When America Calls In Sick: What doctor’s notes from 93,633 telehealth visits say about the American sick day

Research

When do Americans call in sick? Judging by doctor’s notes, before work rather than at nine. Across 93,633 DrHouse telehealth visits, bookings made at 6 a.m. on Mondays were the most likely to end with a note (33.0%, against 21.4% of all visits). Weekday visits produced notes at 23.6%, weekend visits at just 14.9%.

Ask a room of people what day America calls in sick and you’ll hear Monday. Ask what time and most will picture nine o’clock. The workday has started, someone has noticed the empty desk, the call gets made. The first guess holds up, at least in this data. The second misses by three hours, in the wrong direction.

We analyzed 93,633 completed DrHouse telehealth visits, each one stamped with the day and hour it was booked in the patient’s local time. The hour of the week when a visit was most likely to end with a doctor’s note turned out to be 6 a.m. on a weekday, and the hottest of those hours belongs to Monday. One in three visits booked at 6 a.m. on a Monday ended with a note. Across all visits, the rate was roughly one in five. By 9 a.m., the hour most of us would have guessed, it had already slipped below average.

One thing to understand before going further. DrHouse is a telehealth service, and a doctor’s note is one thing a visit can end with when it’s medically appropriate. So this data measures documentation, not illness. It can’t show when Americans get sick. It shows when the people who completed a telehealth visit were most likely to need proof.

That distinction matters, because once you follow the notes across the day, the week, and the year, the pattern lines up with work schedules far better than with any calendar of illness.

Key Findings

• Monday has the highest doctor’s note rate of any day, at 25.4% of visits. Saturday has the lowest, at 14.1%.
• The peak hour of the week is 6 a.m. on Monday, when 33.0% of visits booked ended with a note.
• By 9 a.m., the rate has already fallen below the 21.4% average. The paperwork peaks before work, not after.
• Weekday visits end with a note at 23.6%. Weekend visits, at 14.9%.
• Adults aged 18 to 24 are the most likely to need a note: 38.7% overall, and 47.8% on Monday mornings.
• February is the peak month at 24.9%. The rate collapses in the second half of December, from 24.8% to 15.8%.
• No detectable Sunday Scaries spike: Sunday evening bookings run at 21.9%, against 21.4% for the rest of the week.

Which Day Do People Call In Sick the Most?

Monday, by a nose. Measured by the share of DrHouse visits that ended with a doctor’s note, Monday leads at 25.4% (3,479 of 13,681 visits). Tuesday is right behind at 24.8%, then Wednesday at 24.0% and Thursday at 23.8%. Friday drops to 20.2%. Saturday is the floor of the week at 14.1%, and Sunday recovers slightly to 16.0%.

Two caveats before anyone quotes that. Monday’s edge over Tuesday is small enough to be chance. The early week is a plateau, not a spike. What chance does not produce is the shape of the week: Monday through Thursday, roughly one visit in four ends with a note, Friday slips, and the weekend rate runs nearly 40% below the working week. That drop matters more than whether Monday narrowly beats Tuesday, and it is the first hint that these numbers track when documentation is required rather than when illness strikes.

There are also two ways to date a visit, by the day it was booked and by the day it took place. Most visits happen the same day they are booked, so the two agree. Monday leads on both counts (25.4% by visit day, 25.2% by booking day) and Saturday trails on both (14.1% and 13.6%).

Day	Visits	Note rate (visit day)	Note rate (booking day)
Monday	13,681	25.4%	25.2%
Tuesday	14,464	24.8%	25.0%
Wednesday	13,830	24.0%	23.8%
Thursday	13,540	23.8%	23.7%
Friday	14,486	20.2%	19.2%
Saturday	13,691	14.1%	13.6%
Sunday	9,941	16.0%	17.2%

Share of completed DrHouse telehealth visits where a doctor’s note was issued, by the local day of the visit and of the booking. February 2024 to August 2026, n = 93,633.

Monday has carried this reputation for a long time, usually on thinner evidence than people assume. In the UK, the employment law firm ELAS branded the first Monday of February National Sickie Day back in 2011 after noticing a bump in its clients’ absence records. The label has outlived its data. A 2025 analysis of 90,000 UK employees by the HR platform Employment Hero ranked that day a lowly 112th for absences and found Fridays busiest.

