Coalition's sick note reform faces backlash from own ranks, doctors, and public

The government's plan

On Wednesday evening, the coalition of CDU/CSU and SPD agreed to abolish telephone sick notes and require employees to present a medical certificate from the first day of illness, instead of the current fourth day. Chancellor Friedrich Merz (CDU) justified the move by pointing to high sick leave figures. The reform is part of a broader labour market package that also includes tax relief for Sunday and holiday work, family tax benefits, and easier dismissal rules for high earners.

Internal coalition dissent

Criticism quickly emerged from within the coalition itself. Dennis Radtke, head of the CDU's labour wing (CDA), told Spiegel that the political conflict value "seems in no healthy proportion to the supposed improvements" and that the "good overall package" was being buried under the sick note debate. Bavarian Health Minister Judith Gerlach (CSU) called the abolition of telephone sick notes "only additional bureaucracy," noting that only about one percent of sick notes are issued by phone. Stefan Schwartze, the federal government's patient advocate and an SPD member, warned that visiting a doctor's office is an unnecessary burden for many illnesses and increases the risk of infection.

The political conflict value seems in no healthy proportion to the supposed improvements.

Doctors warn of practice overload

Medical associations reacted with alarm. Markus Blumenthal-Beier, federal chairman of the General Practitioners' Association, described the plan as "a catastrophe for our practices," predicting millions of additional patient visits that would leave less time for the chronically ill. Nicola Buhlinger-Göpfarth, the association's federal chairwoman, called the rules "pure symbolic politics" that would neither reduce sick leave nor prevent abuse. She argued that cracking down on aggressive video consultation providers would be more effective, while telephone sick notes from established family doctors are tied to knowing the patient.

They will neither reduce the sick leave rate nor prevent abuse.

Economists doubt the effect

Daniel Graeber, an economist at the German Institute for Economic Research (DIW), does not expect a noticeable reduction in sick leave. He warned that a sick note requirement from day one could lead to more doctor visits and higher infection risks in waiting rooms. "Should this lead to people going to work with mild infections, workplace contagion could ultimately result in more sick days than if those employees had simply stayed home," he said. Graeber sees no causal link between high sick rates and telephone sick notes; Barmer health insurance data show no increase in sick leave cases from telephone or video consultations, which accounted for only 0.8 to 1.2 percent of all certificates.

Should this lead to people going to work with mild infections, workplace contagion could ultimately result in more sick days than if those employees had simply stayed home.

Public opinion and the data behind sick leave

A YouGov survey of 6,200 adults found that 59 percent oppose mandatory sick notes from day one, while 31 percent support it; 58 percent reject abolishing telephone sick notes, with 33 percent in favour. The debate is fuelled by a statistical quirk: since 2022, electronic sick notes have led to more complete recording of absences, inflating the apparent rise. Short-term illnesses of one to three days account for only seven percent of all sick days, while long-term illnesses over six weeks cause about 40 percent, often involving musculoskeletal or psychological conditions. Graeber argues that prevention would be more effective than tightening documentation rules.