"The Pitt" is TV's newest and biggest hit. Premiering with a 95% rating on Rotten Tomatoes and averaging 10 million viewers across its 14-episode season, the show is a bona fide smash according to all metrics. It's also an extremely complicated show to make, with a broad cast of characters who comprise the entire team of the hospital's emergency room.

In many ways, the show is a throwback to network medical drama "ER" (which has been the source of a much-talked-about lawsuit), but it has innovated with certain modern touches to bring the medical drama into the 21st century. The flashiest examples are its hard-edged realism, which produces tension by accurately reflecting what being inside an emergency room is really like, as opposed to the soap opera antics of other medical dramas.

The show is also innovating behind the scenes in how it pays its cast members. Normally, actors audition for a...