Summary: The German government has agreed measures to tighten rules on medical certificates for short-term illness, part of a broader effort to lift productivity in an economy weighed down by an ageing population and years of weak growth. Researchers and health-insurance data warn the changes may address recording and verification of absence rather than the workplace pressures that drive longer sickness spells, especially in care, nursing and education.
Germany recorded an average of roughly 22 sick-leave days per worker in 2024, according to the association of company health insurers BKK, a level that ranks among the higher international figures. That metric rose sharply in 2022 after electronic sick-note reporting was introduced, which improved the capture of short-term absences and altered the recorded pattern of days lost.
Under a package agreed by Chancellor Friedrich Merz’s coalition, telephone-based sick notes would be eliminated and employers would gain the option to require a medical certificate from an employee’s first day of absence. Policymakers present the change as one element of a wider push to lift productivity in an economy facing demographic pressures and an extended period of subdued growth.
But academics and specialists who study sickness, mental health and labour markets warn that the trend in absenteeism reflects deeper problems concentrated in certain professions. Those sectors - notably nursing, care work and teaching - are characterised by chronic understaffing, relatively low wages, limited career advancement and significant emotional demands, they say. These factors are associated with increased risk of poor mental health and extended absence from work.
Sectoral data for 2024 illustrate the divergence. Women working in healthcare and social work averaged 27 sick days, while teachers averaged 24. By contrast, employees in finance took 18 days on average and those in communication logged 16 days, BKK figures show.
Johannes Siegrist, emeritus professor at the University of Duesseldorf, emphasised that lengthy sickness spells do not always reflect clinical depression. "It doesn’t need to be a full-blown depression," he said. "It can also be a state of exhaustion or burnout as a result of problematic working conditions." His comment underscores how persistent workplace strain can manifest as prolonged incapacity without meeting criteria for a major psychiatric diagnosis.
National health-insurer data underline the disproportionate effect of mental disorders when they occur. Mental illnesses account for 4.8% of recorded sickness cases but lead to an average of 28 days of absence, AOK - Germany’s largest health insurer - reports. AOK also documents a 47% rise in sick days taken for mental-health reasons since 2014, which has made mental disorders the second-largest single cause of absence after respiratory illnesses.
Researchers highlight why certain occupations are more susceptible to these outcomes. Healthcare, education and social services combine high responsibility with intensive social interaction, frequent exposure to emotional problems and, in some settings, physical stressors including violence. Many workers in these fields earn relatively low pay and have lower socioeconomic status, creating what occupational-health scholars describe as an effort-reward imbalance. A substantial body of international research links that imbalance to poorer mental health, longer sickness absence and elevated risk for physical conditions such as coronary heart disease.
Evidence from German schools provides a concrete example. The 2024 German School Barometer found that nearly half of teachers reported psychological or physical violence from pupils at their school, and more than one-third experienced emotional exhaustion several times a week. Nursing shows parallel patterns, with acute staff shortages but only limited wage increases documented in recent German studies, particularly in hospitals and public institutions.
The health ministry declined to comment when asked about absenteeism rates being highest in sectors with the largest mental-health and emotional pressures.
Despite the sectoral concentration of long-term absence, experts caution against attributing high national sick-leave figures to malingering or to sick-pay rules alone. Germany’s statutory arrangements replace 100% of wages from the first day of illness for up to six weeks, among the most generous in the world, but international comparisons are complex, affected by demographics, workplace environments, social norms and institutional arrangements.
Seven OECD countries - Norway, Slovenia, Spain, Finland, France, Portugal and Belgium - report a higher incidence of sick leave among full-time employees, illustrating that generous sick-pay alone does not fully explain cross-country variation. "What we can say is that sick leave rules are one factor among many, and we would caution against reading too much into direct country comparisons of sick leave rates," said OECD researcher Sofia Malinai Domagk.
Several institutional studies looking specifically at the 2022 spike in recorded absences have struggled to find evidence of widespread misuse. Research by insurer DAK and the IGES institute concluded the sharp increase that year was largely driven by improved electronic reporting and unusually strong waves of respiratory illness and COVID infections; the recorded number of sick days has since stabilised. Their analysis found no proof that telephone sick notes, which were introduced in 2020 during the pandemic, were responsible for the surge, and they dismissed routine malingering or remote certification as explanations for the record levels.
"The available scientific studies suggest that sick leave by phone has not led to an increase in sick leave reports," said Enzo Weber from the Institute of Employment Research.
Critics of the government proposal argue that it risks penalising workers without addressing the root causes of absence. The services union Verdi described the measure as emblematic of a "culture of mistrust" toward employees. Medical associations warned that the change would be "absolutely disastrous" for already overstretched practices, concerned about added administrative and clinical burdens on primary-care providers.
The government has responded by saying companies will retain discretion: firms will be permitted to adopt the new requirement or to continue to require medical certificates only from the fourth day of illness. The debate highlights a tension in policymaking between tightening verification to limit absenteeism and tackling workplace conditions that contribute to longer-term sickness - a distinction researchers say is crucial to understanding and reducing lost workdays.
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