The pay for NHS doctors should be frozen for a third year in a row, the body representing health service employers have said.
NHS Employers said that if doctors' wages were to increase, patients' quality of care could suffer and there could be job losses across the health service.
But the British Medical Association (BMA) hit out at the suggestion, saying that there is already a "problem with morale" in the NHS.
NHS Employers confirmed it has recommended the public sector pay freeze for doctors working in the health service should be extended for a further year. It told the Doctors' and Dentists' Review Body (DDRB) the move is "essential to protect services and minimise job losses". NHS Employers said it does not believe increases in national pay rates from April next year are "necessary or affordable".
Last week, financial experts warned that monetary pressures on the health service, which has been ordered to make £20 billion in efficiency savings by 2015, will start to bite next year as the two-year public sector pay freeze comes to an end in April. The King's Fund report said an average staff pay increase of 1% would add around £400 million to £500 million to NHS expenditure.
The NHS Employers submission to the review body said the remuneration package for doctors remains "highly competitive" when pension and non-pay benefits are taken into account.
Dean Royles, director of the organisation, said: "Everyone, including doctors, knows these are challenging times for us all. The simple truth is that NHS organisations cannot afford an unnecessary increase in doctors' pay rates over the next year without it impacting on patient care."
Dr Mark Porter, chairman of council at the BMA, said: "The argument that continuing the freeze on doctors' pay will help NHS employers maintain quality of care simply does not stand up to scrutiny. There is already a major problem with morale, with doctors at the front line dealing with huge efficiency savings and wholesale NHS reorganisation
"Maintaining and improving care in the face of probably the biggest ever financial challenge for the NHS requires a more strategic response than just continuing to cut the terms and conditions of its staff. The focus should be on employers working with doctors and other NHS staff to find more efficient ways of delivering care.
"Junior doctors' take-home pay is dropping, consultants' pay has been frozen since 2009, and the latest earnings figures for GPs show that their net income continues to fall. On top of this, all doctors have just seen more taken out of their take-home pay to fund higher pension contributions - while the value of their pension benefits is being cut - with further contribution increases due to follow. We'll be publishing our own evidence to the review body early next week."