Germany’s Plan for Day-One Doctor’s Notes Sparks Overload Fears and Economic Doubts

Germany’s plan to require a medical certificate from the first day of illness — along with the abolition of phone-in sick notes — could trigger up to 30 million extra clinic visits each year, the country’s association of family doctors has warned. In a statement, the Hausärzteverband described the measure as pure symbolic politics and said it would strain already busy practices. According to the association, telephone sick notes currently account for only between 0.8 and 1.2 percent of all certificates of incapacity — meaning the real impact would be a massive wave of in-person appointments for minor ailments.

Finance Minister Lars Klingbeil defended the controversial requirement on Sunday, while hinting at flexibility. He stressed that no one with a serious condition would be forced to drag themselves into a surgery immediately; the certificate does not have to be physically presented on the first calendar day. Instead, the minister suggested that the exact implementation could be handled through company-level or collective-bargaining agreements. The goal, he said, is a compromise between controlling absenteeism and ensuring practical feasibility. Klingbeil acknowledged that the reform package — which contains 34 measures in total — imposes burdens on citizens, but argued that a considerable backlog of reforms made the steps unavoidable.

The policy is part of a broader economic agenda that includes a federal budget for 2027 with total spending of €555 billion and new borrowing of more than €203 billion, partly justified by military investment. An original budget gap of €34 billion has now been closed, Klingbeil said. He blamed weak economic growth on external factors such as the Iran conflict under US President Donald Trump, which he said is slowing global and national expansion. As a social offset, the government plans annual tax relief of roughly €600 for families and an increase in the top rate of income tax to 47 percent for earnings above €280,000. From 2028, a tighter austerity course with additional savings of 2 percent is to be introduced.

Economists have also raised doubts about the sick-note rule. Researchers at the DIW pointed out that a day-one certificate requirement does not necessarily reduce sick leave. On the contrary, it could lead to infected workers spreading illness in clinics or at their workplace, potentially raising absenteeism. DAK chief Storm proposed an alternative based on the Scandinavian model: partial sick notes that allow employees to work limited hours while recovering. According to DAK data, the average number of sick days per insured person rose from 18 in 2016 to between 19.5 and 22 recently — though some of that increase is attributed to the comprehensive tracking enabled by the electronic sick certificate (eAU).

The Union party had previously demanded unpaid waiting days, but Klingbeil said this demand was taken off the table in the coalition agreement. He reiterated that practical solutions need to be found to avoid overloading either employees or the healthcare system. For now, the day-one certificate plan remains a central—and fiercely contested—element of the government’s reform package.

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