In the US, the most quoted sickest-day ranking comes from Flamingo, a leave-tracking company that reviewed five years of absence records (2018 to 2022) from roughly 300 employers and named August 24 the top day, with February the busiest month.

And the familiar line that Monday is the sickest day of the week traces largely to the careers site Zippia, which measured traffic to its own article on how to call in sick and found Mondays drew about a fifth of it. Absence records, leave software, search traffic. Each measures something different, and none of them records the hour. That is what this dataset adds.

For a national benchmark on missed work in general, the Bureau of Labor Statistics put the 2024 absence rate for full-time wage and salary workers at 3.2%, meaning the share who worked fewer than 35 hours in a given week because of illness, injury, or other personal reasons. That is a different measure with a different denominator, so nothing in this study should be read against it.

What Time Do People Call In Sick?

Measured by note rate, before the workday starts. Set the day of the week aside and look only at the local hour a visit was booked. The note rate peaks before dawn and falls from there. Visits booked at 4 a.m. ended with a note 30.0% of the time. At 5 a.m., 27.8%. At 6 a.m., 26.2%. By 7 a.m. the rate is down to 23.0%, and at 9 a.m., the hour most people would name, it sits at 20.9%, already below the all-day average. It rebounds a little around 11 a.m., holds in the low twenties through the afternoon, and runs at 19 to 20% through the evening.

Read the 4 and 5 a.m. figures gently, since they rest on a few hundred bookings each. From 6 a.m. through 10 p.m., every hour is built on more than a thousand.

Hour booked	Bookings	Notes	Note rate
4 a.m.	277	83	30.0%
5 a.m.	553	154	27.8%
6 a.m.	1,472	385	26.2%
7 a.m.	3,608	830	23.0%
8 a.m.	6,388	1,452	22.7%
9 a.m.	7,508	1,567	20.9%
10 a.m.	7,959	1,636	20.6%
11 a.m.	7,722	1,775	23.0%
Noon	7,372	1,660	22.5%
1 p.m.	6,801	1,537	22.6%
2 p.m.	6,368	1,357	21.3%
3 p.m.	6,154	1,306	21.2%
4 p.m.	6,122	1,243	20.3%
5 p.m.	5,801	1,133	19.5%
6 p.m.	5,515	1,080	19.6%
7 p.m.	4,656	898	19.3%
8 p.m.	3,806	754	19.8%
9 p.m.	2,588	559	21.6%
10 p.m.	1,542	325	21.1%
11 p.m.	618	131	21.2%
Midnight to 3 a.m.	803	186	23.2%

Doctor’s note rate by the local hour a visit was booked, all days combined.

Monday at 6 a.m. Is Where the Two Patterns Meet

Put the day back in and the peak sharpens. Of the 233 visits booked at 6 a.m. on Mondays, 33.0% ended with a doctor’s note. Across all five weekdays, the 6 a.m. hour runs at 29.3%. Among the hours of the week with at least 200 bookings, the nine highest note rates all land between Monday and Thursday, and six of the nine are at 6 or 7 a.m.

Bookings made on Monday between 6 and 10 a.m. (2,978 of them) ended with a note 27.2% of the time, against 21.2% for every other hour of the week. That is 1.28 times the rate.

The pre-work window also carries more than its share of the paperwork. Bookings between 6 and 9 a.m. account for 12.2% of all visits but 13.3% of all notes, and 38.1% of all notes were booked before noon.

