Hospital consultants belonging to the Irish Medical Organisation have overwhelmingly rejected new improved pay scales of up to €175,000 a year aimed at resolving recruitment difficulties in the public health service.
Of those balloted, 83% rejected the proposals, with 17% in favour.
In October 2012, the Health Service Executive cut the starting pay for hospital consultants by 30% from €156,000 to €116,000 - on top of a public service wide cut of 10% in salary scales for new entrants.
However, the pay cuts have been blamed for difficulties in recruiting consultants on the lower wages, with 200 posts currently vacant.
Some are being filled by more expensive agency doctors on a daily basis costing up to €300,000 a year.
Under the proposals brokered by Labour Relations Chief executive Kieran Mulvey, pay for consultants working exclusively in the public hospital system will rise from the current scale ranging from €116,000 - €121,000 to a scale rising from €127,000 and €175,000 over a period of time.
However, any consultant taking up a post under the proposed new pay scales must sign up to the Haddington Road Agreement.
While the IMO has done so, the Irish Hospital Consultants' Association is the only public service union that has not.
The IHCA is seeking full reversal of the 30% pay cut, as it claims the cuts breached their original 2008 contract.
The HSE insists the pay hikes are aimed at addressing a specific recruitment and retention issue outlined in a report by Professor Brian MacCraith, which stressed the need for measures to retain graduates in the Irish system and attract others back from abroad.
The IMO leadership issued no recommendation to members on whether to accept or reject the new pay scales.
It is expected that IMO consultants who have rejected the new deal will now remain on their current salaries, but the HSE will advertise the 200 vacant posts on the new enhanced rates.
Minister for Health Leo Varadkar has called the result of the talks "very disappointing".
Mr Varadkar said the "proposed salary scale ranging from €127,000 to €175,000 is very good by any reckoning. The real losers today are the patients."
He added that "the Government will now have to consider its option in filling the consultant vacancies."