German Doctors Warn of Clinic Chaos as Coalition Plans to Mandate In-Person Sick Notes

Coalition plan to require in-person sick note from day one could add 30 million extra patient contacts yearly. Doctors furious, employers back it, but insurers see no abuse. Law may take effect in 2027.

Doctor representatives have reacted with fury to a coalition plan that would force employees to visit a surgery from the first day of illness — a move they say could generate roughly 30 million extra patient contacts each year and sink already overstretched practices into chaos. The Association of Statutory Health Insurance Physicians (KBV) calculated that the new obligation would add the equivalent of 208,000 working days of additional patient consultations annually.

Robert Maus, a KBV board member, called the proposal “an imposition bordering on insolence.” The German Association of General Practitioners dismissed the scheme as pure symbolic politics, arguing that a large portion of the extra work would come from trivial ailments that now have to be examined in crowded waiting rooms. Regional estimates underscore the strain: Baden-Württemberg alone expects three million extra visits per year. “This new regulation is barely feasible in daily practice,” one GP told the association.

Under the plan, forged in early July, the temporary phone-based sick note introduced in December 2023 would be scrapped permanently. Instead, a doctor’s certificate would be required from the very first day off. The coalition intends to enshrine the change in the broader statutory health insurance savings bill (GKV-Spargesetz), due to pass on 10 July.

Employers cheer, insurers see no abuse

The proposal has drawn strong support from employer organisations worried about rising sickness absence. Rainer Dulger, president of the Confederation of German Employers’ Associations (BDA), explicitly welcomed the measure. Proponents argue that Germany’s climbing sick rate hurts the country’s competitiveness and that a mandatory in-person certificate deters abuse.

Health insurers counter that there is no evidence of systematic exploitation. The AOK executive board stressed that phone-based sick notes account for only 0.8 to 1.2 percent of all cases. DAK health fund analyses reach the same conclusion. Experts instead trace the statistical jump in sick days to the electronic sick-note system (eAU) introduced in 2022, which now captures even short absences more completely — that change alone explains 40 to 60 percent of the rise.

Legal timetable and digital alternatives

The earliest the law could take effect is the start of 2027. Labour lawyer David Rüther noted that employers already have the right under the Continued Pay Act to demand a certificate from day one, provided the employment contract does not stipulate otherwise. Existing contracts that require a note only from day three or four could be protected by the “favourability principle” in German labour law.

As a possible escape valve, video consultations are gaining traction. In the first half of 2025, use among statutory-insured patients rose 14 percent to 1.5 million cases. Some practitioners believe the new rule could be made manageable through wider adoption of digital formats; retroactive sick notes covering up to three days of past illness are also being discussed.

Yet the Kiel Institute for the World Economy warns of a perverse effect: forcing sick employees into crowded waiting rooms could actually increase the spread of infection — exactly the risk the phone-based rule was designed to mitigate.

Coalition friction and a possible smokescreen

The agreement is not yet set in stone. While the SPD leadership confirmed a “basic understanding”, health experts within the party are demanding a scientific evidence base before signing off. The labour wing of the CDU has also voiced opposition. Germany’s upper house, the Bundesrat, already rejected the plan in an official statement.

Industry observers suspect the fierce debate over phone sick notes may serve as a distraction from other, less popular cuts buried inside the same savings package. Final legislative wording has not been published; politicians are expected to continue bargaining behind closed doors over the summer.