A consistently increasing imbalance between the supply of and demand for occupational therapists has led to a critical manpower shortage in occupational therapy. Based on a review of various government reports and related literature, this paper provides an overview of the extent of this manpower problem, identifies factors affecting retention and attrition of occupational therapists and discusses strategies to improve retention and reduce attrition. To address the supply-demand imbalance, recommendations in relation to education, employment, immigration and service delivery for the occupational therapy profession in Ontario are proposed.