The proposed "assessment," which has been incorporated into many of the plans being considered in Congress, will make sure that all insurers share the burden in training new physicians.

Opponents to the measure, especially from states without teaching hospitals, have increasingly assailed the "assessment" as a tax" in recent weeks.

Harvard's teaching hospitals are looking for similar subsidies to fund research and classes at the Medical School.

A powerful ally in the fight for these subsidies will likely be Sen. Edward M. Kennedy "54."56 (D-Mass.), who Corlette says "was an absolute champion of the Boston teaching hospitals and the medical schools."

But even if Kennedy wins the re-election race this year, Corlette says that none of subsidies have much of a chance of passing in Congress.

Nevertheless, at least one hospital president is optimistic about the future.

A recent market survey said that there was "high agreement" among people that teaching hospitals and the relationships in medical schools are important, Gaintner says.

"I'm optimistic that the citizens recognize the value of teaching hospitals," he says. "I think the basic function of the teaching hospitals will be preserved."

Even with reform knocking at their doors, hospital administrators seem unwilling to sacrifice their teaching role.

"We're going to obviously have to do what we have to do, but we're absolutely committed to the academic role in teaching and research," Gaintner says.

'It would really be a shame if these extraordinary organisms...were basically destroyed because of some shift in reimbursement mechanisms.' --Jane H. Corlette