Patrick Dempsey may now be starring in Fox’s Memory of a Killer on the 2026 TV schedule, but the actor will forever be known as Derek Shepherd, a.k.a. McDreamy, on Grey’s Anatomy. He spent the first 11 seasons of the medical drama saving lives and making fans swoon like Meredith Grey. It’s truly a defining role in his career, so it's hard to imagine anyone else playing him. However, it turns out Rob Lowe was up for the part and turned it down.
How to Save a Life: The Inside Story of Grey’s Anatomy by Lynette Rice digs deep into the behind-the-scenes stories of the longest-running primetime medical drama, including casting. In an excerpt from the book, per EW, executive producer Peter Horton revealed that Dempsey was not ABC’s first choice for Derek. They wanted Lowe first:
The network wanted us to cast Rob Lowe as Derek Shepherd. He's not exactly who we had in mind for McDreamy, but we met with Rob. He had a choice of either doing our show or Dr. Vegas for CBS. He chose Dr. Vegas. Then we were like, 'What about Patrick Dempsey?' At that point, Patrick kind of already had his career, and no one was really paying attention to him. The network initially was resistant to it, but we really felt right about it.
Considering Lowe chose between Grey’s and Dr. Vegas, and went with the latter, which was pulled after only five episodes had aired, it’s crazy to think how different things could have been had he gone with the ABC drama. It's also wild to think that the network didn't initially want Dempsey, considering the fan-favorite he became.
McDreamy wouldn’t be McDreamy without Dempsey. Luckily, it all worked out in the end, and Lowe has no regret over his choice, despite how things turned out, as he said:
My picker was awesome! The real, honest reason was [former CBS Corporation chairman] Les Moonves's pitch to me. His personal pitch was amazing, and there was no pitch from ABC. ABC just never said anything. I just had a better meeting with CBS. The scripts were incomparable. The vibe around Dr. Vegas was great. The script for Grey's Anatomy was great. I went with the vibe over the script. The rest, as they say, is McDreamy.
Some things are just meant to be, and Patrick Dempsey was meant to play Derek Shepherd, and it really impacted his career and the fans. It’s possible that if that didn’t happen, Grey’s wouldn’t be where it is today. And it’s not like Lowe didn’t get other great roles after Dr. Vegas failed. He has stayed steady on television for decades, with main roles, recurring roles, and guest roles on all sorts of series, like Parks and Recreation and 9-1-1: Lone Star. Now, he is currently hosting The Floor on Fox, which was recently renewed for two seasons.
Meanwhile, even though Derek was tragically killed off towards the end of Season 11, he made a surprise appearance during Season 17, briefly recurring when Meredith had COVID and dreamt of being on the beach with her lost loved ones. Whether or not Dempsey will ever return again, especially with his new show, is unknown, but stranger things have happened. And while we're dreaming, it would be fun if Lowe appeared on Grey’s, even for an episode, just to fulfill that “What if?” and see what the hospital would have been like with him running around.
Dr. Vegas may have only run for one season, but it might have been the best decision Rob Lowe made, because if not for him and the producers pushing for Patrick Dempsey, who knows what could have happened. Fans can look back at their favorite McDreamy moments with a Hulu subscription, knowing that the role went to the perfect actor.
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