German Doctors Protest Mandatory Day-One Doctor's Note, Warn of Practice Overload

Physicians oppose Germany's plan requiring day-one sick notes, citing 30 million extra visits. Critics say eAU tracking, not phone notes, drives absenteeism.

A planned overhaul of Germany's sick-leave rules is drawing sharp opposition from physicians, who say it would swamp their practices with an estimated 30 million extra patient visits each year.

Under the new policy, employees would be required to provide a medical certificate from the very first day of illness — a major shift from the current rule, which only demands a doctor's note after three calendar days. The government also intends to abolish the telephone sick-note option, a system that was made permanent just a few years ago.

The Kassenärztliche Bundesvereinigung (KBV), the national association of statutory health-insurance doctors, calculates the extra workload at roughly 208,000 additional workdays in medical offices annually. The German Association of General Practitioners dismissed the reform as purely symbolic politics, arguing it would do little to address the underlying causes of high absenteeism.

Germany posted a record average of 19.5 sick days per employee in 2025, according to data from the DAK health insurance fund. That figure has been a key driver of the government's push, backed by chancellor candidate Friedrich Merz. He defended the stricter rules but stressed that a day-one certificate does not automatically require an immediate visit to the practice — retroactive certifications would remain possible.

Yet health experts point to a different culprit behind the surge in recorded sick days. Between 40 and 60 percent of the increase is attributed to the electronic sick note (eAU), introduced in 2022, which enables seamless digital tracking. The telephone sick note, in contrast, accounts for a stable 0.8 to 1.2 percent of all incapacity certificates — a fraction of the total.

Business Split, Coalition Unease

Reaction from the corporate world has been mixed. The Baden-Württemberg employers' association welcomed the plan as an important signal. But major industrial names such as Bosch, Zeiss, and Stihl have held back, while companies like ebm-papst and Ziehl-Abegg prefer to stick with individual, trust-based solutions.

Within the governing coalition, resistance is brewing. Dennis Radtke, head of the Christian Democratic Union's workers' wing (CDA), warned that the new rules risk fostering a climate of mistrust. "There is enormous discontent among CDU employee representatives," he said. The Social Democratic Party (SPD) is demanding scientific evidence for the reform's effectiveness and is pushing for greater use of video consultations to relieve pressure on doctors.

Legal hurdles also remain. The principle of Günstigkeitsprinzip — which protects provisions more favourable to employees — means existing contracts that require a certificate only from the third or fourth day onward would not be automatically overridden. Individual and company-level agreements would still be permitted.

Economists at the German Institute for Economic Research (DIW) and labour-law specialists doubt the reform will reduce sick days at all. Experience suggests that workers forced to visit a doctor for a certificate often end up with longer sick notes than those allowed to recover at home without a medical visit.

On the international stage, Germany ranked seventh among OECD countries for sickness-related absenteeism in the most recent comparison, with 6.8 percent of workdays lost. The government's measure was adopted on July 2, 2026, and now faces a tough path through parliamentary and practical obstacles.