The HSE is to cut the pay of new hospital consultants by 30%.
Consultants and health managers failed to reach an agreement on a new hospital grade for future consultants at Labour Relations Commission talks overnight.
The HSE will proceed with the pay cut anyway, which will mean new consultants will earn €50,000 less than those currently working.
The talks also failed to reach an agreement on the issue of rest days and this will now be referred to the Labour Court.
Agreement was reached on a number of other issues though - such as seven day rosters and new working arrangements for clinical directors.
Industrial Relations Officer with the Irish Medical Organisation Steve Tweed says the new pay grade is not part of the Croke Park deal.
"The new grade is outside the public service agreement and doesn't form part of the proposals we're consulting with our members.
"It's really up to the HSE to decide how they want to deal with that going forward."