More access, more deaths: alcohol’s impact in the COVID-19 pandemic

A new CMAJ study has found that alcohol-related hospitalizations and deaths in Canada surged during the COVID-19 pandemic. While overall alcohol consumption increased only modestly, the toll on the healthcare system was severe, with a 14% rise in hospitalizations and a 24% increase in deaths during the first two years of the pandemic. Researchers suggest that increased access to alcohol—through expanded retail hours and home delivery—contributed to these harms, particularly among heavier drinkers.

Dr. Tim Stockwell, a scientist at the Canadian Institute for Substance Use Research and an emeritus professor at the University of Victoria, discusses the study’s findings and why even a small rise in alcohol consumption can lead to a disproportionate increase in harm. He explains how heavier drinkers, already at risk, were pushed beyond critical health thresholds, contributing to the sharp rise in hospitalizations and deaths.

Dr. Adam Sherk, a senior scientist at the Canadian Centre on Substance Use and Addiction, examines the policy decisions that shaped alcohol access during the pandemic. While economic considerations played a role, he notes that governments were also reluctant to introduce new restrictions on alcohol at a time when the public was already under significant strain. He argues that a more balanced approach is needed in future public health crises—one that allows reasonable access to alcohol but uses measures like increased pricing and decreased availability to moderate its impact on the healthcare system.

The findings underscore the need to rethink how alcohol policy is handled during public health emergencies—not just in terms of balancing health and economic interests, but also in managing public willingness to accept restrictions in times of crisis.

Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.

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Transcript

Dr. Blair Bigham:

I'm Blair Bigham.

Dr. Mojola Omole:

I'm Mojola Omole. This is the CMAJ Podcast.

Dr. Blair Bigham:

Jola, during the pandemic, man, like a lot happened. Like what a crazy time. And today we're going to specifically be asking about alcohol consumption during that crazy time.

Dr. Mojola Omole:

This is a really fascinating topic because for me when it comes to alcohol, I view that we're very permissive when we talk about substance use in terms of alcohol, but very restrictive when we talk about other forms of drug use. At the same time, I hold the thought that in many European countries, meh, everyone just drinks and they seem to be okay. So I'm fascinated to see what the data shows happened in terms of alcohol consumption, alcohol-related deaths during the pandemic.

Dr. Blair Bigham:

Yeah, I'm curious, you know, in Europe, maybe where a glass of wine a day is more common than here in North America, I think binge drinking might not be as common there as it is here. And so I'm curious, you know, during the pandemic, were we binging more? I don't know, I wasn't able to go out to the club. I wasn't able to go out to parties.

Dr. Mojola Omole:

I was pregnant.

Dr. Blair Bigham

You were pregnant. Okay. But, you know, were people taking advantage of being able to drink day to day on their couch?

Dr. Mojola Omole:

And it was viewed as an essential service. And so there was more access. That I remember clearly that there was more access to alcohol.

Dr. Blair Bigham:

Yeah, you would have thought that when we seem to have less access to everything, alcohol was sort of the opposite. So today we're going to be speaking with a co-author of an article in CMAJ entitled, Mortality and hospitalizations fully attributable to alcohol use before versus during the COVID-19 pandemic in Canada.

Dr. Mojola Omole:

And after that, we'll speak with Dr. Adam Sherk. He's a senior scientist and a special policy advisor at the Canadian Centre of Substance Use and Addictions. We'll explore with him how public policy should respond to the article findings.

Dr. Blair Bigham:

But first, we'll speak with Dr. Tim Stockwell. Dr. Tim Stockwell is a co-author of the article in CMAJ. He's a scientist at the Canadian Institute for Substance Use Research, where he served as director for 16 years.

He's also an emeritus professor in the Department of Psychology at the University of Victoria. Tim, thank you so much for joining us today.

Dr. Tim Stockwell:

My pleasure. Thank you for having me.

Dr. Blair Bigham:

Tim, at the start of the pandemic, there was some debate about how we should handle alcohol, particularly access and sales of alcohol. Can you walk us through that?

Dr. Tim Stockwell:

Yes. It seems quite a long time ago. It seems like another age, doesn't it?

Dr. Blair Bigham:

It does. It does, thankfully.

Dr. Tim Stockwell:

So much anxiety. And of course, people were scrambling.

