Toronto's paramedic service struggles to keep pace amid burnout, competitive job market

The union representing Toronto’s paramedics says the city is struggling to retain people within its service because of the increasing stress of the job and the rising cost of living in the city. 

Recruitment, retention challenges come as city enters final year of a plan to staff up EMS service

Man in a dark coat and hat stands in front of an ambulance.
CUPE 416's paramedic unit chair Mike Merriman says Toronto is not doing enough to recruit and retain EMS staff. He says the city is losing paramedics to other GTA communities were pay is about the same or higher, and call volumes are lower. (Greg Bruce/CBC)

The union representing Toronto's paramedics says the city is struggling to retain people within its service because of the increasing stress of the job and the rising cost of living in the city. 

CUPE 416 is sounding the alarm about Toronto's struggle to keep workers in the paramedic service at a time when call volumes are growing at a rate of five per cent per year.

The chairperson of the paramedics local said he's concerned that on top of retirements, the service seeing both pandemic burnout and recruitment by other GTA services eating into the city's staffing levels.

"It's taken an enormous toll on them. We have at least one resignation a week," Mike Merriman said. "There's a few that may be moving on to other careers, but most of them are moving on to other paramedic services."

Since 2020, Toronto says it's hired 578 paramedics. In that same time period, it says 320 have retired or left the service. And that comes after a decade of hiring just to fill attrition, Merriman said, adding the numbers are concerning. 

"It tells me that the working conditions are unsustainable, that the service is basically running on overtime right now," he said.

The city says Toronto EMS employs nearly 1,500 paramedics and is the largest municipal service in Canada. It responds to 40 per cent of the emergency call volume for the province.

But the staffing challenges, coupled with increasingly long delays to off-load patients at Toronto hospitals, are also adding to the strain on staff.

"They go non-stop from the moment they book on in the morning, basically, until the end of the shift," Merriman said.

Charles Labelle, who has been a paramedic for 17 years, said work in paramedicine has always been stressful, but the level of exhaustion felt by many has reached new levels because of the pandemic. For paramedics, COVID-19 is still a daily reality and so too are the tragic scenes they encounter, he said.

Man in a dark sweater stands in front of an EMS station.
Paramedic Charles Labelle says he has seen colleagues leave Toronto EMS for other GTA services for a variety of reasons including workload issues and cost of living. (Greg Bruce/CBC)

"The thing about paramedicine is that this job is not everybody's reality," he said. "What we see and what we do is traumatic. It's something that one person might go through in their lives once. We see it every day."

Labelle, who is also a steward with CUPE, said he's seen a number of friends and colleagues leave the field entirely or move on to other services. He doesn't blame them.

"They can seek employment somewhere else where they're going to be paid the same, or paid more. The city's become unaffordable for many of us," he said. "So, why would they want to work here when they can work somewhere else ... and have a better life?"

And for the veterans of the service who stay on, the turnover impacts morale, Labelle said.

"It's new faces every year," he said.

City pursuing paramedic hiring strategy

In 2019, the city adopted a strategy to help shore up paramedic staffing. At the time, it acknowledged call volumes were expected to increase at a rate of approximately four per cent a year as Toronto's population grew and aged. That would put additional pressure on the service and adversely affect call response times.

Council adopted the plan that called for hiring approximately 60 new paramedics a year beyond attrition levels. This year, the city announced it would hire 66 new paramedics and an additional 82 are slated to be brought on in 2024, the final year of the strategy.

And while Merriman gives the city credit for its hiring plan, he said it isn't keeping up with attrition and estimates it's currently about 100 paramedics short.

He said the city is not doing enough to keep the workers it spends time and money training. That means that investment is wasted when they leave, he said.

"They have to not only come up with something to keep paramedics, they have to come up with something to attract paramedics because they're not getting the numbers that they want to achieve," he said. Among the measures that would help, he said, are pay increases and retention bonuses, like those paid to other first responders.

Competition between services has also picked up. 

Durham Region pays its paramedics more than Toronto does, and it recently began hiring for both full-time and part-time positions. Last summer, York Region adopted a 10-year plan to hire 344 paramedics as it anticipates growing call volumes. 

Chief in dress uniform standing in an auditorium.
Toronto EMS Chief Bikram Chawla says that the competition for new paramedics is a tough, but the city has some competitive advantages. Those include the opportunity for advancement and to build new skills. (CBC)

Tough competition between GTA services

Toronto EMS Chief Bikram Chawla acknowledged that the fight for talent is real.

"As we come out of COVID, other GTA paramedic services are also hiring," he said. "And so that also creates a competitive job market."

Speaking at a graduation ceremony for new recruits, Chawla said the advantage Toronto has over other employers is the chance to build new specialties, access to a greater variety of roles in a large service and the chance for paramedics to hone their skills.

"We respond to so many calls every year, 300,000 calls … they have a chance to practice those skills and get even better at them, where they may not be able to do so in other outlying or rural services," he said.

The city said the paramedic service has responded to the competitive job market by offering full-time employment and flexible start dates.

"Once hired, numerous training and advancement opportunities are available," the city said in a statement, adding it also has various supports available to staff including a comprehensive psychological health and wellness program and staff support centre for issues related to COVID-19."

Omar Hassan says Toronto isn't alone in facing recruitment and retention issues — it's a problem across the country. The York University PhD student researches mental health among first responders and the barriers they face to seeking treatment.

Toronto isn't alone but its problems are big ones

But while Toronto may not be alone, its size means its problems are big ones.

"I spoke to a number of paramedics who say there's a lot of people who are coming in for about maybe five years and then they leave Toronto," he said.

"It's a lot to deal with: the call volume, the types of cases that you've seen, it's not exactly what they may have signed up for. So they move to different municipalities."

Hassan said the pandemic has just exacerbated burnout problems that existed prior to COVID-19. And paramedics also find themselves treating patients with more complex needs, including those with mental health issues.

"Paramedics also get assaulted, they get harassed, they get accosted, spat on and even in some cases, urinated on by patients," he said. "They have to absorb all of that. And that can be challenging over a period of time."

Recent paramedic graduate Francisco Osorio, 29, who started with Toronto EMS earlier this year, said in spite of the challenges, the job gives him an opportunity to make an impact.

"It's something that I was wanting to do and I'm ready for the challenge," he said. "And I'm ready to help people."

Asked about the stress of the job, Osorio said he knows that will be inevitable. But he tries to focus on the people he's helping and their families.

"I try to take it a day at a time," he said. "The most important thing at the end of the day is that smile or the family when you see that you're helping someone."


Shawn Jeffords is CBC Toronto's Municipal Affairs Reporter. He has previously covered Queen's Park for The Canadian Press. You can reach him by emailing