story about experiencing his father's death at the age of 16 and finding solace in a storyline with George (T.R. Knight) and Cristina talking about the "Dead Dad's Club."

"To put my painful loss on TV and help other people through that is deeply meaningful to me," Vernoff says of the origin of that storyline.

As for what comes next, Vernoff did not want to write in a wink and nod to ER — fitting given her relationship with Wells on Shameless and the fact that the former NBC medical drama was one of the series that made her want to be a TV writer in the first place. Instead, Vernoff opted to do something that Grey's had never done before.

"In the 300th episode we did a huge number of winks at the show's history and beginnings. I don't know if ER did it or not but what I came up with was a no-medicine episode," Vernoff says of the Grey's first. Adds McCreary: "We're in this party scene and I keep waiting for somebody to need a tracheotomy! But instead it's great because it feels like a real celebration of these characters."

Meaningful Milestone

As the episode doubles as a celebration of sorts of the record-breaking milestone, the stars all share the same refrain when asked about the significance of doing a whopping 332 hours of television. All involved recall their initial shock that the series few thought would work has become the powerhouse franchise it is today.

"My goal was to do the pilot, take the check and pay some bills!" Wilson recalls with a laugh. Adds Chambers: "When we were in season two, I'd say to everybody, 'Do you think we've got two more years? I just wanted to get my kids to college.' And now some of them are done with it!"

Pompeo also points to the record's value in the current TV landscape where viewers have an option to pick from nearly 500 scripted series and 700-plus unscripted offerings on an array of platforms as competition for eyeballs expands to other forms of entertainment like video games and podcasts.

"The fact that we're still the network's No. 1 drama and can stay afloat in this landscape after 15 years is incredible," Pompeo says. "It's also incredible in a larger sense because it's something that I resisted [and] that I said I would never do."

For his part, Williams has now appeared in more than two-thirds of Grey's Anatomy's total episodes after first joining the cast as recurring player Jackson Avery in season six. It's a jarring fact for the actor who initially thought the show would only be around for only a few more seasons when he first signed on. He now scoffs at those who use Grey's Anatomy as a punchline.

"That response — 'Oh, Grey's is still on' — at first, I took offense to it but now I don't because it's not really about our show; it's about the business because shows don't last that long," says Williams, whose tech companies are all inspired by the message of visibility he sees every day on Grey's. "I'm really proud of what we do here — I wouldn't be here this long if I wasn't."

The Future

While Grey's has not officially been renewed for its 16th season, it's considered a lock as Pompeo's deal covers the 2019-2020 broadcast season. ABC Entertainment president Karey Burke and ABC Studios topper Patrick Moran both bow before what Pompeo and Grey's have been able to accomplish. "We are awed by this rare and incredible achievement," Moran says. "To make 15 seasons of television that are creatively fresh and compelling — and now record breaking — is almost unheard of, but Shonda, Betsy Beers, Krista, Ellen and the incredible cast and crew have managed to do that. We're very proud of this show and this team." Adds Burke: "How fitting and well deserved it is for Grey's Anatomy — a show that never ceases to inspire, surprise and move us — to achieve something no other primetime medical drama can lay claim to. The creative bar set by Shonda, Betsy, Krista, Ellen and the entire cast and crew will keep this iconic show in rarefied air for generations, and as one of their millions of fans, I congratulate them on this historic milestone."

Pompeo, too, knows she has experienced something special in her decade and a half on Grey's, where she has been afforded a rare ability to evolve Meredith as a character while growing as an actor and producer. "I've come full circle on this show from being an actor with no voice, no say and terrified to speak up or advocate for myself in any way," Pompeo says. "I'm now someone who is heard here and who has a say here. I'm one of my bosses and that's an unusual situation for an actress in Hollywood — to get to say what I want and what I don't. If I left the show, I don't think I'd have that same situation anywhere."

That's not to say Pompeo hasn't toyed with the idea of leaving Grey's over the years. The actress has been candid many times about experiencing the nagging pull many stars on veteran series experience as they consider leaving and taking on new and different roles. But at the end of the day, the idea of stepping away from something as big as what Grey's Anatomy has become has proved impossible.

"You can't ignore the worldwide phenomenon that this show is. How do you walk away or ignore that?" Pompeo says. "Being the face and voice of something that can generate that much money, there's only a very small number of people who can say that they have achieved that. If you're lucky enough to be the face and voice of something that's generated billions of dollars for a network, that's something to be proud of."

Meanwhile, Pickens is in talks for a new deal that would see him continue on as Grey's Anatomy's elder statesman Richard Webber. ("Nothing is solid yet but more than likely, I'll be here," he says.) Pickens adds the thought of going after Gunsmoke or Law & Order: SVU — the latter of which will break the former's record as TV's longest-running primetime drama series when it is renewed for its 21st season — remains "intriguing." Wilson, for her part, has one goal in mind now that Grey's has snapped ER's streak. "I would love to be a starter and a finisher of a thing," says the original star, whose contract is also up this season. "When the show is ready for that last shot, I want to be in that."

Seeing Ghosts

Of the many notable cast departures, Vernoff, Pompeo and the cast all have quick answers at the ready when asked about which former Grey's co-stars they'd like to bring back to Prospect Studios:

Pompeo (Meredith): "I would love for Sandra Oh to be on the show but not more than I love seeing Sandra Oh out there in the world doing her thing. Not more than I love seeing her shine on her own at the Golden Globes and on Killing Eve. So I would say no [to that]. I love everybody who has been on this show, regardless of their time here and whether it was tumultuous or not."

Chambers (Alex): "Richard Herrmann. He played my intern for a while and was such a joy to work with. He passed on but I felt very lucky to work with him."

Wilson (Bailey): "Bailey was crazy about George O'Malley. But the thing about our show is we always keep our past characters alive; there is nobody we don't ever not talk about because every one of those characters has been the foundation for why we're here."

Pickens (Richard): "I've been in this business almost 40 years and Sandra Oh brought something very special to every scene."

McKidd (Owen): "Sandra Oh's Cristina, especially the way things are right now with Amelia, Teddy and Owen. To throw her into the mix at the same time? Owen would literally keel over and never get up again."

Raver (Teddy): "Sandra Oh. I started off having crazy, intense scenes with her — like when Henry (Scott Foley) was dying and I love her as a friend and admire her as an actress."

Williams (Jackson): "Frances Conroy. She was here in season seven and I didn't get to work with her. She is tremendous and was on one of my favorite shows ever: Six Feet Under."

Luddington (Jo): "Kyle Chandler. I love Friday Night Lights."

Scorsone (Amelia): "Chyler Leigh (Lexie). She is so much fun and is great with drama and comedy. I'm sad that I didn't get to work with her more."

McCreary (Maggie): "Kate Burton. I'd love for Maggie and Ellis to interact. Kate and I did a play together in 2014. She's one of my favorite people."

Gianniotti (DeLuca): "Jessica Capshaw. We would laugh until snot was coming out of our noses. I miss having her around."

Allen (Katherine): "I had so much fun directing Patrick Dempsey when he was here. I nicknamed him Dash because he would come on the set, look at his watch and want to keep it moving. He never liked to do a lot of takes but was always great. I didn't get to act with him but I did some of his best scenes while I was here. We think of him fondly."

Vernoff (showrunner): "Sandra Oh. I miss writing for Sandra and Cristina."

Grey's Anatomy's record-breaking episode airs Thursday at 8 p.m. on ABC.