After a disappointing contract offer from the city, many Toronto paramedics have cancelled planned voluntary overtime shifts, leaving the province’s largest emergency medical service scrambling to fill the gaps.
It all began with an email.
About two weeks ago, paramedic workers were presented with a contract offer from the City of Toronto, as part of the city’s bargaining of a new four-year deal with all outdoor workers.
The union tried to put an optimistic spin on the draft contract, one longtime paramedic said, but it was ultimately voted down by the majority of TCEU Local 416 paramedics.
TorontoToday agreed not to name the five paramedics interviewed for this story, including four who currently work for the Toronto service and one who resigned last year, as they feared employment-related repercussions.
Soon after the contract was voted down, one paramedic sent an email to the service’s scheduling team, copying the chief of Toronto Paramedic Services, Bikram Chawla, and the worker’s 1,400-odd paramedic peers.
“Today I was told that Senior management do not feel I need more than 25 minutes to recover after a call and complete paperwork,” he said, responding to the draft contract in anger.
“[I was told] that they no longer wish to compensate me for their failure to give me a meal break, [and] that they do not care if I go home after 12 hours of working or 14 hours,” he said.
“As a result, I am no longer able to work my upcoming overtime shifts.”
That missive has since inspired a wave of copycat submissions from other Toronto paramedics and a rebuke in the form of an all-staff email from Chawla, accusing workers of engaging in “inappropriate” labour action that puts city residents at risk.
While a City of Toronto spokesperson said there are plans in place to ensure emergency service continues to function normally, two paramedics said they believe the service is stretched thinner amidst the overtime cancellations.
The friction comes at a moment when the city’s emergency medical service is highly reliant on staff working overtime — after emergency call volumes have risen in recent years and the division has struggled to retain talent, according to a 2024 report by the city’s auditor general and staff who spoke with TorontoToday.
One longtime paramedic said the draft contract was the “final straw” of long-simmering frustrations with workload, pay and labour conditions that, he said, have put patients at risk.
A wave of cancellations
On the afternoon of Dec. 19, a few hours after the initial email to scheduling, a different worker posted a screenshot of the letter to a Facebook group for Toronto paramedics.
“This honestly means nothing unless everyone does it,” he wrote. “[I] would encourage everyone with scheduled overtime to go write a similar email and cancel their OT as well.”
Within 24 hours, about 20 others had posted saying they’d either canceled planned overtime shifts or asked scheduling staff to remove their name from a list of workers interested in overtime.
“Cancelling my OT for the rest of the month,” one said. “Done!” said another.
Frustrated with the state of their labour conditions, paramedics have for years discussed possible collective action, according to one longtime staffer.
However, what was missing, he said, was a spark that united workers' frustrations simultaneously — and a suggestion for a tactic that many believed would not compromise patient care.
Since the worker’s initial email, two longtime paramedics that spoke with TorontoToday each estimated that “hundreds” of the city's 1,400-odd paramedics have cancelled voluntary overtime shifts or gotten off of the on-call list for overtime.
TorontoToday was not able to independently verify the number of overtime shifts that have been cancelled. However, TorontoToday obtained several emails that staff sent to scheduling to cancel shifts or to be removed from the on-call list.
In them, workers do not mince words, citing long-simmering frustration about missed meal breaks and a lack of time to complete paperwork — conditions some staff said are leading to burnout.
What’s the deal with missed meals?
Under the city’s current contract with paramedics, staff working 12-hour shifts are entitled to one 30-minute lunch break — less than half of the legal minimum for most other workers in the province.
However, faced with chronic understaffing, according to several workers, paramedics are frequently forced to miss this break.
“I have personally even taken my own blood sugar during shift, and I have been below what the normal should be,” one Toronto paramedic said. “And I’m still supposed to be properly able to make medical decisions, and treat people — and drive a truck in that condition.”
When a dispatcher diverts a paramedic from their meal break to another call, the individual currently receives about $40 as compensation.
Some workers miss north of 75 meals per year, according to three longtime paramedics, resulting in between $4,000 to $6,000 in additional annual income.
