Is Germany planning to scrap doctors' sick notes over the phone?

Looking at government attempts to reduce bureaucracy in Germany, too often it appears that every step forward is followed by two steps back.

The latest example is seen in rules around sick notes for employees.

German labour law generally requires employees to get a note from a doctor from their fourth day of absence due to illness. But employers may require a sick note (Arbeitsunfähigkeitsbescheinigung - AU) sooner if it’s established in their sick leave policy and written into employment contracts.

The requirement to obtain a doctor’s note forces many patients to visit their general doctor to confirm their illness – sometimes when the visit wouldn’t otherwise be necessary.

Hence the introduction of sick notes given over the phone for some minor illnesses, such as a cold or flu. 

The so-called telefonische Arbeitsunfähigkeitsbescheinigung, or telephone sick-note, was introduced during the Covid pandemic in order to save patients who might have Covid from coming into doctor’s offices for a note and potentially infecting others.

Then the practice was abolished along with other Covid-specific precautions. But in December 2023, the Joint Federal Committee of doctors, health insurance companies and clinics brought it back as a permanent regulation. It was intended to reduce bureaucracy for patients and also to relieve doctor's offices from being over-crowded with patients who simply need to confirm their illness.

There are key limits for when over-the-phone sick notes apply. First, notes are only given over the phone for infections with basic cold or flu symptoms - other illnesses or conditions will usually require an in-person consultation. Second, a telephone sick note may only be issued once for the first week of absence (for up to five working days). Should you need to extend your sick leave, you'll need to receive a second consultation in person. However if your first consultation occurred in person, you may be able to receive an extension over the phone.

Why kill the telephone sick note?

Critics suggest that being able to call in for a sick note is among the factors to blame for Germany’s high sickness rate.

German businesses have reported employees taking sick leave at rates above average since 2023.

In January, the German association of research-based pharmaceutical companies (VFA) published a report suggesting that the record level of sick leave taken by German workers was partially to blame for the country’s economic recession.

Now, as part of its growth initiative for the economy, the German government has agreed to review the measure due to the increased sickness rate.

Finance Minister Christian Lindner (FDP) is leading the charge: "In the future, you will have to go to the doctor again to report sick and not just be able to do it by phone." 

According to a report by Tagesschau, Lindner refrained from accusing workers of exploiting the regulation but noted a "correlation between the annual sick leave in Germany and the introduction of the measure".

The Finance Minister was echoed by the Federal Association of Employers (BDA), which is also calling for the abolition of telephone sick notes. The chief executive of the Confederation of German Employers' Associations suggested in his comments to the press that “abuse seems likely”.

Why doctors’ associations defend telephone sick notes

To suggest that absenteeism is correlated primarily with telephone sick notes seems to ignore the fact that the rate of respiratory infections have been at record levels since Covid became endemic in the population.

Germany’s centre for monitoring and preventing disease, the Robert Koch Institute (RKI), has reported abnormally high levels of respiratory infections several times in the past year.

Earlier this month the RKI noted spikes in both rhinoviruses (the common flu) and Covid-19 infections.

READ ALSO: Should you get a flu shot in Germany before the winter season?

The Association of General Practitioners in Germany said the introduction of sick notes by telephone for some minor illnesses made sense from a medical point of view and has so far been "one of the very few successful political measures to reduce bureaucracy in the healthcare system".

In addition to relieving the bureaucratic burden for patients, telephone sick notes could actually reduce the rate of infections by allowing those who are sick to remain isolated at home.

Nicola Buhlinger-Göpfarth, chairwoman of the association, told the Rheinische Post newspaper: "To abolish it now would simply be absurd. Anyone who wants to abolish telephone sick notes would jeopardise patient care in the coming months.

"Our practices definitely don't have the capacity to deal with the consequences of any phoney solutions from individual politicians," the chairwoman added.

READ ALSO: Can my company in Germany check on me at home when I’m sick?