While Byock's early career focus was on rural family practice and emergency medicine, he developed an interest in the then-nascent hospice movement. While still an intern in 1978–79, Byock teamed with a social work intern to create the Esperanza Care Cooperative, a “fledgling hospice program” for Valley Medical Center in California's Central Valley. While among the best-rated instruments in terms of validity, including cross-cultural, the Missoula-VITAS Quality of Life Index is considered better in clinical applications, as a psychometric as well as therapeutic tool, than in research. In 1996, Byock was asked to lead the Robert Wood Johnson Foundation's national program in Promoting Excellence in End-of-Life Care, intended to expand access to hospice and palliative care to regions and populations not easily served under the
Medicare Hospice Benefit. Under Byock's leadership with deputy director, Jeanne Shields Twohig, the program directed up to $15 million over 10 years to 26 demonstration projects to develop and test models for palliative care within a variety of medical specialties, care settings, and underserved populations. Eight peer workgroups of healthcare leaders specifically focused on specific diseases or issues, while nine projects addressed knowledge and practice gaps—all under an overarching communications strategy, with significant results. Also in 1996, with separate funding from another program area of the Robert Wood Johnson Foundation, Byock co-founded (with Barbara Spring, PhD) and served as principal investigator for the Missoula Demonstration Project, a community organization focused on studying the experiences of illness, dying, caregiving, and grieving within the context of community, and engaging the community of
Missoula, Montana in improving care and support for seriously ill people and their families. During the 1990s, Byock helped to launch and assumed leadership roles in the
American Academy of Hospice and Palliative Medicine During this period, Byock had a faculty appointment at the
University of Montana, Practical Ethics Center, as research professor of philosophy. In late 2003, Byock moved to New Hampshire as director of palliative medicine for
Dartmouth-Hitchcock Medical Center and associate director for patient and family-centered care at the affiliated
Norris-Cotton Cancer Center. He remains an active emeritus professor of medicine and of community health and family medicine at Dartmouth's
Geisel School of Medicine. In 2014, he founded the Institute for Human Caring of
Providence Health & Services in Torrance, California, where he currently serves as chief medical officer. ==Opposition to physician-assisted suicide==