The new contract promised instead, however, to provide staff with a $1 raise for each hour worked in recognition of the fact that missed meals happen “from time to time,” according to a copy of the draft contract obtained by TorontoToday.
Added up, this worked out to several thousand dollars less per year for some paramedics. “It’s a big difference” in a city where the cost of living is so high, said one worker.
But even more than the income loss, another paramedic said he feared the new arrangement would disincentivize management from hiring additional staff to ensure existing workers can take meal breaks.
“In a service that already likes to burn its employees out, we are very doubtful management would even continue giving us lunches,” he said.
“Most medics are so tired and [drained] during a shift lately that we honestly just want a lunch break — 30 [minutes] to de-stress.”
Paperwork woes
Some workers were also concerned about language proposed by management that several paramedics said would not allow sufficient time to complete the required paperwork after each patient visit.
From the moment hospital staff provide a patient with a bed, paramedics currently have about forty minutes to get the person settled, clean their equipment and complete paperwork about the call.
However, because of short-staffing, workers are sometimes sent to another call before they have a chance to finish the documentation, leading forms to pile up at the end of a shift, according to a former Toronto paramedic.
In the draft agreement, management proposed to reduce paperwork time by about fifteen minutes.
One longtime paramedic said this was a “Band-Aid” solution to understaffing — arguing that rather than hiring additional workers, management was essentially trying to squeeze more out of existing staff.
A former Toronto paramedic said a lack of sufficient time to complete paperwork was one of the factors that contributed to his belief the work was not sustainable, and prompted him to resign, taking up a job with another Ontario service.
He recalled a time when he finished a busy shift at 2.a.m, but had to stay at work for another two hours, trying to recall details from patient visits hours prior, having not been given the proper time after he finished each call.
“I couldn’t even remember what I did, but I had to fill out this medico-legal documentation,” he said.
Another worker agreed. “The real problem is we are tired and want to go home after a 12- or 14-hour shift, not stay and do paperwork,” he said.
The longtime paramedic added that staff have been raising these issues with management for many years, but have not seen progress.
“We are still in negotiations with the power to change things,” he said of the collective bargaining process. “Once the negotiations are done, we are stuck with another four years.”
Staff solidarity around overtime cancellations
In the Facebook group in December, a few workers expressed some hesitation about their peers’ cancellation of overtime shifts.
They said they were concerned the action would put stress on scheduling staff and the paramedics who remain on the road.
But those comments were the outliers.
As posts came in and workers said they were cancelling their overtime, fellow paramedics celebrated the posts with heart and like emojis.
“I understand it’s the holidays and times aren’t the best right now … but we need to stand up together!” one said.
“The work day will be tough but in the long run it will be worth it,” said another.
Not all were excited by the action, however.
At around 6 a.m. on Sunday, Dec. 22, three days after the initial workers’ email, Chawla responded with his own missive to staff.
“I am writing today regarding a concerning number of sick calls and a growing number of staff refusing overtime,” he said.
The chief said he respected workers' right to vote for or against proposed contracts offered by the city, but that calling in sick, refusing overtime or otherwise being absent without reason is a form of “inappropriate” labour action.
“Culpable absenteeism undermines the trust placed in paramedics and can harm the communities we serve,” he said.
Is cancelling OT ‘inappropriate’?
The early-morning email came as a shock to one paramedic who spoke with TorontoToday.
She said the decision to cancel overtime shifts came from workers — not instruction from the union — and that there was nothing inappropriate about staff deciding against spending their free time taking on additional work.
She and another paramedic TorontoToday spoke to said they were not aware of anyone faking being sick.
December is a high period for illness because of seasonal colds and flus, she said. (The auditor general’s report found that between 2019-2023, paramedic staff took the most sick leave in December.)
TorontoToday contacted TCEU Local 416 president Eddie Mariconda for his perspective on the chief’s email, but did not receive a response prior to publication time.
Brock University labour professor Simon Black said workers’ decisions to cancel voluntary overtime is strategic.
Paramedics are considered essential workers, which means they can’t strike.
