German Doctors and Public Unite Against Coalition’s Day-One Sick-Note Rule

A new YouGov survey of 6,200 respondents delivers a clear verdict: 59% are against requiring a doctor’s certificate from the first day of illness, and 58% oppose scrapping the phone-based sick-note option. The figures add weight to warnings from doctors, unions, and state governments as the black-red coalition pushes through what physicians call a “bureaucratic super-GAU” — a worst-case scenario for overburdened practices.

Decision That Undoes Pandemic Flexibility

The coalition committee voted on 3 July to abolish the possibility of obtaining a sick note by telephone, a measure introduced in late 2023. From now on, employees must present a medical certificate on day one of illness. Previously, the AU (Arbeitsunfähigkeitsbescheinigung) was generally required only from the fourth day. Alongside the change, the government plans to tighten Paragraph 278 of the criminal code, which deals with false health certificates, by imposing harsher penalties.

Chancellor Friedrich Merz described the package as “a tough but necessary decision.” He argued that high absenteeism figures are a competitive disadvantage for the economy. Head of the Chancellery, Carsten Frei, added: “We are returning to the conditions that applied before the Covid-19 pandemic.” Businesses, however, are still allowed to deviate from the strict rule on an individual basis.

Experts Question the Logic

The German Institute for Economic Research (DIW) is sharply critical. DIW economist Daniel Graeber warned that the new requirement will push sick people into crowded waiting rooms, raising infection risks and potentially increasing, rather than reducing, days lost. He noted there is no scientific evidence linking the phone-based sick note to rising sickness rates.

Data from Barmer Ersatzkasse backs that up: between 2020 and 2023, phone-based sick notes accounted for just 0.8 to 1.2 percent of all certificates. In 2024, employees were absent an average of 14.8 workdays. The DAK health fund records 19.5 calendar days for 2025, but attributes part of the increase to better digital recording.

Doctors Foresee Chaos, States Push Back

The National Association of Statutory Health Insurance Physicians expects 30 million additional practice visits each year. The German Association of General Practitioners branded the plan a “bureaucratic super-GAU,” warning that acute care for the seriously ill will be compromised and practice teams reduced to administration-only functions.

Resistance is also mounting from the states. Baden-Württemberg’s health minister, Manfred Hildenbrand, decried a “general suspicion against insured persons.” His colleague from Rhineland-Palatinate, Clemens Hoch, cautioned: “Outpatient care will be paralysed by this activism.” SPD health expert Dimitrios Pantazis stressed that the phone sick note had proven its worth and relieved everyday practice pressure.

A Possible Middle Ground

Absenteeism costs Germany an estimated 82 to 85 billion euros annually. Around 37 percent of sick notes fall on a Monday. Long-term illness lasting more than six weeks accounted for roughly 40 percent of all sick days in 2024.

Health Minister Karl Warken is therefore planning to introduce partial sick notes. Employees could be certified as 25, 50, or 75 percent fit for work, depending on their condition. DAK chief Andreas Storm welcomed the idea as a chance for a more flexible return.

Trade unions, meanwhile, warn of the opposite effect: presenteeism. Fear of bureaucratic hurdles may drive employees to show up sick, endangering colleagues and productivity alike.

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