There is a call on the Government to tackle the ongoing crisis in hiring and keeping doctors.
The Irish Medical Organisation (IMO) is making the call in its pre-Budget submission for Budget 2020 today.
It says there is a consultant shortfall of up to 72% in key specialties and 520 posts are unfilled or on a temporary basis.
IMO President Dr Padraig McGarry says pay is a factor but there are other issues causing the retention problems.
"Sub-standard working conditions in understaffed hospitals are having a terrible impact on patient care and unconscionable pay inequality means doctors are emigrating in their thousands to countries that actually value the skills they provide," said Dr McGarry.
The IMO said in its submission that consultants face unequal pay of up to €50,000 a year based on when they were appointed.
A survey carried out by the IMO revealed that 83% of non-consultant hospital doctors said that pay disparity at consultant level will impact their decision on whether to apply for consultant posts in Ireland.
"It is no wonder they are leaving the country for health systems around the world that respect their skills and do not have a pay discrimination policy," said Dr McGarry.
"Time and again, we have heard empty promises from a Government that cannot grasp the scale of the emergency we are facing – this needs to change.”
Dr McGarry said that steps need to be taken to prevent the emigration of doctors.
"I think they should have tax relief on the loans that medical graduates have when they are coming into the service and hopefully that might help retain them here because most are going abroad as soon as they qualify," said Dr McGarry.
"We are facing a huge defecit in that regard."
Another issue is that half of the country's 92 public health doctors are due to retire within the next five years.
According to the IMO, posts that have been advertised have attracted few or no applications.
The organisation estimates that a quarter of the country's GPs are also due to retire in the next five years.
Dr McGarry said that the doctor recruitment and retention crisis has affected every area of the health service.
"Irish people deserve a health system of which they can be proud, and without immediate investment, it will remain one of which we are all ashamed," he said.
The IMO pre-Budget submission call for: