The Government has taken the first dramatic step to dismantle the two-tier health system by forcing new consultants to exclusively treat public patients for a salary of €252,150.
The new Sláintecare contract will be mandatory for all newly-hired hospital consultants from March and is aimed at ending queue jumping by fee-paying patients in public hospitals over the next decade.
Health Minister Simon Harris described it as "one of the biggest shake-ups in Irish healthcare in a generation", but a doctors' body dismissed it as "discriminatory".
Around 2,600 hospital consultants, most of whom treat public and private patients, will be offered to switch over to the new contract but it will not be compulsory.
The contract will offer pay of up to €222,460, jumping to €252,150 in 2022.
Several hundred existing consultants, hired since 2012 who are earning €50,000 less than longer-serving colleagues, will benefit from the new pay scale if they change over. They are on salaries of between €135,000 and €187,000 and most also have private practices.
The announcement by Mr Harris and Public Expenditure Minister Paschal Donohoe followed the result of a ballot by the Irish Medical Organisation (IMO) in favour of industrial action in the new year if this pay gap for the post-2012 doctors is not addressed.
The pay gap has been blamed for contributing to a failure to recruit and retain consultants, leaving around 500 posts not permanently filled.
The IMO insisted there needed to be negotiation on any new contract.
"In the absence of such negotiations, our plans for industrial action in the new year continue," it said.
The offer of the new public-only €252,150 was dismissed as "electioneering" by the Irish Hospital Consultants Association.
In a statement it claimed the contract, which would make it compulsory for doctors to only treat public patients, was discriminatory.
"Over 500 consultant posts are unfilled. This will deteriorate further due to the Government's proposal which perpetuates the discrimination against consultants who we need to retain and recruit," it said. The organisation also said it would create a €650m black hole in funding for public hospitals over time as private income would be lost.
Commenting on this loss of private income, Mr Donohoe said the Government's expectation is that from 2021 the cost per year to the State in forfeiting private medical fees will be between €16m and €25m. He said this would have to be considered as part of the Budget process.
He said a "core feature" of the plan "is only public work in public hospitals".
The recent Donal de Buitléir report recommended the removal of private practice from public hospitals over 10 years, in keeping with the Sláintecare plan. He noted that the number of consultants who exclusively treat public patients had dwindled to 6pc.
Under the plan, private patients would still be eligible for treatment in public hospitals but they would have to join the public queue and would not be treated faster just because they can pay.
Mr Harris said it will take time but they were "committing to hiring 1,885 consultants between now and 2030 on public-only contracts".
"This will deliver better value for money and will unlock the Sláintecare vision with a net increase of 1,000 consultants by 2030."