In the United Kingdom National Health Service (NHS), the growing number of hybrid clinical leaders has given rise to professional practice and identity struggles. Co-construction theories of leadership point to a need for leaders to engage in significant ‘identity work’ to construct themselves as leaders and to make legitimate claims for a leadership identity to potential followers. Our research aimed to contribute to the leader-follower literature by examining how medical leaders deal with professional identity struggles and changes to traditional work identities. We draw on data from a study of senior hospital doctors (consultant-level doctors from a variety of medical specialties in Health Boards in NHS Scotland). Our findings suggest that most senior hospital doctors in our study struggle to grant leadership identities to their medical leaders who claim such leadership identities, although they seek to see more doctors engaging in leadership. This article contributes to extant research on the influence of medical leadership roles on leader-follower identity construction.