Morris Barer: An Accidental Career

June 28, 2018

Sometimes a little serendipity trumps a lot of planning. Recently retired School of Population and Public Health and Centre for Health Services and Policy Research Professor Morris Barer’s career path seems littered with a little more than a random smattering. That he became a health economist, or landed in Vancouver, or became a professor in the (former) Department of Health Care and Epidemiology were all “against the odds.” Morris’ first stroke of luck, as he tells it, was realizing, during third year undergraduate honors math at UBC, that he didn’t have the appropriate neural wiring to be a mathematician. That led him to start picking up a few economics courses in his fourth year. Among them was a course in Money and Banking, which (as luck would have it) was being delivered by Ron Shearer (now emeritus Professor) from the then Department of Economics. Morris enjoyed the course so much that he decided to pursue graduate work in economics at UBC. That, in turn, again through happenstance, led to Bob Evans, who happened to be teaching the introductory macroeconomics course in which Morris enrolled in his first year of graduate school. After a year of graduate courses, Morris was able to transfer directly into the PhD program (“thus avoiding having to do two theses”).

“I can’t recall now how I ended up deciding to take a (directed readings) course in health economics in my second year, but I do know I had an abiding interest in health care through parental influence, and I’m guessing it was a combination of conversations with Bob, and with fellow student Greg Stoddart, who had arrived at UBC the year before in order to pursue a PhD in health economics with Bob. Greg was the consummate planner, so he’d figured out where the best health economics education in the country could be had. I, on the other hand, literally stumbled into it, though once I started down that track, it didn’t take long for me to realize that that was where I belonged.”

His second stroke of luck arrived during his third year in his first job, at the Ontario Economic Council in Toronto (where he had responsibility for the health care file). He had applied for a job in the (then) Department of Health Administration at the University of Toronto, was short-listed, and was runner-up. Shortly thereafter, as it happened, Bob Evans alerted him to a position as Associate Director with the (then) Division of Health Services Research and Development (HSR&D) in the Office of the Coordinator of Health Sciences at UBC. Both the Division and that Office were long-ago relegated to the scrap heap of UBC history. But not before Annette Stark (a former faculty member in the Department of Health Care and Epidemiology (HC&E)) hired Morris into that Associate Director position in 1979. It just happened that HSR&D at the time was primarily funded through a grant from the Ministry of Health, to provide health human resources support to the Ministry. “The fact that I ended up doing health human resources research, and in particular work on physician resource policy throughout my career was almost certainly a result of those circumstances.” Two years later Morris joined the HC&E faculty (at about the same time as recently retired colleague Sam Sheps), while continuing as the HSR&D Associate Director.

Even then, Morris wasn’t completely convinced that this was the career for him. On top of his responsibilities as Associate Director, as a new Assistant Professor, and as a new father, Morris decided to enroll part-time in UBC’s MBA program, “just in case the first career didn’t work out”. He completed his MBA in 1987; well before that, the academic career had started to gel, though as he puts it:

“the MBA turned out not to have been waste motion, as the skills were useful in the various administrative roles I was to take on later.”

In 1983, Steve Kenny, then an Executive Director in the Ministry of Health, invited Morris to spend a year at the Ministry. That provided Morris with a first-hand, up close and personal look at the world of health care policy-making, an experience that, in Morris’ words, “paid dividends for at least the following decade, arguably for the rest of my career.” Among the things that surfaced during that year was the fact that the Ministry routinely purged its administrative (hospital use and physician payments) data after five years. To a researcher addicted to data, this was sacrilege. Morris and Steve Kenny negotiated an agreement whereby HSR&D would begin to serve as a secure archive site for these data, so that they were not lost to the research community. This was, arguably, the beginning of the journey that eventually led to the establishment of the BC Linked Health Database and, a few generations later, what we now know as Population Data BC.

In the mid-1980s Clyde Hertzman arrived at UBC, and immediately got involved in the activities of HSR&D (Sam Sheps became involved about the same time):

“One of the unusual things about me and my close colleagues at that time was the way in which we often collaborated. We would literally gather in a room together, around a single computer, usually with Bob or me at the keyboard, and do joint writing, with ideas and turns of phrase filling the room and much chocolate being consumed. It was productive, but it was also a lot of fun, and that style of writing endured throughout most of my career.”