What were the essential services? My memory is that there were four things that were made essential in most Canadian jurisdictions, and that was fuel to get around, pharmaceuticals, food, and the final one was booze. And that was kind of interesting.

And one of the debates going on, it was stated, actually, this came from alcohol industry groups, that the health services would be overwhelmed if we cut off the supply of alcohol, with people going into alcohol withdrawal. There are also other considerations that people were stuck at home and might be pretty upset if they weren't allowed access to one of their favourite beverages for those who like that. So, I know that that's another issue.

So, the decision was made to actually, in most parts of Canada, to increase availability or to guarantee availability for purchases at liquor stores, bars, restaurants, of course, famously at times were completely closed. Also, there were changes to regulation so home delivery of alcohol could happen. So, what we ended up with was, in some ways, longer hours of access, being able to purchase alcohol at a liquor store, the opportunity to have it delivered to your doorstep, and actually, if you ordered enough in most places, it would be free delivery.

And liquor store prices are lower, of course, than bar and restaurant prices. So, what ended up was that we had considerably more access within the constraints, of course, of being stuck at home for good parts of the early period, anyway, of the pandemic.

Dr. Blair Bigham:

So, not only did alcohol become easier to access, but people took advantage of that access, so to speak, and had more consumption. 

Dr. Tim Stockwell:

Exactly.

How much consumption, like, can you quantify that?

Dr. Tim Stockwell:

Yeah, well, the actual sales out of liquor stores, where that's been measured, went up by about 8%, 9%, 10%, depending on which jurisdiction. Overall, it doesn't sound huge. It was, I think, just like 2%, 3%, 4% increase in total consumption.

There was some evidence from surveys that sort of heavier drinkers were particularly prone to increasing their consumption. Not everybody increased their consumption. But there was an overall effect.

It depended also on tourism, because in some parts, in some provinces of Canada, we have a lot of people coming from outside to look at our glorious mountains and forests and coastlines. And they drink while they're doing that. And there's more people coming in than leaving.

So, there's some variation. But across the whole of Canada, I think it was like 2% or 3% increase in per capita consumption.

Dr. Blair Bigham:

So, let's get into your findings here, Tim. What are your top three most interesting pieces of data that you've pulled out from this study? What happened during the pandemic?

Dr. Tim Stockwell:

Right. So, for the first two years, substantial increases in hospitalizations and deaths. So, 14% increase in hospitalizations, 24% increase in deaths from alcohol during the first two years.

And then there were slight decreases in the third year. So, whatever was done with alcohol and how we managed it, made it available, etc. If the intention was to reduce impact on healthcare services, it didn't work because there was a greater impact from alcohol-related diseases on healthcare services.

Dr. Blair Bigham:

How does a small increase in consumption of 3%, 4%, 5% lead to such a large increase in alcohol-related deaths? It seems disproportionate.

Dr. Tim Stockwell:

Yes. In the first two years, there were substantial increases. I should say, overall, it was like an 8% increase in hospitalizations caused by alcohol and a 17.6% increase in deaths. We've seen this before. Often, it doesn't take a very large increase in total consumption for behind that to be heavier drinkers having considerably more consumption. It's like, if you imagine a whole reservoir of people who are heavy drinkers and just on the verge of getting liver cirrhosis, for example.

So, there's a sudden jolt and everybody's drinking a bit more and they tip over the edge and they become sick. And this has been observed all over the world. People are puzzled by a small increase in total consumption. Suddenly, you get an increase in liver cirrhosis rates. That's one of the ways we understand it. And there's a little corresponding decline in the third year. So, it's like tipping over the edge, quite a few people, and then there's a reduction in the third year.

Dr. Blair Bigham:

So, people who were already drinking were maybe on that cusp of cirrhosis or requiring hospitalization or being at risk of death. And that little bit of alcohol consumption increase at three or four percent has a much larger impact on the healthcare system that way.

Dr. Tim Stockwell:

Yeah. And I suppose just thinking about the patterns and the way we drink and how much we drink. So, because people are drinking at home, there's less social drinking, but the bars and restaurants were closed for long periods of time.

So, there's a lot more personal consumption. Obviously, people were having drink parties by Zoom or whatever, but the opportunity to drink on your own, unmonitored, while you're working. I mean, one of the observations from police was that there were more impaired driving offenses going on across the day in the morning, it wasn't just at nighttime. So, I think one of the things that was happening was the heavier drinkers were drinking on their own more, and that made them ill.

