Coalition agrees end to phone sick notes – medical profession responds with sharp criticism

The core element in the health sector is the end of the telephone sick note. The decision paper states verbatim: "Die telefonische Krankschreibung wird abgeschafft." Until now, patients known to the practice and not showing severe symptoms could have incapacity to work certified without an in-person visit to the practice since the end of 2023. In future, this will no longer be possible.

At the same time, the obligation to provide medical certification is being brought forward. From now on, the following applies: "Wir führen eine verpflichtende Vorlage der AU-Bescheinigung ab dem ersten Tag der Erkrankung ein." Employees must therefore present a medical certificate from the first day of illness – until now, this was only required from the fourth calendar day. According to Merz, employers may deviate from this by individual or collective agreement as well as by works agreement.

Government's Justification

The justification for the coalition is provided primarily by parliamentary group leader of the CDU/CSU Jens Spahn (CDU). One cannot "medically explain" the high levels of sickness absence in Germany; rather, so-called "edge-of-the-bed decisions" are made on Mondays and Fridays. Germany has "one of the highest numbers of sick days, around 18 sick days per year per employee." Head of the Chancellery Thorsten Frei (CDU) also pointed in the RTL/ntv "Frühstart" to "particularly many sick days at the start of the week and the weekend."

Chancellor Merz stated on the ZDF programme "maybrit illner" that employees should "nicht am ersten Tag in die Arztpraxis" – video consultations will continue to be possible. Anyone who is "wirklich krank" should "natürlich auch zu Hause bleiben" be able to. The SPD supports the compromise; SPD General Secretary Tim Klüssendorf spoke on ARD/ZDF "Morgenmagazin" of a "Kompromiss, der notwendig war."

The criticism from the medical profession is sharp. The chair of the German Association of Family Physicians, Markus Blumenthal-Beier, called the decisions "absolut katastrophal." The sick note requirement from day one would "Millionen zusätzliche Menschen in die Arztpraxen" flood – "ohne dass das medizinisch irgendeinen Sinn ergibt." The coalition accepts the "komplette Überlastung unserer Praxen" and acts with "vollkommen faktenfreien Beschlüssen."

Criticism from the Medical Profession

Bettina Schultz spoke of an "Irrsinn, der für Millionen zusätzliche Arztbesuche sorgt." Barbara Römer, chair of the Family Physicians Association of Rhineland-Palatinate, called the regulation "den bürokratischen Super-GAU für die Hausarztpraxen." The board of the National Association of Statutory Health Insurance Physicians (KBV) described the plans as a "Zumutung"; KBV chief Andreas Gassen warned: "Wer hustet, eine Magen-Darm-Infektion hat, gehört ins Bett – und nicht in die übervolle Praxis."

The Association of Statutory Health Insurance Physicians Westphalia-Lippe also voiced criticism. Family practices work "vielerorts bereits an ihrer Kapazitätsgrenze"; the plans lead to "mehr Verwirrung statt Klarheit." Manfred Imbert, deputy chair of the board of the Family Physicians Association of North Rhine, said: "Angesichts der hohen Zahl an Krankmeldungen ist es nachvollziehbar, dass die Politik einen Filter vorschieben will." At the same time, he warned: "Das wird eine Welle von Menschen in unsere Praxen spülen – in vielen Fällen ohne medizinische Notwendigkeit, sondern aus rein administrativen Gründen." Politics promises bureaucracy reduction and "legt am Ende mit diesen Planungen wieder eine Schippe drauf."

The Association of Statutory Health Insurance Physicians Schleswig-Holstein spoke of an "Irrsinn, der für Millionen zusätzliche Arztbesuche sorgt." The German Medical Association emphasized that "die telefonische Krankschreibung hat sich in der Praxis bewährt." Federal Health Minister Nina Warken (CDU) also considers the step correct: the hurdles for obtaining a sick note had been "deutlich gesenkt" through the telephone option; the aim is to rule out abuse.

Statistical Context

AOK shares the diagnosis of high levels of sick days but disputes the effectiveness of the measure. The chair of the board of the AOK Federal Association stated that abolishing the telephone sick note does not reduce sickness rates but is "reine Symbolpolitik." Among AOK-insured persons, the figure was 23.3 days on average in 2025, slightly less than the previous year's 23.9 days. Birgit Becker, economics editor at Deutschlandfunk, pointed out that the rise in sickness rates is attributable to statistical effects and "nicht auf eine sprunghaft erhöhte Neigung zum Kranksein."

The Central Institute for Statutory Health Care Physicians (Zi) explained that the increase in sick note numbers is primarily due to reporting effects from the electronic sick note introduced in 2022 as well as a higher incidence of infections – and not to the telephone sick note. According to Zi, this accounts for only between 0.8 and 1.2 percent of all sick note cases annually. The SPD-affiliated AOK also emphasizes: "Statistiken und Untersuchungen belegten zweifelsfrei, dass die telefonische Krankschreibung nicht zu mehr Krankschreibungen geführt habe." In international comparison, Germany, with 3.6 weeks of illness per year according to the OECD, is in the upper middle range; Norway has 5.9, Finland 5.0 weeks.

On the labor market, the reform package provides for a significant expansion of fixed-term contracts without objective reasons: in future, fixed-term contracts without an objective reason should be possible for up to 48 months with up to six extensions – a doubling compared to the previous maximum of 24 months and three extensions. The regulation applies on a temporary basis until the end of 2030. Marion Paul, regional head of ver.di Rhineland-Palatinate, criticized: "Wer Beschäftigte ab dem ersten Krankheitstag in die Arztpraxis schickt, schafft nicht mehr Produktivität, sondern mehr Bürokratie." She added: "Wer Menschen vier Jahre lang von einem befristeten Vertrag in den nächsten schickt, baut keine Zukunft, sondern organisiert strukturelle Unsicherheit," and spoke of "Beschäftigte werden unter Generalverdacht gestellt und gegängelt."

Further Reform Points

On taxes, CDU/CSU and SPD agreed to raise the top tax rate to 45 percent from 250,000 euros of taxable income and to 47 percent from 280,000 euros. The wealth tax rate is to apply in future from an income of around 177,450 euros. In addition, several tax allowances are being adjusted: the so-called "craftsman's bonus," a deduction for craft services, will be reduced from 20 to 15 percent; Sunday and holiday supplements will be tax-free from January 2027, provided the hourly wage does not exceed 75 euros.

Business is divided. Johann Pöttering, chief executive of the Association of the Metal and Electrical Industry of North Rhine-Westphalia, welcomed the abolition of the telephone sick note: "Die Bundesregierung erkennt erstmals an, dass die im internationalen Vergleich wirklich überdurchschnittlich hohen Krankentage in Deutschland ein wirkliches Problem für die Wettbewerbsfähigkeit des Standorts sind." Germany has the highest level of occupational safety and the best working conditions in European comparison, "aber eben auch die höchsten Ausfalltage." Karsten Tacke, chief executive of the State Association of Employer Associations (LVU) of Rhineland-Palatinate, said: "Ich sage, je leichter die Möglichkeiten zur Krankschreibung sind, desto höher ist auch das Risiko der unsolidarischen Nutzung. Da wäre ein verpflichtender Karenztag mit Sicherheit ein Instrument gewesen hier, was hier deutliche Wirkung gezeigt hätte."

The coalition agreement had originally only envisaged "Korrekturen" to the telephone sick note, such as excluding private online platforms. With the abolition now decided, the government goes further. A waiting day regulation – that is, the waiver of continued pay on the first day of illness – was, in the words of the SPD General Secretary,