In 1987 Morris took on the responsibilities as the Senior Editor for Health Economics with Social Science and Medicine, continuing in that role until 1991, and then staying on as an Advisory Editor until the end of the decade. In 1988 Annette Stark headed for Ottawa to take up a new position there, and Morris became the Director of HSR&D. Somehow a sabbatical at the Australian Institute of Health in Canberra was squeezed in there. Shortly thereafter, Bob Evans took up residence in an HSR&D office (since most of his research was taking place in collaboration with Morris and colleagues Greg Stoddart and Jonathan Lomas from McMaster, rather than in the halls of the Department of Economics); and Mort (David) Low became the Coordinator of Health Sciences, got very excited about what was going on in the Division, and decided that this work needed a higher profile within the University. In 1991 the UBC Senate approved the establishment of the Centre for Health Services and Policy Research (CHSPR) and Morris became its founding Director. The Centre had very little UBC funding, but a sustaining grant from the Ministry of Health. The vision was that it would be a UBC home for interdisciplinary research focused on health care policy. It housed the BC Office of Health Technology Assessment (directed by Arminée Kazanjian), as well as a Health Policy Research Unit, a Health Human Resources Research Unit, and a Health Information Development Unit. It drew from around the campus, and beyond, for collaborators. At various points in time, UBC faculty Patricia Baird (genetics), Peter Nemetz (business), Joan Anderson (nursing), and Bill Webber (medicine) were involved in varying ways and degrees.

During the late 1980s, Geoff Anderson joined the group as a Research Associate, and he, Clyde and Morris began the process of getting approvals, and the infrastructure in place, for the BC Linked Health Database. About the same time, the Population Health Program of the Canadian Institute for Advanced Research (CIAR) was established, with Bob as its inaugural Director. Morris joined that group as an Associate in 1988, and was heavily involved in the program for fifteen years. And as if that were not enough, the federal, provincial and territorial Ministers of Health came knocking in 1990, looking for an in-depth assessment of the state of physician resource policy in Canada. Out of that work, In 1992, came the (in)famous “Barer-Stoddart Report” released by Health Canada. Greg and Morris subsequently converted it into a series of twelve articles for the Canadian Medical Association Journal. In 1991, Morris was promoted to the rank of professor.

“Looking back now, those were exciting, impossibly frenetic, but very professionally rewarding years. I have no idea how I survived them, but twisting around Bob Dylan a bit, “Ah, but I was so much younger then, I’m older than that now.””

The highlights from the rest of the 1990s were 1) Morris’ 1993-94 sabbatical spent at the Institute for the Future in Menlo Park, California (a chance to see first-hand the futility of the Clinton effort at health care reform); 2) the creation and publication of the CIAR population health program book, Why are Some People Healthy and Others Not (co-edited by Bob, Morris and their Yale colleague, Ted Marmor); 3) the inaugural conference of the International Health Economics Association (iHEA) in Vancouver in 1996; and 4) the work with Steven Lewis, former HC&E PhD student Claudia Sanmartin, and Sam Sheps, on a major report for Health Canada on the health care wait list situation in the country. The CIAR book was the culmination of what Morris describes as:

“an amazing intellectual journey, and an unprecedented opportunity to explore areas of research way outside my comfort zone.”

The iHEA conference was organized and hosted by CHSPR, with Morris and Greg Stoddart serving as the entire scientific program committee. The conference was a huge success, attracting over 600 delegates, and truly launching iHEA (it now regularly attracts 1500-2000 delegates to its conferences). Closer to home, the 1980s and 1990s were Morris’ busiest decades with respect to teaching. He developed the first “Economic Evaluation” course for the Department, and taught it for a number of years. He also pinch-hit for Bob Evans, teaching the ECON 384 (health economics) course, and one year the Department even had to enlist him to teach “Program Evaluation” (speaking of being outside one’s comfort zone). In the latter half of the 1990s he developed, and then led a “Topics in Healthcare Policy” seminar course. About mid-way through that decade, the BC Linked Health Database open its (virtual) doors for business, with Kim McGrail taking on a lead role.

