Doctors and Unions Push Back Against Germany’s Plan to End Remote Sick Notes

Germany's coalition plans to scrap telephone sick notes for a mandatory doctor's certificate from day one to curb €82B+ costs, but unions and experts warn of rising stress and 30 million extra doctor visits.

Germany’s governing coalition is pushing to scrap the telephone sick note and require a doctor’s certificate from the first day of illness — a move that unions, health experts and some politicians warn will drive up stress and overwhelm medical practices.

The proposed change would replace the current system, under which an electronic sick note (Arbeitsunfähigkeitsbescheinigung, or AU) is legally possible but not mandatory nationwide from day one. The coalition argues tougher rules will cut the country’s soaring sickness costs. For 2024, employers are estimated to pay 82 to 85 billion euros in continued wage compensation, while production losses reach roughly 134 billion euros.

But the backlash has been fierce. Worker representatives inside the governing parties fear the reform will fuel “presenteeism” — employees turning up ill rather than face pressure for a certificate. The Social Democrats (SPD) have called for flexible company-level agreements instead of a blanket mandate.

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Professor Marvin Reuter of the University of Bamberg is blunt: tightening the proof requirement will not lower sick-leave rates. It will, he says, increase mental strain. Medical associations calculate that the change could trigger up to 30 million extra doctor visits each year, severely straining already crowded practices.

The debate has erupted just as the Federal Institute for Occupational Safety and Health (BAuA) releases the second issue of its magazine “baua: Aktuell”, titled “Understand data, shape the working world.” The publication draws on the BIBB/BAuA employment survey and a working-time survey that marks its tenth anniversary in 2025. Since 2015, the survey has tracked how employees experience their hours — and where stress is mounting.

The BAuA aims to adapt occupational safety to a flexible working world. Its data show that mental burdens are rising, and new forms of employment are leaving their mark.

Experts like Lea Feder argue for prevention over control. Companies should invest in stress reduction and resilience, she says, because psychological illness leads to especially long absences. Pushing harder on paperwork won’t solve the root problem.

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Lea Feder’s call for prevention over control aligns with a comprehensive health and safety approach. The free Health & Safety Toolkit includes risk assessments, COSHH checklists, fire safety templates, and more—already trusted by over 37,000 UK businesses to maintain safer workplaces. Get the free Health & Safety Toolkit

A glance beyond Germany’s borders shows how differently other countries manage sick leave. Japan has no statutory wage continuation. Italy relies on official medical checks and waiting days. Poland and the Czech Republic require a doctor’s note from day one — but with a reduced percentage of wage replacement.

Amid the domestic row, an international symposium on agricultural work is being held in Zollikon, Switzerland, from 7 to 10 July. Safety experts and labour scientists will discuss workplace security and sector attractiveness. The event will also award the Ludwig-Wilhelm-Ries Prize for outstanding contributions to ergonomics and work science.