Doctor Groups Warn of 'Symbolic Politics' as Germany Moves to Mandate Sick Notes from Day One
Published on 07/05/2026 at 14:05 | Redaktion boerse-global.de
Germany's incoming coalition government plans to require a doctor's certificate from the very first day of illness and scrap the phone-in sick note introduced during the pandemic. Medical associations are pushing back hard, calling the move a bureaucratic nightmare that targets a problem that barely exists.
Current rules allow workers to stay home without a medical certificate until the fourth calendar day, unless their employer demands one earlier. The change would flip that: an Arbeitsunfähigkeitsbescheinigung (AU) becomes mandatory on day one. Chancellor Friedrich Merz defends the shift by pointing to rising sickness absence rates since the pandemic.
Yet the phone-in sick note – made permanent in winter 2023 – represents only a tiny fraction of all certifications. According to data from the Barmer health insurance fund and the Central Institute for Statutory Health Insurance Care, just 0.8 to 1.2 percent of all sick notes are issued over the phone. SPD health expert Dr. Pantazis stressed that there is no evidence linking phone-based certificates to higher absence levels.
The reform is not expected to take effect before early 2027. In-person video consultations would remain permitted.
Doctors Predict Chaos for Practices
The German Association of General Practitioners dismissed the plan as "purely symbolic politics" and warned of up to 30 million extra patient contacts per year. The National Association of Statutory Health Insurance Physicians (KBV) and the Hartmannbund – both representing doctors – called the extra burden unacceptable for already stretched practices.
Economists at the German Institute for Economic Research (DIW) cautioned against a boomerang effect: forcing patients with mild infections into waiting rooms could increase the spread of illness. Moreover, research shows that patients who visit a doctor often receive a longer sick note than if they had been allowed to recover at home for a day or two without a certificate.
The TK Health Report 2025 adds context. Roughly 40 percent of all sick notes last fewer than four days. High absence levels in 2024 were primarily driven by long-term illnesses of more than six weeks – a category that accounts for 40 percent of all lost workdays and would be entirely unaffected by the new rule.
What the Law Actually Means
Labour lawyers point out that the day-one certificate requirement does not force a patient to see a doctor on the same day. Retroactive certification is allowed for up to three days. The transmission of the eAU (electronic sick note) already runs digitally to health insurers.
A Look Beyond Germany
No single international model exists. France, Italy and Poland require a doctor's note from day one. Spain waits until the fourth day; Sweden only from the eighth day. The CEO of the DAK health fund, Andreas Storm, has floated an alternative: a partial sick-leave model inspired by Scandinavia, where employees can work reduced hours despite being ill. Storm said the German health ministry is currently reviewing that concept.
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