She Is Not Fine: The Women Quietly Leaving Your Leadership Pipeline

She has not missed a deadline in six years. She runs the highest-performing team in her division. She was on your succession plan last cycle and she is on it again this cycle. She is one of the three or four people in the company you could not easily replace.

She is quietly looking for a new job. You will not find out until she has already accepted the offer.

I have had this conversation more times than I can count. Not in a boardroom. In my clinic, with the mothers who bring their children in for strep tests and well-child visits and vaccinations. In the parking lot after church. In the group text I have with women I went to medical school with, who are now running departments and divisions and companies of their own. The pattern is the same every time.

She is not fine. She is high-functioning, which is not the same thing.

The medical difference matters. Fine means the body is operating within its normal parameters. High-functioning means the person has adapted to operating under conditions the body is signaling are not sustainable. The signals are measurable. Elevated cortisol, disrupted sleep, cardiovascular strain, hormonal irregularity, inflammatory markers that should not be where they are at her age. Underneath those markers is a nervous system that has been in a sustained state of threat response for months or years. The body does this quietly. It does not announce itself until the strain becomes damage.

Your highest-performing women have learned to override every signal the body sends. They have had to. They have been working in organizations that were not designed with their physiology in mind, carrying operational and emotional labor that is not in their job description, and absorbing the kind of chronic pressure that produces exactly the clinical picture I described above. When their nervous systems finally reach the threshold where override is no longer possible, one of two things happens. They crash into a health event you did not see coming. Or they leave.

Here is the pattern I see in the women who are leaving. They do not have a dramatic moment. They do not file a complaint. They do not sit down with HR and explain what has been happening. They simply reach a quiet decision that something has to change, and because they cannot change the conditions of work, they change their job. They update their resume on a Sunday afternoon. They take a call with a recruiter during their lunch break. They do all of this while continuing to hit their numbers, run their team, and show up to the leadership offsite with a smile.

Your retention strategy is almost certainly not catching this. Most retention programs are designed around sentiment. Did she say she was engaged. Did she rate her manager highly. Did she indicate on the survey that she was planning to stay. The women I am describing will answer all of those questions in a way that looks healthy right up until they turn in their resignation. They are not lying on the survey. They are performing on the survey, the same way they are performing in every other arena of their life.

What you need is a clinical lens on what is actually happening in the bodies of your top-quartile performers. You need to know what the warning signs look like, how to spot them before resignation becomes the outcome, and what organizational changes actually address the source rather than the symptom.

If you are an executive, a CHRO, or a head of culture reading this and thinking of two or three specific women whose names just surfaced in your mind, that is the conversation to have. Not with them. Not yet. With the leadership team about what you are actually asking of these women and whether the conditions of their work are producing the clinical reality I am describing.

She is not fine. The sooner your organization is willing to see that clearly, the sooner you can address the actual reasons your highest performers are quietly updating their LinkedIn profiles.