In a break from years of fierce competition, Harvard Medical School's historically independent teaching hospitals have begun to discuss ways of cooperating.

The talks, which are "just getting started," were initiated by Medical School Dean Daniel C. Tosteson '44, said Stephen B. Kay '56, vice chairman of the trustees of Beth Israel Hospital.

"It's the various hospitals getting together," said Kay, a newly-elected Harvard overseer.

Kay said the likely result will be something between the traditional, fiercely competitive, stand-alone model of the 1980s, where each hospital offered a full array of services, and the formation of a single mega-hospital.

"I don't think there'll ever be a complete merger," Kay said. "I'm not sure that it really makes sense to have a 5000 bed hospital."

Nevertheless, changes are clearly in store. The hospitals--including Massachusetts General, Brigham and Women's, the Beth Israel, Children's and New England Deaconess--are apparently hoping to capture efficiencies and eliminate some duplication of services, preparing for the onset of national health care reform.

"The trustees are aware that there's a whole new era here," Kay said.

Still, the hospitals also each have proud histories from eras gone by. "These are very old, very strong, very established institutions," Kay said. Individual departments, and department chairs, within each hospital would likely resist being shut down as part of some cost-cutting plan.

Kay pointed out that, at Beth Israel, at least, there have been no layoffs, and he said there has been no loss of independence.

He said he's unsure what the efficiencies of cooperation would be, whether departments in some hospitals would be closed and centralized at another hospital specializing in that one area.

Not all consolidation schemes make sense. After all, Kay said, Harvard and MIT both have economics departments, and no one is suggesting that the two institutions merge and move all economics operations to one campus.

Tosteson's office referred calls to the Medical School's associate dean for public affairs, who did not return a phone call yesterday afternoon. Officials at Mass. General, Brigham and Women's, Beth Israel and the New England Deaconess Hospitals also did not return phone calls. Business School Dean John H. McArthur, chair of the board of Brigham and Women's, did not return a phone call to his office.

The Boston Globe, citing anonymous sources, first reported the talks in Wednesday's editions. A report in yesterday's Wall Street Journal was based on a brief comment from a spokesperson for Brigham and Women's Hospital, who was reported to say that the hospitals had agreed to a "six-month planning process on closer affiliation."

The Globe reported speculation that the four Longwood Medical Area institutions would merge into one system, while Mass. General would form the nucleus of another system. Kay yesterday discounted that speculation, saying that Mass. General is "very much part of the process."

Kay, who said hospital trustees have been closely briefed on talks between the hospitals, said an antitrust lawyer had been sitting in on the discussions.