The nine hottest hours of the week

Day and hour booked	Note rate	Bookings
Monday, 6 a.m.	33.0%	233
Wednesday, 6 a.m.	30.3%	211
Thursday, 6 a.m.	30.0%	253
Monday, 7 a.m.	29.1%	560
Tuesday, 6 a.m.	29.1%	244
Thursday, 7 a.m.	28.9%	564
Tuesday, noon	28.6%	1,069
Tuesday, 8 a.m.	28.2%	932
Monday, 1 p.m.	28.1%	1,085

And the four coldest

Day and hour booked	Note rate	Bookings
Sunday, 9 a.m.	11.7%	836
Saturday, 6 p.m.	11.3%	631
Saturday, 7 a.m.	11.1%	485
Saturday, 8 a.m.	10.3%	1,052

Day-and-hour combinations with fewer than 200 bookings are not shown. A few pre-dawn combinations run higher on a handful of bookings and are excluded for the same reason. Monday 6 a.m. is the highest combination that clears the bar, though the 6 a.m. hours on Tuesday, Wednesday, and Thursday run close enough that the honest summary is “6 a.m., early in the week,” with Monday at the top of it.

Why 6 a.m.? Look at the Call-Out Policy

The most practical explanation is the call-out rule. Workplace attendance policies routinely require employees to report an unplanned absence one to two hours before a scheduled shift starts, and attendance policy templates from workforce software companies like TeamSense build that notice window right into the rules.

The math is simple. A 6 a.m. shift can mean a 4 a.m. call. Roughly three quarters of American workers start their day between 6 and 10 a.m., and about one in eleven starts before 6, according to a Population Reference Bureau analysis of 2006 Census survey data. 

Put those together and a 6 a.m. booking looks less like a decision made after the day begins and more like one made against a deadline the shift sets. The data cannot see the shift, so that is an inference. It is just the one the numbers keep pointing to.

The 9 a.m. assumption, meanwhile, is an office assumption. It belongs to a world where a late start is a message to a manager rather than a missed shift, and where nobody asks for a note at all. This dataset records the hour, not the job, but the people booking at 6 a.m. are mostly not living in that world. And the hours when the note rate runs highest are exactly the hours when most in-person care is closed. A clinic that opens at 8 cannot help someone whose shift starts at 7.

Weekdays vs. Weekends: The Doctor’s Note Is a Work Document

Of every way to cut this data, the split between the working week and the weekend holds up on the biggest numbers. On weekdays, 23.6% of visits ended with a note (16,527 of 70,001). On weekends, 14.9% (3,524 of 23,632). Weekends supply a quarter of all visits but fewer than a fifth of all notes.

And it is not simply that weekends are quieter. The same pre-work window that runs hot Monday through Friday goes cold on Saturday and Sunday. Bookings between 6 and 9 a.m. ended with a note 26.7% of the time on weekdays and 12.5% of the time on weekends, less than half the rate. Same hours, same platform. The obvious candidate for what changed is whether there was a shift to document.

The weekend rate is not zero, for ordinary reasons. Plenty of people work Saturdays, and a note issued on a Sunday can cover Monday. But the direction is unmistakable, and it is the plainest evidence in the data that the doctor’s note follows the work calendar rather than the illness calendar.

Do the Sunday Scaries Show Up in the Data?

Not measurably. If one piece of modern folklore ought to leave a fingerprint here, it is the Sunday Scaries. A 2018 Harris Poll survey of 1,017 working adults, commissioned by LinkedIn, found that 80% feel some version of Sunday-evening dread about the week ahead.

If that dread turned into documentation, Sunday evenings would show it. They do not. Visits booked on Sundays between 5 and 10 p.m. ended with a note 21.9% of the time, against 21.4% for the rest of the week. That half-point gap, on 1,869 bookings, is not a statistically detectable increase.

Whatever people feel on Sunday night, this data finds no measurable surge in paperwork to match. On this evidence, the Monday effect begins Monday morning.

Who Needs a Doctor’s Note the Most? The Youngest Adults

Age changes the level of everything above far more than the shape. Across the whole dataset, visits by 18-to-24-year-olds ended with a note 38.7% of the time. The rate falls steadily from there: 25.9% for ages 25 to 34, 18.0% for ages 35 to 44, and 10.5% for patients 45 and over.

Monday mornings then lift every group above its own baseline by a similar proportion, between 1.24 and 1.38 times. For the youngest adults, that means 47.8%. Nearly half of their Monday-morning visits end with a doctor’s note.

