The Labour Court has recommended that hospital consultants should lose a quarter of their backlogs of overtime.
In some cases this could cost consultants over €50,000 each.
The Irish Hospital Consultants Association Secretary General Martin Varley said they will be assessing the recommendations.
He also said that they had sought a meeting with the Chief Executive of the HSE, Tony O'Brien, on the outcome of the IHCA survey on proposed reforms for consultants.
Under a 1997 arrangement known as "historic rest days", some consultants were entitled to take their last year prior to retirement off on full pay in lieu of overtime worked earlier in their careers.
Some who chose to work for that final year of their career were entitled to double pay.
The Heath Service Executive sought to halve the accumulated entitlements of up to one year per consultant on financial grounds.
The Irish Medical Organisation argued that any change would be grossly inequitable and would breach contractual entitlements.
Labour Court Deputy Chair Brendan Hayes said that a balance had to be struck between the rights of consultants affected and the financial reality facing the HSE, the State and taxpayers.
He found that the HSE had made a reasonable case for reducing the accrued leave entitlement.
Mr Hayes' view was that halving leave entitlement would be excessive.
He recommended overtime backlogs be reduced by a quarter, and that the deadline for when the leave could be taken be extended from 2018 to 2020.
The Labour Court also addressed the issue of compensatory rest days for on-call and call-out duties.
Mr Hayes recommended that the on-call and call-out arrangements for consultants should be brought into line with standard arrangements for other professional grades in the public health services.
This would involve linking compensatory rest to actual call-out incidents.
Revised arrangements are to be agreed and implemented within six weeks.
However, current on-call systems affecting a small number of consultants should be retained pending changes in rosters.
The HSE had also sought to eliminate second-opinion allowances for psychiatrists of up to €500 per opinion.
Mr Hayes points out that if the payment had been described as a fee rather than an allowance, the HSE would have been entitled to eliminate the payment.
It could also incorporate the work involved into the contract of employment under the Croke Park Agreement.
However, he says that as both parties insist on describing the payment to employed consultants as "an allowance", it must be dealt with in the same manner as all other allowances that are currently under discussion between the parties to Croke Park.
The recommendations on psychiatric second-opinions and compensatory rest are binding under the terms of Croke Park.
However, the historic rest days recommendation is not binding.