German Doctor’s Note Mandate Sparks Warnings of 30 Million Extra Surgeries as Coalition Pushes Labor Reform

A sweeping labor-market package approved by the German cabinet on Thursday will require employees to present a doctor’s certificate from their first sick day, scrap telephone sick notes, and allow fixed-term contracts to run twice as long. The reforms — bundled with tax incentives and bureaucratic cuts — have drawn fierce criticism from medical associations, unions, and opposition parties, even as employer groups applaud what they call a necessary course correction.

Under the new rules, the telephone sick note introduced during the pandemic disappears entirely. Instead, a general certificate mandate takes effect from day one of illness. Until now, employers could decide when a medical certificate became necessary. Government officials stress that retroactive issuance remains possible, a move meant to keep doctors’ offices from being overwhelmed on the first day.

But the German Association of General Practitioners and the health insurer AOK dismiss the change as pure symbolism. According to their figures, telephone sick notes accounted for only between 0.8 and 1.2 percent of all sickness certifications — far too small a share to meaningfully lower absentee rates. What the policy will do, they warn, is generate an estimated 30 million additional practice visits each year, packing waiting rooms and triggering what one official called a “bureaucratic super-GAU” for outpatient care. The recent rise in sick days, they add, stems largely from better digital tracking via the electronic sick-note system, not from any real surge in illness.

Beyond sick notes, the package dramatically expands fixed-term contracts without a specific reason. Starting immediately and running until the end of 2030, companies will be able to hire up to four years and renew the contract as many as six times. The previous requirement that such contracts be in writing has also been dropped. For high-income workers — those earning roughly €177,000 in annual gross salary, though other sources cite €240,000 — the government is easing dismissal protection, making it simpler to terminate employment by mutual agreement with a severance payment.

Employers’ president Rainer Dulger hailed the “necessary shift” to boost competitiveness. The IG Metall union countered by calling it an “attack on fundamental employee rights.”

The package also includes tax relief measures. From January 2027, the ceiling on tax-free basic wages for Sunday and public holiday work will rise from €50 to €75 per hour. In 2028, a family with two children and a household income of €60,000 should save roughly €600 per year through a new tax break. The government is also planning a blanket elimination of numerous reporting duties and simplifications in data protection, along with accelerated approval procedures for emerging industries such as artificial intelligence.

Reactions remain sharply divided. The Federation of German Industries (BDI) said the package offers only spot improvements and lacks a powerful growth impulse. The German Association for IT SMEs (BITMi) called the tax relief marginal and criticized the absence of a corporate tax reform. The Greens denounced the proposal as a “tax sham,” while the Left Party called it a “social slash.” The German Trade Union Confederation (DGB) welcomed the relief for lower incomes and higher Sunday pay but warned that longer fixed-term contracts would increase insecurity.

Meanwhile, the Council of Economic Experts projects that without deeper structural reforms, social-security contributions could climb to as high as 50 percent by 2040.

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