Purpose - The purpose of this paper is to call for strong medical co-leadership in transforming the Australian health system. The paper discusses how Health Local Environmental Awareness Development (LEADS) Australia, the Australian health leadership framework, offers an opportunity to engage medical clinicians and doctors in the leadership of health services. Design/methodology/approach - The paper first discusses the nature of medical leadership and its associated challenges. The paper argues that medical leaders have a key role in the design, implementation and evaluation of healthcare reforms, and in translating these reforms for their colleagues. Second, this paper describes the origins and nature of Health LEADS Australia. Third, this paper discusses the importance of the goal of Health LEADS Australia and suggests the evidence-base underpinning the five foci in shaping medical leadership education and professional development. This paper concludes with suggestions on how Health LEADS Australia might be evaluated. Findings - For the well-being of the Australian health system, doctors need to play an important role in the kind of leadership that makes measurable differences in the retention of clinical professions; improves organisational cultures; enhances the engagement of consumers and their careers; is associated with better patient and public health outcomes; effectively addresses healthinequalities; balances cost effectiveness with improved quality and safety; and is sustainable. Originality/value - This is the first article addressing Health LEADS Australia and medical leadership. Australia is actively engaging in a national approach to health leadership. Discussions about the mechanisms and intentions of this are valuable in both national and global health leadership discourses. Keywords Health leadership initiatives, Health services, Health leadership capabilities Paper type General review