Dr. Blair Bigham:

Help me understand the drop in consumption, or sorry, the drop in these bad outcomes that happened towards the third year.

Dr. Tim Stockwell:

Well, partly that the main driver is always how much is being consumed. And there's been actually since there was a peak in Canada's alcohol consumption in 2020. We've been keeping records and Stats Canada has for years and years and years.

Like 2020 was one of the highest years on record. And then it gradually decreased the following year. And it's been falling off a cliff since, I guess, 2021.

So, 2022, that last year of the three we looked at, consumption had dropped. And I think that's partly due to economic trends, inflation, we had less disposable income. And it's been continuing since then.

It's the largest reduction in levels of consumption we've seen in Canada for decades.

Dr. Blair Bigham:

What do we know about how that increase in mortality, specific to alcohol use, affected overall mortality during the pandemic? And we've seen a lot in both science and the popular press around how life expectancy became shorter, more all-cause mortality went up. How much of that societal burden can be attributed to alcohol?

Dr. Tim Stockwell:

In general, it's about 5%. So, it's 5% of total mortality. It's roughly, think of all the bad things that can happen to us. If we consider a world in which there was no drinking, it would only reduce hospitalizations and deaths by about 5%.

Dr. Blair Bigham:

Sounds like a lot for a single disease or a single toxin.

Dr. Tim Stockwell:

Yeah, it's one of the most leading preventable causes of premature death, disability, injury and disease. So, although I say only 5%, I think that's the wider context. So, 5% of everything bad that can happen to us health-wise is substantial.

Dr. Blair Bigham:

During the pandemic, it wasn't just access that was driving these statistics. What else do we know about why people were consuming more alcohol?

Dr. Tim Stockwell:

Yes, piecing together some of the threads. Some of this is my interpretation, having been following the data that was collected over that period in Canada and other countries, people who reported having high levels of stress were drinking more during the pandemic. Some demographic groups were drinking more, particularly younger people, women increased their consumption.

They're still consuming less alcohol than men do and having less harm, but they increased more relative to where they were beforehand. The other thing is about the economics. I was touching on that before, that how much we drink as a country is largely to do with how much disposable income we have.

So, particularly with the efforts made to keep people in work and to be able to pay their bills while being stuck at home and having fewer things to spend our money on. So, I guess there was convenience, the opportunity to buy more alcohol with more disposable income, and the alcohol itself was cheaper because you weren't going out to buy more expensive alcohol in bars and restaurants where it's four or five times more than from the liquor store or three or four times more.

Dr. Blair Bigham:

So, shot for shot, you were getting your money's worth.

Dr. Tim Stockwell:

Absolutely. See, it's a perfect storm. And then for some people drinking during the day, you didn't have to show up, you could turn your Zoom camera off and people wouldn't see what you were doing or the state you were in.

Dr. Blair Bigham:

Right.

Dr. Tim Stockwell:

I think that applied to some people.

Dr. Blair Bigham:

Tim, thank you so much for joining us today. Dr. Tim Stockwell is a scientist at the Canadian Institute for Substance Use Research and an emeritus Professor in the Department of Psychology at the University of Victoria.

Dr. Mojola Omole:

We now know how alcohol policies affected public health during the pandemic, but what comes next? How should these lessons shape future policy decisions in the next public health crisis that might be around the corner? Dr. Adam Sherk is a senior scientist at the Canadian Centre of Substance Use and Addiction.

He was the co-author of “Canada's Guide on Alcohol and Health”. He joins us today from the beautiful Vancouver Island. Thank you so much for joining us today, Adam.

Dr. Adam Sherk

Thanks for having me on, Jola. Good to speak with you.

Dr. Mojola Omole:

So how surprised were you by the key findings in Tim Stockwell's paper?

Dr. Adam Sherk

I can't say that I was particularly surprised. There was, as Tim was saying, a bit of an increase in alcohol consumption during the pandemic. And so I can't say that we were that surprised that it led to increased deaths and hospitalizations during the first few years of the pandemic.

Dr. Mojola Omole:

How sympathetic are you to the argument that it should have been classified an essential service? Versus just the way it was.

Dr. Adam Sherk

Yeah, I'm reasonably sympathetic for the following reason. I mean, deeming it an essential service optically is bad from a public health perspective. Is alcohol really essential compared to the other things that were deemed an essential service?

