Burnout Inclusion in ICD-11: Media Got It Wrong, WHO Says

Megan Brooks

June 07, 2019

Multiple news stories in the lay press stating that burnout is now an official medical diagnosis, according to the World Health Organization's new International Classification of Diseases (ICD-11), are incorrect, according to the WHO.

"There was a misunderstanding. 'Burnout' has not in fact been recognized by WHO as a medical condition. Having said that, the importance of well-being in the workplace is well understood by WHO," Christian Lindmeier, spokesperson for the health agency, told Medscape Medical News.

In ICD-11, burnout is included in the chapter titled "Factors influencing health status or contact with health services."

"The inclusion in this chapter specifically indicates that burnout is not conceptualized as a medical condition, but rather as an occupational phenomenon," said Lindmeier.

"Burnout is a factor that modifies or affects an individual or an individual's interaction with the healthcare system. It's not a medical diagnosis. It's not a disease," Richard Summers, MD, chair of the American Psychiatric Association (APA) Workgroup on Psychiatrist Well-being and Burnout, further explained in an interview with Medscape Medical News.

Specifically, ICD-11 states that burnout is:

a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:

1) feelings of energy depletion or exhaustion

2) increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job

3) reduced professional efficacy

Burnout refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.

Not a Big News Story

Summers noted that ICD-10 also includes burnout but only gives a short one-sentence description.

"The change in ICD-11 is it specifically refers to burnout in the occupational context and gives a more detailed one-paragraph description of burnout, essentially using the Maslach definition of burnout. This is actually a very incremental change," said Summers, clinical professor of psychiatry at the Perelman School of Medicine of the University of Pennsylvania in Philadelphia. 

"This really is not a big news story that it was made out to be. That said, burnout is a very serious problem. It's a ubiquitous problem but it's a subjective experience and not a disease in and of itself," Summers noted. 

Burnout does have a code in ICD-11 and greater use of the code, where appropriate, will be helpful going forward, Edward M. Ellison, MD, executive medical director and chairman of Southern California Permanente Medical Group, told Medscape Medical News.

As people are coded for burnout based on the definition provided with the ICD-11 code, "we’re going to gain more data and information that can help us better understand the causes that contribute to burnout and help find solutions that can most effectively address it," Ellison explained.

A recent study pegged the monetary costs related to physician burnout at $4.6 billion annually, as reported by Medscape Medical News. "The non-monetary or human costs include the loss of life due to suicide and disengagement from family, friends, and loved ones," said Ellison.

On a more positive note, a recent study for the first time suggested a decline in physician burnout. The study showed that 43.9% of US physicians exhibited at least one symptom of burnout in 2017, compared with 54.4% in 2014 and 45.5% in 2011.

"That's encouraging, but clearly we still have a lot of work to do," said Ellison. 

Lindmeier, Summers, and Ellison have disclosed no relevant financial relationships.

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