Doctors' leaders are to begin work this week on drawing up the timetable for holding a ballot on industrial action as Health Secretary Andrew Lansley expressed his regret at their decision.
The British Medical Association (BMA) has decided more than 100,000 doctors and medical students should vote on whether to take action over the Government's controversial public sector pension reforms in the first poll of its kind since the 1970s.
However, leaders ruled out strikes in a move designed to limit the impact on patients across the country.
The BMA's decision follows overwhelming rejection by doctors of the "final" offer on pensions. It said the changes would see younger doctors paying more than £200,000 extra over their lifetime in pension contributions and work eight years longer, to 68.
Officials have urged the Government to reopen talks with the health unions, but said neither the Treasury or the Health Department had signalled any change to their position.
Dr Hamish Meldrum, chairman of the BMA council, said: "Doctors are not asking for special treatment - quite the opposite. Just four years ago, NHS staff agreed to major reform of the NHS pension scheme to make it fair, affordable and sustainable. Now the Government wants to go back on that deal. The NHS pension scheme is in a strong financial position and the economic downturn does not affect that as staff have already accepted responsibility for covering any future cost increases."
Dr Meldrum said the decision to ballot for the first time in 40 years has not been taken lightly, adding that BMA leaders had "pursued every avenue" to bring the Government back to meaningful talks.
"Taking industrial action remains a last resort and we urge the Government to work with us - and the other health unions - to find a fairer way forward," he added. "Should industrial action be necessary, the priority would be to limit disruption and prevent harm to patients. That is why we have completely ruled out strike action and are committed to reviewing the risks for patients at every stage."
On Saturday, Mr Lansley said he was disappointed by the decision, because in negotiations before Christmas heads of agreement had been reached with all the NHS trade unions except Unite. "I felt we had secured for the NHS, and staff of the NHS, the sort of pension they could rely upon, and feel confident in, in the future," he told the BBC.
The Health Secretary argued the pension scheme agreed in 2008 had not been sustainable in the long term, and was not fair to taxpayers. "All we are asking is that normal pension age in the NHS scheme for doctors should be in line with the state pension age," he added.