Germany moves to end telephone sick note as lawmakers require medical certificate from day one
Government plan to abolish the telephone sick note and require a medical certificate from the first day of absence in Germany sparks alarm among doctors and the SPD.
The coalition agreed to remove the option of a telephone sick note and make submission of an Arbeitsunfähigkeitsbescheinigung (AU) mandatory from day one, reversing the pandemic-era allowance that permitted remote certification. SPD officials said they accepted the change to head off tougher measures from the opposition, while medical associations warned the move could overwhelm outpatient practices. Health-policy analysts and employer groups cited costs and international comparisons as central to the debate around the telephone sick note reform.
Coalition committee orders end to telephone sick notes
The government’s coalition committee decided this week to abolish the telephonic sick note and make a medical certificate compulsory from the first day of illness. Previously, employees could submit an AU after three days unless an employer demanded immediate proof; the change reverses that default so a doctor’s certificate will be required unless an employer explicitly waives it. Lawmakers framed the measure as restoring pre-pandemic procedures, while opponents argue it reinstates an inflexible system that was modified for public-health reasons.
SPD accepts measure to block tougher proposals
Senior SPD figures, including party general secretary Tim Klüssendorf, publicly registered concerns about the policy but said they agreed to the change to prevent harsher alternatives from the opposition. The SPD feared proposals such as unpaid waiting days at the start of an illness would have drained employee protections and provoked wider conflict within the coalition. Party leaders emphasized the need to balance employer interests with protecting patient access to care.
Doctors’ association warns of millions of extra consultations
Medical bodies say ending telephone certification will substantially increase in-person visits and strain outpatient services. The National Association of Statutory Health Insurance Physicians (KBV) has estimated an additional 30 million practice visits annually, a level that, the association warns, could displace patients with urgent needs. KBV chair Andreas Gassen cautioned that an influx of short sick‑note appointments would reduce availability for those needing medical treatment rather than administrative certification.
Government defenders point to pre‑COVID norms
Supporters of the reform, including Chief of the Federal Chancellery Thorsten Frei, argued that returning to pre‑pandemic rules is reasonable and feasible. Frei said the policy aims to curb patterns of clustered sickness at the start and end of the week that he described as difficult to explain medically. Chancellor Friedrich Merz has expressed similar sentiments, framing the change as reestablishing long‑standing practice rather than introducing a novel restriction.
Regional leaders and infection‑risk concerns
Not all center‑right figures back the move without qualification: North Rhine‑Westphalia’s minister‑president Hendrik Wüst warned that requiring immediate doctor visits for infectious conditions such as stomach flu could increase risks for other patients in waiting rooms. He called for clarifications so that individuals with contagious symptoms would not inadvertently spread illness by seeking in‑person certification on day one. Health officials are under pressure to design guidance that balances certification requirements with infection‑control measures in clinics.
Costs, international context and special German features
Analysts note Germany is not an outlier for sickness absence but occupies a higher tier compared with many peers, a point highlighted by Susanne Hildebrandt of the IGES Institute. Employer groups point to the scale of wage continuation payments as a distinctive factor: the employers’ federation (BDA) estimates annual costs for continued salary payments during illness at roughly €82–85 billion. Observers also note features such as long sick‑pay periods and full, indefinite continuation of pay for civil servants make Germany’s overall system unusually generous and expensive compared with many other countries.
Many experts warn the proposed return to mandatory in‑person certification could have unintended side effects for patients and employers. Health researchers argue that while the number of deliberate “no‑shows” is small, the reform risks pushing more people to obtain longer certified absences once they reach a physician, potentially increasing total absenteeism. They also stress that employer tools already exist to address suspected abuse by requiring an immediate AU from particular employees, a targeted approach that some contend is more proportionate than a universal mandate.
The parliamentary process ahead will determine whether the proposal becomes law in its current form, and health officials are expected to propose implementation rules to reduce infection risk and preserve appointment capacity. As debate continues, stakeholders from physicians’ associations to state governments will press for adjustments that aim to protect both clinical access and workplace integrity.
