Germans Push Back as Coalition Revives Doctor's Note Rule From Day One of Illness
05.07.2026 - 00:41:06 | boerse-global.de
A newly announced reform requiring employees to present a medical certificate from their very first sick day has ignited fierce opposition from doctors, state officials, economists, and a clear majority of the public. The coalition of the Christian Democratic Union (CDU) and Social Democratic Party (SPD) agreed to scrap the pandemic-era option of a telephone sick note nationwide, mandating that an Arbeitsunfähigkeitsbescheinigung (AU) be submitted from day one of any illness.
Chancellor Friedrich Merz (CDU) said patients would not be forced to physically visit a practice immediately, but the certificate itself must be available from the first day. The reform is intended to combat what some policymakers see as abuse of sick leave, yet critics call it pure symbolism that will overwhelm an already strained primary-care system.
Doctor warned of 30 million extra visits
The German Association of General Practitioners (Hausärzteverband) denounced the move as bureaucratic activism devoid of scientific backing. Vice chair of the Bavarian branch, Beate Reis-Berkowicz, described the measure as a symbolic gesture. According to the association, it could trigger at least 30 million additional practice visits each year.
Rhineland-Palatinate’s health minister, Clemens Hoch (SPD), also rejected the tightening, warning of a bureaucratic collapse in primary care. His state’s GP association echoed the criticism.
One of the most contentious points is the abolition of the telephone sick note. Data from 2020 to 2023 shows that such certificates represented only 0.8 to 1.2 percent of all sick notes issued during that period. DIW economist Daniel Graeber questioned any causal link between telephone certificates and the high sickness rate in Germany. He argued the opposite may happen: forcing ill workers into crowded waiting rooms increases the risk of cross-infection, potentially driving absenteeism higher.
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Carola Reimann, chair of the AOK health insurance fund, stated there is no evidence of systematic misuse of the telephone rule. She noted that the statistical rise in reported illnesses is partly due to the switch to an electronic Arbeitsunfähigkeitsbescheinigung (eAU) system in 2022, which now captures sick notes more completely than before.
Another way: part-time sick leave
DAK health insurance chief Andreas Storm proposed an alternative: a part-time sick leave model inspired by Scandinavian countries. In Sweden and Norway, employees can work at reduced capacity—anywhere from 25 to 75 percent of their normal hours—while recovering. The DAK recorded an average of 19.5 sick days per employee per year. Storm argued that a partial sick note keeps people connected to the workplace and cuts absenteeism more effectively than policing the first day.
Germany’s health minister, Warken (CDU), said the government would examine the model. Union politician Jens Spahn also pointed to video consultations as a digital workaround that could satisfy the first-day certificate requirement without forcing patients into a practice.
Within the coalition, resistance is simmering. While CDU figures frame the reform as a matter of fairness, SPD representatives push for modifications. SPD leader Lars Klingbeil and Bundestag President Bärbel Bas promised a review. SPD general secretary Klüssendorf described the compromise as the lesser evil—one that fends off even stricter demands such as unpaid waiting days.
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Public opinion: clear rejection
A YouGov poll published on July 3 found that 59 percent of respondents oppose the requirement for a doctor’s note from the first sick day, and 58 percent reject the end of telephone sick notes. Unions such as the DGB and IG Metall warned that the rule could encourage presenteeism—showing up at work while ill—which in the long run leads to more severe illness and longer absence periods.
Data from 2024 already shows that long-term sickness episodes lasting more than six weeks account for roughly 40 percent of all lost workdays. Critics argue that the reform, by making it harder to stay home on day one, may paradoxically worsen that figure.
