German Federal Government Plans Mandatory Doctor's Note from First Day of Illness

Last year, Oliver Bäte, CEO of Allianz Insurance, made headlines by describing Germany as the "world champion" in sick leave rates. The federal government also argues that sick leave rates, which have become "exorbitant" since COVID, have become a competitive disadvantage for Germany. Through a waiting day — meaning one day without continued pay at the start of an illness — around 40 billion euros per year could be saved, according to this reasoning.

Criticism of the plan comes from the medical profession. Peter Kowatsch of the Austrian Society for General and Family Medicine emphasizes that in the general practice setting, where doctors know their patients, it does not make sense for patients to have to come to the practice for every cold. "Patienten, die ständig krank sind, würde ich nicht telefonisch krankschreiben," Kowatsch says, "Sie müssen jedes Mal kommen." At the same time, he warns that a mandatory doctor's note from day one would place additional strain on already scarce capacities in family practices.

Criticism from the Medical Profession

That people fraudulently obtain sick leave and feign symptoms is, according to Kowatsch, an "absolute Minderheit." The coalition partners SPD and CDU/CSU have also not yet concluded their deliberations on the draft. From circles within the federal government, it was stated that the goal was to fundamentally preserve sick days while simultaneously removing false incentives.

Figures and Background

The background to the debate is current data: in 2025, according to calculations by the Iges Institute, every employee in Germany was sick for an average of 19.5 days. Short-term sick leaves of less than four days accounted for 44.7 percent of cases, but made up only around ten percent of all days of absence. Since 2022, the electronic certificate of incapacity to work (eAU) has been transmitted directly to health insurance funds.

The discussion is also being conducted intensively in Austria. According to the current absence report compiled by the Austrian Institute of Economic Research (Wifo) on behalf of the umbrella association of social insurance institutions, the Chamber of Labor, and the Chamber of Commerce, dependent employees spent an average of 14.7 calendar days on sick leave last year. Women were slightly more often on sick leave, at 15.5 days, than men, at 14.1 days.

Regardless of gender, absences increase significantly from age 50 and reach their peak among employees between 60 and 64 years old. While the share of musculoskeletal disorders has declined over the years (1994: 22.4 percent, 2025: 19.1 percent), there has been an increase in mental health conditions: their share currently stands at 11.8 percent. A reform must also address this, the social partners demand.

Outlook on the Parliamentary Debate

Observers view the move as part of a larger package aimed at relieving the economy. By the end of the parliamentary summer break, an initial ministerial draft could be available. Whether the mandatory doctor's note from the first day of illness actually becomes law also depends on whether a majority can be found in the Bundestag from CDU/CSU and SPD.

Kowatsch emphasizes how important trust in patients is: "Es ist extrem wichtig, dass man den Menschen vertraut." He views a blanket mandatory doctor's note from day one, as planned by the federal government, with skepticism. Instead, he advocates tailored solutions that keep both the protection of employees and the functioning of the healthcare system in view.