[Day-1 sickness certification : Evidence, economics, and implications for outpatient orthopaedic practice]

In July 2026, Germany's coalition committee announced plans to abolish telephone-based sickness certification and make medical certification from the first day of illness the statutory default. The policy is intended to address high sickness absence and potential misuse, while additional medical consultations are likely; no detailed bill had been published by 21 July 2026.

To review evidence on self-certification, physician certification, and sickness absence monitoring and to assess the expected consequences for office-based orthopaedic practice.

Focused narrative review of PubMed and the Cochrane Library, supplemented by German legal, health services, and sickness absence data and international policy examples available through 21 July 2026.

Evidence on universal day‑1 certification is of low to very low certainty, while evidence for a certification-induced prolongation of short episodes is conflicting and highly uncertain. Short episodes account for a large proportion of cases but a substantially smaller proportion of days lost than long-term absence. Additional consultations may consume specialist capacity and could prolong some otherwise brief absences; their magnitude has not been quantified for German orthopaedic practices.

A graduated policy combining short self-certification periods, targeted monitoring of selected absence patterns, work-related functional assessment, rehabilitation, and return-to-work pathways appears most consistent with the available evidence and the requirements of outpatient orthopaedic care.