SPOILER ALERT: This interview contains major spoilers from “Collide,” the Season 23 premiere of ABC’s “Grey’s Anatomy,” streaming on Hulu.

There’s a new sheriff in town at Grey Sloan Memorial Hospital.

In the Season 23 premiere of “Grey’s Anatomy,” the doctors of TV’s most indomitable hospital are convened for the grand opening of a lavish new VIP floor. Ostensibly designed to give wealthy patients a luxury stay — complete with private suites, high-level security, hotel-quality bedding and access to private chefs — the venture is backed by Seth Norton (James Wolk), a physician-turned-businessman who also happens to be Grey Sloan’s new chief of surgery.

Following the simultaneous departures of former chiefs Owen Hunt (Kevin McKidd) and Teddy Altman (Kim Raver) at the end of last season, long-time fans might have expected another familiar face to take the helm. Instead, showrunner Meg Marinis opted for a corporate outsider, using Norton’s appointment to reflect the stark financial sacrifices modern hospitals must make just to keep their doors open to the general public.

“I was really interested in this idea of a VIP floor and exploring the upstairs-downstairs of medicine, which is really being talked about lately. The healthcare disparity is only growing more, unfortunately, and it’s something that felt very topical,” Marinis tells Variety. “We at Grey Sloan have always provided VIP care to the entire hospital, but I wanted to see what that conflict would look like for our doctors.”

Meredith makes it immediately clear to Seth, Catherine (Debbie Allen) and Richard (James Pickens Jr.) that she feels like the hospital is already prioritizing corporate interests over the hospital’s standard of care. “Grey’s” has explored that friction in the American healthcare system before, but what new sides of that conversation are you looking to open up this season?

I think it’s different, because Meredith is now not just a resident, she’s an attending who also has an ownership stake in the hospital. The risk of a hospital shutting down and patients losing all their doctors, all their care — that is something you have to really balance. We will explore what it looks like when a hospital shuts down, too. It’s not going to necessarily be Grey Sloan, but you’ve seen it happen in L.A., and sometimes it can happen without a moment’s notice. It’s something I’ve always been interested in. And also, who’s going to take all those patients?

How much will we see of Ellen as Meredith this season? Will she still appear in around seven episodes like she has in past seasons?

We haven’t confirmed that yet, but I say this every year: I want her as much as we can get her. When she’s here on the show, it’s great for us. She’s got a couple of different projects happening on the side, so at this point it just becomes a scheduling game. We love Meredith; we’ll have Meredith in as many episodes as we can. We just have to respect her other projects too.

You have previously told me about how you tend to stretch Meredith’s arc across multiple episodes, so that Ellen can come in and shoot a bunch of scenes at once to accommodate her busy schedule. Did Ellen feel particularly strongly about where she wants Meredith to go this season?

100%. We talk about the creative ahead of time. I want her to feel like she has a part in the stories that we’re going to tell for Meredith. She’s played the character for 23 years. She’ll often have little things that she wants to talk about, but sometimes, she’ll see something in the news or she’ll read about something in medicine, and she’ll call me and say, “Are y’all thinking about doing this?” She’s definitely a collaborative partner, and we try to make it work. It just depends, again, on schedule.

Is Meredith’s arc going to be tied to this new patient (Martin Martinez) who is in the foster care system and potentially has cancer?

They will have more stories together. That’s not her only arc, but yes.

Scott Speedman has already wrapped production on Season 2 of “R.J. Decker,” so he will presumably be available to return to “Grey’s” this season. Will we get to see Meredith and Nick’s wedding onscreen this season?

I’m going to see him soon! That’s what I’ll say.

Bailey (Chandra Wilson) realizes that she needs to take something off her plate in order to take on this new challenge of getting her masters in public health, so she decides to name Winston (Anthony Hill) the new residency director. How much will we see of Bailey in the classroom this season?

We’ll see a little bit of her at school, but it was important to me that we still see her in the hospital, because what she’s seeing in the hospital is inspiring her educational journey. But we’ll see her on campus in Episode 2.

What are you looking to explore with Winston and Jules’ (Adelaide Kane) relationship this season, now that you have the added complication of Winston being directly responsible for the residency program?

Well, I’m exploring some mess! Because we’ve created a big old mess for them. Twenty-three years ago, this storyline would’ve been much different, but now we’re in 2026. This has been their fear for as far back as when they started experiencing this attraction — that they can’t be together. There’s a power dynamic. Honestly, maybe they were thinking about coming clean to everybody, but then he couldn’t say no to Bailey because being residency director is also good for his career. So I think they’re both flawed, right? They’re not making every decision the way they should, so I think that we’re going to see that rocky path.

At the end of last season, Toni (Jen Landon) was finally ready to take a leap and pursue a romantic relationship with Amelia (Caterina Scorsone) — until she caught her hooking up with Cass (Sophia Bush). Toni was so hurt that she felt the need to leave the state to get away from Amelia temporarily, but the two finally reconcile and share a steamy kiss in the premiere. What did you want to convey through the writing of that speech, and what’s next for them?

