The Irish Medical Organisation has decided unanimously to proceed to a ballot for industrial action, up to and including strike action.
Hospital consultants have never taken strike action in Ireland, but non-consultant hospital doctors (NCHDs) have on a number of occasions.
The IMO had given the Government a 21-day deadline to table serious proposals to deal with what the union says is a consultant recruitment crisis and the issue of pay parity for more recently appointed consultants.
The move to ballot for action was endorsed at a national meeting of members in Dublin this evening.
Around 3,500 consultants and NCHDs are expected to be involved in the ballot.
It remains unclear exactly what form any industrial action would take.
It could involve a work-to-rule, with doctors withdrawing from non-contractual duties.
If it proceeded, it also might in time affect outpatient clinics and planned operations.
The IMO described the first found of talks with the Department of Health last month as disappointing.
The union has said it is prepared to discuss reform in the health service with the Government, but that it could only do so when all consultants are starting from the same pay point.
A strike by IMO NCHDs in the late 1980s over working hours lead to the formation of a rival body for consultants, the Irish Hospital Consultants Association, which has a no-strike clause in its constitution.
The organisation has said that any industrial action would have to be taken carefully, but all options would be considered.
Former IMO president Dr Matt Sadlier said nothing had been decided yet, but it could affect outpatient clinics or planned operations.
The IMO said patient safety would be a priority.
It said it had not received any new proposals from the Department of Health on increasing consultant staffing and dealing with pay disparity.
The organisation has also said that any industrial action would not take place until next year.