Age group	All visits	Overall note rate	Monday 6 to 10 a.m. bookings	Monday-morning note rate	Lift
18 to 24	13,287	38.7%	389	47.8%	1.24x
25 to 34	23,928	25.9%	760	32.1%	1.24x
35 to 44	21,315	18.0%	696	24.9%	1.38x
45 and over	29,281	10.5%	934	13.5%	1.28x

Doctor’s note rates by adult age group, overall and for Monday-morning bookings. Differences between age groups are statistically significant.

The dataset records age, not occupation, so it cannot say why. The most plausible reading is that the jobs that ask for documentation (hourly, shift-based, attendance-point roles) are more common early in working life, and that the need for a note fades as careers move toward jobs where a message to a manager is enough.

That is an interpretation of the labor market rather than a finding of this study, and we offer it as one. It is not the only candidate either, since college-age patients may need notes for school rather than work, and the dataset does not record a note’s purpose. What the data does establish is the age gap itself, and it is large in every cut we checked.

Patients under 18 make up 6.2% of visits. They are included in the overall figures but booked too few Monday-morning visits to report separately.

Which Month Do People Call In Sick the Most?

February, at least by doctor’s notes. This data cannot say which month people get sick the most, but it can say which month visits most often ended with a note, and February leads at 24.9%. It was the peak month in 2025 and in 2026 taken separately. March and April follow at 23.4%, the rate slides into a summer trough of 19.0 to 19.4% from June through August, and it recovers through the fall. Then December, the heart of cold and flu season, comes in at 19.2%. That is summer territory.

It is not for lack of visits. December and January were the two busiest months in the most recent twelve months of data, and January’s rate is 22.5%. What December is doing becomes obvious once you split it in half. From December 1 through 15, 24.8% of visits ended with a note, a February-level rate. From December 16 through 31, the rate fell to 15.8%, close to the weekend rate, and over the final ten days of the month it hit 15.0%. Counting weekdays only, the two halves are 27.4% and 17.0%.

People do not stop getting sick on December 16. Work schedules, school calendars, and office closures change, and the paperwork follows them. Flamingo’s leave records reach the same peak from the other side, with February the busiest month for sick leave in their data too.

Month	Visits	Note rate
January	11,118	22.5%
February	8,919	24.9%
March	8,416	23.4%
April	8,198	23.4%
May	8,320	22.1%
June	8,181	19.0%
July	8,646	19.1%
August	6,490	19.4%
September	4,932	20.7%
October	4,472	22.1%
November	5,694	20.3%
December	10,247	19.2%

Rates pool every occurrence of each month in the study window. A balanced two-year window gives the same shape. See the methodology below.

Is the Day After the Super Bowl Really America’s Biggest Sick Day?

There is one Monday a year with a reputation all its own, and the dataset includes two of them: February 10, 2025, and February 9, 2026. On those two Mondays, 32.4% of visits ended with a doctor’s note, against 25.2% on an ordinary Monday. Case closed?

Not quite. February Mondays run hot across the board, at 29.2% on the other February Mondays in the data. Against that comparison, the Super Bowl’s own bump is too small for this dataset to confirm.

It is a useful lesson in reading statistics. The fun headline is that Super Bowl Monday runs hot. The accurate one is that February Mondays run hot, and the Super Bowl happens to land on one.

What the Shape of the Week Says

Line the findings up and they all point the same way. The note rate climbs before the workday and falls after it. It is high Monday through Thursday, lower on Friday, lowest on the weekend. It peaks in February, sags through the summer, and collapses in the second half of December. It is strongest among the youngest adults. And it does not stir on Sunday evenings, when people can feel the week coming but do not yet have to prove anything to anyone.

That is not the shape of illness. Illness does not take weekends off or wind down on December 16. It looks like the shape of work: shift starts, notice windows, attendance policies, the weeks when everyone is on the schedule and the weeks when nobody is. On this evidence, the doctor’s note keeps shift hours.

Which raises a practical question about access. Someone who wakes up sick at 5:30 a.m., has a shift starting at 7:00, and needs documentation before it begins cannot wait for a clinic that opens at 8. The timeline their workplace set has already run out. Telehealth changes that math, not by changing attendance policies but by putting a clinician within reach during the hours when, for a lot of workers, the sick day is actually decided. For DrHouse patients, that moment arrives before most of us have poured a first cup of coffee.

