Germany’s Sick-Note Battle Splits Generations as Experts Warn of Higher Absenteeism

Young Germans overwhelmingly oppose mandatory day-one doctor's notes while seniors support it; economists warn the rule could backfire by increasing infections and sick days.

A proposal to require a doctor’s note from the first day of illness has exposed a deep generational rift in Germany, with younger workers overwhelmingly opposed and older citizens strongly in favor. But as the coalition government struggles to agree on the details, economists warn the plan could backfire by actually increasing sick days.

The debate is nearly deadlocked. An INSA poll conducted on July 4, 2026, found 43 percent of Germans in favor of the so-called “Attestpflicht” and 44 percent against it. The near-tie, however, masks a sharp age divide: among 18-to-29-year-olds, 51 percent reject the requirement and only 30 percent support it. Among those aged 70 and older, the numbers flip — 62 percent back the early sick note, while just a minority oppose it.

INSA also found that ending the option for a phone-based sick note — which the government also wants to scrap — is unpopular: 47 percent oppose that move, with only 40 percent in support. A separate YouGov survey was even clearer: 59 percent of respondents said no to the day-one doctor’s note, and 58 percent rejected the abolition of telephone sick notes.

Parental Pressure and a Civey Snapshot

Life circumstances appear to shape opinions too. A Civey survey conducted on July 2 and 3, 2026, revealed that 61 percent of respondents with children oppose the planned rule changes. Among those without children, 54 percent support the new requirement — a mirror image of the parental stance.

The Infection Paradox

DIW economist Daniel Graeber points to a counterintuitive risk: compelling more people to visit surgeries could drive up infection rates in packed waiting rooms, thereby increasing overall absenteeism. He notes that telephone sick notes currently account for just 0.8 to 1.2 percent of all work incapacity certificates — hardly the driver of Germany’s high sick leave rates. Official 2024 data backs him up: long-term illnesses lasting more than six weeks were responsible for 40 percent of all missed workdays.

Markus Blumenthal-Beier, head of the German Association of General Practitioners, called the planned Attestpflicht “catastrophic” on July 3, 2026, predicting a massive surge in appointment requests and overflowing waiting rooms. DAK health insurer CEO Andreas Storm echoed the warning about overburdened family doctor practices.

Coalition Tensions and Conflicting Signals

The federal government itself is split on how to proceed. Chancellor Merz stated that employees would need to present a certificate from day one, but would not necessarily have to visit a doctor’s office immediately — leaving the exact mechanism vague. Health Minister Warken wants to expand digital options such as video consultations, but insists on ending the telephone sick note. Labor Minister Bas distanced herself from the proposal, saying it did not originate from her ministry, and promised a thorough impact assessment. SPD leader Klingbeil called for “sensible implementation,” while Union parliamentary group leader Spahn defended the crackdown, noting that with an average of 18 sick days per year, Germany tops the EU rankings.

SPD General Secretary Klüssendorf framed the doctor’s note requirement as the “lesser evil” compared with waiting days (Karenztage). Meanwhile, the German Trade Union Confederation (DGB) warned of rising presenteeism — workers showing up ill — and further strain on surgeries from purely bureaucratic visits.