In this special episode, Toby Campbell sits down with palliative care legend Dr. Ira Byock for a candid, far-reaching conversation about the field's origins, its current challenges, and the path forward. Joined by the CEO of the Center to Advance Palliative Care (CAPC),  Brynn Bowman, Byock reflects on his early days as a rural family medicine resident drawn to patients "put down the hall" and forgotten—a pull that would lead him to become one of hospice and palliative care's most influential voices.

Forty years later, Byock pulls no punches in assessing the field he helped build. He calls out the "epidemic" of fraudulent hospice programs, the unacceptable variability in quality, and what he sees as palliative care's timidity in advocating for itself. According to Dr. Byock, the solution to these challenges lies in establishing clear clinical and programmatic standards and a willingness to embrace, rather than hide from, healthcare's capitalist reality.

Brynn Bowman offers a generational counterpoint, acknowledging the field's growing pains while finding reasons for optimism: culture change, an undeniable value proposition, and emerging work on quality standards that could finally separate excellent care from the merely mediocre.

This episode is a master class in leadership, honesty, and the courage to speak truth—even to the field you love.