How We Did This Analysis

The analysis covers 93,633 completed DrHouse telehealth visits recorded between February 29, 2024, and August 17, 2026, from patients in all 50 states and the District of Columbia. The note rate throughout is the share of completed visits where a doctor’s note was issued, and 20,051 visits ended with one. Canceled appointments and no-shows are not part of the file.

Every visit carries a booking timestamp and a visit date. Booking times were converted from UTC to local time using the primary time zone of the patient’s state, with daylight saving rules applied, then analyzed by the local hour and weekday of the booking. Day-of-week rates were checked both by visit date and by booking date. Most visits happen the day they are booked, which is why the two agree. Age was calculated at the date of the visit. Forty-two records with a date of birth later than the visit date are included in the all-ages totals and excluded from the age groups.

Day-and-hour combinations with fewer than 200 bookings are not reported. Differences described as significant were tested with two-proportion z-tests or chi-square tests: Monday 6 to 10 a.m. against all other times (p < 0.001), weekdays against weekends (p < 0.001), the two halves of December (p < 0.001), February against December (p < 0.001), and the differences between adult age groups (p < 0.001). Monday 6 a.m. is not statistically distinguishable from the 6 a.m. hour on Tuesday, Wednesday, or Thursday, and Monday is not distinguishable from Tuesday as a whole day. The Sunday evening comparison is not significant (p = 0.62). Super Bowl Monday differs from an ordinary Monday (p = 0.003) but not from other February Mondays (p = 0.27). Not every eye-catching number earns an eye-catching conclusion.

Because visit volume grew over the period and the months are unevenly represented, monthly rates were re-run on a near-balanced two-year window from September 2024 through August 2026 (the final August is partial, since records stop on August 17): February 24.9%, the summer months 18.2 to 18.5%, December 19.2%, with the same shape throughout. Restricting the analysis to adults also leaves the main findings in place: Monday 24.6% and Saturday 14.3%, weekdays 22.7% and weekends 15.0%, Monday 6 a.m. 32.0%, and December’s two halves at 23.3% and 16.2%. The Monday-morning effect holds in each of the three calendar years covered and is significant in 2025 and 2026 separately. 2024, with 8,073 visits, is too small to test on its own.

All data were de-identified and analyzed in aggregate, and no patient-level information is published. Visit counts, note counts, confidence intervals, and test statistics for every figure above are available in the data supplement that accompanies the full case study.

What This Study Cannot Tell Us

Two limits are worth stating plainly. First, DrHouse patients chose to seek care through a telehealth platform. These figures describe them, not the American workforce, and should not be projected onto it. Second, the dataset contains no occupations, employers, shift times, or attendance policies, so the link between work schedules and doctor’s notes is an interpretation of the timing patterns, not direct proof of cause. A note also does not tell us why a patient wanted it or how they used it afterward. What the data can show, at unusually fine resolution, is when documentation appears in this population. That pattern is consistent everywhere we looked.

The figures in this article are free to use with attribution. Cite DrHouse Research and link to this study as the source. This analysis is part of our ongoing work on where healthcare access meets everyday life. For the complete tables, confidence intervals, and methodology, read the full DrHouse case study.

Sources

• DrHouse internal visit records, February 29, 2024 to August 17, 2026. Primary dataset for all study figures (93,633 completed telehealth visits).
• Health Assured: National Sickie Day (origin of the ELAS designation, 2011)
• HR Grapevine: National Sickie Day, new data reveals the real story behind workplace absences (Employment Hero analysis, 2025)
• CBS News: What is America’s “sickest” day of the year? (Flamingo analysis)
• Zippia: The days people are most likely to call in sick (website traffic analysis)
• Bureau of Labor Statistics: Absences from work of employed full-time wage and salary workers, 2024 annual averages
• LinkedIn Official Blog: Decoding the Sunday Scaries (Harris Poll survey, 2018)
• TeamSense: Employee Attendance Policy Template
• Population Reference Bureau: A Demographic Profile of U.S. Workers Around the Clock