In 2022–23, agency staff accounted for 0.4% of front-line hours in Ontario hospitals and 6% of hospital labour costs. That finding comes from a 2025 report by Andrew Longhurst of the Canadian Centre for Policy Alternatives, which also found that Ontario hospitals paid for-profit staffing agencies $9.2 billion between 2013–14 and 2022–23.
We’re not writing this to argue for or against agencies. Hospital leaders have heard that debate many times. We’re writing because the number points to a decision most organizations don’t look at closely: what happens in the minutes before an agency call is made.
What the number does and doesn’t tell us
The two figures use different denominators, front-line hours on one side and total labour costs on the other, so they shouldn’t be read as a precise cost multiple. The data covers Ontario hospitals through 2022–23, and the report was commissioned by the Ontario Council of Hospital Unions. We’re citing its data here, not its policy recommendations, and other provinces and more recent years may look different.
What the figures do show is that a small share of hours can carry a larger share of cost. Coverage of the study also notes that agencies often charge double or even triple the regular hourly rate, and that smaller and northern hospitals tend to rely on them more. At a time when more than 70% of Ontario hospitals are forecasting deficits, lines like this draw attention.
The chain most leaders don’t see
A shift goes vacant. Someone reaches out to internal staff, often by phone. If no one responds in time, overtime or an agency may be next. Leaders usually see the invoice at the end of that chain and rarely the steps before it.
Public data can’t tell us how many agency hours were avoidable. Most hospitals can’t tell from their own records either, because phone-based callouts often leave no record of who was asked, in what order, and for how long. That is not a criticism of schedulers, who are working with the tools they have. It’s a gap worth naming, because it’s hard to manage what can’t be seen.
Four questions to ask on Monday morning
- What share of last month’s agency shifts were first offered to our own staff?
- How long passed between a shift becoming vacant and the first internal offer?
- When someone decides to go external, what do they see: eligible internal staff, hours worked and overtime exposure, or a phone list?
- What does a filled shift cost by route: straight time, overtime and agency?
If you can answer all four from your own data, you have a clear picture. If you can’t, that’s the first finding.
Where agencies belong
Agencies fill real gaps: remote communities, unexpected closures, seasonal surges. The aim isn’t zero. It’s intention, with agency use as a decision rather than a default.
There is also movement on transparency. Ontario legislation tabled in late 2024 and reintroduced in 2025 would require agencies to report billing and pay-rate information. Whatever happens next, leaders are likely to be asked to explain agency spending more often, and it’s easier to answer from data you already have than to assemble it under a deadline.
When the fallback becomes an outcome of process
When an open shift goes to all eligible staff at once, in the order a collective agreement requires, internal staff have a fair first chance before overtime or an agency is considered. Every offer and response is time-stamped, so the questions above can be answered from the record rather than from memory.
At ShiftLink, customer results include 1,900+ vacant shifts filled at Concordia Hospital with a 90% straight-time fill rate, and an average staff response time under two minutes. Results vary by organization.
Find your number
Take last quarter’s agency hours and spend and compare them with total front-line hours and total labour cost. Where does your organization sit relative to 0.4% and 6%? Then work through the four questions above.
If it would help to see how internal offers can be recorded and measured, we’re glad to walk through it.
You can book a conversation at shiftlinkapp.com/book-a-demo.
Sources: Canadian Centre for Policy Alternatives, “Hollowed Out: Ontario Public Hospitals and the Rise of Private Staffing Agencies” (2025), as reported by The Canadian Press/CTV News and The Globe and Mail; Canadian Press, April 2026, on Ontario hospital deficits. Customer results are selected outcomes based on ShiftLink platform data and vary by organization.
