German doctors call coalition's sick note reform 'absolutely catastrophic' as Berlin tightens rules

The coalition's decision

On Thursday, the German coalition government of CDU/CSU and SPD agreed to tighten sick leave rules. The main changes: the option to obtain a sick note by telephone will be abolished, and employees will be required to present a doctor's certificate of incapacity for work from the first day of illness. Currently, a note is only required from the fourth day, though employers can request it earlier. The telephone sick note was introduced at the end of 2023, allowing patients known to their practice and without severe symptoms to get a certificate for up to five days without an in-person visit. Chancellor Friedrich Merz and Health Minister Nina Warken (CDU) had repeatedly questioned the measure, linking it to what they described as 'exorbitant' post-COVID sickness rates.

We are abolishing the telephone sick note and introducing the requirement to present a certificate of incapacity for work from the first day of illness. That is a hard decision. We know that. But we can no longer afford this competitive disadvantage caused by long absences in companies.

Doctors' outrage

The medical profession's response has been swift and sharp. The chair of the German General Practitioners' Association, Markus Blumenthal-Beier, called the plan 'absolutely catastrophic' and warned that it would unleash a 'huge wave of bureaucracy' on already overstretched practices. He argued that all statistics showed telephone sick notes had not led to more sickness absence; the increase in recorded cases was a statistical effect of electronic recording. Blumenthal-Beier said the day-one requirement would force millions of patients to visit a doctor solely for paperwork, lengthening waiting times for those with genuine medical needs.

The coalition is making these completely fact-free decisions and is knowingly accepting the total overload of our practices. The consequences will be longer waiting times for patients who really need our medical help.

Jana Husemann, head of the Hamburg association of general practitioners, called the move an 'incomprehensible wrong decision'. She noted that in many other countries, a doctor's note is only required after five to seven days, and that Germany was going the opposite way. In her daily practice, she said, she more often had to urge sick patients to stay home rather than suspect abuse.

I consider this an incomprehensible wrong decision. In practice, I have to push sick patients to stay at home. Abuse is the exception.

Andreas Gassen, head of the National Association of Statutory Health Insurance Physicians, also criticised the plan, telling Bild newspaper that it would bring even more people into practices that are already full.

This will bring even more people into the practices, which are already full.

What the reform means

The coalition's decision is part of a broader package of reforms that also includes pension changes and tax relief for lower and middle incomes. The sick note rules will be implemented through a directive from the Federal Joint Committee of doctors, insurers and hospitals. Merz noted that individual companies or collective agreements could deviate from the requirement. The government also plans to penalise the false issuance of sick notes more severely.

The current rule, requiring a certificate only from the fourth calendar day, has been in place for years, with the telephone option added as a pandemic-era convenience to reduce infection risks. The abolition of telephone sick notes and the day-one certificate requirement are expected to face significant political and public opposition, with the Green party already voicing sharp criticism.