Morris’ primary research foci throughout the first two decades of his career were physician resource policy, health care financing, health care utilization focusing on the impact of an aging population, and access to care — in short, most of the ‘hot button’ areas in health care policy. His published work ended up in a wide variety of national and international journals, including the New England Journal of Medicine, Health Affairs, the Milbank Quarterly, Social Science and Medicine, the Canadian Medical Association Journal, the Journal of the American Medical Association, and the Journal of Health Politics, Policy and Law.

Early in 2000, then UBC Vice-President Research Indira Samarasekera contacted Morris to encourage him to apply for a position as Scientific Director with the nascent Canadian Institutes of Health Research (CIHR). “To that point, I had not been paying much attention to this new development in the Canadian health research landscape, but that phone call changed all that.” By the end of that year, he had been appointed as the inaugural Scientific Director of the Institute of Health Services and Policy Research (IHSPR). “This was a whole new adventure that once again offered the opportunity to work with impossibly smart people from other walks of research life. The beginnings were rather overwhelming — imagine if you can, no office space, little in the way of support staff, and no particular rules of engagement.” Things eventually worked out, in no small part because of:

“another stroke of amazing good luck. In addition to trying to get the University to create office space for the Institute, I also needed to find an Associate Director who could be based in Vancouver in that office. I cannot now recall who connected us, but I learned that Diane Watson, a recent PhD graduate in health services research from the University of Toronto, and then in a senior administrative role with the Manitoba Centre for Health Policy and Evaluation might be available. Long story short, I interviewed her, realized that she was precisely what the Institute needed (therein lies a huge understatement), and the rest is history. We had a great five+ years working together building the Institute and helping the health services and policy research community in Canada grow. The things from that period of my career that were the most satisfying were the establishment of the Canadian Association for Health Services and Policy Research (CAHSPR), the development of the various health services research training programs across the country, and the creation of Healthcare Policy which was, at the time, I believe, the only journal of its kind that required papers to be both peer- and relevance-reviewed, by both academic researchers and health care policy-makers.”

During his tenure as Scientific Director, he did manage to find some personal research time, for example working closely with Tom Noseworthy, David Hadorn, Steven Lewis, Claudia Sanmartin and others on the Western Canada Waitlist Project. The CIHR role and the research role intersected when the provincial and territorial Deputy Ministers of Health asked Morris and the IHSPR to help them develop wait time benchmarks for five priority areas. In 2004 Morris was invited to deliver the fifth Justice Emmett Hall Memorial Lecture, and in 2006 his contributions to the field were recognized with the awarding by the Canadian Health Services Research Foundation of the Health Services Research Advancement Award.

After a year’s administrative leave, Morris returned for a second run as Director of CHSPR, from 2007–2012. During that time, the preoccupations were helping the data linkage enterprise (which had morphed from the BC Linked Health Database, to the Population Health Learning Observatory, to Population Data BC) through some growing pains, co-leading the Health Systems and Services group within the School of Population and Public Health, and growing CHSPR (with the arrival on faculty of Kim McGrail, Jason Sutherland and Mike Law being an important milestone in the Centre’s life). He also served as a member of the Boards of the Canadian Health Services Research Foundation, and the Justice Emmett Hall Memorial Foundation during this period. A final sabbatical in 2013 was followed by a period of pre-retirement ‘slowing down’ during which Morris focused on completing work on his final CIHR-funded grant, supervising and serving on thesis committees of SPPH/CHSPR graduate students, serving as the treasurer for the Emmett Hall Foundation, and one final “mega-project” — leading the creation and editing of a collection of Bob Evans’ works — An Undisciplined Economist (McGill-Queens, 2016).

Although now officially retired, Morris agrees that Sam was right — old faculty never really completely retire. That last CIHR-funded research project still lingers, and other aspects of CHSPR life (including its annual health policy conferences) continue to draw him in. He expects he will continue to be involved in whatever ways make sense to him and to the Centre. But he doesn’t miss the teaching, the meetings, or the alarm clock.

“I am exceedingly grateful for the (mostly accidental) opportunities that led to me being able to spend a career at a great (even if at times frustrating) University, doing interesting work with amazing staff and colleagues, and at the same time being able to live and raise a family in the greatest city on earth.”