Doctors have rejected the Government's planned pension changes and two out of three would be prepared to take industrial action over the issue, it was announced today.
A survey of members of the British Medical Association showed an "overwhelming" vote against the controversial reforms, dealing a blow to Government hopes of an end to the bitter dispute.
Around 46,000 doctors took part in a survey - a response rate of 36% - with over four in five saying the proposals should be rejected.
Almost two thirds said they would be prepared to take industrial action to pursue changes to the proposals.
More than a third of doctors over the age of 50 said they intend to retire early if the changes go ahead as planned.
The BMA has formally written to the Government rejecting the "final" offer and urging ministers to meet unions to agree "fairer" changes.
The association said it will work up detailed plans on taking industrial action, adding that all attempts will be made to ensure that any action would minimise any risk of harm to patients.
An emergency meeting of BMA Council will be held on February 25 to decide on the options for balloting on industrial action, unless there is a "significant" change in the Government's position.
Dr Hamish Meldrum, chairman of BMA Council, said: "The strength and scale of feeling among doctors is abundantly clear - they feel let down and betrayed, and for many this is the final straw.
"Doctors are at the forefront of attempts to save the NHS £20 billion, while trying to protect patient care, are in the midst of huge system reform in England, which is causing chaos in many areas, and are about to enter a fourth successive year of a pay freeze.
"Now on top of this, they are facing wholesale changes to their pension scheme, which was radically overhauled less than four years ago and is actually delivering a positive cashflow to the Treasury.
"Forcing doctors to work to almost 70 is one of our most serious concerns as it could put pressure on doctors to work beyond the age at which they feel competent and safe.
"Industrial action remains a last resort and the Government must urgently reconsider its damaging plans. The action we are considering is unprecedented in recent decades. This demonstrates the current level of discontent among NHS staff."
The BMA said that although there have been minor improvements on the Government's original offer through negotiation, all doctors still stand to be hit "very hard".
"The retirement age would increase, with many having to work to 68 before being able to draw a full pension. The amount doctors have to pay into their pension would rise significantly, with those at the start of their careers facing the prospect of paying over £200,000 in additional lifetime contributions.
"And the current final salary scheme would be replaced with a new career average scheme, which would leave most doctors with worse overall benefits."
The BMA has not taken industrial action since the 1970s when there was a dispute over junior doctors' working conditions, including hours.
An estimated 1.5 million public sector workers went on strike last November over the pension reforms, which affects teachers, civil servants, nurses, council staff as well as doctors.
The BMA did not take part in the strike, but even holding an industrial action ballot would be a serious blow to the Government's hopes of achieving a deal.
A number of unions are still considering the final offer, with some workers now being given the chance to vote on whether it should be accepted.