Certainly not as essential as food and fuel. But really what essential service means is it kept the stores open. It provided governments the ability to keep those stores open, those alcohol stores.

And I'm reasonably sympathetic to the argument that the public was already being asked a lot of during the beginning of the pandemic. And to also turn off the taps in an alcohol standpoint might have been too much.

Dr. Blair Bigham:

So it seems like there's sort of three elements in all of this. The first being like a health element. We've heard from Tim that some places were saying, oh, people might go into withdrawal. Other places were balancing the risk of alcohol use. We've heard about the compassionate view like, oh, we're all locked down in COVID, like don't take away our liquor. And then the economic argument, right, which is being subtly talked about, but like how much of a consideration was just keeping the stores open and keeping the revenue flowing?

Dr. Adam Sherk

Yeah, that's a good question, Blair. I think it certainly came into consideration for governments, both in terms of government revenue, but then in terms of the broader economic perspective about keeping some businesses open when many were closed. And so I think you have keyed on something important.

Governments were rightly very concerned about economic well-being at the beginning and throughout the pandemic. And this is one thing that would have kept the economy moving along a little bit more than it otherwise would have. Now, what I will say, though, is if closing all the stores is one end of the spectrum and keeping all the stores open at the same number of hours that they've always been is the other end of the spectrum, of course, the government policymakers could choose anything along that spectrum.

Stores didn't have to be open as much as they were before. They could be closed certain days, for example, or their hours could be reduced. And given what Tim was saying, that alcohol caused deaths and hospitalizations increased during the pandemic, maybe that would have been a better balance to maintain access to alcohol, but decrease that access a bit in order to balance the health care utilization that came from the increased alcohol sales.

Dr. Mojola Omole:

Do you think the decision was made from the position of public health or was it more politically minded?

Dr. Adam Sherk

I would say to that that I don't think public health had a large voice at the table, I think. And frankly, rightly, the public health voices were more concerned about the pandemic itself, about the COVID virus, the spread of that.

Dr. Blair Bigham:

But a huge part of that was capacity of the health care system. How do you balance health system strain with this political imperative to keep the taps flowing?

Dr. Adam Sherk

Right. So yeah, at the beginning of the pandemic, I would say when alcohol was deemed an essential service, there was not enough discussion of the fact that by maintaining priority access to alcohol, it would also maintain the flow of people to the hospital and draw on health care resources. So particularly at the start of that pandemic, when we were as a society very keen to protect our health care resources for dealing with the pandemic, there could have been more talk about how deeming alcohol an essential service was also providing a big draw on that health care system and health care utilization.

Dr. Mojola Omole:

Were there any jurisdictions that were successful in balancing alcohol policies and public health that you're aware of?

Dr. Adam Sherk

Yeah, I mean, successful is a difficult word, so I'm having a little...

Dr. Mojola Omole:

Okay, better?

Dr. Adam Sherk

Yeah.

Dr. Mojola Omole:

A little better?

Dr. Adam Sherk

I would say that most countries went the way that Canada did, was that they deemed alcohol an essential service, meaning that they kept access to alcohol coming as much as they could, given that bars and restaurants were closed. And so that restricts access in some way already. But stores remained open, and then most provinces expanded their home delivery options so people could order alcohol and have it delivered at home.

So in terms of how governments can address alcohol policy at the beginning of a pandemic, really a lot of it is around access, access and availability, store opening hours, whether stores are open or not. In a broader sense, though, beyond the pandemic, the policies that we look to be really effective at protecting public health in terms of alcohol policy are things like pricing, are things like advertising restrictions on alcohol, which we don't have many of in Canada, are things like labeling, health warning labels, which we don't really have any labels on alcohol containers in any way that warn us about the potential health effects.

So in a broader sense, those are kind of some of the bigger policies. But then when we tunnel down into what happened, particularly during the pandemic emergency, the policy choices were more focused around access and availability.

Dr. Mojola Omole:

So do we know how alcohol-related harms were distributed across different population groups? Was it evenly distributed, or did we see more harm in certain groups than others?

Dr. Adam Sherk

Yeah, that's a great question, Jola. And the answer is that it certainly was not distributed evenly. So alcohol harms are disproportionately impacting people of lower socioeconomic position.

