Doctors specialising in public health have voted overwhelmingly to take industrial action, up to and including strike action, in their 20-year campaign to be upgraded to hospital consultant status.
The doctors play a key role in the battle against infectious diseases, such as Covid-19.
The Irish Medical Organisation Public Health Committee will decide on Monday the timing and form the industrial action by the 60 doctors will take, but sources said a withdrawal of labour could not be ruled out.
After Monday's meeting, the IMO will engage with the HSE and Department of Health about emergency cover during any industrial action.
The union described the prospect of industrial action as "deeply regretful".
It added: "The absence of any proposals from the Department of Health since the ballot was announced was indicative of the department's lack of respect for the medical workforce and its lack of urgency on Public Health Medicine even during a pandemic."
The 60 doctors are currently involved in key anti-Covid activities, including overseeing "complex" contact tracing in settings, such as nursing homes and schools.
However, because they are not ranked at consultant grade, they earn up to 48% less than their hospital consultant colleagues and have been campaigning to close that gap for around 20 years.
The public health specialists can currently earn up to €111,822, but their hospital consultant counterparts with a "type-A" public-only contract can take home between €141,026 and €195,653.
Consultants with other contracts permitting an element of private practice could take home significantly more.
The IMO also argues that more public health specialists need to be recruited, and noted that all other doctors stood behind their public health colleagues in their campaign for consultant status.
Chair of the IMO Public Health Committee Dr Ina Kelly said the doctors would be taking industrial action to save public health medicine in Ireland and make it "fit for purpose".
"The refusal to follow international best practice and recognise consultant status and provide consultant contracts for suitably qualified specialists in Public Health Medicine and the inadequate staff and resources for Public Health Medicine can no longer be tolerated," she said.
Dr Kelly said the doctors fully recognised their ethical responsibilities to patients, but stressed that the Government must also recognise that it too had an ethical responsibility to provide a comprehensive, safe, effective and sustainable public health medicine service to the Irish people.
Dr Geraldine McDarby, who recently graduated from the Higher Specialist Training Scheme in Public Health Medicine and is Ireland's first Health Service Improvement Fellow, said: "With my clinical experience and training, countries around the world are more than willing to employ me as a consultant in Public Health Medicine, but I can't be recognised at that level here in Ireland. This is blatantly unfair."
Dr McDarby said the message she and her colleagues heard "loud and clear" was that if they wanted their qualifications to be recognised, they would have to go abroad, where consultants were being actively recruited.
The Department of Health said it was committed to creating consultant roles in public health.
It said it and the HSE had "finalised a detailed framework for a future Public Health model, to include consultant level roles".
It added: "The business case, outlining the proposed framework, was submitted by the Minister for Health to the Minister for Public Expenditure and Reform on the 19th November 2020.
"We would hope that the issue can be resolved through engagement with the IMO on the matter under the provisions of the PSSA and that industrial action can be avoided."