Why Justin Chambers' Dr. Alex Karev Left Grey's Anatomy

When Shonda Rhimes' medical drama "Grey's Anatomy" premiered as a humble mid-season replacement in 2005, it centered around five brand-new surgical interns: Dr. Cristina Yang (Sandra Oh), Dr. George O'Malley (T.R. Knight), Dr. Isobel "Izzie" Stevens (Katherine Heigl), Dr. Alex Karev (Justin Chambers), and the titular Dr. Meredith Grey (Ellen Pompeo). As of 2025, all of those original interns have left the series, including the woman who gives the show its cheeky title. (For the uninitiated, it's a play on the famous medical textbook "Gray's Anatomy.") Cristina canonically "lives in Switzerland" now at a new hospital, George gets hit by a bus and dies a pretty agonizing death (sorry for the spoiler?), and Izzie vanishes into the ether after Heigl had some on-set drama with Rhimes; Pompeo still appears on the series from time to time and serves as an executive producer but isn't part of the regular cast anymore.

So what of Chambers and Alex Karev? Chambers was famously a late addition to the pilot, whose scenes were largely added during post-production, but despite that, he became the second-longest-running original intern to stick around on the series. I'll get back to Alex's genuinely phenomenal character evolution, but first, I have to address how he leaves the series, as well as the in-universe explanation that fans like me found unbelievably frustrating.

Chambers' last on-screen appearance happens in the show's 16th season in the episode "My Shot," where Meredith is forced to defend her medical license after falsifying documents to help a young and uninsured patient. Alex then just ... vanishes for a while until an episode in that same season, "Leave a Light On," clears things up — so to speak. 

In voiceover, Alex explains to Meredith that years after his dramatic split from Izzie, he found out she used the embryos she froze while undergoing cancer treatment in the early days of their marriage and had two children. After meeting his kids, Alex decides to leave his life in Seattle behind completely. There's one enormous problem here, though: Alex is remarried, and we also learn this information from a letter he sends to his current wife, Dr. Jo Wilson (Camilla Luddington). Now do you see why fans got so mad about the way Alex left "Grey's Anatomy?!" 

The five original interns all play pretty distinct roles on "Grey's Anatomy." Cristina is a wildly driven workaholic, Meredith is grappling with the legacy of being a famous surgeon's daughter, George is often in over his head, Izzie is viewed as too "bubbly" and "pretty" to be taken seriously, and Alex is a jerk. For a little while, that's all Alex is, particularly when he cheats on Izzie early in their relationship. Over time, though, Alex softens, but to say he's unlucky in love is a massive understatement. After falling in love with one of his patients, a woman injured in a ferry boat crash named Rebecca (Elisabeth Reaser), she succumbs to severe mental illness, and after Izzie almost dies from cancer, she leaves him (marking Katherine Heigl's exit from the show). 

Alex might not always thrive personally, but he does grow professionally. Once he takes an interest in pediatric surgery, he starts working under the department's chief, Dr. Arizona Robbins (Jessica Capshaw), who helps him become a better surgeon and a more compassionate physician. He also forms an intensely close bond with Meredith, especially after Cristina, her "person," leaves the show in the season 10 finale.

It's impossible to talk about Alex's growth on the show, though, without discussing Jo Wilson. When Jo starts her residency at Grey Sloan Memorial Hospital (née Seattle Grace), she and Alex butt heads but eventually bond over the fact that they both had tough upbringings; both were in the foster care system and struggled with family structures and poverty before getting into medical school and becoming doctors. At the end of the show's ninth season, Jo and Alex finally become a couple, and despite a few highly dramatic speed bumps, they stick it out and get married in the season 14 finale. 

This makes it particularly disappointing and dispiriting that Alex's exit is linked to Izzie, a woman who deeply hurt and abandoned him, at the expense of Jo, a woman who loved Alex fiercely and stuck by his side through the best and worst of times. In Jo, Alex finally found a supportive equal and partner, and in Alex, Jo found the stability she'd lacked all her life. So how did the showrunner during season 16, Krista Vernoff, justify this dreadful exit?

After "Leave a Light On" aired on March 5, 2020 — note that date — Krista Vernoff, who took over from Shonda Rhimes as showrunner and has since handed the reins to Meg Marinis, spoke to TVLine in April of that year. By the time the episode aired, "Grey's Anatomy" was only one week away from suspending production due to the COVID-19 pandemic, which the series did on March 12 ... so that may have been a factor in Alex's hasty exit. Still, as Vernoff said, she thought the writer's room had three options after Chambers expressed interest in leaving the series, and they all sucked.

"At the end of the day, there were three choices," Vernoff said. "Kill Alex off camera; have Alex be alive and in Seattle — and still married to Jo — and we just never see him; or [reunite him] with Izzie. There was no way to not put those characters through gut-wrenching, ongoing grief if we had killed Alex off camera."

At the same time, Vernoff told The Hollywood Reporter that she actually loved Alex's bizarre send-off. "It was perfectly imperfect and it was perfectly messy," she claimed. "It allowed for Alex to have grown as a human in a variety of ways and to still be imperfect and to disappoint a woman he has loved greatly. It allows for Jo to have been a person who really healed him and in so many ways that he's now able to go be this wonderful dad to these kids. And it allowed for the characters who are still at Grey Sloan to not have to go through another massive chapter of grief. I thought it was beautiful and I'm really proud of it."

Look, I'm not a showrunner, and I objectively get that between COVID and Chambers' desire to leave the series, there weren't many good options that didn't have "Poochie died on the way back to his home planet" vibes. Still, there had to be a better way to do this, right? Also, to Vernoff's third point, the characters at Grey Sloan go through plenty of chapters of grief when you consider that some sort of disaster strikes this hospital literally every season (seriously, the fatality rate amongst doctors at this hospital is alarmingly high). Anyway, Alex's exit stinks, but you can watch his genuinely lovely character arc and growth on "Grey's Anatomy," which is streaming on both Netflix and Hulu now.