Junior doctors are set to strike for the first time in Scottish history after rejecting a 14.5% pay offer from the Government.
The NHS medics are poised to walk out for three days from July 12.
Members of the BMA union voted against the latest deal, made in May, with 71% balloting to reject with a 66% turnout.
They were offered 3% on top of last year’s 4.5% pay award alongside another rise of 6.5% this year, amounting to a cumulative increase of 14.5% over two years.
“Our membership has once again spoken decisively and clearly,” said Dr Chris Smith, chair of the BMA’s Scottish junior doctor committee.
“It is beyond doubt that they do not consider this offer sufficient to begin the process of addressing the pay erosion we have suffered since 2008 – when pay for a junior doctor was some 28.5% higher,”
The BMA said years of “pay erosion” had left them with a significant real-terms pay cut since 2008.
The union had called for an effective 35% pay increase to match what it said members had lost over 15 years.
According to the BMA, the latest deal would see pay fall in real terms by 26.5% since 2008 for foundation year doctors.
The Scottish Government said the offer would cost £61.3m, which it said was the best deal in the UK.
BMA Scotland said strike action could still be avoided if Matheson comes back with a better offer.
Health secretary Michael Matheson has said an offer higher than that is “simply unaffordable” and would mean making cuts elsewhere in the budget.
Dr Smith said: “Our NHS simply won’t be here for the people of Scotland in the long term if there is not action and investment now.
“That is why our message to the Scottish Government today is stark.
“Come back with an improved offer and we can still avert the need for strikes and the disruption they will cause us all and patients in particular.
“The ball is now firmly back in the Government’s court, and I hope they respond urgently and positively.”
The Scottish Government has been approached for comment.
The Health Secretary said he was “disappointed” with the rejection, adding that strikes are “in no one’s interest”.
“I respect the outcome of the ballot. We negotiated in good faith, addressing concerns from junior doctors but this was only the start of the journey, not the end,” Matheson said.
“This was the biggest investment in junior doctor pay for the last 20 years and a step forward to modernising pay bargaining, restoring confidence amongst junior doctors and ensuring that their contribution to our healthcare system is appropriately recognised.
“My door remains open, and I will meet with BMA Scotland later this week to discuss how we move forward.”
Scottish Tory health spokesman, Dr Sandesh Gulhane, said junior doctors were “at their wits’ end”, adding: “Michael Matheson has a duty to urgently address the poor conditions junior doctors are facing, such as guaranteeing they will get hot, nutritious meals at night and that rotas will be done six weeks in advance.
“The onus is on the SNP Government to get back round the table and find a solution to this dispute and deliver the modern, efficient and local health service that patients and staff need in Scotland.”
Scottish Labour deputy leader Jackie Baillie urged the Health Secretary to restart negotiations.
“The responsibility for this strike lies solely with Michael Matheson,” she said.
“Today, I am urging Michael Matheson to get around the table with the BMA and act to avert this strike by providing fair pay and conditions for junior doctors.”