Doctors Decry 'Affront' as Germany Mandates Sick Notes From Day One – Unions Warn of New 'Culture of Mistrust'
03.07.2026 - 03:56:10 | boerse-global.de
Physicians’ associations and labour groups have slammed a sweeping reform that ends the practice of certifying illness by phone and requires employees to produce a doctor’s note on their very first day off. The measure, approved by Germany’s coalition cabinet after two days of talks, is part of a 34-point package that also introduces partial sick leave and eases dismissal protection for top earners.
Chancellor Friedrich Merz defended the change, arguing that Germany’s persistently high sickness absence has become a major competitive disadvantage. Under the previous rule, a medical certificate was generally not required until the fourth day of absence. That grace period now disappears.
Compromise With Caveats
Finance Minister Lars Klingbeil described the outcome as a coalition compromise, stressing that the Social Democrats (SPD) had prevented unpaid waiting days from being introduced. He acknowledged that the precise implementation details remain to be worked out – no one, he said, should be forced to visit a doctor’s surgery while seriously unwell.
Company-level agreements and collective bargaining contracts can still carve out exceptions to the immediate-certificate rule. At the same time, the government plans to stiffen penalties under Paragraph 278 of the criminal code for issuing false medical certificates.
Doctors and Unions Push Back
The backlash has been immediate. The German Association of General Practitioners warned of bureaucratic overload in practices and said there is no scientific evidence to justify the measure. The National Association of Statutory Health Insurance Physicians (KBV) also voiced sharp criticism.
The German Medical Association (BÄK) called the abolition of telephone sick notes an “affront” that puts the entire medical profession under blanket suspicion. It argued that the recent statistical rise in reported cases is due to the switch to electronic sick notes, not to abuse of the system.
The Verdi trade union condemned what it sees as a new “culture of mistrust” spreading through workplaces. Green Party representatives cautioned that people with colds belong in bed, not in waiting rooms. Bavaria’s Economy Minister Hubert Aiwanger warned that the rule could paradoxically lead to even more sick days.
According to DAK health insurance data, the average number of sick days per employee stood at 19.5 in 2025, down slightly from 19.7 a year earlier.
Partial Sick Leave Introduced
Alongside the stricter absence rules, the reform package introduces partial sick leave. Employees will be able to be certified as unfit for only 25, 50, or 75 percent of their normal working hours – a measure designed to ease phased returns to the job.
The broader reform agenda also includes structural tax relief. From 2028, a total of €10 billion in tax cuts are planned, meaning a typical family of four could save more than €600 per year. The top marginal tax rate remains at 42 percent, but the “wealth surcharge” tiers have been adjusted: 45 percent for annual incomes above €250,000 and 47 percent above €280,000.
For high earners with incomes of €177,000 or more, dismissal protection is being loosened. The maximum permissible duration for fixed-term contracts without a specific reason rises to 48 months. In the pension system, higher contributions for the capital-based component and a further increase in the retirement age beyond 67 are on the table.
Business lobby BDI welcomed what it called positive signals but said stronger growth impulses were still missing. Former Health Minister Karl Lauterbach expressed scepticism and noted he had not supported the tightening of sick-note rules.
