Hospital consultants have overwhelmingly rejected a new proposal to end a pay dispute.
Members of the Irish Medical Organisation voted by 83% against the deal put forward by the Health Service Executive.
The IMO has said the plan to reduce pay of new entrants by 30% would create a two-tier system for doctors working side-by-side.
The consultants are demanding equal pay for equal work, warning that the HSE proposal will result in a manpower crisis.