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Analysis of Paramedic Services Recruitment and Retention

Report To: Manitoulin-Sudbury District Services Board

From: Robert Smith, Interim Chief of Paramedic Services

Date: May 16, 2024

Re: Analysis of Paramedic Services Recruitment and Retention - Issue Report


Manitoulin Sudbury District Service Board (DSB), Paramedic Services is seeking direction from the Board of Directors to examine the current and historic state of staff retention and recruitment success and to explore strategies employed by comparator organizations. Additionally, staff are requesting direction to bring forward strategies that could mitigate ongoing challenges to the successful operation of the Manitoulin-Sudbury DSB Paramedic Services.  

Executive Summary        

Challenges with the retention of Manitoulin-Sudbury DSB Paramedic Services staff as well as the external recruitment of paramedics are issues that require intervention/mitigation to ensure ongoing efficient and effective service operation. The challenges experienced over the recent years is impacting on the service delivery and the financial responsibility. 

An analysis of the current state and recent trends will provide staff the data and opportunities necessary to develop mitigation strategies. Staff are promoting this work as a priority and will have to be collaborative with internal and external partners to ensure success. A status quo approach will not be sustainable for system success across the Manitoulin-Sudbury districts.   


The recruitment and retention of paramedics across Ontario has been an issue of ebb and flow over the last two decades. Immediately following the downloading of Paramedic Services from the province, there was a need to modernize and improve service delivery in every area.  The result was a widespread increase in staffing profiles.

Additionally, during that period, the college paramedic program expanded to its current two-year model. The result was a cohort loss for the year where students had to remain in college.  

These two factors resulted in significant Health Human Resources (HHR) issues that extended through 2007. In many instances, recruitment efforts across the province resulted in unstable staffing profiles and retention challenges. By late 2007 and beyond, strategies to increase the number of paramedics entering practice resulted in more stable retention profiles thereby mitigating many of the recruitment challenges. The industry in Ontario entered a more stable period for HHR.

Since 2020, there has been a renewed challenge with recruitment of paramedics across Ontario. Upstream, the benefit of Community Paramedic (CP) programs has resulted in the need to recruit front line paramedics to replace those advancing to CP. Additionally, there has been a reduction in college graduations. The Covid-19 pandemic has also impacted on both retention and recruitment of paramedics. Cumulatively, the factors brought forward in this report have impacted on recent paramedic services workforce stability.       

Current Issues

The current issues impacting Manitoulin-Sudbury DSB Paramedic Services workforce stability can be broken out into two main categories, retention and recruitment. 

Retention of Paramedic Services personnel must be examined in a very specific manner to determine causation. A rudimentary analysis has revealed that few of the staff leaving employment with DSB are doing so to obtain employment elsewhere in the same position. Advancement in the profession, movement to a more stable position, and separation to enter another profession have impact on the overall retention.  There are other factors that are also impacting on overall retention.

Recruitment is a significant factor impacting on MSDSB Paramedic Services operations. An initial analysis reveals a trend to lower annual hiring over the period from 2020. This is a direct result of a reduced pool of available recruits. The reasoning for this reduction is multifaceted but is a provincial trend.     


Manitoulin-Sudbury District Services Board Paramedic services staff are initiating a recruitment and retention analysis to understand the correlation and causation impacting on Paramedic Services stability. A final report will be prepared and provided to the Board with mitigation strategies.  

Comparator Action Plans

Staff are aware of recruitment and retention assessments in a limited number of paramedic services across the province, however the plan is to leverage work done in some NOSDA services areas over the last two years to help inform the DSB review.  

Funding Impact

The lack of successful recruitment of paramedics into Manitoulin-Sudbury DSB Paramedic Services is demonstrated as follows:

Year Number of Recruits
2020 13
2021 8
2022 11
2023 7
2024 1(YTD)

The diminishing number of recruits into the Paramedic Services with the associated attrition and realignment of personnel into other positions within the DSB has impacted on the backfill coverage capacity. A review of costs for overtime shifts, something that is directly impacted by part-time staffing levels has increased exponentially. In 2019, the overtime shift hours totaled 448 and in 2023 the total hours were 8,603. This 18-fold increase has had a significant impact on the cost-of-service delivery. 

The recruitment churn resulting from multiple hiring/orientation processes has both direct and indirect costs associated with the hiring and onboarding of new staff, costs that extend to personnel across the DSB. 

The design and implementation of a sound retention and recruitment strategy would have potential costs associated with success, but those costs would offset current impacts experienced within the DSB.

The alternative to direction to undertake a fulsome analysis of retention and recruitment within Paramedic Services would result in a continued degradation of staffing levels and the ability to effectively manage costs associated with necessary staffing levels.  Moreover, the failure to analyze and mitigate the issues will likely impact on provision of the emergency services. The comparison of resource down staffing from 2022 to 2023 revealed an increase from 393 hours (~32 shifts) total to 1220 hours (~102 shifts) total. 


Challenges associated with Paramedic Services retention and recruitment are multifaceted and have evolved over the last two decades.  External factors impact operations across the province and more specific organizational issues can impact locally. 

There have been specific trends over time and there are some system strategies that the Ontario government has put in place to help address recruitment and retention, with specific northern initiatives. As mentioned to the board in February 2023, these include the learn and stay initiative where college tuition costs are covered by the Ontario government and the increased enrollment numbers approved for some Northern Ontario colleges.   

DSB staff will need to explore current issues and trends and develop strategies to mitigate the increasingly negative impacts associated with HHR challenges.  It is likely that the Manitoulin-Sudbury DSB Board will need to prioritize strategies in the short to medium term to ensure success in the long term.