After nearly two decades of medical marvels and dramatic twists, there are still more shakeups in store for Grey Sloan Memorial in Grey's Anatomy's 20th season.

In an exclusive first look at the upcoming installment, shared with PEOPLE, Ellen Pompeo is back as Meredith Grey for the hit medical drama's milestone return.

"How long do I have to wait?" Meredith asks before the scene shifts to a shot of the surgical interns getting ready for a new day. "What are you waiting for? Let's go," Miranda Bailey (Chandra Wilson) calls.

ABC

While walking the halls of the hospital, Miranda tells Meredith: "The interns are in trouble."

The teaser picks up where season 19 left off and gives a little insight into the cliffhangers that left fans wondering about the fate of their favorite characters in last year's finale.

ABC

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Jo Wilson (Camila Luddington) and Atticus Lincoln a.k.a. Link (Chris Carmack) are on the precipice of a budding romance, Richard Webber (James Pickens Jr.) struggles with his sobriety and Simone Griffith (Alexis Floyd) tells Lucas Adams (Niko Terho) they "need to talk about what happened" after their hookup.

When Teddy Altman (Kim Raver) collapses during an operation after complaining of a toothache, Winston Ndugu (Anthony Hill) reveals that "Dr. Altman is in critical condition."

ABC

The long-running medical drama, which wasrenewed for a 20th seasonin March 2023, will see some major changes.

Season 20 will be the first not to feature Pompeo as a series regular. The actress already hada scaled-back rolein season 19 but will remain as an executive producer on the series moving forward, in addition to providing the opening and closing voiceover for each episode.

In an installment ofVariety's Actors on Actorsseries, Pompeo opened up toher formerGreyscostarKatherine Heiglabout the future of her character.

Liliane Lathan/ABC/Getty

I will be making some appearances hopefully next year, if I can find some time, she said. Its not a complete goodbye. And I think weve got an interesting story to tell."

Pompeo isn't the only one fans will miss in the upcoming season. In March, Kelly McCreary, who took on the role of Meredith's half-sister Maggie Pierce, announced her departure from Grey's Anatomy after becoming a series regular in season 11.

"After nine seasons, I am saying goodbye to Maggie Pierce and her Grey Sloan family. It has been a tremendous honor to be a part of such a legendary television institution asGrey's Anatomy," she said in a statement. "I will always be grateful toShonda Rhimes,Krista Vernoffand ABC for the opportunity, and to the incredible fans for their passionate support."

"To spend nine years exploring a character inside and out, while reaching a global audience with impactful stories, is a rare gift," McCreary continued. "It has afforded me an opportunity to collaborate with, learn from, and be inspired by countless brilliant artists both in front of and behind the camera."

She added: "Playing Maggie Pierce has been one of the true joys of my life and I leave with profound gratitude for every step of this journey. I am excited for this next chapter, and what the future holds."

Season 20 of Grey's Anatomy premieres March 14 at 9 p.m. ET on ABC.

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Ellen Pompeo Marks Her Return as Meredith Grey in 'Grey's Anatomy' Season 20 First Look (Exclusive) - PEOPLE