If you look at the history of the character of Amelia, even going all the way back to “Private Practice,” she has this tendency to self-sabotage, and I was really interested in seeing a piece of growth from that self-sabotage where she can at least acknowledge and name it. She didn’t intend to cheat on Toni with Cass because she wanted to cheat. She slept with her because she was hurt, and she thought that Toni was going back to her ex-wife. We made it look like Toni was going back with the ex-wife.

We have debates about this in the writers’ room on who was at fault here, because a lot of people are like, “Team Amelia! Toni strung her along in those last two episodes saying, ‘I might go back with her. I might not go back with her.’” But then a lot of people are like, “No, Amelia slept with somebody else! She’s dead to Toni!” So it really depends on who you ask, but I think those two actors have fantastic chemistry. I love working with Jen. I love the character of Toni and what she does also for Ben Warren. That’s a really fun dynamic to watch. We’re going to see more of that as well. So we’re just going to have to see if they can find this new happiness, but it’s “Grey’s.” We’ll throw things at them, don’t worry.

Are you planning to delve more at all into Toni’s background before Grey Sloan? Will we meet Toni’s elusive ex-wife this season?

Never say never!

Besides her personal relationship with Toni, will Amelia be dealing with anything new on the professional side this season?

Yes. This will affect all the doctors, but for her, there’ll be more of a story because some of our residents are going to have to choose what area they’re focusing on. We know that there’s a familial connection to neurosurgery, so we’ll definitely explore that between her and Lucas [Niko Terho].

Jo (Camilla Luddington) is still dealing with the trauma of almost dying while giving birth to her and Link’s (Chris Carmack) twins midway through last season. She officially quits her job by the end of the premiere. This feels particularly like a fork-in-the-road moment for her — and it’s not entirely clear if she’ll be able to go back to her old self after this experience.

We’re not going to wrap it up in Episode 2. We have a lot of people quit and then come back. But her traumatic health scare really impacted her last season. PTSD after birth trauma is something that affects so many women, and I didn’t want to gloss over the fact that it takes time to process. So we’ll see her question that, and it’s going to affect how she chooses to parent her kids. She’s a fighter. This is going to be a time of personal discovery of a couple of ups and downs. The really difficult part is she thinks that she’s the only problem at home right now, but there’s a whole other thing brewing that she doesn’t know about.

You pointed out to me last season that Link is a little bit more traditional, in the sense that he doesn’t always want to ask for help. You also mentioned that your writers’ room will explore addiction “in a more nuanced way than the stereotypical thing of seeing someone popping pills every five minutes.” What are those more nuanced conversations about drug dependency going to look like going forward?

We’re going to see him get a little bit deeper into what’s going on, and then we’ll explore those conversations. Right now, he’s in denial, right? There are stages of addiction that impact everyone. It’s a different journey for everybody, but we’re really interested in telling the story of how someone is functioning in all areas of their life, but then there’s this little secret going on. It makes it even more heartbreaking because everybody else thought everything was fine at home and at work. He will hide it at first, and then it makes it much more painful, but it will come out.

“Grey’s” being “Grey’s,” Simone (Alexis Floyd) discovers that she is pregnant with either Lucas or Wes’ (Trevor Jackson) baby. Why did you want to throw yet another baby into the middle of a love triangle on this show?

It’s going to take a few episodes to unravel, and that’s why we told the fertility story last season. We had been planning it that way. It’s different in the sense that she just found out that she may not be able to have children the old-fashioned way, so that adds another layer to it. She’s definitely not ready to have a baby, but she doesn’t know if this is the one time that she’s got. I think a lot of women have to struggle with that. Do you put everything on pause? Do you have it? Or do you make the decision to focus on your career? And is she going to go through that alone, or is she going to tell one of these guys?

Did Alexis always know that you were planning for Simone to get pregnant, or did you also spring this reveal on her when she read the premiere?

I waited to tell her until the premiere. Honestly, we planned it last season, then I wrote the premiere and didn’t do it because everyone on social media thought we were going there, and then I missed it and I put it back. So I’m as transparent a showrunner as I can be to the cast, but I didn’t want her to be stewing over that over the summer if I wasn’t sure.

Richard fired Blue (Harry Shum Jr.) at the end of last season for injecting a patient with an unapproved drug, and Blue has been keeping himself occupied by taking online French lessons. He ends up treating his teacher secretly at Grey Sloan after he realizes that she is suffering a medical emergency, and he is clearly still itching to get back to practicing medicine. What else has he been up to since his firing, and what is next for him?

For Blue, there’s been a lot of video-game playing and sitting on the couch, and he’s going through the different stages where he is in shock and denial. He’s trying to pretend that he’s fine and filling up his day with activities like French lessons, but that isn’t how it is in Episode 2. He’s saying that he’s happy being unemployed, but there’s no way that character is happy not practicing medicine. We’ll have to see whether or not he is going to sacrifice and go into something else, or if he’s not going to give up and try to get back into Richard’s good graces. Also, it’s not necessarily Richard who will let him back. Maybe there’s another way into it…

How much will we see of Harry Shum Jr. this season now that he’s busy competing on “Dancing With the Stars”?

