In June, ACEP Now brought you the story of emergency physician and documentary filmmaker Ryan McGarry, MD, and his film Code Black, which chronicles life in the emergency department at University of Southern California Los Angeles County General Hospital. With a successful film launch under his belt and a television pilot being explored, Dr. McGarry recently sat down with ACEP Now’s medical editor-in-chief, Kevin M. Klauer, DO, EJD, FACEP, to provide an update on the film that has brought the reality of work in the ED to audiences nationwide.

KK: How did the opening of Code Black go?

RM: One could describe Code Black as a series of small miracles. It probably feels very similar to anyone who’s embarked on a push for a major grant. You get the grant, you’re so relieved that you got the grant, and you realize, “Oh my gosh, now that I’ve got the grant, I have to do the study.” And there are all the barriers and things that could fall through. In the same way, Code Black has been on that trajectory where at every point I’m guardedly surprised that we keep advancing, and a theatrical release is no exception.

New York was a big surprise for us. Your film is going to get reviewed by The New York Times when you open a film in New York—it’s partly why you do it—and they’ve been known to really be tough. When [the review] came out, man, was it great! They made us a Critic Pick, which is a pretty high honor; only a handful of films get that each year. New York is a pretty competitive place, and we held for two weeks there, which is very strong for a documentary, seeing that every Friday new films come in.

Dr. McGarry

We premiered in L.A. a week later, and the L.A. Times gave us a glowing review. We held strong almost for six straight weeks here, which is really unusual for any film in the summer but especially for a documentary is almost unheard of.

KK: How many people have seen it so far?

RM: Around 50,000, including the festival screenings and everything else. Keep in mind that people see movies now at home on their laptops, on Netflix, on iTunes, so that’s still to come. We will be on those platforms around the holidays. We expect the greater viewership to occur at that time.

KK: Any criticisms from viewers?

RM: Some of the Q&As have been a little tough. They have all been very civil, but we’ve been challenged with people asking complicated questions, for example, “Your film doesn’t offer any solution. Why did you do that? What is your solution to health care?” My answer was, “Hey, the solution is thinking. Our problem with health care is that in our country we haven’t really defined yet what our lowest level of care is. What is the lowest level we’re going to accept? And, unfortunately, in too many places it’s still none.” The goal of the film was to create a bit of a primer for dialogue that maybe didn’t exist before. There’s plenty of polarizing films that are going to present to you one solution. I don’t think you want us to do that as artists, and as a physician, I don’t have enough experience yet to proclaim some answer.

KK: What opportunities have come from this success?

RM: There is interest in making Code Black into a drama/fiction series. CBS has officially cordoned it off for a pilot. We’re in competition with two other medical pilots.

KK: What would your role in the show be?

RM: I would be involved day-to-day in the writers’ room as an executive producer, and I would have a great interest in directing episodes as well.

KK: Any other opportunities?

RM: There is very early talk of an awards season run. We have no expectations, but we’re excited about the possibility of emergency medicine being exposed at that level.

KK: What awards are you looking at?

RM: You enter the market hoping to be eligible for an Oscar—I’ll just go out and say it. The field is very competitive, but [documentaries] are really tough films to get made, and so there are only about 300 films a year that are actually eligible, maybe even less. That’s still a huge pool, but it’s also not 10,000. [To be eligible, you have to] run in L.A. and New York for one week multiple times a day in a commercial theater—you cannot have just private screenings and qualify. I can say that in the earliest of early tracking, we’re in the running for the short list.

Dave Pomeranz, MD, Ryan McGarry, MD, at bedside.

KK: What’s next?

RM: We’re showing the film at many grand rounds. What a great honor to come and visit with colleagues and show them a story about scenes that we all know. The film will then go on to what’s called the ancillary platform—iTunes, Netflix, DVD, and all that good stuff. That will be around the holidays.

For me, the next challenge is can we create the next great ER show. Whether you loved it or hated it, there was no doubt that ER the TV series influenced America’s vision of what emergency medicine was, often in positive ways. I don’t think we’ve had a show like that on any major platform for a while. [We want to] create a fiction series that touches people and shows them the challenges of the field and ultimately proves that emergency physicians have the combined challenge of being methodical, almost machinelike, in their intensity and pace at times, but also have the incredible ability of being humanistic and healers.

KK: You recently started your first position out of residency. Are you cutting back on your shifts yet?

RM: No, not yet. I’m still full-time for the moment and partly out of respect for where I am in my training. I think young attendings, and even veteran attendings, are all continuously learning. If things start to really pick up on this CBS project, I’ll have to revisit some things. I will say this much: I would never give up my clinical shifts, even if I had to do one every two weeks—just something to stay fresh. [Med school was] too much of an investment to abandon and too much of something that my brain needs to be present. If I suddenly took that away, it would screw up the equilibrium, and I don’t know if, even creatively, I would be as functional.

KK: Final thoughts?

RM: I feel relieved that we’ve been able to make something that sort of brings our specialty together. When we’ve shown it across the country—whether it’s from academic or private programs, public or not-for-profit, and everything in between—it is nice when, as physicians, we all come together and say, “There are themes in here that we all know and all live with together.” There’s something powerful in that.