The German coalition government has agreed to mandate a medical certificate from the first day of illness, overturning a rule that allowed workers up to three days without a doctor’s note and abolishing the telephone sick-note system introduced during the Covid-19 pandemic. The decision, part of a 34-point economic reform package, has drawn sharp criticism from medical associations and triggered internal dissent within the ruling Social Democratic Party (SPD). Chancellor Friedrich Merz of the Christian Democratic Union (CDU) described the move as a “tough decision” but necessary to address what he called “exorbitant” sick leave levels that place German companies at a competitive disadvantage.

Government figures, including CDU parliamentary leader Jens Spahn, point to an average of 18 sick days per employee per year, among the highest in the European Union. The chancellor’s office argues that the reform merely restores pre-pandemic rules, though the three-day grace period had been in place since 1994. Under the new system, employers will be able to waive the first-day certificate requirement, but the default will shift to immediate documentation. SPD leaders, including Vice-Chancellor Lars Klingbeil and Labour Minister Bärbel Bas, have sought to temper the announcement, promising to examine the practical impact and find “workable solutions.” The CDU’s own employee wing has suggested the measure be reconsidered, citing a disproportionate political cost.

Medical groups in Germany have warned of severe operational strain. The National Association of Statutory Health Insurance Physicians (KBV) estimates the change could generate 30 million additional doctor visits annually, clogging waiting rooms and delaying care for patients with serious conditions. General practitioners caution that forcing people with minor infections into surgeries risks spreading illness. The debate has also exposed a cultural fault line: Italian and German commentators note that the shift from a trust-based system to one of mandatory verification represents a significant break with post-war labour norms, with some regional leaders, such as North Rhine-Westphalia’s premier Hendrik Wüst, warning of unintended health consequences.

International comparisons place Germany’s sick leave in the upper third of OECD countries, behind Norway but far ahead of Italy and Greece, according to data cited by Italian and German outlets. The German system’s combination of full salary continuation for six weeks is described by labour market analysts as generous but not unique. The sick-note reform is embedded in a broader package that includes a gradual rise in the retirement age to 67 and tax cuts, aimed at reviving an economy that has struggled since the pandemic and the energy price shock following Russia’s invasion of Ukraine. Government spokespeople have clarified that the certificate need not be physically presented on the first day and that video consultations remain permissible. The coalition aims to pass the main elements of the package through parliament by the end of the year, with the precise wording of the sick-note rule still under review.