I’ve got to give Harry Shum Jr. so much credit. I know he’s doing “Dancing With the Stars” because I was approached about it and he is on my TV, and I don’t have him on Tuesdays. But besides that, everything is completely normal, except when you see him practicing with Jenna Johnson outside of the stages. He must not be sleeping, because he’s not called me once to say, “I need time.”

So have you been holding “DWTS” viewing parties every week with the cast and crew?

Yes. We put up the East Coast feed on a screen outside the stages with a QR code reminding people to vote, and a few of us have gone to the tapings.

Looking ahead to the next couple of episodes, I understand that Episode 3 features a Dolly Parton impersonator as a patient.

We were in the middle of shooting that storyline when Dolly Parton passed. It was a story that was pitched out of our writers’ room by the writer of Episode 3, Jase Miles-Perez. We were laughing, and we thought it was a hilarious storyline and so endearing because, again, who doesn’t like Dolly Parton? The impersonator storyline is so fun, but it was emotional over here, in particular for Debbie [Allen]. She was directing that storyline when we had to walk over there and pull her aside and tell her what happened. Obviously, it wasn’t planned, but we were able to honor her with the storyline, and it must have been a trip. I don’t understand how Debbie did that. We were literally filming the storyline that day on stage — and the title of that episode [“It’s All Wrong, but It’s All Right”] is a Dolly Parton song.

Are the rest of the characters going to pick up the slack in trauma now that Owen and Teddy are gone?

Yeah, right now, that’s how it’s going. I really didn’t want to say that those two characters or doctors at the hospital were replaceable. So I think even just having somebody like Seth Norton as chief, that’s showing how much this hospital will miss Teddy.

Are there any plans right now to revisit Maggie (Kelly McCreary)? She appeared in the 450th episode last season, and shared with Meredith and Amelia that she is pregnant via a sperm donor.

That’s so funny. Kelly texted me yesterday. She was letting me know about a play or something that she was doing. I would love to have an update on Maggie. It depends on where we are creatively. She probably has a baby by now, unless it’s the longest pregnancy like Jo Wilson’s was.

Are you able to confirm how many episodes you are making for Season 23?

No, that hasn’t been confirmed with me yet.

You and I have spoken about the challenges of trying to make “Grey’s” — which features one of the largest ensembles on TV — in today’s financial climate. You’ve had to reduce the number of episodes that characters appear in, and like so many other shows, you’re potentially facing a reduced episode count for this season.

Every show is feeling it. You even feel it when you’re developing a new show, when you learn what’s available. I’ve had conversations that I never had before when starting up the new [“Grey’s” spinoff]. Every episode at Season 23 is a gift, and a lot of people here feel that way. Maybe it’ll go on to Season 50, but probably not. You look at the budget every episode, and you’re like, “Can I go on location? Can I not go on location? Can I afford visual effects? Can we not see a green screen?” Every episode, there are conversations like that.

No one’s told me that the end is coming, so for that I’m grateful. I feel like because of what this show has done, they will give me a little bit of a heads’ up. But it’s always top of mind because of what you’re seeing in the industry. We always know that this year could be the [final] year, but so far, we’re still going; they’re still allowing us to make these episodes. And if there is a shorter order or not, again, we’re just grateful that we’ve had what we’ve had, and we’ll take whatever we can get. It’s an honor to tell these stories.

What is the status of the “Grey’s” West Texas spinoff that you are co-creating with Shonda?

It’s in the works, and we’re very, very excited about it. It’s so cool to get the opportunity to create something with her, especially about something that is so dear to me. I can’t say much about it because I’m not authorized to do it, but it’s still everything that you’ve heard or read. It’s in rural West Texas. It is a spinoff, so we’ll connect it to “Grey’s.” The timing on that is still being discussed, just because we want to do what’s best for both shows. All those conversations are happening literally as we speak, and I wish I could clone myself.

You were born and raised in Houston, Texas. Did you pitch Shonda the idea of a West Texas spinoff and have her come on board to co-write the pilot with you? How involved is she in this new expansion of the universe she created?

She’s very involved. She’s been involved from the very beginning. She wanted to expand the universe, and I wanted to be involved in it. I’m from Texas, so I’ve always wanted to tell a story about West Texas. I’m a huge fan of the TV shows that have been in West Texas. My father’s from there, and I’ve spent quite a bit of time there.

Something that I’ve always been interested in just from working on “Grey’s” is what’s happening in these medical deserts, and the amount and how quickly these places are closing. People are having to travel an hour just to get a sore throat looked at. The amount of birthing centers that have closed — people have to travel two hours to have their baby. And it’s happening not just in West Texas; it’s happening all over the country. I think Vermont is a state that has one of the worst medical deserts. So even though it’s in Texas, I think it will apply and resonate with what’s happening in all small towns in America.

This interview has been edited and condensed.