The lower your socioeconomic position, the much higher your alcohol harms are in that group. And this is despite the fact that people of lower socioeconomic position drink less than people of higher socioeconomic position.

Dr. Blair Bigham:

Wait a minute, that trips me up.

Dr. Mojola Omole:

So what happened? Like, why do we see that?

Dr. Blair Bigham:

So yeah, let me just try this on. So if you're in a lower socioeconomic group, if you're poorer, you drink less alcohol, but have more adverse events from alcohol.

Dr. Adam Sherk

Correct. Yeah, it's called the...

Dr. Blair Bigham:

All right, you got to break that down for us.

Dr. Adam Sherk

Yeah, so this is something in the field. It's called the alcohol harms paradox. And it's people at...

Dr. Blair Bigham:

Oh, okay, so it's not just me.

Dr. Adam Sherk

People, I mean, whether it should be called a paradox, I would say is debatable, but it's certainly a gradient. So alcohol is, it's an interesting field of study. It's really the only kind of, quote, unquote, unhealthy behavior that follows a positive income gradient.

The more income we have, the more we drink. And most, quote, unquote, unhealthy behaviors go the other way. The more income we have, the healthier choices are made.

But alcohol shows this kind of flip around. But at the same time, people of lower socioeconomic position, even though they drink less as a group, they experience far greater harm from alcohol, two or three times more alcohol deaths and hospital stays, as a group, of course, not as any individual, than those people in the higher socioeconomic positions. And that is a finding that jumped out at me from Tim and his colleagues' paper.

The alcohol harms in those more disadvantaged groups are far higher and went up more during the pandemic. And so alcohol policy also has an important role, maybe even a very important role to play in health equity, because alcohol policy can help to address this disproportionate harm that's caused by alcohol among economically disadvantaged groups.

Dr. Mojola Omole:

So then how do we have policy that better address this disproportionate impact on vulnerable populations?

Dr. Adam Sherk

Right. There are two parts to that potential answer, Jola. The first is that there are policies outside of alcohol, broader social policies that can help to reduce inequality and inequity in our societies.

So this is not my particular expertise that's outside the alcohol realm. But turning to specifically around alcohol policy, something that can be quite effective at reducing the harms, particularly among those of lower socioeconomic position, is something like a floor price for alcohol, a minimum unit price for alcohol. So this targets a specific section of the alcohol marketplace, which is ultra cheap alcohol, very cheap alcohol, which is disproportionately drank by people of lower income and also heavier drinkers.

Dr. Blair Bigham:

This is the same argument that if you put a really high tax on cigarettes, people will smoke less.

Dr. Adam Sherk

Yes. Yeah. In a broad sense, that's right, Blair. But the floor price tends to be reasonably low. It doesn't affect virtually all products, but it does affect products that are put there really just to be cheap, like just to really have a very high bang for the buck in terms of how much pure alcohol you can get for a dollar, say. So by targeting that ultra cheap section of the market and removing it, it can first off reduce the harms among those groups at the current time, but then it can also reduce harms over time as people are less able to access that very cheap alcohol.

Dr. Mojola Omole:

So some of the alcohol policies that were introduced during the pandemic, like home delivery, restaurants being able to also have expanded restaurant sales, they're supposed to be temporary, but we still have them remaining in place. So what are some of the long term implications of these changes having these policies that have expanded alcohol accessibility?

Dr. Adam Sherk

Yeah, that's a very good point, Jola, to bring up. So many of those things, like you said, that were brought in as temporary measures during the pandemic, people kind of got used to them. And the businesses started to lobby for them, and people became accustomed to getting alcohol delivered right to your door.

And so despite the fact that they were originally put in temporarily, many jurisdictions, provinces and territories have chosen to make those more permanent. So these will, I would say, subtly push in the same direction to increase alcohol consumption, as opposed to them not being there. And so as Tim was saying, the alcohol harms, deaths and hospital stays that are caused by alcohol are very linked to how much alcohol is sold, how much alcohol is consumed.

So policies like this that can push up consumption or prop up consumption in the face of, as Tim was saying, some declines over time, will, you know, if it props up alcohol consumption, it'll also prop up alcohol harms. It's not exactly one-to-one, but there is, of course, a very strong link there.

Dr. Mojola Omole:

So as we're moving forward, there's going to be another pandemic. Maybe you won't have the same risk. Well, there's bird flu, there's measles, there's everything.

