Doctors’ associations are predicting a wave of unnecessary infections and 30 million extra surgery visits each year if the federal government follows through on its plan to scrap telephone-based sick notes and force employees to get a doctor’s certificate from the first day of illness. The proposal, put forward by Health Minister Nina Warken (CDU), has triggered a rare cross-party revolt and drawn sharp criticism from patient advocates, who say it treats the vast majority of honest workers as potential cheats.
At the heart of the reform is a double-barrelled change: the removal of the option to obtain a sick note by phone and the reintroduction of a mandatory medical certificate from day one of absence. Currently, employees can be signed off by phone for up to seven days if they are already known to a practice; after that, a physical visit is required. Warken’s plan would end that arrangement entirely, even as the government continues
The medical establishment is unanimous in its opposition. The statutory health insurance physicians’ association (KBV) estimates the extra workload from compulsory surgery visits at roughly 30 million appointments per year — a crushing burden for practices that are already running at full capacity. “This is pure symbolic politics,” said Nicola Buhlinger-Göpfarth, leader of the German Association of General Practitioners. She warned that forcing people with contagious respiratory infections to sit in waiting rooms would endanger other patients and do nothing to reduce the overall sickness rate.
Statistics undercut the government’s argument for tightening the rules. Telephone sick notes account for just 0.5 to 1.2 percent of all certificates issued, and a study by the Barmer health insurance fund found no evidence of systematic abuse. The real driver of rising absenteeism is long-term illness: between 40 and 44 percent of all sick days are due to conditions that last more than six weeks, primarily mental-health disorders and musculoskeletal problems. Moreover, the jump in average sick days from 18 in 2016 to 22 in 2024 is largely a paperwork effect: economists at the BKK insurance association attribute 40 to 60 percent of the increase to better data capture via the electronic sick-note system.
Economic researchers warn that forcing workers to visit a doctor as soon as they feel unwell could backfire. Daniel Graeber of the German Institute for Economic Research (DIW) argues that people who have to take time off for a physical appointment tend to ask for a longer sick note than if they simply recovered at home. The German Trade Union Federation (DGB) has also raised the risk of “presenteeism” — employees showing up ill because they fear repercussions. Public opinion is firmly against the changes: a YouGov poll found that 59 percent reject a day-one certificate requirement, and 58 percent want to keep telephone sick notes.
The reform is dividing the ruling coalition. Chancellor Friedrich Merz has defended the plan, citing Germany’s high rate of workplace absences. But within his own Christian Democratic Union, the workers’ wing is pushing back. Dennis Bäumler, deputy chair of the CDA, has called for the entire proposal to be dropped given the level of discontent. The Social Democrats, led by Vice-Chancellor Lars Klingbeil, are urging a more pragmatic approach: they want to preserve the option of video consultations and give companies more flexibility to negotiate individual arrangements with their staff. Under the current SPD counter-draft, known patients could still be certified by video for up to seven days, new patients for three days, and backdating of certificates by up to three days would remain possible — options that Warken’s plan would eliminate entirely.