Black said Toronto’s Paramedic Service has failed to sufficiently hire, per the auditor general’s report, making the force particularly reliant on overtime.
Toronto’s auditor general found that in 2023, paramedics worked an average of five full weeks of overtime — an increase of about 170 per cent since 2019.
The report said the service has been reliant on overtime to manage peaks in service demand; and that after an early pandemic dip, call volumes increased between 2021 and 2023 amidst a family doctor shortage.
The report said the reliance on overtime to manage spikes could lead to staff burnout, stress-related injuries and turnover, noting that between 2019 and 2023, the staff turnover rate among paramedics increased from five to eight percent — meaning that the equivalent of 500 paramedics left the service during this period.
The auditor also made the link between staffing challenges and patient wait times, noting that over the last several years, Torontonians have been waiting longer for ambulance services — particularly the most critically injured patients.
The number of instances where there are no staffed ambulances available to respond has also increased over the five year period, per the report — from 29 episodes in 2019 to over 1,200 episodes in 2023.
Paramedic chief accepts auditor’s recommendations
The Toronto Paramedic Service has said they are working to address these issues.
The auditor’s report said the paramedic service had previously identified some of the problems she raised and taken several steps to remediate them.
With respect to staffing, management told the auditor’s team it was implementing multiple retention strategies, including providing more staff recognition, opportunities for career advancement, and better equipment and facilities.
Last summer, Chawla also accepted all of the 10 recommendations from the auditor’s report, including several related to staffing.
On Monday, a spokesperson for the chief said the city “remains committed to supporting the overall health and wellbeing of all staff, including Paramedics.”
“We recognize the demanding nature of the work and take seriously all concerns brought forward,” she said.
But one of the longtime paramedics that spoke with TorontoToday said things have been getting worse not better over the past year, and said that some workers felt the need to press the issue.
He said that the Toronto Paramedic Service used to be the most desired municipal service to work for, but now it struggles to retain staff.
“We cannot continue to work voluntary overtime if we are sick or burnt out and becoming a liability to our patients due to exhaustion.”
Impact of OT cancellations
The impact of the recent cancellation of overtime shifts on patient care over the past two weeks is unclear.
One of the longtime paramedics that spoke with TorontoToday said the cancellations have made workers’ jobs more difficult and busier. Dispatchers are rerouting medics to new calls faster, he said, meaning less time for paperwork.
Another longtime paramedic said she’s been dispatched to calls in farther-flung parts of the city than usual, suggesting perhaps the service is short-staffed.
On Monday, the paramedic service sent an alert to city hospitals, advising them of a continued struggle with “low unit availability” and delays in offloading patients at hospitals.
The service notice asked hospital staff to do anything in their purview to free up paramedic crews.
Notices of this kind have been increasingly frequent, according to one longtime paramedic. However, two paramedics said this was the first time they’ve seen the service highlight the low number of ambulances on the road as the concern. Normally, they said, the service cites hospital delays exclusively.
A city spokesperson confirmed sick days and overtime cancellations have increased since Dec. 16, but said the paramedic service is being maintained.
“The City is monitoring the situation closely, with plans in place to ensure service continues as needed,” she said.
A longtime paramedic said he and his colleagues are willing to work harder while cancellations continue to ensure patients get the best care.
Negotiations ongoing
On Tuesday, one day after the hospital alert was issued, Toronto paramedics’ existing contract with the City of Toronto expired.
The two parties continue to negotiate toward a new, four-year collective agreement.
A spokesperson said the city is committed to “finding a fair and equitable agreement that underscores the critical and difficult work of being a paramedic in Canada’s largest city, while also delivering value to Torontonians.”
“During this time, paramedics are expected to continue providing life-saving services by working in the normal course,” she wrote in an emailed statement.
If no agreement is reached, the two parties will proceed to arbitration, per the city spokesperson.
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CORRECTION: An earlier version of this story said a paramedic receives about $70 as compensation when a dispatcher diverts them from a meal break. The regular compensation is about $40 but the $70 missed-meal pay comes if a paramedic works a 14-hour shift.
