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Junior doctors in Scotland are set to strike after rejecting a pay offer made by the Scottish government.
BMA Scotland said three days of strike action would take place between 12 and 15 July unless an improved offer was made.
The Scottish government had proposed a 14.5% pay rise over a period of two years, which it described as the best offer in the UK.
But the union said that 71.1% of its members had voted to reject the offer.
Dr Chris Smith, the chair of the BMA's Scottish junior doctor committee, said members had spoken "decisively and clearly" - but that strike action would be taken "reluctantly".
He said: "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.
"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 union, which has been calling for a 23.5% increase, says it is now seeking an urgent meeting with Health Secretary Michael Matheson.
He previously told the BBC he would "do everything" to avoid industrial action.
First Minister Humza Yousaf said: "In my time as health secretary we didn't lose a single day of winter to NHS strikes - which is very different to every other part of the UK.
"We will continue to engage with junior doctors. They have said themselves there has been meaningful engagement with the Scottish government, and that will continue."
In May, the Scottish government offered junior doctors an aggregate 14.5% pay increase over two years, plus talks on a change to the system of pay reviews in future.
That would have involved a pay rise of 6.5% in 2023/24 and an additional 3% towards an already agreed 4.5% uplift in 2022/23.
Picket line
BMA Scotland put the offer to its members with no recommendation.
Junior doctors - fully-qualified medics who are not specialty staff doctors, consultants or GPs - make up 44% of the doctors in the NHS in Scotland.
In England, Junior doctors are set to head to the picket line again on Wednesday as part of a 72-hour walkout. The latest industrial action by members in England follows strikes in March and April, leading to the cancellation of more than 196,000 hospital appointments.
Ambulance staff in England and Wales have also taken action with members belonging to three unions - GMB, Unison and Unite - striking in January. Unite members in the south-east walked out in May.
Despite the action south of the border, Scotland has yet to see any strikes by NHS staff.