To think the NHS in Scotland will be protected from UK public spending cuts is naive, British Medical Association Scotland has said.
An honest debate is needed to establish what the health service "can and cannot afford" but drastic cuts are not needed, the trade union said in a submission to the Independent Budget Review group.
Clinicians should be consulted on where any cuts should be implemented in order to avoid "knee-jerk, slash-and-burn" responses to the UK government cuts.
The Scottish government established the budget review group to help manage and assign the cuts, which will see the Scottish Budget reduced by £3.7bn over a period of three years. The review group recommended last week that public services do not need to be protected from the cuts.
The Westminster government has said health budgets will be protected in England, and Scottish Finance Secretary John Swinney has promised that any extra money coming to Scotland because of the UK pledge will be spent on the NHS in Scotland.
The BMA said the global recession and continuing economic crisis ensure that much more demand will be put on the health service across the UK and that now is "not the time to look for drastic cuts in health spending".
The union has urged the Scottish government to scrap some of its targets for the NHS, which the BMA says will give health boards more of a say in how to run the services being provided.
A Scottish government spokesman said: "The Scottish government has made it clear that we will apply any Barnett consequentials arising out of the protection given to the health service by the UK government to the health service in Scotland."