What is a smart approach? What have we learned looking back from these policies? And how can we apply it to smart alcohol policies in a future crisis?

Dr. Adam Sherk

Yeah, it's really the nut of the question there. And so I think what I would say to that great question is we need to find a more balanced approach to alcohol. What we did during the COVID-19 pandemic was we kept access the same or even tried to increase it with things like home delivery, notwithstanding the fact, of course, that bars and restaurants were closed, but liquor stores, their access remained very similar.

I would argue, I think, and the results of this paper kind of argue that by doing that, we increased alcohol-caused harms, deaths and hospital stays during the beginning of the pandemic, at a time when we wanted to protect our people, of course, but then also our healthcare resources. So a more balanced approach might be something like maintaining access, but reducing it in some balanced way. Having less stores open for less time, doing things that would modestly decrease alcohol consumption instead of modestly increase it.

Dr. Blair Bigham:

So it sounds like there's sort of a fine line between policy and politics. But this has been super interesting. You've certainly helped illuminate maybe where we erred in the last couple of years, and how we might do things in a more balanced way now, hopefully, or in the future.

Thank you so much for joining us.

Dr. Adam Sherk

Right. I enjoyed the conversation. Thanks for having me.

Dr. Mojola Omole:

That's great. Dr. Adam Sherk is a senior scientist at the Canadian Centre on Substance Use and Addiction, and he joins us from the beautiful Vancouver Island.

Dr. Blair Bigham:

All right, Jola, if you were Premier, what do you think the right answer is here? We had a policy meant to keep the taps flowing, keep people happy, keep the money coming in, and it didn't work, as far as I can tell.

Dr. Mojola Omole:

I think there has to be a fine balance. And some of the things that both Tim and Adam mentioned, in terms of being able to regulate the amount of hours that's open, for example, in Ontario, some people will argue, well, do we need to be able to buy alcohol at your corner store now that we're able to do that?

Dr. Blair Bigham:

I guess from a policy perspective, we can kind of focus in on that population that Tim identified as the most at risk, which was people who were already drinking on the heavier side of things. But how do you say certain people can have more access to alcohol than others?

Dr. Mojola Omole:

To me, it also sounds kind of like, well, because I'm poor, I'm not allowed to have the ability to drink as much as I want. But if you are rich, you can drink as much as you want.

Dr. Blair Bigham:

You're saying there's like a paternalistic, targeted.

Dr. Mojola Omole:

It is, if you're heavily taxed the alcohol for lower social income. That's the way it seems to me right?.

Dr. Blair Bigham:

And I would wonder, in addiction, people might not feel that they have the choice to say, oh, I can't afford that anymore. Maybe they're going to make choices about not affording other things so that they can continue to maintain an alcohol dependency.

Dr. Mojola Omole:

I don't necessarily know if that would be the answer. And I definitely am a person that believes that it should be fair for everybody. We shouldn't overburden a certain percentage of the population in this type of way. I  don't know what the right answer is. I truly don't.

Dr. Blair Bigham:

Yeah, because other taxes that are meant to be punitive to affect behavior are not progressive taxes. They're all regressive. It's a cigarette tax, a gas tax, whatever the tax is that's meant to be a burden so that people stop using a certain type of product.

Those are all going to affect people who make less money more than they affect rich doctors like you and me.

Dr. Mojola Omole:

Yeah, I think we know that the method that we had during the last pandemic did not work. And I think something that Adam brought up is that we need to also have public health who look at this, whose work is, you know, alcohol from the public health perspective, also be at the table when these policies are being made.

Dr. Blair Bigham:

And as usual, doctors with expertise are pushed out whenever it becomes a political model.

Dr. Mojola Omole:

Yeah, and like, I mean, public health is…

Dr. Blair Bigham:

Or a campaign slogan.

Dr. Mojola Omole:

Yeah, public health is like our unsung heroes in medicine, right? 

Dr. Blair Bigham:

Absolutely. 

Dr. Mojola Omole:

Underpaid and never listened to until it's too late.

Dr. Blair Bigham:

That's it for this week on the CMAJ Podcast. If you like what you heard, do us a favor and like or share or just tell your colleagues in the break room. We would love to help get our message out and you are key to that.

The CMAJ Podcast is produced by PodCraft Productions. I'm Blair Bigham.

Dr. Mojola Omole:

I'm Mojola Omole. Until next time, be well.