Doctor’s Note on Day One: German Coalition Plan Faces Legal Hurdles and Widespread Rejection

A push by Germany’s incoming coalition government to force workers to present a medical certificate from the first day of illness is drawing fire from opposition parties, unions, medical associations — and even members of Chancellor Friedrich Merz’s own CDU. The plan also includes scrapping the option of a telephone sick note, a practice introduced during the pandemic.

But a little-noticed legal principle may blunt the reform’s impact. A specialist in labour law has pointed to the Günstigkeitsprinzip — the “favourability principle” — which protects existing contract clauses that are more beneficial to employees. Individual agreements that already allow a doctor’s note only from the third or fourth day of illness could remain in force, the lawyer said, even if the law tightens the general requirement.

That nuance is just one of several complications facing Merz’s administration as it tries to curb what it calls an excessive sickness absence rate.

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Coalition tensions simmer

The CDU leadership insists on a blanket obligation to produce a sick note (AU, Arbeitsunfähigkeitsbescheinigung) from the first day. The SPD, its junior coalition partner, is demanding a “practicable implementation.” In early July, Christian Bäumler, deputy head of the CDU’s workers’ wing (CDA), publicly urged the government to drop the plan, calling it an unnecessary distraction that the coalition should clear off the table. CDA chairman Dennis Radtke also advised a rethink.

Merz justified the measure as necessary to lower the country’s elevated sickness rate. The current law — the Entgeltfortzahlungsgesetz — already lets employers demand a certificate before the third day, but few companies enforce that clause.

A flood of extra visits

Medical groups are pushing back hard. Nicola Buhlinger-Göpfarth, chair of the German Association of General Practitioners, branded the reform “pure symbolic politics.” Her organisation estimates it would trigger at least 30 million extra practice visits every year, swamping doctors with paperwork and reducing time for actual care.

Patient advocates and unions warn that forcing sick people into waiting rooms on day one would spread infections, not reduce them. The German Trade Union Federation (DGB) said the policy could backfire by promoting Präsentismus — workers showing up ill to avoid a trip to the surgery — which would ultimately burden colleagues and raise overall health costs.

Doubts over effectiveness

Economists question whether the rule would even lower absenteeism. A researcher at the German Institute for Economic Research (DIW) noted that telephone sick notes account for only 0.8 to 1.2 percent of all AU certificates. No causal link exists between that option and high sickness rates, he said. A stricter certificate requirement might even push doctors to sign patients off for longer periods — since they already made the trip, the argument goes.

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The AOK health insurance fund’s board chair Carola Reimann said the real reason for the recent rise in recorded sick days is the introduction of the electronic sick note in 2022, which captured short absences that previously went unrecorded. And most of the lost working time stems from long-term illness: in 2024, conditions lasting more than six weeks caused around 40 percent of all absence days.

Public opinion and international context

A YouGov survey found that 59 percent of Germans oppose requiring a doctor’s note from day one, and 58 percent reject abolishing the telephone option.

Internationally, Germany sits among the top OECD countries for paid sick days, but a standardised survey on weekly working-time loss puts the country at 6.8 percent — only seventh place, far behind leader Norway at 10.7 percent, according to a study by the Institute for Health and Social Research (IGES).

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