Management of sick leave certificates—an online survey with primary care physicians in Germany

Abstract

Background: Issuing sick leave certificates (SLCs) regularly confronts general practitioners (GPs) with competing demands, such as weighing the interests of patients against those of the solidarity community. Objective: The goal was to survey how the influences and challenges related to sick leave certificates are handled and to survey the GPs attitude towards alternative models of sick leave certificates. Methods: An anonymous online survey was used to collect data from GPs practicing in Germany as part of a cross-sectional study from October–December 2024. The questionnaire was developed on the basis of existing literature and by the authors experiences and was pretested. Results: A total of 432 GPs from 14 federal states were included in the analysis. Participants felt well prepared for the topic of SLCs (mean = 2.44 on the German school grading scale with 1 the best and 6 the worst). They were particularly influenced by legal regulations (mean = 2.42), the planned therapy (mean = 2.54), and obligations toward the solidarity-based health system (mean = 2.76). Among the challenging situations most frequently reported were patients rejecting a sick leave recommended by the GP (43% of respondents experienced this at least once per week), extending a sick leave initially issued by another physician (28% ≥ once per week), and patients requesting a SLC as a favor (24% ≥ once per week). Alternative models for SLCs, such as partial sick leave, were rated more positively (mean = 2.4) than the requirement to provide a certificate only starting from the second week (mean = 3.69), or the possibility for other healthcare professionals to issue SLCs (mean = 4.37). Conclusion: Influences and challenges were common concerns among our participants and should be explicitly addressed in education. One reason why the model of partial sick leave was received more positively by the participants than models outside of the general practitioner’s office could be expected economic losses.