Germany’s Tougher Sick-Leave Rules Draw Fire: Doctors Warn of ‘Overcrowded Waiting Rooms’ and More Contagion

Germany’s coalition government has pushed through a sharp tightening of sick?leave requirements, mandating a doctor’s certificate from the very first day of absence and scrapping the pandemic-era option of a phone-based sick note. The changes, presented as a response to record-high absenteeism that officials consider a drag on the country’s economic competitiveness, take effect immediately.

Medical groups and unions are pushing back hard. The German Association of General Practitioners (Hausärzteverband) warns that the new bureaucracy will overwhelm already stretched practices. The National Association of Statutory Health Insurance Physicians (KBV) calls the policy “an imposition on both doctors and patients.” DAK health?insurance CEO Andreas Storm predicts waiting rooms will fill up fast.

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Under the old rules, employees needed a medical certificate only after the fourth day of illness, unless their employer demanded one earlier. Now an attest is required from day one, though companies can still negotiate alternative arrangements through collective bargaining agreements. At the same time, the telephone sick note—introduced during the pandemic to reduce virus exposure—is being abolished. Health Minister Anja Warken describes it as “an emergency instrument that is no longer needed,” pointing instead to video consultations as a digital alternative.

Yet the numbers suggest the phone?sick?note was hardly a driver of absenteeism. Analysts at the Central Institute for Statutory Health Insurance in Germany (Zi) found that telephone sick notes accounted for only 0.8 to 1.2 percent of all illness cases. Researchers at the German Institute for Economic Research (DIW) caution that making a certificate mandatory from day one could ironically raise overall sick?leave rates: patients with simple infections would have to visit crowded practices, where they risk infecting others.

Opposition extends well beyond the medical community. The German Trade Union Federation (DGB) and the service?sector union ver.di see the reform as a symptom of a “culture of mistrust.” They warn it will fuel “presenteeism”—employees showing up at work while genuinely ill, thereby spreading illness and reducing productivity.

The government itself is not united. SPD leader Lars Klingbeil insists on a “sensible implementation,” stressing that no one should be forced to drag themselves to a doctor’s office while acutely ill. He notes that his party blocked the introduction of unpaid waiting days—a proposal that would have cut workers’ pay for the first days of sickness. Bundestag President Bärbel Bas has promised a careful review of the reform’s impact.

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The centre?right Union defends the crackdown as essential to relieve pressure on social?security systems. Union health politician Jens Spahn points to an average sick?leave rate of 18 days per year; DAK data for 2025 shows an even higher 19.5 sick days per worker. Employer associations welcome the signal. The Hessen Federation of Hessian Employers’ Associations (VhU) puts the annual cost of continued wage payments in that state alone at more than €6 billion. North Rhine?Westphalia’s Minister?President Hendrik Wüst calls for pragmatic clarification of the remaining open details.

Also under discussion: partial sick?leave certificates allowing employees to work 25, 50 or 75 percent of their hours, and new criminal?law provisions to penalise fraudulent medical certificates. For now, the immediate consequence is a return to the pre?Covid rulebook—and a fierce debate over whether the cure might be worse than the disease.

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